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nhc
November 2nd, 2008, 11:28 PM
Is this an alarm that we should swim more to strengthen our hearts? Though similar tragedies happened to swimmers in the past, too, I believe. Seems all are in their late 50's?

News from
http://www.newsday.com/sports/ny-nyrun0312133574nov03,0,6679842.story


Marathon runner dies after collapsing at finish line

BY DANIEL EDWARD ROSEN9:32 PM EST, November 2, 2008
A 58-year-old runner who had just finished the New York Marathon Sunday collapsed at the finish line after going into cardiac arrest and later died at a local hospital, police said.

Carlos Jose Gomes, of Sao Paolo, Brazil, was pronounced dead at Lenox Hill Hospital at about 5:20 p.m., police said. He had fallen ill after he crossed the finish line of the 26.2 mile race near the intersection of 81st Street and Central Park (http://www.newsday.com/topic/travel/tourism-leisure/gardens-parks/central-park-PLTRA0000101.topic) West.

Two other people suffered cardiac arrest Sunday while running in the race, police said.

A 59-year-old man collapsed in the middle of the Queensboro Bridge (http://www.newsday.com/topic/travel/commuting/queensboro-bridge-NY0509200835.topic), police said. A fellow runner stopped and administered CPR until two emergency medical technicians arrived.

The runner was taken to New York-Presbyterian/Weill Cornell Medical Center, where he was listed as critical but stable, according to one of the EMTs.

Jean-Louis Maubaret, 59, a French national, was running alongside his wife across the Queensboro Bridge between the 15th and 16th mile of the race when he collapsed, unconscious and not breathing, according to EMT Salvatore Sangeniti.

Sangeniti, 47, of the New York Fire Department (http://www.newsday.com/topic/disasters-accidents/fires/fire-department-of-new-york-ORGOV000087.topic) EMS Division 4, was crossing the bridge from the Manhattan side when he and his partner, Amanda Wong, received a radio call about the runner. They reached the middle of the bridge to find another runner performing CPR.

Sangeniti, of Centereach, said he placed a defibrillator on Maubaret's chest. After one shock, he said, the runner regained consciousness and resumed breathing.

The runner who performed CPR returned to the race once he saw that Maubaret had regained consciousness, Sangeniti said.

Another marathoner suffered cardiac arrest on East 107th Street yesterday afternoon. The man, whose name was not immediately known, had collapsed and was not breathing, according to an FDNY spokesman. EMTs performed CPR as he was rushed by ambulance to Mount Sinai Medical Center.

nhc
November 3rd, 2008, 01:58 AM
Almost a year ago to the day a younger man died of heart condition during marathon trial. See

http://www.foxnews.com/story/0,2933,307896,00.html

Note that the article says:

"Scientists long have noticed the phenomenon of the "athlete's heart." Athletes who train hard in aerobic sports, such as cycling, running or swimming, tend to have a bigger heart that pumps more blood throughout the body."

Thoughts?

craiglll@yahoo.com
November 3rd, 2008, 05:34 AM
I was once told that for an aerobic athlete, I have a relatively small heart. I told my brother who is a nurse in an ER this. he said that sometimes hearts get large but the vessels carrying the blood can't adapt to the pumping of the heart and the heart pumps blood that goes no where. Or the hard pumping heart doesn't have enough blood to pump so it is pumping and there is nothing there, I think is how he explained what also can happen. He thought that most runners or swimmers who die after competition tend to have a condition where vessels aren't good. I think it is an inherited condition that most people don't know about. Or they have plaque in a vessel somewhere that either comes loose or blocks blood flow. Maybe soem doctors on here can explain.

smontanaro
November 3rd, 2008, 05:41 AM
"Scientists long have noticed the phenomenon of the "athlete's heart." Athletes who train hard in aerobic sports, such as cycling, running or swimming, tend to have a bigger heart that pumps more blood throughout the body."

Not quite sure what you're getting at here, but a larger heart, in and of itself, is not necessarily a bad thing. There is a big different between a large heart with more muscle mass such as an athlete would develop than a large heart which is simply distended because the muscle is not strong enough to completely empty the left ventricle of blood when it contracts.

