(from The Paper Press)
3月24日，苏州峰学蔚来教育科技有限公司发布讣告称，41岁的张雪峰因突发疾病，经抢救无效不幸去世。一时间，关于跑步与心源性猝死到底有多大关联，又引发“破圈”热议，因为张雪峰除了教育工作者的身份之外，他也是一位有能力完成半程马拉松的新晋跑者。加上前一段时间，当大众路跑赛季重新拉开大幕时，跑圈里也出现了几则跑者在训练中昏厥甚至猝死的消息，于是乎，跑步到底会不会伤害心脏，引发了越来越多讨论。
On March 24th, Suzhou Fengxue Weilai Education Technology Co., Ltd. issued an obituary stating that 41-year-old Zhang Xuefeng had passed away due to a sudden illness despite all efforts to save him. This immediately sparked a renewed and heated debate about the link between running and sudden cardiac death, as Zhang Xuefeng was not only an educator but also a capable half-marathon runner. Coupled with recent reports of runners collapsing or even dying during training when the mass road running season resumed, the question of whether running damages the heart has become increasingly debated.
事实上，根据国内外专业跑步媒体援引一项发表于顶尖医学期刊《美国医学会杂志·心脏病学》（JAMA Cardiology）的权威研究显示，高强度的跑步训练和比赛确实会对心脏造成极大的即时负荷，但在长达十年的随访期内，持续运动的跑者心脏功能并未出现任何持久性的损伤迹象。
虽然有权威科学实验的支持，跑步依旧不应该被视为一项“迈开腿说跑就跑”的运动。在真正进行跑步特别是高强度跑步之前，每个人都应该先问自己一个问题“我到底适不适合跑步”。不管是资深跑者还是跑步新人，只有在运动前确认自己准备好了，才是安全跑步的第一步。
In fact, according to a leading medical study published in the top medical journal *JAMA Cardiology*, cited by professional running media both domestically and internationally, high-intensity running training and competition do indeed place a significant immediate burden on the heart. However, during a ten-year follow-up period, runners who continued exercising did not show any signs of lasting damage to their heart function.
Although supported by authoritative scientific experiments, running should still not be considered an activity that can be undertaken “just pick up your leg and start running.” Before actually engaging in running, especially high-intensity running, everyone should first ask themselves the question, “Am I really suited for running?” Whether you are a seasoned runner or a beginner, confirming your readiness before exercising is the first step to safe running.
这些人其实不适合跑步
These People Are Actually Unsuitable for Running
据国际体育组织统计，平均每5万名马拉松长跑者中会有1人死于突发性心脏病，另外，比赛期间因为各种原因被救治的人占到总参赛人数的20%-25%。多年前，时任上海瑞金医院陆一鸣教授曾经统计过，在中国每8万名跑友中就有1人会发生心脏骤停。
数据多少说明了一个问题，并不是拥有跑步能力的规律跑者，就不会遇到类似心源性猝死之类的心脏疾病。美国专业跑步杂志《Runner’s World》就曾经邀请运动医学专家列出了“不适合跑步的几类人群”，即便是拥有很强跑步能力的跑者，如果属于这几类，也会面临受伤甚至猝死的高风险。
According to statistics from international sports organizations, on average, one in every 50,000 marathon runners will die from a sudden heart attack. Furthermore, 20%-25% of participants require medical attention during the race for various reasons. Years ago, Professor Lu Yiming, then at Ruijin Hospital in Shanghai, estimated that one in every 80,000 runners in China would experience cardiac arrest. These statistics illustrate that even regular runners with strong running abilities are not immune to heart conditions like sudden cardiac death. The American professional running magazine *Runner’s World* once invited sports medicine experts to list “several groups of people unsuitable for running.” Even runners with strong running abilities face a high risk of injury or even sudden death if they belong to these categories.
1.严重的心脏病患者
跑步会使跑者的心跳加快，增加体内氧的消耗量，很容易出现上气不接下气的感觉。心脏病患者是最不能激动的，如果一下子心跳过快，很容易出事情。因此，不建议患有严重心脏病的人进行跑步运动，以免发生意外。
1. People with severe heart disease
Running increases a runner’s heart rate and oxygen consumption, easily leading to shortness of breath. People with heart disease should be especially careful; a sudden rapid heartbeat can easily cause serious injury. Therefore, running is not recommended for people with severe heart disease to avoid accidents.
2.心血管疾病患者
跑步过程中需要耗费大量氧气，并且消耗糖分、脂肪和蛋白质为身体供能。跑步速度加快，心率加快，心脏的泵血量就会增加，这样会对心脏和血管造成负担，增大心血管疾病患者的风险。
2. Patients with cardiovascular disease
Running requires a significant amount of oxygen and consumes sugars, fats, and proteins for energy. Increased running speed leads to a faster heart rate and a greater volume of blood pumped by the heart, placing a strain on the heart and blood vessels and increasing the risk for patients with cardiovascular disease.
