We hope that your training is progressing well and that you find this section informative. Your information that you provided by completing the online medical questionnaire, is very important to the medical team in the planning of a safe race. The aim of today’s feature is to discuss the implications of running when you have asthma or other respiratory tract disease, or if you have hormonal (endocrine) diseases such as diabetes mellitus (sugar sickness) and thyroid gland disease.

Asthma and respiratory tract disease
Asthma is one of the more common respiratory medical conditions that can affect a runner. Regular exercise, including running has substantial benefits for an asthmatic. However, while running, asthmatics may also develop acute bronchospasm (narrowing or closing of the airways, known as an asthma attack). If this occurs, it can be a very serious medical emergency if not treated.

The preliminary results of our medical questionnaire show that a number of you have indicated that you suffer from exercise- and non-exercise induced asthma or bronchospasm. There are also some of you who indicated that you experience ‘wheezing’ and ‘coughing’ during exercise, and these are symptoms of asthma.

During running, there is an increased airflow through the nose, mouth and upper airways into the lungs. This increased flow, together with factors such as cold air, dry air or pollutants and dust in the air, could potentially trigger an asthma attack.

We would like to provide you with some information about several important safety concerns for runners who are running with asthma and other respiratory tract disorders, such as emphysema and other lung diseases. Specifically, we would like to give you some guidelines on how to make sure that you can run safely with your asthma or your lung disease.

Guidelines for runners with known asthma or other lung disease
We suggest the following guidelines to reduce the risk of developing an acute asthma attack during running:

• Every runner with known asthma or other chronic lung disease should undergo a full medical evaluation (possibly followed by lung function tests before and after exercise) to evaluate the response of your airways and lungs to exercise. A qualified medical doctor should do this evaluation.
• Following such an evaluation, your medical doctor will assess if your medications are adequate and give advice on any modifications if required.
• An evaluation of this nature should be done once a year and more frequently if symptoms are not controlled or you developed new symptoms. The opposite may also have happened to you – as an adult you might have ‘outgrown’ your asthma and you may need less or no medication. Therefore, if you were diagnosed as an asthmatic during childhood, you may not necessarily still have the condition.
• We also suggest that you have this evaluation well in advance of the race, so that there is enough time to for you to adapt to any possible changes in treatment.
• Please be aware of any new or changing symptoms of asthma. These symptoms include the following: coughing, wheezing, excessive shortness of breath (a feeling that ‘air can’t be exhaled’), dizziness associated with these symptoms. One of the main symptoms of asthma remains recurring ‘tight chest’ or a ‘dry cough’. If you develop any of the above symptoms associated with your exercise, please seek medical evaluation.
• One of the triggers of an acute asthma attack while running may be a recent chest infection. Chest infections can ‘irritate’ the inner lining of the airways and make them more sensitive. If you recently had a respiratory tract infection, please be aware of this and consult with your doctor if needed.
• If you use an inhaler for relieving symptoms of asthma, it would be recommended to carry this with you during the race, in case you might need it.
• If you are a potential medal contender please be aware of the rules regarding the use of drugs in sport: These rules stipulate that use of some asthma medications by athletes may need a specific TUE (therapeutic use of exemption certificates). This has to be completed by your doctor, as you may be tested after the race. Other medications may be on the banned list and this also has to be checked by your doctor.

Diabetes mellitus (sugar sickness)
Diabetes mellitus is one of the most common endocrine diseases in the general population, including runners. A number of you have indicated in the medical questionnaire, that you suffer from diabetes. Well done on exercising with diabetes as this has been shown to improve the control of diabetes and reduce long-term complications.

Diabetes is a disease in which the body has a higher than normal blood sugar level. If the blood sugar is chronically elevated and not optimally controlled, it can lead to damage to other organs in the body including the eyes, kidneys, nerves, blood vessels and even the heart. Regular exercise, together with weight loss and healthy eating, are very important in the treatment of diabetes. Treatment may also include the use of tablets and or insulin injections.