Skip

swimshark
November 3rd, 2008, 07:50 AM
This hits home for me today. My dad is having heart surgery as I write this. He is in excellent shape but has a genetic defect which causes blockages in tiny vessels. Heart rate monitors have saved his life since he monitors his heart rate as he runs, bikes and swims.

gull
November 3rd, 2008, 08:29 AM
Most of these cases occurring in middle aged athletes are due to atherosclerosis (coronary artery disease) with plaque rupture and ventricular fibrillation resulting in sudden cardiac death. There is a small but definite increase in the risk of these events with vigorous (as opposed to moderate intensity) exercise.

fanstone
November 3rd, 2008, 08:32 AM
There is a statistics problem here. Can we see how a control group of 35,000 with about same ages did not running the marathon? There were other deaths of cardiac failure, or heart attack in New York at about the same time. As these other dead people were not running, their deaths did not make the headlines. Most heart attacks happen during sleep in the early dawn hours. Most heart attacks after exertion are caused by snow shoveling...

haroldbuck
November 3rd, 2008, 08:45 AM
There is a statistics problem here. Can we see how a control group of 35,000 with about same ages did not running the marathon? There were other deaths of cardiac failure, or heart attack in New York at about the same time. As these other dead people were not running, their deaths did not make the headlines. Most heart attacks happen during sleep in the early dawn hours. Most heart attacks after exertion are caused by snow shoveling...

Thanks for saying that so I didn't have to. :applaud:

People are awful at estimating risk. I heard recently that, on average, people are willing to pay more for a $1 million life insurance policy to cover death from terrorism on a plane flight than they are willing to pay for the same amount of coverage against death from all causes during the flight (which obviously includes terrorism).

There will be thousands of people who desperately need to lose weight and get in shape that will point to this runner's death and say, "Well, there you go, running is bad for you so I'm just going to continue being an out-of-shape fatty!"

USMSarah
November 3rd, 2008, 09:01 AM
This hits home for me today. My dad is having heart surgery as I write this. He is in excellent shape but has a genetic defect which causes blockages in tiny vessels. Heart rate monitors have saved his life since he monitors his heart rate as he runs, bikes and swims.

Hope your Dad has a quick and speedy recovery from his procedure today.

Ripple
November 3rd, 2008, 10:58 AM
My neighbor three-doors-down was a thin, active man with low cholesterol levels when his younger brother suddenly died of a heart attack. The neighbor went to his doctor shortly after, was sent for an angiogram, and a few days later was in hospital having a quad bypass for 95% blocked arteries. I don't know how he is now, he's moved away, but this shows that being thin and healthy and active only improves the odds, it's no guarantee. Anyone over age 40 who wants to remain active should probably get thoroughly checked out, even if they've always been active.

I recently got a heart-rate training book which states that half the heart sends blood to the upper body and the other half to the lower body. If so, doing a form of exercise that only works half the body might not be enough. Bring on the cross-training!

anita
November 3rd, 2008, 12:04 PM
This hits home for me today. My dad is having heart surgery as I write this. He is in excellent shape but has a genetic defect which causes blockages in tiny vessels. Heart rate monitors have saved his life since he monitors his heart rate as he runs, bikes and swims.

I hope today goes smoothly for your dad and he has a quick recovery. Sending healthy vibes his way...

nhc
November 3rd, 2008, 12:40 PM
I recently got a heart-rate training book which states that half the heart sends blood to the upper body and the other half to the lower body. If so, doing a form of exercise that only works half the body might not be enough. Bring on the cross-training!

Running exercises mostly the lower half, but swimming is better as it exercises all parts of the body.

Bad news, according to NY Times: by now two runners of the Sunday marathon have died.

swimshark
November 3rd, 2008, 02:47 PM
I hope today goes smoothly for your dad and he has a quick recovery. Sending healthy vibes his way...


Hope your Dad has a quick and speedy recovery from his procedure today.

Thank you both. My dad is on his way home this afternoon. He is one that has a genetic defect where his tiny arteries get blocked. He had triple bypass in 2004 to help part of it but not all can be fixed by surgery.

