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Completing a safe and successful marathon requires adequate preparation and vigorous training. The American College of Sports Medicine has established guidelines for pre-participation assessment prior to starting a program of vigorous exercise.
The ACSM recommends a complete physical examination and physician-monitored, graded exercise test prior to beginning a vigorous exercise program for those who are apparently healthy and over the age of 45, those with risk factors for cardiovascular disease and over the age of 35, and those with symptoms or disease at any age. Marathon running is not recommended for individuals under the age of 18.