{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:04:53Z","timestamp":1789707893159,"version":"4.0.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Climate change has led to a discernible increase in the intensity of extreme weather events, contributing to growing public health concerns regarding temperature-related mortality and morbidity. Recently, there has been an increase in the number of sudden cardiac arrests (SCAs) occurring during annual Taipei Marathon events compared with previous years. This study aimed to explore the correlation between weather conditions and SCA risk in runners.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study used data from the Taipei Marathon event held between 2013 and 2024 in Taiwan. We examined the relationship between the SCAs and weather conditions for each year using a Poisson regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 95,866 full- and 220,580 half-marathoners, all SCAs occurred in Taiwanese runners. There were three SCAs in male marathoners (median age, 50 years). In half-marathon runners, 10 SCAs occurred (median age, 30 years), including nine males and one female. Each 1\u00a0\u00b0C increase in the standard deviation of apparent temperature (AT) over the 7-day time window (lag 0\u20136) was associated with an SCA incidence rate that was 6.63 times as high on race day (IRR\u00a0=\u00a06.63, 95% profile likelihood CI 1.85\u201352.11; LRT p &amp;lt; 0.001). The incidence rate was significantly higher during half-marathons than during full marathons (4.53 versus 3.13 per 100,000 participants) and among men than among women (5.17 versus 1.18 per 100,000). The highest proportion of SCA (61.5%) occurred in the final quarter of the race. Bystander-administered cardiopulmonary resuscitation (CPR) was provided in all SCA events (100%). Automated external defibrillator shocks were delivered to 11 of 13 runners (84.6%). All 13 runners (100%) achieved return of spontaneous circulation in the field.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Greater short-term AT variability was associated with a higher incidence of SCA during Taipei Marathon events, suggesting that temperature variability over several days preceding and including race day may be associated with SCA occurrence. Runners should remain highly vigilant and take proactive measures under cold\/high-risk weather conditions. The on-site presence of trained first responders to initiate CPR is mandatory at these events. A well-planned model of in-event emergency medical services is of vital importance in scenarios such as marathon events.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2026.1843910","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:33:40Z","timestamp":1789706020000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations between the standard deviation of apparent temperature and sudden cardiac arrest during the Taipei Marathon, 2013\u20132024"],"prefix":"10.3389","volume":"17","author":[{"given":"Yin-Hsien","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, MacKay Memorial Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, MacKay Memorial Hospital","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang-Lin","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, MacKay Memorial Hospital","place":["Taipei, Taiwan"]},{"name":"Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing, and Management","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pang-Yen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, MacKay Memorial Hospital","place":["Taipei, Taiwan"]},{"name":"Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing, and Management","place":["Taipei, Taiwan"]},{"name":"Institute of Biomedical Engineering, National Tsing Hua University","place":["Hsinchu, Taiwan"]},{"name":"School of Medicine, College of Medicine, MacKay Medical University","place":["New Taipei City, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsu-I","family":"Hsia","sequence":"additional","affiliation":[{"name":"Graduate Institute of Life Sciences, National Defense Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chorng-Kuang","family":"How","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Veterans General Hospital","place":["Taipei, Taiwan"]},{"name":"Department of Emergency Medicine, School of Medicine, National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Kuang","family":"Lin","sequence":"additional","affiliation":[{"name":"Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University","place":["Taoyuan, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Hui","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, MacKay Memorial Hospital","place":["Taipei, Taiwan"]},{"name":"School of Medicine, College of Medicine, MacKay Medical University","place":["New Taipei City, Taiwan"]},{"name":"Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Song","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, MacKay Memorial Hospital","place":["Taipei, Taiwan"]},{"name":"School of Medicine, College of Medicine, MacKay Medical University","place":["New Taipei City, Taiwan"]},{"name":"Graduate Institute of Long-Term Care, MacKay Medical University","place":["New Taipei City, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Kun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, MacKay Memorial Hospital","place":["Taipei, Taiwan"]},{"name":"School of Medicine, College of Medicine, MacKay Medical University","place":["New Taipei City, Taiwan"]},{"name":"Department of Electronic Engineering, National Taipei University of Technology","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ding-Kuo","family":"Chien","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, MacKay Memorial Hospital","place":["Taipei, Taiwan"]},{"name":"School of Medicine, College of Medicine, MacKay Medical