I think he also has a bit of the "athlete's heart" since he's been very active for about 45+ years (he's 68). He just did a triathlon a few weeks ago - came in 2nd in his age group. And that was only a few days after a prostate biopsy which revealed prostate cancer -we're dealing with that next.

blainesapprentice
November 4th, 2008, 08:33 AM
Sorry to hear about your dad Alison...wish him the best of luck with all his recoveries...my dad too has prostate cancer...he's had it since I was 10 (12 years)...luckily treatment options are pretty good for placing it in remission these days. I'll keep him in my prayers!

funkyfish
November 4th, 2008, 08:53 AM
A 59-year-old man collapsed in the middle of the Queensboro Bridge (http://www.newsday.com/topic/travel/commuting/queensboro-bridge-NY0509200835.topic), police said. A fellow runner stopped and administered CPR until two emergency medical technicians arrived.

I thought this was good to read. I'm glad to see there are still folks who will step in and do what's right.

gull
November 4th, 2008, 09:16 AM
There is a statistics problem here.

Actually not. From The Journal of the American College of Cardiology, 2005; 45:1348-1353: "Despite these beneficial exercise effects, vigorous physical activity also transiently increases the risk of both acute myocardial infarction and sudden cardiac death with the greatest exercise risk among the most habitually sedentary individuals."

FlyQueen
November 4th, 2008, 11:20 AM
My non-medical opinion:
- You are doing yourself more good than harm by exercising (duh)
- The people that die during marathons (seems to be almost one a year during the Chicago marathon) probably either prolonged their lives by running OR had a genetic condition of which they were unaware
- Your chances for living through a heart attack are dramatically increased if your heart is as healthy as it can be through exercise and diet choices

There was a man who had a heart attack during a meet I was at last year and his doctors told him (he had one previously) that he was alive because he swam.

Blackbeard's Peg
November 4th, 2008, 12:33 PM
just curious, but what does this have to do with swimming?:hijack:

gull
November 4th, 2008, 12:37 PM
just curious, but what does this have to do with swimming?:hijack:

Sudden cardiac death in middle aged athletes seems pretty relevant to this forum.

gull
November 4th, 2008, 12:49 PM
- You are doing yourself more good than harm by exercising (duh).

Absolutely. Moderate intensity aerobic exercise lowers your risk of cardiovascular disease.



- The people that die during marathons (seems to be almost one a year during the Chicago marathon) probably either prolonged their lives by running OR had a genetic condition of which they were unaware.

Not exactly. The usual cause of sudden cardiac death in middle aged athletes is atherosclerosis, an acquired disease for which heredity is just one of many risk factors. And while exercise certainly reduces your risk of heart disease, hypertension, and diabetes, it has not been established that your life expectancy will be prolonged.



- Your chances for living through a heart attack are dramatically increased if your heart is as healthy as it can be through exercise and diet choices


Your chances of avoiding a heart attack are increased through exercise and diet. Your chances of surviving a heart attack depend on how quickly you receive medical attention. Prompt defibrillation, if necessary, and rapid reperfusion are the key elements. Time is muscle.

scyfreestyler
November 4th, 2008, 01:28 PM
I don't think there is any additional health benefit to running and training for marathons, as opposed to routine physical activity such as an hourlong running or swimming workout several times a week. It does not surprise me at all to see people dying during marathons, you are putting your body under significant stress.

swimshark
November 4th, 2008, 02:25 PM
Sorry to hear about your dad Alison...wish him the best of luck with all his recoveries...my dad too has prostate cancer...he's had it since I was 10 (12 years)...luckily treatment options are pretty good for placing it in remission these days. I'll keep him in my prayers!

Thanks Morgan. HE's home today and feeling great. He'll be back to his weekly walk along the river tomorrow.

jim thornton
November 4th, 2008, 02:47 PM
My layman's understanding of cardiac death associated with exercise is that a "heart attack" is different from "sudden cardiac arrest"--though the two can be related.

A heart attack, or myocardial infarction, occurs when a blood clot (usually from a dislodged atherosclerotic plaque fragment) ends up blocking one of the coronary arteries, starving heart muscle of the oxygen and nutrients it needs to keep operating. When you have a heart attack, you can usually live long enough to get to the hospital; clot busting drugs (including tPa and even chewing an aspirin tablet) can make a difference. In a sense, a heart attack is a PLUMBING problem.

