CLEVELAND, Ohio -- While health professionals say marathons can offer a multitude of health benefits, some major health risks could go undetected until mid-race.

Medical tests can find these hidden problems, but the procedures are usually pricey.

Timothy Miller, director of endurance medicine at Ohio State University’s Wexner Medical Center, said in an interview with cleveland.com that deaths during marathons are more common than you might expect.

Taylor Ceepo, a 22-year-old former college soccer player from Medina, collapsed during the Cleveland Marathon and died. Preliminary investigations by the Cuyahoga County Medical Examiner’s office did not find a definitive cause of death.

Last year, two men under the age of 40 died suddenly at the Cardiff Half Marathon in England.

Earlier in 2018, a man died at the London Marathon from a heart-related condition.

A study in the New England Journal of Medicine found that of the 10.9 million marathon and half-marathon runners between 2000 and 2010, 59 people suffered cardiac arrest.

Miller said key to assessing these risks is a general physical before training for a strenuous event. If doctors know you’re about to attempt a feat that puts major stress on the body, they can ask screening questions that will inform the need for tests.

One question: whether anyone in your family has died of heart-related causes before the age of 50. Another is whether you’ve had pains in your chest or problems breathing while you’ve been training.

“I’m not discouraging people from training and doing endurance sports, quite the opposite in fact,” Miller said. “I’m an endurance athlete myself for many years. The benefits of endurance sports far, far outweigh the risk. At the same time, if you don’t train properly, if you don’t do it safely, that’s when people run into trouble.”

Here are some of the health risks that could emerge during an marathon or other endurance event:

Hypertrophic cardiomyopathy - preexisting condition

Hypertrophic cardiomyopathy, where the wall of the heart becomes enlarged, is a cause of death among young athletes. When the walls enlarge, they can restrict the heart’s ability to pump blood.

Symptoms often don’t emerge until later in life, according to multiple reports. Most people with hypertrophic cardiomyopathy have a family history of the disease, according to the Mayo Clinic.

An echocardiogram can help detect the disease, Miller said, but people may feel its unnecessary when their young and fit. Costs can range from $50 up to thousands of dollars, depending on the hospital, insurance and deductible.

Wolff Parkinson White Syndrome - preexisting condition

Wolff Parkinson White Syndrome is a rare disease that causes irregular heart rhythm because of an extra electrical pathway in the heart. Sometimes signs emerge early, but the disease also could be symptomless. The irregular heartbeat can be aggravated with exercise.

This disease can easily be screened for using an electrocardiogram, commonly known as an EKG. A stress test, where patients are monitored while exercising, can also detect the disease. The costs vary depending on hospital and insurance coverage.

Exercised-induced asthma - preexisting condition

Exercise-induced asthma often shows itself in coughing during or after exercise, according to the Asthma and Allergy Foundation of America. It can be caused by cold weather exercise, allergies and pollen, Miller said, and can sometimes be so severe that it can lead to a collapse during an event like a marathon.

Asthma narrows the airway, causing coughing and wheezing. Since many people have some trouble breathing while exercising, sometimes the symptoms can be overlooked. A physician will be able to assist with treatment options.

Heat-stroke/heat exhaustion

Heat exhaustion and heatstroke can particularly affect runners in spring marathons. In northern states where the months leading up to a spring race day are in the 30s and 40s or below, warmer temperatures can be a real problem for athletes.

“Your body is just not ready for that,” Miller said.

Increased heat can lead to dehydration, heat stroke and in more extreme cases, heat exhaustion. Heat exhaustion is a life-threatening condition.

For the Cleveland Marathon this year, temperatures were about 10 degrees warmer than normal.

Hyponatremia

Hyponatremia is when the body’s salt content drops to dangerously low levels and can be caused by over-hydration. Some also call it “water poisoning.” If an athlete drinks too much water before or during a race, it can throw their sodium levels off.

Hyponatremia can be life-threatening. Symptoms can include nausea and vomiting, muscle weakness, spasms or cramps, headache and confusion, according to the Mayo Clinic. This is one of the conditions that medics who cover races worry about the most, Miller said.

Rhabdomyolysis

When people attempt a half-marathon or marathon too quickly, their muscles can break down, Miller said. This breakdown can lead to a release of myoglobin, which in excess amounts can flood the kidneys and be deadly.

Tests can be done post-race to test the level of myoglobin in the urine, but specific screening for potential rhabdomyolysis isn’t really possible, Miller said. The condition can be treated.

What else can you do to prevent problems on race day?

Proper training is important, especially for people who aren’t competitive athletes, Miller said. For every 5 miles of running, you need to train for a month. So for a marathon - 26.2 miles - that’s a total of more than five months.

Miller said setting reasonable goals, like a 5K or a 10K, can help you build up to a half marathon or a full marathon.

“You should almost feel refreshed after a workout,” he said. “If you’re training six times a week and two to three times you’re thinking ‘I’m not sure if I’m going to complete this workout,’ you’re probably working too hard and need to back off a little bit.”

And though there will be some discomfort during training, keep track of whether you feel chest pain or have problems breathing. If you’re experiencing body aches that last a few hours outside of your workout, pull back, Miller said.