University","place":["New Taipei City, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Han","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, MacKay Memorial Hospital","place":["Taipei, Taiwan"]},{"name":"School of Medicine, College of Medicine, MacKay Medical University","place":["New Taipei City, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/circulationaha.122.061832","article-title":"Associations between extreme temperatures and cardiovascular cause-specific mortality: Results from 27 countries","volume":"147","author":"Alahmad","year":"2023","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"6878","DOI":"10.3390\/ijerph17186878","article-title":"Physical activity change during covid-19 confinement","volume":"17","author":"Casta\u00f1eda-Babarro","year":"2020","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1017\/s1049023x19004345","article-title":"An overview of chicago (illinois USA) marathon prehospital care demographics, patient care operations, and injury patterns","volume":"34","author":"Chan","year":"2019","journal-title":"Prehosp Disaster Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"S17","DOI":"10.1016\/j.jfma.2023.08.016","article-title":"Covid-19 public health surveillance and response in taiwan: From containment to mitigation","volume":"123","author":"Chen","year":"2024","journal-title":"J. Formos Med. Assoc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1001\/jama.1972.03200220058013","article-title":"Physiology of marathon running","volume":"221","author":"Costill","year":"1972","journal-title":"Jama"},{"key":"B6","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1177\/1941738110373066","article-title":"Cardiac risks associated with marathon running","volume":"2","author":"Day","year":"2010","journal-title":"Sports Health"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246300","article-title":"Running behaviors, motivations, and injury risk during the covid-19 pandemic: A survey of 1147 runners","volume":"16","author":"DeJong","year":"2021","journal-title":"PloS One"},{"key":"B8","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1111\/acem.13987","article-title":"Mobile smartphone technology is associated with out-of-hospital cardiac arrest survival improvement: The first year \"greater paris fire brigade\" experience","volume":"27","author":"Derkenne","year":"2020","journal-title":"Acad. Emerg. Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1007\/s11332-020-00697-5","article-title":"Effects of social distancing on psychological state and physical activity routines during the covid-19 pandemic","volume":"16","author":"Di Corrado","year":"2020","journal-title":"Sport Sci. Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1136\/jech.51.6.643","article-title":"Early increases in ischaemic heart disease mortality dissociated from and later changes associated with respiratory mortality after cold weather in south east england","volume":"51","author":"Donaldson","year":"1997","journal-title":"J. Epidemiol Community Health"},{"key":"B11","doi-asserted-by":"publisher","first-page":"428","DOI":"10.2165\/00007256-200737040-00040","article-title":"Marathon race medical administration","volume":"37","author":"Ewert","year":"2007","journal-title":"Sports Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2531","DOI":"10.1093\/eurheartj\/ehv675","article-title":"Registry on acute cardiovascular events during endurance running races: The prospective race paris registry","volume":"37","author":"Gerardin","year":"2016","journal-title":"Eur. Heart J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1177\/2047487320943001","article-title":"Life-threatening and major cardiac events during long-distance races: Updates from the prospective race paris registry with a systematic review and meta-analysis","volume":"28","author":"Gerardin","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.1289\/ehp149","article-title":"Temperature variability and mortality: A multi-country study","volume":"124","author":"Guo","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e1130","DOI":"10.1161\/cir.0000000000001419","article-title":"Nonoptimal temperature and cardiovascular health: A scientific statement from the american heart association","volume":"153","author":"Hanneman","year":"2026","journal-title":"Circulation"},{"key":"B16","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1177\/19417381231175384","article-title":"Research on the rescue time of the taiwan marathon emergency medical service system between 2013 and 2021","volume":"15","author":"Hsia","year":"2023","journal-title":"Sports Health"},{"key":"B17","doi-asserted-by":"publisher","article-title":"Climate change 2021: The physical science basis. Chapter 11: Weather and climate extreme events in a changing climate","year":"2021","DOI":"10.1017\/9781009157896.013"},{"key":"B18","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1017\/s1049023x18001206","article-title":"Health care provision during a sporting mass gathering: A structure and process description of on-site care delivery","volume":"34","author":"Johnston","year":"2019","journal-title":"Prehosp Disaster Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2949","DOI":"10.1113\/jp272268","article-title":"Physiological limits to endurance exercise performance: Influence of sex","volume":"595","author":"Joyner","year":"2017","journal-title":"J. Physiol."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwaf712","article-title":"Risks of ambient temperature in sudden cardiac arrest during exercise among school children and adolescents","volume":"33","author":"Kato","year":"2025","journal-title":"Eur. J. Prev. Cardiol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2026.102965","article-title":"Meteorological and environmental factors associated with sudden cardiac arrest during marathons in japan","volume":"5","author":"Kato","year":"2026","journal-title":"JACC Adv."