Sudden cardiac arrest, on the other hand, occurs when the electrical impulses that mediate coordinated beating of the heart chambers get badly out of whack, especially in the lower ventricles which supply blood to the body, brain, and lungs. Normally, the heart's pacemaker causes a regular thud-thud, thud-thud that correlates with the shunting of blood from the atria (upper two chambers) to the ventricles (lower two chambers) and then into circulation. In really bad cases, the electrical coordination here gets so out of whack that the heart beats like an uncoordinated "bag of worms"--Latin, I once heard, for fibrillation. Once this starts, your body, brain, lungs, etc. stop getting any blood supply. Victims of sudden cardiac arrest usually die within minutes if their hearts are not shocked back into a normal rhythm by a defibrillator. Sudden cardiac arrest thus is an ELECTRICAL problem.

Most athletes who die in marathons are victims of the cardiac arrest. In pool competitions, paramedics are supposed to have automatic defibrillators at the ready. I doubt there's been much research, but I would suspect that pool swimming would have a lower death rate than marathons because of proximity of defibrillators to the participating athletes. In open water swimming, I would think that sudden cardiac arrest would have even higher mortality because the victim would slip under the water and more likely drown without assistance.

One final note: atherosclerosis can contribute to sudden cardiac arrest by causing small classic heart attacks that scar the heart muscle, making it less able to propagate electrical signals properly. High blood pressure can also lead to pathological enlargement of heat muscle, which also affects electrical conduction in sometimes harmful ways. But the bottom line is that heart attacks and sudden cardiac arrest are two different problems.

fanstone
November 4th, 2008, 03:10 PM
"It does not surprise me at all to see people dying during marathons, you are putting your body under significant stress."
Believe me, if you're running at a slow pace, enjoying the views (NYC and Marine Corps Marathon), talking some, taking a ton of ibuprofen, you ain't stressing all that much, which was my case back in 1997,98 and 99. The training, that was stressful, all those long runs, without modern Ipods, with just those old Sony Walkmans with tapes...Jim Thornton summarizes well most of what happens. It seems this Brazilian guy who died in NYC was well trained, had all his tests done before training and running the marathon. Marathons are more dangerous for the fast athletes or for those who didn't prepare well enough. But usually all that hurts is your feet bones and joints after spending hours jogging along. The one factor that running has that is more dangerous than swimming is the fact that while running your heart has to pump blood upstream to your head and while swimming it just flows easily along, thus avoiding a problem (which might have killed Jim Fixx, of running fame) which is lack of oxygen to the brain.Unless swimming butterfly with poor technique (my case) it is pretty difficult to get your HR way up high while swimming.

gull
November 4th, 2008, 03:41 PM
But the bottom line is that heart attacks and sudden cardiac arrest are two different problems.

That is not a correct statement. The majority of sudden deaths occurring in middle aged athletes are due to atherosclerosis with plaque rupture resulting in myocardial infarction (heart attack) and ventricular fibrillation. And the survival rate for out of hospital cardiac arrest is only 10%.

It is true that patients with a prior history of myocardial infarction, particularly if they have sustained significant damage to the heart muscle, are at risk for sudden death on the basis of an arrhythmia, which at that point is a purely electrical problem. These individuals should have a defibrillator implanted prophylactically.

In young athletes, the most common cause of sudden death is hypertrophic cardiomyopathy.



The one factor that running has that is more dangerous than swimming is the fact that while running your heart has to pump blood upstream to your head and while swimming it just flows easily along, thus avoiding a problem (which might have killed Jim Fixx, of running fame) which is lack of oxygen to the brain.


Also incorrect. Blood flow to the brain ceases when your heart fibrillates, regardless of your body position. Jim Fixx had extensive atherosclerosis at the time of his death.

david.margrave
November 4th, 2008, 04:05 PM
Dr. Gull, check it out. What do you think?

http://en.wikipedia.org/wiki/Epigenetics#Transgenerational_epigenetic_observati ons

scyfreestyler
November 4th, 2008, 04:33 PM
"It does not surprise me at all to see people dying during marathons, you are putting your body under significant stress."
Believe me, if you're running at a slow pace, enjoying the views (NYC and Marine Corps Marathon), talking some, taking a ton of ibuprofen, you ain't stressing all that much, which was my case back in 1997,98 and 99. The training, that was stressful, all those long runs, without modern Ipods, with just those old Sony Walkmans with tapes...Jim Thornton summarizes well most of what happens. It seems this Brazilian guy who died in NYC was well trained, had all his tests done before training and running the marathon. Marathons are more dangerous for the fast athletes or for those who didn't prepare well enough. But usually all that hurts is your feet bones and joints after spending hours jogging along. The one factor that running has that is more dangerous than swimming is the fact that while running your heart has to pump blood upstream to your head and while swimming it just flows easily along, thus avoiding a problem (which might have killed Jim Fixx, of running fame) which is lack of oxygen to the brain.Unless swimming butterfly with poor technique (my case) it is pretty difficult to get your HR way up high while swimming.