3.糖尿病患者
糖尿病患者在注射胰岛素后，不适宜马上进行跑步，避免出现低血糖情况。而重症糖尿病患者，在没有注射胰岛素时或出现急性感染发热情况时，也不适宜跑步。这时患者体内胰岛素水平低，体内葡萄糖无法满足跑步的能量供给，身体就会消耗大量的脂肪来为运动提供能量。而大量消耗脂肪产生的脂肪代谢物有可能会致人中毒。
3. Diabetic Patients
Diabetic patients should not run immediately after injecting insulin to avoid hypoglycemia. Patients with severe diabetes should also avoid running when not injecting insulin or experiencing acute infection and fever. In these situations, insulin levels are low, and the body’s glucose supply is insufficient for running, forcing the body to consume large amounts of fat for energy. The resulting fat metabolites can potentially lead to poisoning.
4.痛风患者
对于痛风患者，跑步锻炼存在一定的隐患和风险。患者出汗增加，血容量、肾血流量减少，尿酸、肌酸等排泄减少，易出现高尿酸血症，还可能会诱发痛风性关节炎。因此痛风患者要避免剧烈运动和长时间的体力活动。痛风患者锻炼最好的方式是快走或者有氧运动，不宜太过剧烈，在运动过程中要从小运动量开始，要注意运动中的休息和水分补充。如计划运动1小时，每活动15分钟应停下来休息1次，并喝水补充水分，休息5-10分钟后再活动15-20分钟。这样1小时分为3个阶段进行，避免运动量过大和时间过长。
4. Gout Patients
Running poses certain risks and hazards for gout patients. Increased sweating reduces blood volume and renal blood flow, decreasing the excretion of uric acid and creatine, increasing the risk of hyperuricemia, and potentially triggering gouty arthritis. Therefore, gout patients should avoid strenuous exercise and prolonged physical activity. The best exercise for gout patients is brisk walking or aerobic exercise, avoiding overly strenuous activities. Start with low-intensity exercise and pay attention to rest and hydration during exercise. If you plan to exercise for one hour, you should stop and rest every 15 minutes, drink water to replenish fluids, rest for 5-10 minutes, and then continue exercising for another 15-20 minutes. Divide the one hour into three phases to avoid excessive exercise intensity or duration.
5.严重肥胖者
严重肥胖者是指体脂率远超过30%的肥胖者。过于肥胖者的下肢承受了身体的大部分重量，本身已经受到较大压力。如果还进行跑步，只会给下肢关节造成更大的压力，容易造成膝关节受伤。因此，建议严重肥胖者少做或不做跳绳、跑步等这些对关节压力大的运动，可以多做游泳、快走、骑车等负担小的运动。
5. Severely Obese Individuals
Severely obese individuals are those with a body fat percentage well over 30%. The lower limbs of severely obese individuals bear most of their body weight and are already under considerable pressure. Running will only put even more pressure on the lower limb joints, easily leading to knee injuries. Therefore, it is recommended that severely obese individuals reduce or avoid exercises that put high pressure on the joints, such as skipping rope and running, and instead engage in less strenuous activities such as swimming, brisk walking, and cycling.
感冒或熬夜后跑步，是运动的大忌
不少跑者会对自己的运动能力和身体状态出现一些“盲目自信”，比如在进行过马拉松赛前所规定的例行体检后没有被查出任何问题，或是偶尔轻微感冒或者熬夜后，认为自己的身体状况依旧没有太大问题，但实际情况并非如此，往往这就是跑步“最危险的时刻”。
专门负责马拉松急救的“第一反应”创始人陆乐就曾在接受澎湃新闻（www.thepaper.cn）记者采访时指出，他们团队在对曾经救援过的人进行调查后甚至发现，这些出现意外的跑者中绝大多数其实都没有严重的心脏病，甚至都不需要吃药，但他们却成了在跑步时倒下的少数一部分。
陆乐根据数百场马拉松急救的经历分析，大部分出现问题的跑者都是在跑前经历了熬夜、感冒、中暑，以及出现腹泻等状况，又对此不太重视。
“很多人都认为感冒、中暑、腹泻都不是什么大毛病，忍一忍也不会影响训练或者比赛。还有人甚至在体检时查出心律不齐，但仍然坚持要跑，结果就出事了。”在陆乐看来，这些小症状其实非常危险，在跑前不加注意足以致命，“心脏骤停的原因可能包括电解质紊乱、过度劳累、情绪剧烈波动、药物副作用、心脏疾病等。其中，腹泻和中暑会造成体内电解质紊乱，通过剧烈运动后会加剧心脏骤停；而病毒性感冒则会在剧烈运动中，容易引发跑者出现心肌炎。”
时任上海中山医院心外科副主任魏来医生也和陆乐持有相同的观点，他此前告诉澎湃新闻（www.thepaper.cn）记者，想要更安全的跑步，跑者需要关注身体发出的信号，“很多出问题的跑者其实没有什么疾病史，都是在最后出现了恶性心律失常，导致心脏骤停。其实在跑步到达极限前，都会有一些前兆，比如出现胸闷、心悸、出虚汗甚至有呕吐等症状。”
Running after a cold or staying up late is a major no-no for exercise.