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1136\/bmj.289.6456.1405","article-title":"Increases in platelet and red cell counts, blood viscosity, and arterial pressure during mild surface cooling: Factors in mortality from coronary and cerebral thrombosis in winter","volume":"289","author":"Keatinge","year":"1984","journal-title":"Br. Med. J. (Clin Res. Ed)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1001\/jamacardio.2020.5890","article-title":"Coronavirus disease 2019 and the athletic heart: Emerging perspectives on pathology, risks, and return to play","volume":"6","author":"Kim","year":"2021","journal-title":"JAMA Cardiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1056\/NEJMoa1106468","article-title":"Cardiac arrest during long-distance running races","volume":"366","author":"Kim","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1001\/jama.2025.3026","article-title":"Cardiac arrest during long-distance running races","volume":"333","author":"Kim","year":"2025","journal-title":"Jama"},{"key":"B26","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1056\/NEJMc1803218","article-title":"Mobile automated external defibrillator response system during road races","volume":"379","author":"Kinoshi","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1016\/j.jmii.2023.04.001","article-title":"How taiwan has responded to covid-19 and how covid-19 has affected taiwan 2020-2022","volume":"56","author":"Lai","year":"2023","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"B28","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s40279-024-02163-5","article-title":"Sex differences in the incidence of sudden cardiac arrest\/death in competitive athletes: A systematic review and meta-analysis","volume":"55","author":"Li","year":"2025","journal-title":"Sports Med."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/9682520","article-title":"Training for marathons during a marathon pandemic: Effect of the covid-19 pandemic on fitness among high-level nonelite runners","volume":"2021","author":"Matsumura","year":"2021","journal-title":"J. Sports Med. (Hindawi Publ Corp)"},{"key":"B30","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1161\/circulationaha.121.054824","article-title":"Sars-cov-2 cardiac involvement in young competitive athletes","volume":"144","author":"Moulson","year":"2021","journal-title":"Circulation"},{"key":"B31","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.imr.2016.06.002","article-title":"Effects of environmental temperature on physiological responses during submaximal and maximal exercises in soccer players","volume":"5","author":"No","year":"2016","journal-title":"Integr. Med. Res."},{"key":"B32","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1177\/1941738120984149","article-title":"Medical tent usage from bank of america chicago marathon 2015-2017","volume":"13","author":"Parker","year":"2021","journal-title":"Sports Health"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1152\/physrev.00038.2020","article-title":"Exercise under heat stress: Thermoregulation, hydration, performance implications, and mitigation strategies","volume":"101","author":"P\u00e9riard","year":"2021","journal-title":"Physiol. Rev."},{"key":"B34","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1136\/bjsports-2012-091119","article-title":"Marathon related cardiac arrest risk differences in men and women","volume":"47","author":"Roberts","year":"2013","journal-title":"Br. J. Sports Med."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1016\/j.jacc.2005.07.008","article-title":"Evidence for decreasing occurrence of sudden cardiac death associated with the marathon","volume":"46","author":"Roberts","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.5114\/biolsport.2023.124842","article-title":"Core body temperature responses during competitive sporting events: A narrative review","volume":"40","author":"Singh","year":"2023","journal-title":"Biol. Sport"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1175\/1520-0450(1979)018<0861:taospi>2.0.co;2","article-title":"A universal scale of apparent temperature","volume":"23","author":"Steadman","year":"1984","journal-title":"J. Clim. Appl. Meteorol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1038\/nrcardio.2017.76","article-title":"Seasonal variations in cardiovascular disease","volume":"14","author":"Stewart","year":"2017","journal-title":"Nat. Rev. Cardiol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1177\/10105395231203117","article-title":"Covid-19 outbreak in taiwan: Spring 2022","volume":"35","author":"Su","year":"2023","journal-title":"Asia Pac J. Public Health"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1175\/2009jcli3243.1","article-title":"Another look at interannual-to-interdecadal variations of the east asian winter monsoon: The northern and southern temperature modes","volume":"23","author":"Wang","year":"2010","journal-title":"J. Clim."},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2019.108771","article-title":"Mortality risk and burden associated with temperature variability in china, united kingdom and united states: Comparative analysis of daily and hourly exposure metrics","volume":"179","author":"Zhang","year":"2019","journal-title":"Environ. Res."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1843910\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:33:45Z","timestamp":1789706025000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1843910\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":41,"alternative-id":["10.3389\/fphys.2026.1843910"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2026.1843910","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"article-number":"1843910"}}