I don't believe you...sorry. Running at any pace for more than 10 miles sounds like a bad idea to me.

jim thornton
November 4th, 2008, 05:53 PM
"The majority of sudden deaths occurring in middle aged athletes are due to atherosclerosis with plaque rupture resulting in myocardial infarction (heart attack) and ventricular fibrillation."

So you are saying that the plaque rupture blocks one of the coronary arteries, the resulting blood insufficiency to heart muscle triggers the ventricular fibrillation, the ventricle then ceases to pump effectively, and the victim dies from systemic oxygen/nutrients depletion rather than merely just heart muscle insufficiency?

In other words, the m.i. triggers the v-fib?

If the m.i. does not trigger v-fib, and does not block so much blood flow to the heart that parts of it can continue to function a little, then the so-called coronary thrombosis patient (again, the "classic" heart attack) has pain and other symptoms, but can last for hours or longer, correct? It's only when v-fib (or other catastophic arrythmias) is triggered that he or she has only minutes to live, right?

Isn't it also possible that electrolyte imbalances, heat stress, pre-existing vulnerabilities in the heart's electrical system, etc. are also causes for v-fib in highly exertional exercise? When they do autopsies of victims of sudden cardiac death in exercisers, do most of the victims have evidence of blocked arteries that acted as the first domino and triggered the v-fib?

Let me paste in an excerpt from a story I wrote on this recently:

Another external culprit: extreme disturbances in the salts the body uses to propagate electrical signals. Ironically, this can happen in guys who otherwise epitomize robust health. So-called hyponatremia of exercise, for instance, strikes when endurance athletes drink too much water to remain well-hydrated in the heat while failing to replace the sodium and other key electrolytes they're sweating away. Despite revised fluid replacement guidelines from organizations like USA Track and Field,some runners continue to over-hydrate themselves literally to death.
"The electrical system of the heart relies on sodium and potassium and calcium to work," says William H. Maisel, MD, MPH, director of the Pacemaker and Device Service at Beth Israel Deaconess Medical Center. "If these get too far out of whack, it can lead to cardiac arrest--something that unfortunately still happens at almost every major marathon."

By far the most common cause of arrhythmias, however, are changes to the heart caused by the aging process itself, especially when this includes all-too-common co-travelers like high blood pressure, valve damage, and other forms of heart disease. It turns out, for instance, that cells in the sinus "pacemaker" are not the only ones capable of firing off an inaugurating electrical signal. Every cardiac muscle cell has this ability--and with age, the tendency increases for "loose cannons" to fire spontaneously, usurping the sinus's role


*


Billy, as far as ibuprofen goes, as common as it is to pop a bunch of these and then go exercise, it's not a good idea. Besides kibboshing the prostaglandins that foster inflammaton, NSAIDs also hamper the prostaglandins that protect the stomach lining (causing ulcers or low grade bleeding in some people) and, even more importantly, hinder the prostaglandins that promote fluid flow through the kidneys. If you become dehydrated, and take a lot of NSAIDs, you are at risk for kidney failure. Though not common, one fellow after the Boston Marathon did precisely this and went into kidney failure on his flight home.

The evidence that NSAIDs promote healing is sketchy at best; most so-called tendinitis conditions are, in fact, tendonopathies--you want to foster blood flow to poorly vascularized tissues (like the Achilles tendon, knee, tennis elbow, shoulder, plantar fascia) rather than inhibit inflamation here. Hence newer techniques like nitroglycerine patches for some of the slow healing areas.

