How paralyzed man regained hand movements

The early stage research has been tested in a lab with just one patient so far, yet someday it may change the lives of many with spinal cord injuries, said lead author Abidemi Bolu Ajiboye, an assistant professor at Case Western Reserve University.

Even though the system would not become immediately available to patients, Ajiboye believes that all the technical hurdles can be overcome within five to 10 years. “We actually have a handle on everything that we need. There are no significant novel discoveries we need to make for the system,” he said.

Ajiboye said that what makes this achievement unique is not the technology, but the patient. Unlike any previous experiments, a man who is nearly completely paralyzed — or tetraplegic — regained his ability to reach and grasp by virtue of a neuroprosthetic.

Cycling accident

Bill Kochevar, a resident of Cleveland, injured his spinal cord in 2006 prior to enrolling in the study.

“It was a bicycling accident,” said Ajiboye, who explained that Kochevar, 53, was doing a 150-mile bicycle ride on a rainy day. “He was following a mail truck and the mail truck stopped and he ended up running into the back of the truck,” said Ajiboye. As a result, Kochevar has paralysis below the shoulders.

“So he can’t walk, he can’t move his arms, he can’t move his hands,” said Ajiboye.

While the American Spinal Injury Association classifies him at the most disabled level of paralysis, Kochevar is capable of both speaking and moving his head. Prior to enrolling in the study, he often used head tracking software technology that relied on him moving his head to move a cursor on a screen. “But he had no ability to do any sort of functional activities,” said Ajiboye.

Kochevar underwent two surgeries fitting him with the neuroprosthetic. The first operation on December 1, 2014, implanted the brain computer interface, or BCI, in the region of Kochevar brain that is responsible for hand movement, called the motor cortex.

The BCI is an electrode array which penetrates the brain between one to one and a half millimeters, said Ajiboye.

Next, Kochevar underwent a second surgery to implant 36 muscle stimulating electrodes into his upper and lower arm. Known as functional electrical stimulation or FES, these electrodes are key to restoring movement in his finger and thumb, wrist, elbow and shoulders.

The Cleveland Functional Electrical Stimulation Center, of which Ajiboye is a part, first developed electrical stimulation technology for reanimating paralyzed function nearly 30 years ago. As Ajiboye explained, the technology is similar to a pacemaker in that it applies electrical stimulation to the muscles in order to stir movement.

After the separate technologies were implanted, the researchers connected Kochevar’s brain-computer interface to the electrical stimulators in his arm. At this point, Kochevar began learning how to use his neuroprosthetic and that process started with a virtual arm.

“We had him watch the virtual arm move, he attempted to move his arm in the same way, and that elicited some patterns of cortical activity — some patterns of electrical neural activity,” said Ajiboye.

This electrical activity was recorded and based on this recording, Ajiboye and his colleagues created a “neural decoder” — an algorithm specific to Kochevar — that could translate the patterns of Kochevar’s recorded brain signals into commands for the electrodes in his arm.

“Then we had him use our algorithm to control the virtual arm on the screen just using his brain signals,” said Ajiboye. “Very early on he could hit the target with 95 to 100% accuracy.” This ‘virtual’ step in the process helped Ajiboye and his colleagues refine the algorithm.

“Then, finally, we basically do the same thing with his actual arm. We manually move his arm, and we have him imagine he’s doing it,” said Ajiboye. Kochevar is then able to move his arm on his own by thinking the command (and so generating once again the same brain pattern when he imagined moving his arm) and this is then actuated through electrical stimulation.

Essentially, the technology circumvents the spinal injury feeding the electrical stimulation of his brain through wires to the electrodes in his arm.

After mastering simple movements, Kochevar was tested on day-to-day tasks, including drinking a cup of coffee and feeding himself. In all of these, Kochevar was successful.

“There were no significant adverse events, the system is safe, so as far as the clinical trial endpoint goes, he has met those,” said Ajiboye.

“Now he has opted voluntarily to continue working as a participant in our study for at least another five years,” said Ajiboye. Kochevar hopes to experience the benefits of the technology for himself while also seeing it advance to the point of becoming available for other people with spinal cord injuries, according to Ajiboye.

CNN attempted to contact Kochevar for comment.

‘Encouraging’ results

A previous unrelated study showed paraplegic people with spinal cord injuries using brain-machine interfaces to gain control of their brain activity and stimulate movement in their legs. A separate study used a brain-spine interface to communicate nerve signals and helped paralyzed monkeys to regain movement.
According to Andrew Schwartz, a professor of neurobiology at the University of Pittsburgh, the new study “shows the potential that [a brain-machine interface] can be used to reanimate a limb.” Schwartz was uninvolved with the current study.

