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Hydration Strategies of Runners in the London Marathon

Williams, Jonathan MSc*; Tzortziou Brown, Victoria MSc*; Malliaras, Peter PhD*; Perry, Mark PhD†,*; Kipps, Courtney MSc

Clinical Journal of Sport Medicine: March 2012 - Volume 22 - Issue 2 - p 152–156
doi: 10.1097/JSM.0b013e3182364c45
Original Research
In the Press

Objective To explore the hydration strategies of marathon runners, their sources of information and knowledge about fluid intake in the marathon, and their understanding of exercise-associated hyponatremia (EAH).

Design Anonymized questionnaire.

Setting London Marathon.

Participants Marathon race participants.

Main Outcome Measures Responses regarding planned fluid consumption, volume to be consumed, volume of water and sports drink bottles, and the number of stations from which planning to take a drink. In addition, sources of information about appropriate drinking and understanding of hyponatremia.

Results In total, 93.1% of the runners had read or been told about drinking fluids on marathon day and 95.8% of competitors had a plan regarding fluid intake. However, 12% planned to drink a volume large enough to put them at higher risk of EAH. Only 21.7% knew the volumes of water and sports drink bottles available on the course; 20.7% were planning to take a drink from all 24 water stations. Only 25.3% planned to drink according to thirst. Although 68.0% of the runners had heard of hyponatremia or low sodium levels, only 35.5% had a basic understanding of its cause and effects.

Conclusions Marathon runners lack knowledge about appropriate fluid intake to prevent hyponatremia on race day. Twelve percent reported drinking strategies that put them at risk of EAH. Effective educational interventions are still necessary to prevent overdrinking during marathons.

*Centre for Sports & Exercise Medicine, Queen Mary, University of London, United Kingdom

National Clinical Guidelines Centre, Royal College of Physicians, United Kingdom

Institute of Sport, Exercise and Health, University College London, United Kingdom.

Corresponding Author: Jonathan Williams, MSc, Centre for Sports & Exercise Medicine, Queen Mary, University of London, c/o 80 Slade Rd, Portishead, Bristol BS20 6BH, United Kingdom (

The authors report no conflicts of interest.

Received March 8, 2011

Accepted August 23, 2011

© 2012 Lippincott Williams & Wilkins, Inc.