Just my layman's point of view based on hearing a talk about this at the ACSM conference and readings hither and yon from medline.

haroldbuck
November 4th, 2008, 06:29 PM
- The people that die during marathons (seems to be almost one a year during the Chicago marathon) probably either prolonged their lives by running OR had a genetic condition of which they were unaware

Or they were underprepared. A lot of people want to be able to say they did a Marathon without the bother of actually training properly for it. Many people do Marathons despite not having been runners for very long at all.

gull
November 4th, 2008, 06:54 PM
Plaque rupture leads to thrombosis (clot formation). A portion of the heart muscle, deprived of blood flow and oxygen, begins to die. If you are unlucky, the heart fibrillates, at which point circulation (pulse/blood pressure) is lost. If circulation is not restored within the next several minutes, you suffer irreversible brain injury. Ironically, even small heart attacks (where the extent of heart muscle damage is minor) can be associated with ventricular fibrillation/sudden death. And unfortunately, sudden death may be the first manifestation of coronary artery disease.

jim thornton
November 4th, 2008, 07:50 PM
Researchers have known for a few years now that a marker for heart stress usually seen in heart attacks rises in the blood of marathon runners. Whether or not this is dangerous remains somewhat debated, but it does suggest that marathons are stressful to even well-trained hearts.

Representative study conclusion:

CONCLUSION: Troponin increases were relatively common among marathon finishers and can reach levels typically diagnostic for acute myocardial infarction. Less marathon experience and younger age appeared to be associated with troponin increases, whereas race duration and the presence of traditional cardiovascular risk factors were not. Further work is needed to determine the clinical significance of these findings.

Gull, just for the record, are you saying that the majority of cardiac arrest deaths in endurance exercise events are triggered by clots? Or is this just one of multiple possibilities, including other problems (perhaps unknown to the runner) such as valve damage, left ventricle hypertrophy from high blood pressure, hyponatremia, and/or foci for arrhythmia due to occult scar tissue from earlier small m.i.'s., etc. ?

fanstone
November 4th, 2008, 08:52 PM
Jim: the ibuprofen comment was "tongue in cheek". Internet does not carry humor very well. Tell you what really works: a shot of cortisone (depo-medrol) right on top of the offending tendon. I had my supra spinal (one of those on the rotator cuff of the shoulder) tendon "fixed". My radiologist friend pressed his thumb till he found a painful spot and shot a cc of the drug. I only use the tendon for recovery in freestyle swimming. But the pain is such that a backhand is impossible. Wonder why the backhand ends up hurting the tendon that it isn't using at all? But, NSAIDs are harmful to those susceptible to their side effects. I have no problem with most NSAIDs and every now and then will take something for mild muscular discomfort.

Gull: as written by the original Cooper, in "Running without fear", he mentions the fact that Fixx did not cool down after his run, by walking and getting his heart rate down, but stopped suddenly and in a standing or leaning position near a hedge or fence. He probably had a problem with his venous return causing a deficit in his cardiac preload which, according to Dr. Cooper, might have lead to his heat attack, because of his already clogged coronaries.
This is one of Cooper's theories. But it sure scared me into never stopping suddenly when running, but slowly getting my heart rate down to at least 120 and then maybe slowing down. His recommendation is for a runner who feels faint, or light headed to lay down, to better his venous return and also to help oxygenate the brain. Gull, I am not arguing against or with you. I am writing as a former runner and a swimmer. The little I knew I have long forgotten.

The Fortress
November 4th, 2008, 10:34 PM
Thanks guys. Mr. Fort has just declared he's going back to marathoning. I hope I'm not a widow soon.

gull
November 5th, 2008, 12:00 PM
Gull, just for the record, are you saying that the majority of cardiac arrest deaths in endurance exercise events are triggered by clots?

In middle aged athletes, the answer is yes--if by "clots" you are referring to the sequence of atherosclerosis, plaque rupture and thrombosis. That is the current thinking, supported by published autopsy studies.

Ian Smith
November 5th, 2008, 09:48 PM
Since my wife ran the NYC Marathon this Sunday & finished (alive, thank goodness) - 25th in her age group without her normal marathon training, I've been perusing the aftermath articles.

I read somewhere the odds of dying in a marathon are about 1 in 100,000 (depending on whose statistics you take) vs 1 in 6,500 of being killed in a car accident (during the same period of time, I assume).

