COLUMBIA- High temperatures were a major concern Labor Day for the 59th annual Heart of America Marathon. 

By the end of the race, temperatures reached 87 degrees Fahrenheit with a heat index of 93. Volunteers and medical staff were on site to make sure runners were cared for and getting enough to drink.

"We have to be on high alert at all times," physician Tiffany Bohon said. "Sometimes people who need our attention don't say anything because they're exhausted. We need to be on lookout for them."

Runner Michael Sager said this was his second time running this race and his 22nd marathon overall.

“It’s a tough race, it’s a hot race, it’s a humid race, but everyone knows it coming in," Sager said. "When you train you have to realize you're preparing for September in Columbia."

Sager said he trained for the race all summer wearing sweatpants and sweatshirts.

"I wanted to mimic the heat and humidity out here the best I could," Sager said. 

Several runners said heat isn't the only thing you have to look out for. Stephens College girls cross-country coach Nancy Yaeger said this course is one of the toughest in the nation. 

"Other than mountain courses this one ranks pretty high up there," Yaeger said. "You have rolling hills constantly popping up and it takes a lot of extra work."

Sager said the hilly terrain and hot temperatures means you have to stop at every water station along the course. Dr. Bohon agreed and added hydration is the best way to avoid cramping and heat exhaustion.

"If you feel yourself stumbling and overheating it means you need fluids right away," Bohon said. "Being safe is much more important than finishing the race."

The medical tent was placed right next to the finish line with large buckets of ice and a few training tables to treat runners with cramps. 

Dr. Bohon said she didn't notice whether or not more runners needed medical attention this year, but you always need to be ready. 

Stephanie King took home first place in the women's division, while Hayden Legg finished first for the men. Official results will be posted Tuesday morning online.