Marathon runner, 24, dies of rhabdomyolysis: How extreme running can put your heart at risk

The death of 24-year-old marathon runner Rachel Apa, who collapsed just 3 km short of the finish line during the New York City Marathon on November 1, 2026, has raised concerns about the risks of endurance running. Participating in her first marathon, Apa reportedly suffered a cardiac arrest. According to her father, doctors later attributed her death to rhabdomyolysis, a condition involving severe muscle breakdown. The incident raises an important question: Can extreme physical exertion pose similar risks to otherwise healthy runners?

Senior Consultant Orthopaedic Minimal Invasive/Robotic Joint Replacement and Sports Medicine Specialist Dr Gazanfar Patel of Wockhardt Hospitals, Mumbai Central, explains how prolonged endurance activity can trigger rhabdomyolysis, why it can affect the heart, and which warning signs runners should never ignore.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.

What is rhabdomyolysis, and how can a marathon trigger it?

Rhabdomyolysis occurs when muscle fibres break down and release their contents, including a protein called myoglobin, into the bloodstream. Prolonged and intense physical activity, such as running a marathon, can cause excessive muscle breakdown.

“During a marathon, it is the sheer amount of muscle activity over a long period that can lead to excessive muscle breakdown. The greater the exertion, the less the recovery and the more likely it is to occur,” says Dr Patel.

The risk increases with extreme exertion, inadequate recovery, dehydration, and running in hot or humid conditions. Once released into the bloodstream, muscle contents can damage the kidneys and disrupt the body’s electrolyte balance.

Can rhabdomyolysis cause cardiac arrest in a healthy young runner?

“As muscle cells break down, they release potassium into the blood. A dramatic rise in serum potassium can disrupt the heart’s electrical activity, leading to dangerous arrhythmias and potentially cardiac arrest,” explains Dr Patel.

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Acute kidney injury can further aggravate these electrolyte imbalances, increasing the risk of complications.

However, the doctor cautions against attributing every cardiac arrest during a marathon to rhabdomyolysis. Other possible causes include an underlying cardiac condition and heat stroke. “Rhabdomyolysis should not be assumed to be the cause without confirmation from the medical team,” he adds.

Warning signs runners should never ignore

While muscle soreness and fatigue are common after strenuous exercise, certain symptoms could indicate something more serious.

According to Dr Patel, runners should watch out for:

* Severe muscle soreness: Pain that is disproportionate to the effort involved.
* Unusual muscle weakness: Difficulty performing movements that would otherwise feel manageable.
* Muscle swelling: Noticeable swelling accompanied by pain or reduced range of movement.
* Dark urine: Tea-coloured or cola-coloured urine, which may indicate myoglobin release.
* Reduced urine output: Passing significantly less urine than usual.
* Nausea and severe fatigue: Symptoms that go beyond expected post-exercise tiredness.

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“You absolutely should not just write them off as normal post-race tiredness. If you’re experiencing severe muscle pain, swelling, dark urine or unexplained weakness, you need to stop exercising and get assessed by a doctor,” he says.

A 24-year-old marathon runner dies just 3 km before the finish line. Could this happen to any of us?
🔸Rachel Apa, 24, collapsed while running the New York City Marathon on November 1, 2026. She was participating in her first marathon.
🔸Bystanders rushed to help. They found no pulse. CPR was initiated, and medical personnel used a defibrillator. Despite prolonged resuscitation efforts, she died in hospital.
🔸Her father told The New York Times that doctors attributed her death to rhabdomyolysis.
🔸This heartbreaking incident deserves attention from the running community.

As a doctor and a distance runner myself, I want to explain an important, potentially life-threatening complication of strenuous exercise.
This is a bit lengthy but please read it once; as it could potentially be life-saving.

— Dr Sudhir Kumar MD DM (@hyderabaddoctor) November 3, 2026

How can runners reduce their risk of rhabdomyolysis?

Preventing exertional rhabdomyolysis begins well before race day. Dr Patel recommends a gradual training programme that allows the body to adapt to increasing physical demands.

He shares a few precautions:

1. Increase training intensity gradually: Avoid sudden increases in running distance or intensity. Marathon preparation should allow muscles sufficient time to adapt.
2. Prioritise recovery: Include rest days in your training schedule. Adequate recovery is as important as the workout itself.
3. Maintain adequate nutrition: Ensure sufficient carbohydrate intake to support the energy demands of endurance training.
4. Hydrate appropriately: Adjust fluid intake according to individual sweat loss and weather conditions. However, avoid excessive water consumption.
5. Be mindful of the weather: In hot and humid conditions, reduce your pace, avoid peak heat whenever possible and watch for signs of overheating.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.