The NYC marathon 'instruction handbook' has quite a bit on the dangers of taking anti-inflamatories close to running time (before & after).

The reaction to the deaths I heard from most runners was a variation on "these guys would have died the next time they exerted themselves, shoveling snow or whatever."

Ian.

jim thornton
November 5th, 2008, 11:11 PM
Ian, how are you doing? We miss our Canadian role model, and by we, I mean me, and perhaps many others, too, but definitely me.

What is your SCY 50 and 100 free times these days?

rtodd
November 5th, 2008, 11:11 PM
Didn't the original marathon dude die?

A marathon is not easy.

Ian Smith
November 6th, 2008, 11:07 AM
Ian, how are you doing?
What is your SCY 50 and 100 free times these days?

Jim, I have been futzing around this year, been semi-serious at an SCM meet - 27.67 50m free, 1:03.15 100m & 31.39 50m fly. OK, at 67 you start slowing down but I should do better. The problem is that this requires work (i.e. working out more than my 3 times a week) But at least that's a lot less than for a marathon. Cheers, Ian.

LindsayNB
November 6th, 2008, 01:11 PM
I would guess that those statistics would be more clearly stated as 1 in 100,000 deaths occur in a marathon while 1 in 6,500 deaths are due to car accidents. That is quite different from the odds of dying in a marathon are 1 in 100,000 as the odds of dying in a marathon are near zero if you don't participate in marathons. If it were the case that 1 in 100,000 people in the population participate in marathons then that stat would say that virtually all people who participate in marathons die in them. I would guess the participation rate is higher so the odds are lower. I'm just saying that I don't think the stats lead to the conclusions you want to draw.

I also question the logic behind saying that those people would have died the next time they shoveled snow anyway, that presupposes that the risk of dying is unrelated to the intensity of the stress placed on the body, since running a fast marathon is a fairly extreme stress there is a good chance that some of those runners would never have encountered a similar stress in their regular lives and some of them would have lived for many more years. I am in turn presupposing that some people are in a state where moderate stress won't trigger a problem while an extreme stress will.


Since my wife ran the NYC Marathon this Sunday & finished (alive, thank goodness) - 25th in her age group without her normal marathon training, I've been perusing the aftermath articles.

I read somewhere the odds of dying in a marathon are about 1 in 100,000 (depending on whose statistics you take) vs 1 in 6,500 of being killed in a car accident (during the same period of time, I assume).

The NYC marathon 'instruction handbook' has quite a bit on the dangers of taking anti-inflamatories close to running time (before & after).

The reaction to the deaths I heard from most runners was a variation on "these guys would have died the next time they exerted themselves, shoveling snow or whatever."

Ian.

gull
November 6th, 2008, 01:36 PM
I do not agree with the statement that the runners would have died the next time they exerted themselves. The point is that we have to accept a small but definite risk when we participate in vigorous (as opposed to moderate) exercise.

Red60
November 6th, 2008, 02:00 PM
I've had this conversation with my cardiologist about ten times, and I think we've finally resolved it. (I have benefited from the electronic wisdom of Dr. Gull myself on this forum). If I swim, I compete. If I don't compete, I don't have tangible goals. If I don't have goals, I don't swim. If I don't swim, I don't do anything. If I don't do anything, my stress goes up, and my alcohol consumption follows. I get unhealthy quickly. Thus, I swim hard and know that I have a slightly elevated chance of a second heart attack as a result. The total package calls for the elevated risk, because of the costs associated with not taking that risk. Ultimately, a complete no-brainer.

jaegermeister
November 6th, 2008, 02:03 PM
The point is that we have to accept a small but definite risk when we participate in vigorous (as opposed to moderate) exercise.


This is the crux of the whole issue. On average, we who are active are helping ourselves in the long run, but there is some short-term risk.

The rate of death from marathons is about 1 in 50,000. There were some well-publicized deaths among triatheletes this past year, but surprisingly USAT doesn't have a denominator (number of entrants) so we don't know the rate. It would be very hard to estimate the risk from swimming with much precision, just because risk of this (small) magnitude would take a very large sample, and of course there are many fewer masters swimmers than marathon runners. Go figure.

gull
November 6th, 2008, 02:16 PM
Aquatic facilities should have AEDs and staff trained in their use. That is the key to surviving an out of hospital cardiac arrest.