While the “generated movements were somewhat rudimentary” with a rather limited range of action, “the attempt to use multiple degrees of freedom was encouraging,” said Schwartz.

“I liked the idea that movements were decoded first and then transformed to muscle activations,” he added. “For real movements in the real world, this transformation will be very difficult to calculate and that is where real science will be needed.”

In an editorial published alongside the study, Steve I. Perlmutter, an associate professor at University of Washington in Seattle, said the research is “groundbreaking as the first report of a person executing functional, multijoint movements of a paralysed limb with a motor neuroprosthetic. However, this treatment is not nearly ready for use outside the lab.”

Similar to Schwartz, Perlmutter noted that Kochevar’s movements were “rough and slow” and had limited range due to the necessary motorized device.

“Stimulation of nerves or the spinal cord, rather than muscles, and more sophisticated stimulation technology may provide substantial improvements,” wrote Perlmutter.

“The algorithms for this type of brain computer interface are very important, but there are many other factors that are also critical, including the ability to measure brain signals reliably for long periods of time,” Perlmutter said in an email. He added another critical issue is execution of movement.

Hurdles that all motor neuroprostheses must overcome have yet to be addressed, noted Perlmutter, including “development of devices that are small enough, robust enough, and cheap enough to be fully mobile and widely available.”

See the latest news and share your comments with CNN Health on Facebook and Twitter.

Ajiboye acknowledges the need for smaller technologies. Still, he said, his new study differs from previous work done in the field. Although other labs have worked with non-human primates or partially paralyzed participants, his study helped someone who is completely paralyzed.

“This is an exponentially harder problem,” said Ajiboye. “Our study is the first in the world, to my knowledge, to take someone paralyzed and give him the ability to both reach and grasp objects… so that he can regain the ability to perform functional activities of daily living.”

One other way the new study differs from previous research is Ajiboye and his colleagues built their neuroprosthetic from separate technologies, each of which had already been proven viable. This translates to the entire system, when refined, more easily gaining approval and becoming available to patients.

“The goal is to do much more than a cool science experiment,” said Ajiboye.

How paralyzed man regained hand movements

The early stage research has been tested in a lab with just one patient so far, yet someday it may change the lives of many with spinal cord injuries, said lead author Abidemi Bolu Ajiboye, an assistant professor at Case Western Reserve University.

Even though the system would not become immediately available to patients, Ajiboye believes that all the technical hurdles can be overcome within five to 10 years. “We actually have a handle on everything that we need. There are no significant novel discoveries we need to make for the system,” he said.

Ajiboye said that what makes this achievement unique is not the technology, but the patient. Unlike any previous experiments, a man who is nearly completely paralyzed — or tetraplegic — regained his ability to reach and grasp by virtue of a neuroprosthetic.

Cycling accident

Bill Kochevar, a resident of Cleveland, injured his spinal cord in 2006 prior to enrolling in the study.

“It was a bicycling accident,” said Ajiboye, who explained that Kochevar, 53, was doing a 150-mile bicycle ride on a rainy day. “He was following a mail truck and the mail truck stopped and he ended up running into the back of the truck,” said Ajiboye. As a result, Kochevar has paralysis below the shoulders.

“So he can’t walk, he can’t move his arms, he can’t move his hands,” said Ajiboye.

While the American Spinal Injury Association classifies him at the most disabled level of paralysis, Kochevar is capable of both speaking and moving his head. Prior to enrolling in the study, he often used head tracking software technology that relied on him moving his head to move a cursor on a screen. “But he had no ability to do any sort of functional activities,” said Ajiboye.

Kochevar underwent two surgeries fitting him with the neuroprosthetic. The first operation on December 1, 2014, implanted the brain computer interface, or BCI, in the region of Kochevar brain that is responsible for hand movement, called the motor cortex.

The BCI is an electrode array which penetrates the brain between one to one and a half millimeters, said Ajiboye.

Next, Kochevar underwent a second surgery to implant 36 muscle stimulating electrodes into his upper and lower arm. Known as functional electrical stimulation or FES, these electrodes are key to restoring movement in his finger and thumb, wrist, elbow and shoulders.

