Health PS Muthoni urges careful preparation to avoid risks in endurance events

With the surge in the number of Kenyans participating in extreme physical challenges, the government has issued a public advisory to ensure their safety.

Principal Secretary for Public Health and Professional Standards Mary Muthoni noted that extreme challenges can build resilience and achievement, but they carry real medical, musculoskeletal, and psychological risks.

“Thoughtful preparation, medical screening, adequate fueling and hydration, listening to warning signs, and prioritising recovery are essential to protect long-term health and wellness,” PS Muthoni said.

The public advisory was mainly directed to individuals undertaking extreme physical challenges, such as mountaineering, ultra-marathons, long-distance cycling or running, military-style bootcamps, desert or heat exposure challenges, and high-altitude trekking, as well as the implications for health and wellness.

Contextual risks relevant to Kenya

Kenya's extreme endurance events push athletes to their limits amid intense heat in arid regions like the Rift Valley, Northern Kenya, and the Coast, where heat stress, heatstroke, dehydration, and electrolyte imbalances pose severe risks.

High-altitude challenges on Mt Kenya, the Aberdares, and Rift Valley escarpments can trigger acute mountain sickness, while prolonged exertion on rough, uneven terrain frequently leads to overuse injuries, rhabdomyolysis, and cardiovascular strain—particularly in those with undiagnosed heart conditions.

Additional hazards include exposure to insects, snakes, and rough-ground trauma, compounded by mental health pressures from performance demands, sleep deprivation, and burnout, as well as poor air quality in urban races.

Who is most at risk

Certain groups face heightened risks during Kenya's extreme endurance events. Individuals with undiagnosed heart conditions, diabetes, hypertension, or asthma are especially vulnerable to sudden cardiovascular strain under intense physical stress.

Those with a low fitness baseline who abruptly tackle ultra-challenging races, adolescents pushed into rigorous high-altitude training camps, and people who ascend to elevations like those on Mt Kenya or the Aberdares without proper acclimatisation are all at greater danger of collapse, injury, or life-threatening complications.

Additionally, participants who severely restrict food intake or rely on unregulated supplements and stimulants further compound the perils of dehydration, electrolyte imbalance, and organ stress in such demanding conditions.

Pre-participation medical screening (Strongly recommended)

Pre-participation medical screening is strongly recommended for Kenyans preparing for extreme endurance challenges. Participants should undergo a basic medical evaluation at a sports clinic or healthcare facility, including checks of blood pressure, blood sugar, haemoglobin levels, and—if possible—heart rhythm. Clinicians can help manage any chronic conditions, review medications that might impair hydration or heat tolerance, and—for high-altitude events—consider screening for sickle cell trait or disease where relevant. Such proactive steps are vital to identify hidden risks and reduce the likelihood of sudden medical emergencies during intense physical exertion in Kenya's demanding environments.

Training and preparation

The Ministry of Health has urged people carrying out extreme exercises to build up gradually and avoid sudden “crash training”, which may be dangerous.

They are urged to include rest days and recovery cycles in their training schedules.

They are also advised to practise event conditions (heat, altitude, terrain) safely, ensure adequate sleep, cross-training, strengthening, and flexibility, as well as to avoid unsupervised intense training camps or harmful initiation rituals.

Hydration and nutrition in Kenyan settings

On diet and energy, participants are advised to carry sufficient safe drinking water and plan for scarce water points. It is advisable to avoid extremes, especially overhydration or dehydration. They are also advised to replace salts and electrolytes during prolonged activity and maintain adequate caloric intake to prevent Relative Energy Deficiency in Sport (RED-S). Of particular importance is to avoid unregulated supplements from informal markets, which could cause stomach upsets and discomfort.

Warning signs — Stop immediately and seek care

The ministry also told sportsmen to be on the lookout for any unusual signs, and urged them to report to the nearest health facility if experiencing chest pain, fainting, or severe shortness of breath.

Other danger signs include confusion, collapse, hot or dry skin (which could indicate possible heatstroke), dark or cola-coloured urine, very painful swollen muscles, severe headache at altitude, vomiting, and loss of coordination.

Persistent severe cramps, vomiting, or inability to drink fluids are also warnings that require immediate medical attention.

Mental health and social pressures

Kenyan athletes and trainees may experience pressure to perform or secure sponsorship, body image stress or extreme dieting, and training addiction or compulsion.

To alleviate such pressure, they should seek support through coaches, counsellors, peers, or healthcare workers.

Safety and practical measures

To remain healthy during such extreme challenges, inform someone of your route and expected return time. Use appropriate clothing, sun protection, and footwear.

It is also important to acclimatise gradually at altitude, avoid alcohol and stimulants before and during such events or challenges, and carry ID, emergency contacts, basic first aid, and a mobile phone.

Knowing the nearest health facility or evacuation plan is also essential.