Many runners have a kind of “blind confidence” in their athletic ability and physical condition. For example, they might not have any problems after a routine pre-marathon medical check-up, or they might think their body is fine after a minor cold or staying up late. However, this is often the case, and this is often the “most dangerous moment” for running.
Lu Le, founder of “First Response,” a marathon emergency rescue service, pointed out in an interview with The Paper (www.thepaper.cn) that after investigating people they had rescued, his team even found that the vast majority of runners who suffered accidents did not actually have serious heart conditions and did not even need medication, yet they were among the minority who collapsed while running.
Based on his experience with hundreds of marathon emergency rescues, Lu Le analyzed that most runners who encountered problems had experienced staying up late, having a cold, heatstroke, or diarrhea before the run, and had not paid enough attention to these conditions.
“Many people think that colds, heatstroke, and diarrhea are not serious illnesses and that enduring them won’t affect training or competitions. Some even discover they have arrhythmia during a physical exam but still insist on running, resulting in accidents.” Lu Le believes these seemingly minor symptoms are actually very dangerous and can be fatal if not addressed before running. “Causes of cardiac arrest can include electrolyte imbalance, overexertion, drastic emotional fluctuations, medication side effects, and heart disease. Diarrhea and heatstroke can cause electrolyte imbalances, which can worsen cardiac arrest after strenuous exercise; while viral colds can easily trigger myocarditis in runners during strenuous exercise.”
Dr. Wei Lai, then deputy director of cardiac surgery at Shanghai Zhongshan Hospital, shares Lu Le’s view. He previously told The Paper (www.thepaper.cn) that for safer running, runners need to pay attention to their bodies’ signals. “Many runners who experience problems actually have no medical history; they only experience malignant arrhythmias leading to cardiac arrest at the end. In fact, there are usually some warning signs before reaching the limit of running, such as chest tightness, palpitations, cold sweats, or even vomiting.”
值得一提的是，身体发出一些“求救信号”其实也和运动强度有关。
世界卫生组织（WHO）健康专家以运动医学里的代谢当量（MET）来解释了运动的强度。所谓的代谢当量（MET，Metabolic Equivalent）就是指运动时的代谢率与安静时代谢率的比值。
1MET也被定义为每公斤体重每分钟消耗3.5毫升氧气，大概相当于一个人在安静状态下坐着，没有任何活动时每分钟的氧气消耗量。一个5METs的活动表示运动时氧气的消耗量是安静状态时的5倍。根据这种计算方式，在3METs以下的运动，属于低强度运动；介于3-6METs之间的运动，属于中等强度运动；而在6METs以上的运动，就算是高强度运动了。
美国运动医学学会（ACSM）根据代谢当量的测算和判定方式，以“儿童及青少年”和“成年人及老人”两种分类，给出了中等强度的运动指导——
对于儿童和青少年来说，速度约为5公里/小时的步行和快步走，算是中等强度的运动，除此之外，还有速度为16公里/小时的骑行；对于成年人及老人来说，速度约为5公里/小时的步行和快步走以及速度为16公里/小时的骑行也是属于中等强度的运动。
因此，运动者们不应该根据自己是否能完成半马或者全马来判定自己的训练强度是高还是低，而是应该通过更科学的运动指标来更合理地安排自己的训练和比赛。
跑步，可以算是没有硬性门槛的运动，但是如果想要健康安全地跑步，它终究是有前提条件的，那就是科学训练和敬畏生命。
It’s worth noting that some of the body’s “SOS signals” are actually related to exercise intensity.
World Health Organization (WHO) health experts use the metabolic equivalent (MET) from sports medicine to explain exercise intensity. The metabolic equivalent (MET) is the ratio of the metabolic rate during exercise to the resting metabolic rate.
1 MET is also defined as the consumption of 3.5 ml of oxygen per kilogram of body weight per minute, roughly equivalent to the oxygen consumption per minute of a person sitting at rest without any activity. An activity of 5 METs means that the oxygen consumption during exercise is 5 times that at rest. According to this calculation method, exercise below 3 METs is considered low-intensity exercise; exercise between 3 and 6 METs is considered moderate-intensity exercise; and exercise above 6 METs is considered high-intensity exercise.
The American College of Sports Medicine (ACSM), based on its metabolic equivalent (MEE) measurement and assessment methods, provides moderate-intensity exercise guidelines categorized into “children and adolescents” and “adults and seniors.”
For children and adolescents, walking and brisk walking at a speed of approximately 5 km/h are considered moderate-intensity exercise. Additionally, cycling at a speed of 16 km/h is also considered moderate-intensity exercise. For adults and seniors, walking and brisk walking at a speed of approximately 5 km/h and cycling at a speed of 16 km/h are also considered moderate-intensity exercise.
Therefore, athletes should not determine the level of their training intensity based on whether they can complete a half-marathon or a full marathon. Instead, they should use more scientific exercise indicators to more rationally plan their training and competitions.
Running can be considered a sport without strict entry barriers, but to run healthily and safely, it ultimately has prerequisites: scientific training and respect for life.