The Cleveland Functional Electrical Stimulation Center, of which Ajiboye is a part, first developed electrical stimulation technology for reanimating paralyzed function nearly 30 years ago. As Ajiboye explained, the technology is similar to a pacemaker in that it applies electrical stimulation to the muscles in order to stir movement.

After the separate technologies were implanted, the researchers connected Kochevar’s brain-computer interface to the electrical stimulators in his arm. At this point, Kochevar began learning how to use his neuroprosthetic and that process started with a virtual arm.

“We had him watch the virtual arm move, he attempted to move his arm in the same way, and that elicited some patterns of cortical activity — some patterns of electrical neural activity,” said Ajiboye.

This electrical activity was recorded and based on this recording, Ajiboye and his colleagues created a “neural decoder” — an algorithm specific to Kochevar — that could translate the patterns of Kochevar’s recorded brain signals into commands for the electrodes in his arm.

“Then we had him use our algorithm to control the virtual arm on the screen just using his brain signals,” said Ajiboye. “Very early on he could hit the target with 95 to 100% accuracy.” This ‘virtual’ step in the process helped Ajiboye and his colleagues refine the algorithm.

“Then, finally, we basically do the same thing with his actual arm. We manually move his arm, and we have him imagine he’s doing it,” said Ajiboye. Kochevar is then able to move his arm on his own by thinking the command (and so generating once again the same brain pattern when he imagined moving his arm) and this is then actuated through electrical stimulation.

Essentially, the technology circumvents the spinal injury feeding the electrical stimulation of his brain through wires to the electrodes in his arm.

After mastering simple movements, Kochevar was tested on day-to-day tasks, including drinking a cup of coffee and feeding himself. In all of these, Kochevar was successful.

“There were no significant adverse events, the system is safe, so as far as the clinical trial endpoint goes, he has met those,” said Ajiboye.

“Now he has opted voluntarily to continue working as a participant in our study for at least another five years,” said Ajiboye. Kochevar hopes to experience the benefits of the technology for himself while also seeing it advance to the point of becoming available for other people with spinal cord injuries, according to Ajiboye.

CNN attempted to contact Kochevar for comment.

‘Encouraging’ results

A previous unrelated study showed paraplegic people with spinal cord injuries using brain-machine interfaces to gain control of their brain activity and stimulate movement in their legs. A separate study used a brain-spine interface to communicate nerve signals and helped paralyzed monkeys to regain movement.
According to Andrew Schwartz, a professor of neurobiology at the University of Pittsburgh, the new study “shows the potential that [a brain-machine interface] can be used to reanimate a limb.” Schwartz was uninvolved with the current study.

While the “generated movements were somewhat rudimentary” with a rather limited range of action, “the attempt to use multiple degrees of freedom was encouraging,” said Schwartz.

“I liked the idea that movements were decoded first and then transformed to muscle activations,” he added. “For real movements in the real world, this transformation will be very difficult to calculate and that is where real science will be needed.”

In an editorial published alongside the study, Steve I. Perlmutter, an associate professor at University of Washington in Seattle, said the research is “groundbreaking as the first report of a person executing functional, multijoint movements of a paralysed limb with a motor neuroprosthetic. However, this treatment is not nearly ready for use outside the lab.”

Similar to Schwartz, Perlmutter noted that Kochevar’s movements were “rough and slow” and had limited range due to the necessary motorized device.

“Stimulation of nerves or the spinal cord, rather than muscles, and more sophisticated stimulation technology may provide substantial improvements,” wrote Perlmutter.

“The algorithms for this type of brain computer interface are very important, but there are many other factors that are also critical, including the ability to measure brain signals reliably for long periods of time,” Perlmutter said in an email. He added another critical issue is execution of movement.

Hurdles that all motor neuroprostheses must overcome have yet to be addressed, noted Perlmutter, including “development of devices that are small enough, robust enough, and cheap enough to be fully mobile and widely available.”

See the latest news and share your comments with CNN Health on Facebook and Twitter.

Ajiboye acknowledges the need for smaller technologies. Still, he said, his new study differs from previous work done in the field. Although other labs have worked with non-human primates or partially paralyzed participants, his study helped someone who is completely paralyzed.

“This is an exponentially harder problem,” said Ajiboye. “Our study is the first in the world, to my knowledge, to take someone paralyzed and give him the ability to both reach and grasp objects… so that he can regain the ability to perform functional activities of daily living.”

One other way the new study differs from previous research is Ajiboye and his colleagues built their neuroprosthetic from separate technologies, each of which had already been proven viable. This translates to the entire system, when refined, more easily gaining approval and becoming available to patients.