Exercise can also affect the glucose control in the body, because the body uses glucose as fuel for the muscles. Therefore, exercise can affect the regulation of your blood sugar. If you suffer from diabetes, there are a number of safety concerns that are important. For example, there is increased risk of developing either low or high glucose during exercise, and in rare circumstances, this may even lead to a coma. We would like to provide you with some guidelines on diabetes and running.

Guidelines: Running with diabetes

• Every runner with known diabetes should undergo a full medical evaluation by a qualified medical doctor at least once a year. This medical evaluation should include a full history and examination, as well as blood tests to see how well your diabetes is controlled. In addition, the evaluation should include a screen for any of the complications of diabetes, as well as your response to exercise.
• Regular exercise may, over time, improve your glucose control and you will need to be reassessed regularly as indicated by your doctor. It is possible that you may even need less medication. A too high dose of medication in these circumstances may result in a low blood glucose level during exercise and that can cause medical complications or affect your performance. Also the timing of taking your medication or insulin, needs adjusting as you train and change your fitness level.
• Try to stick to your normal running routine during races. This includes developing a routine for hydration, type of fluid and food intake during running. Do not try new routines on race day.
• Eat 2 to 3 hours before exercise.
• Have carbohydrate food/drinks at hand to take during the race if you are feeling low on sugar (hypoglycaemic).
• Eat something immediately post race to replenish your glucose stores.
• If you are ill prior to the race, or have an infection somewhere in your body, please consult with your doctor first, as infection can upset glucose control.
• If you are on insulin injections, inject yourself in the abdomen rather than in muscles that you use during running (absorption of insulin is affected in exercising muscles).
• Medical alert bracelets: If you are a diabetic, it is always a good idea to wear an identification bracelet with medical information, so that medical staff can see exactly what type of diabetic you are and what medications you take.
• As an exercising diabetic, your main aim should be prevention of either low or high glucose during and after the race.
• If you are already a diabetic, you will know your warning signs well, but remember to check your glucose more regularly in the hours after the race, especially when feeling exhausted, weak and having an increased appetite.

Thyroid gland disease and other endocrine diseases

Diseases of the thyroid gland are also fairly common in the general population, particularly in females. In the medical questionnaire a number of you indicated that you suffer from either an overactive or an underactive thyroid gland. The thyroid gland secretes hormones, which are mainly responsible for the regulation of your metabolic rate. Thyroid hormones act on most cells in your body, where they affect your basal metabolic rate, protein synthesis, bone growth, nerve maturation and the body’s reaction to stress hormones, such as adrenaline. These hormones are also involved in heat generation. Generally, abnormalities in thyroid gland function can be either an over- or under-production of thyroid hormone (hyperthyroidism and hypothyroidism respectively). Both of these abnormalities can cause a variety of symptoms and can affect your exercise performance and general well-being.

Common symptoms of thyroid disease Some of the most common symptoms of thyroid disease are:
Overactive thyroid: anxiety, irritability, insomnia, weight loss, palpitations and fast resting heart rate, shaky hands, sweating, weakness of muscles of upper arms & legs, fine brittle hair
  Underactive thyroid: fatigue, sluggishness, depression, ‘brain fog’, weight gain (unexplained), dry hair and skin, feeling cold, constipation, heavy menstruation and infertility and miscarriages.
Guidelines: Running with thyroid disease If you suffer from thyroid disease, we suggest the following general guidelines during running:

• Every runner with a thyroid disorder should have a medical examination and a review of thyroid blood levels at least in the last 6 to 12 months. These levels should be repeated more frequently if you developed any new or increasing symptoms.
• You should never stop your medication when feeling fine – remember this is a chronic condition and any medication alterations can only be decided by your medical doctor.
• If your thyroid levels are optimally controlled and you have no symptoms of either being over – or under active regarding your disease, you should be perfectly safe during race day.

We wish you a healthy and happy last few weeks of training before race day.

The Medical Team