Running as a leisure-time activity is increasing in popularity in adult, sedentary people and especially marathon running a marathon is a steeply growing field ( 1 ). The desportification and deinstitutionalization of the sports are continuing since the sixties and people more and more are engaged in running to become happy and a part of the adventure; rather than a competitive athlete. Nowadays running is living its high popularity (i.e. number of finishers of the largest marathons has increased from 25.000 in 1976 to 1.600.000 in 2012 ( 2 , 3 ). Just in the US, in 2009, 397 marathons have been organized ( 4 ).

Besides different reasons to run, people are participating due to health and survival benefits of regular running. The belief that intense physical activity has health gaining effects has increased the participation in marathons 25 fold in the last 20 years. But the participants are not young anymore and they seem to overlook this. They get exposed to increased adverse health risks (i.e. musculoskeletal injuries, cardiac problems etc.)( 1 , 5 ).

The frequency and numbers of activities of marathon running in Turkey are overwhelming, but a documentation on participants is missing. We, therefore, were interested to know the perception and view of leisure-time runners (LTR) on the marathon and related health services in a purposeful sample in Turkey.

Leisure-time runners living in different cities were asked to participate in this study in May- October 2017. Sixty-three LTR agreed and gave verbal consent to participate. Participants were purposefully selected (purposive sample) from the community of LTR because it was expected that it would represent diverse LTR in Turkey. The survey included 22 questions (19 closed-ended and three open-ended) and was divided into 3 parts. The first part included questions on demographics. The second part included questions about running experience, and finally, the 3 ^rd part asked questions about their personal thoughts and experience concerning health care issues of running.

The survey was piloted with ten LTR and the results of the pilot questionnaire were not included in the final dataset. Data were analyzed with descriptive statistics. The level of significance was set at alpha=0.05.

Sixty-three LTR participated in this study. Their mean age was 37.2 (SD=11.62;range 20-61); 11 (31%) were female and 36(69%) were male; 20 (32%) were single, 36(56%) were married, and 5(8%) divorced/widowed. Sixteen(29%) were employed in the public sector, 31(55%) in the private sector, and 9 (16%) were students. Forty-seven (81%) participated in a marathon before. The reason for running was as follows: to stay healthy (49; 36%), to keep fit (34;26%), to minimize risk factors of disease (25;19%), to lose weight (15;11%), and to get socialized (10; %8). Forty-six (%72) practiced sports in their youth. Ten (17%) had a chronic condition and six (11%) were on a drug treatment for their condition. Thirty-two (55%) had a medical examination before participating in a marathon and 25 (39%) had periodical medical exams during their sportive activities. LTRs think, that the annual frequency of periodical physical exam should be at least twice (mean=2.8; SD: 2.67; min-max: 1-12). LTRs were satisfied with the running-related health services (median: 2; min-max:1-5) (1: very satisfied, 5: not satisfied at all). They were also satisfied with competence of their physician (median: 2; min-max: 1-5) (1: very satisfied, 5: not satisfied at all). LTRs were training six hours (min-max: 1-20 hours) a week. Sixteen (29%) had a trainer to prepare for the marathon and they were satisfied with the training services (median: 2, min-max: 1-5) (1: very satisfied, 5: not satisfied at all).

Eight (15%) received also counseling from a nutritionist and they were very satisfied with the nutritional services they receive (median:1; min-max:1-5) (1: very satisfied, 5: not satisfied at all). Eighteen (32%) LTR had a sports injury before or during the marathon. Their preference for a health care provider is displayed in Table 1. LTRs, who suffered from a running injury and received medical attention were satisfied with the healthcare services (median:2.5, min-max: 1-5) (1: very satisfied, 5: not satisfied at all). They were also satisfied with competence of their physician (median: 2; min-max: 1-5) (1: very satisfied, 5: not satisfied at all).

Findings of our study revealed that participants and found that most were at their middle-age, male, married, private sector employed, most participated in a marathon before. Our results are comparable with the findings from Greece, where the participants were mostly over 30 years, highly educated, and dominantly working in the private sector. Their motivation was related to physical and mental benefits ( 6 ). One third had a personal coach in our study, which is comparable to a study where most served as their own coaches ( 4 ). Almost all sports-related cardiac deaths occur in people over 35. The increase of the age of runners will increase the risk of these events in participants. Most of the participants to marathons are believed to consult a physician to get advice and approval before the race ( 1 ). In our study, only half had a medical examination before participating in the marathon, some had periodical medical exams during their sportive activities, think that the annual frequency of periodical physical exam should be at least twice.

Even the attitudes concerning the need for pre-participation physical clearance in runners nothing should be left to a chance and a rigorous should be established in a systematic way ( 5 ). Because some of the participants might harbor occult coronary artery disease and might have switched from a sedentary lifestyle to a competitive one ( 7 ). In our survey, most athletes participated in a marathon before and run to stay healthy, to keep fit and to minimize risk factors of disease. Most practiced sports in their youth. But even a minority had a chronic condition and were on a drug treatment for the condition, which might make them vulnerable to acute events during training or competition. Symptoms of novice and non-professional athletes might be often misinterpreted as minor problems, which might be endorphin related. But even a slight chest pain, palpitation, dizziness, nausea should be considered as a reason for thorough clearance of a serious cardiovascular incident ( 1 ). The training pattern of professional and amateur athletes should not be overlooked either. While professional athletes are used to intense exercise since their youth and have an adapted organism to long and strenuous exercise; have professional guidance in training forms, condition, nutrition, and the sports-related injury prevention ( 8 ); amateur athletes instead might start running in middle adulthood, when the degenerative process of aging has already begun (i.e, atherosclerosis and related disease). They might train at too high intensities ( 9 ), do not change their bad lifestyle habits, and neglect their private life. Unfortunately, a small group has access to a coach or better health care, and they is under the risk of blindly copying training methods, which are especially tailored for the elite athletes ( 1 ).

Our respondents were training six hours a week (ranging 1-20 hours a week), some had a trainer to prepare for the marathon, a minority had nutritional counseling, some had before or during marathon, most seek assistance from a physician, and were satisfied with the running-related health services-the competence of their physician-training services-nutritional services-the health care services and the competence of their physician during sports injury.

Findingsof our study revealed that participants and found that most were at their middle-age, male, married, private sector employed participants. Their main motivation for running was health-oriented. Only half had a medical examination before participating in a marathon, some had periodical medical exams during their sportive activities, and thought that the annual frequency of periodical physical exam should be at least twice. Even there was a positive attitude toward health services, some space for improvement in health might be required. Since these athletes were mainly formerly sedentary and might harbor latent risk factors, which could be provoked after strenuous activities like marathons, provision of a rigorous screening for this athletes should be provided.