“The goal is to do much more than a cool science experiment,” said Ajiboye.

Paralyzed man uses experimental device to regain hand movements

The early stage research has been tested in a lab with just one patient so far, yet someday it may change the lives of many with spinal cord injuries, said lead author Abidemi Bolu Ajiboye, an assistant professor at Case Western Reserve University.

Even though the system would not become immediately available to patients, Ajiboye believes that all the technical hurdles can be overcome within five to 10 years. “We actually have a handle on everything that we need. There are no significant novel discoveries we need to make for the system,” he said.

Ajiboye said that what makes this achievement unique is not the technology, but the patient. Unlike any previous experiments, a man who is nearly completely paralyzed — or tetraplegic — regained his ability to reach and grasp by virtue of a neuroprosthetic.

Cycling accident

Bill Kochevar, a resident of Cleveland, injured his spinal cord in 2006 prior to enrolling in the study.

“It was a bicycling accident,” said Ajiboye, who explained that Kochevar, 53, was doing a 150-mile bicycle ride on a rainy day. “He was following a mail truck and the mail truck stopped and he ended up running into the back of the truck,” said Ajiboye. As a result, Kochevar has paralysis below the shoulders.

“So he can’t walk, he can’t move his arms, he can’t move his hands,” said Ajiboye.

While the American Spinal Injury Association classifies him at the most disabled level of paralysis, Kochevar is capable of both speaking and moving his head. Prior to enrolling in the study, he often used head tracking software technology that relied on him moving his head to move a cursor on a screen. “But he had no ability to do any sort of functional activities,” said Ajiboye.

Kochevar underwent two surgeries fitting him with the neuroprosthetic. The first operation on December 1, 2014, implanted the brain computer interface, or BCI, in the region of Kochevar brain that is responsible for hand movement, called the motor cortex.

The BCI is an electrode array which penetrates the brain between one to one and a half millimeters, said Ajiboye.

Next, Kochevar underwent a second surgery to implant 36 muscle stimulating electrodes into his upper and lower arm. Known as functional electrical stimulation or FES, these electrodes are key to restoring movement in his finger and thumb, wrist, elbow and shoulders.

The Cleveland Functional Electrical Stimulation Center, of which Ajiboye is a part, first developed electrical stimulation technology for reanimating paralyzed function nearly 30 years ago. As Ajiboye explained, the technology is similar to a pacemaker in that it applies electrical stimulation to the muscles in order to stir movement.

After the separate technologies were implanted, the researchers connected Kochevar’s brain-computer interface to the electrical stimulators in his arm. At this point, Kochevar began learning how to use his neuroprosthetic and that process started with a virtual arm.

“We had him watch the virtual arm move, he attempted to move his arm in the same way, and that elicited some patterns of cortical activity — some patterns of electrical neural activity,” said Ajiboye.

This electrical activity was recorded and based on this recording, Ajiboye and his colleagues created a “neural decoder” — an algorithm specific to Kochevar — that could translate the patterns of Kochevar’s recorded brain signals into commands for the electrodes in his arm.

“Then we had him use our algorithm to control the virtual arm on the screen just using his brain signals,” said Ajiboye. “Very early on he could hit the target with 95 to 100% accuracy.” This ‘virtual’ step in the process helped Ajiboye and his colleagues refine the algorithm.

“Then, finally, we basically do the same thing with his actual arm. We manually move his arm, and we have him imagine he’s doing it,” said Ajiboye. Kochevar is then able to move his arm on his own by thinking the command (and so generating once again the same brain pattern when he imagined moving his arm) and this is then actuated through electrical stimulation.

Essentially, the technology circumvents the spinal injury feeding the electrical stimulation of his brain through wires to the electrodes in his arm.

After mastering simple movements, Kochevar was tested on day-to-day tasks, including drinking a cup of coffee and feeding himself. In all of these, Kochevar was successful.

“There were no significant adverse events, the system is safe, so as far as the clinical trial endpoint goes, he has met those,” said Ajiboye.

“Now he has opted voluntarily to continue working as a participant in our study for at least another five years,” said Ajiboye. Kochevar hopes to experience the benefits of the technology for himself while also seeing it advance to the point of becoming available for other people with spinal cord injuries, according to Ajiboye.

CNN attempted to contact Kochevar for comment.

‘Encouraging’ results

A previous unrelated study showed paraplegic people with spinal cord injuries using brain-machine interfaces to gain control of their brain activity and stimulate movement in their legs. A separate study used a brain-spine interface to communicate nerve signals and helped paralyzed monkeys to regain movement.
According to Andrew Schwartz, a professor of neurobiology at the University of Pittsburgh, the new study “shows the potential that [a brain-machine interface] can be used to reanimate a limb.” Schwartz was uninvolved with the current study.

While the “generated movements were somewhat rudimentary” with a rather limited range of action, “the attempt to use multiple degrees of freedom was encouraging,” said Schwartz.

“I liked the idea that movements were decoded first and then transformed to muscle activations,” he added. “For real movements in the real world, this transformation will be very difficult to calculate and that is where real science will be needed.”

In an editorial published alongside the study, Steve I. Perlmutter, an associate professor at University of Washington in Seattle, said the research is “groundbreaking as the first report of a person executing functional, multijoint movements of a paralysed limb with a motor neuroprosthetic. However, this treatment is not nearly ready for use outside the lab.”

Similar to Schwartz, Perlmutter noted that Kochevar’s movements were “rough and slow” and had limited range due to the necessary motorized device.

“Stimulation of nerves or the spinal cord, rather than muscles, and more sophisticated stimulation technology may provide substantial improvements,” wrote Perlmutter.

“The algorithms for this type of brain computer interface are very important, but there are many other factors that are also critical, including the ability to measure brain signals reliably for long periods of time,” Perlmutter said in an email. He added another critical issue is execution of movement.

Hurdles that all motor neuroprostheses must overcome have yet to be addressed, noted Perlmutter, including “development of devices that are small enough, robust enough, and cheap enough to be fully mobile and widely available.”

See the latest news and share your comments with CNN Health on Facebook and Twitter.

Ajiboye acknowledges the need for smaller technologies. Still, he said, his new study differs from previous work done in the field. Although other labs have worked with non-human primates or partially paralyzed participants, his study helped someone who is completely paralyzed.

“This is an exponentially harder problem,” said Ajiboye. “Our study is the first in the world, to my knowledge, to take someone paralyzed and give him the ability to both reach and grasp objects… so that he can regain the ability to perform functional activities of daily living.”

One other way the new study differs from previous research is Ajiboye and his colleagues built their neuroprosthetic from separate technologies, each of which had already been proven viable. This translates to the entire system, when refined, more easily gaining approval and becoming available to patients.

“The goal is to do much more than a cool science experiment,” said Ajiboye.

Short-term kidney injury linked to marathons

“It’s possible that marathon running could be an acute stress and may contribute to the progression of existing chronic kidney disease, and this is where runners with this condition need to talk to their physicians and talk to their trainers,” said Dr. Chirag Parikh, a professor at the Yale University School of Medicine and lead author of the study.

He added that, with adequate training, the kidneys can adapt to such physical stress.

“I would think that the majority of marathon runners are doing OK because the 22 people who participated in the study had normal kidney function and had been running marathons for an average of 12 years,” Parikh said. “So, if running marathons caused a great deal of permanent kidney injury, these runners would have minimal kidney function remaining.”

Marathon running in the United States has grown in popularity in recent years.

Between 1990 and 2014, the number of US marathon finishers skyrocketed from about 224,000 to a record high of 550,637, according to Running USA, a nonprofit that tracks the number of marathon runners each year in an annual report.

Last year, about 507,600 runners finished a marathon in the United States, said Scott Bush, a spokesman for Running USA, which was not involved in the new study.

Kidneys show signs of damage, repair themselves

Runners participating in the 2015 Hartford Marathon in Connecticut were recruited for the study and 22 met the study requirements, as well as completed the study.
A day before the marathon, urine and blood samples were collected from the runners and analyzed under a microscope. The researchers examined the samples for cellular changes and shifts in levels of a compound called creatinine, which is a marker used to diagnose acute kidney injury.

Then, within 30 minutes of completing the race, urine and blood samples were again collected from the runners and analyzed for signs of acute kidney injury.

“We wanted the blood drawn soon after the marathon, which is not an easy thing. Many of the runners are exhausted,” Parikh said.

The researchers found higher-than-normal levels of creatinine in the urine and blood samples of almost all of the runners immediately after the marathon, with 82% of the runners showing signs of at least stage 1 acute kidney injury.

“Almost everybody had a significant increase in the novel markers of injury, inflammation, and repair,” Parikh said.

The kidneys’ responses to the stress of a marathon were eerily similar to what Parikh said he would see among patients who might be treated in a hospital for complications with medications that impact the kidneys, or who might be suffering kidney complications after cardiac surgery, for instance.

“It was very surprising that the intensity of the findings were similar,” Parikh said.

About a day and a half after the marathon, samples again were collected, and they no longer showed signs of acute kidney injury.

“The good part was that we were able to confirm that by day two or by 48 hours after the marathon, the findings returned to baseline,” Parikh said.

‘Be careful, think about it, and be prepared’

The participants in the study were not taking non-steroidal anti-inflammatory drugs, such as ibuprofen, within 48 hours of the race, however such drugs can impact the kidneys and may put runners’ health at risk when combined with marathon running.

Dr. Malissa Wood, co-director of the Corrigan Women’s heart health program at Massachusetts General Hospital and associate professor at Harvard Medical School in Boston, called the study findings “a real wake-up call.”

“I do know these are people who are not taking non-steroidals, who are pretty well trained, and had an average finish indicating they had properly prepared for the marathon, and still 82%, had some kidney impact from the running,” Wood said about the study, in which she was not involved.

“That just says to me, be careful, think about it, and be prepared,” she said.

A limitation to the new study, besides its sample size, is that the researchers didn’t compare the findings among their runners to other race participants or marathon runners as a whole, said Dr. Martin Hoffman, a health sciences clinical professor at the University of California, Davis and a founding member of the Ultra Sports Science Foundation.
The study also didn’t include a change in body weight as a way to get an assessment of how hydrated each runner was, Hoffman said. He was not involved in the new study but has led separate research on acute kidney injuries following ultramarathon running.

“The fact that kidney injury markers were normalized or improving within 24 hours should help alleviate fear of permanent kidney injury, and supports what we have previously demonstrated,” Hoffman said about the new study.

The kidneys are temporarily impacted during marathon running for various reasons, one being that some of the blood supply kidneys typically receive is being pumped to the body’s muscles instead of the organ, Parikh said.

“When someone runs 26 miles, the blood supply to the skin and muscle increases tremendously, because they need a lot of oxygen,” he said. “It’s estimated that up to 25% of blood ends up going to skin and muscle, and when this happens, that means the blood is getting diverted from other organs. So, while the skin and muscle are perfused at a higher rate, the kidneys are receiving a reduced blood supply.”

The environment in which you are running can also influence how a marathon may impact your body, said Wood, the associate professor at Harvard Medical School.

Tips for runners

“The truth is, when you’re exercising for four hours, your body needs to maintain levels of glucose and it needs to be hydrated, especially if you’re running in a warm climate,” Wood said. “Sixty to 70 degrees for a marathon, that’s warm, and 80 or 90 is really warm.”

Wood led a study on 60 runners who completed the Boston Marathon in 2004 and ’05. The runners had some abnormalities in heart structure and function after completing the marathon, according to the study, which was published in the journal Circulation in 2006.

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“What we saw in our study was that if people didn’t train very much and they were sort of new to marathon running they had a lot more leakage of heart enzymes and it’s a lot harder on their bodies because they haven’t been chronically exposed to the conditions imposed by prolonged exercise,” Wood said. “Prolonged endurance exercise increases bloodflow to the leg muscles but can shunt blood away from the gut and kidneys.”

Therefore, adequate training is key to minimizing any potentially harmful impacts marathon running can have on the body, she said.

Wood and Hoffman, the professor at the University of California, Davis, both offered some tips for safely running a marathon:

  • Pay attention to what your body is telling you during and after a run, Hoffman said.
  • When it comes to proper hydration, simply drink to thirst. By doing this, you will most likely avoid both severe dehydration, which increases the risk of kidney injury, and overhydration, which can also cause serious health issues, Hoffman said.
  • Wood added that many runners don’t like to stop for water during a race due to fear that it may significantly affect their finish time, but “being dehydrated and exercising is really bad for your organs and your physiology,” she said.
  • Make sure that you eat breakfast the morning of a race, Wood said.
  • Get a good night’s sleep the night before a race, Wood said.
  • Properly train before a marathon to avoid injury, Wood said.

“Generally, athletes recover without any need for specific medical intervention by simply rehydrating based on their thirst,” Hoffman said about what to do after running.

“It’s also important to keep this all in perspective,” he said. “While there may be some risks with marathon running, the lack of regular exercise among most of our population is far more dangerous and costly to society than the overall risks from participation in marathon running.”

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