Rich Abrahams
November 6th, 2008, 03:41 PM
Jim,
Do you have any sources you could link me to that discuss the nitroglycerine protocol for tendonitis (or tendonopathies)? I've been kicking only the last several weeks due to right shoulder flare up and I don't want to rely on NSAIDS for a variety of reasons.

As always, your posts are fantastic, either very informative or very funny (sometimes both at the same time).

Ian,
Nice to see that your "futzing" has you within .62 of the world record in the 50.

Rich

jim thornton
November 6th, 2008, 05:09 PM
Hi, Rich. Thanks for the nice words. I originally stumbled upon nitroglycerine patches as a possible treatment of tennis elbow, but I didn't actually try these (winter layoff followed by spring racquet change seemed to cure the problem). At the ACSM conferences last summer, some docs told me they do use these for shoulders sometimes, too. I came across the following citation:

Justin A. Paolini, MBBS, PhD, et al. Topical Glyceryl Trinitrate Application in the Treatment of Chronic Supraspinatus Tendinopathy. In The American Journal of Sports
Medicine. June 2005. Vol. 33. No. 6. Pp. 806-813.

I don't know how effective these are, but I would imagine most good orthopedic docs--especially those with swimming backgrounds--would know. Tom--Jaegermeister--is a very knowledgable doc at Mayo. Tom, if you read this, could you ask some of your colleagues?

If you don't know Rich, I am sure you know the Legend of Rich. I am pretty sure that the Smithsonian and the International Swimming Hall of Fame have already begun bickering about which institution gets first dibs on his body when, in 60 or 70 years, he finally passes on to the next world. In any event, we need to do everything in our capacities to keep Mr. Abrahams in full sprinting inspirational mode for as long as possible!

He is, if anything, to our nation what Ian Smith is to Canada!

And that, my good doctor friend, is saying something!

Ian Smith
November 6th, 2008, 05:49 PM
Because of Lindsay’s question, I dug up the quote I remember seeing on “Risk of Death while Marathoning”. It is in the December 2008 Running World p98 with the original source being cited as the “American Journal of Medicine and Sports, 2005”.

“According to data from three large research studies dating back to the mid-1970s, the risk of dying from a heart attack in a marathon is about one in 75,000 (Twin Cities Study), one in 89,000 (London Study) or one in 126,000 (Toronto Study); the first two estimates are based on marathon medical reports, the third on newspaper reports. Your annual risk of dying in a car accident is one in 6,535.”

That's all that was said for what it's worth.

gull
November 6th, 2008, 08:37 PM
Those statistics are misleading, since not all entrants are at equal risk. Coronary artery disease is more prevalent among men over the age of 45. Of the 38,000 runners in the NYC marathon, 25,000 were men. Of these, 40% were over the age of 45. If there were two deaths among men over the age of 45, the risk for that population was 2/10,000 or 1/5,000. And while we drive hundreds of hours annually, a marathon lasts only a few hours.

LindsayNB
November 7th, 2008, 10:43 AM
Thanks for the clarification on the stats Ian.

There is an article today on this topic in the Globe and Mail:
http://www.theglobeandmail.com/servlet/story/RTGAM.20081107.wxljockology07/BNStory/specialScienceandHealth/home

Unfortunately, the author falls into the false dichotomy of comparing running marathons versus complete inactivity instead of versus more moderate exercise.

One particularly interesting bit is given at the end:

Beware the final sprint

University of Toronto doctors analyzed 26 sudden cardiac deaths that occurred among 3,292,268 marathoners in the United States. They found that nearly half of the deaths happened in the final mile or shortly after the finish, suggesting that hard anaerobic exercise is about five times riskier than aerobic exercise.

I find the conclusion a bit of leap, I suspect the probability of problems in that last mile is strongly affected by whether one has run the previous 25 miles just prior, so it probably isn't a simple matter of anaerobic versus aerobic. I do wonder if there are implications for workout design though, perhaps high intensity anaerobic work at the end of a long workout is not a good idea? It is also too bad they didn't separate final mile from after the finish events.

It would be interesting if there were statistics showing if there is any correlation between different pool events and cardiac events, i.e. is the risk different for a 50 than a 1500? Pool swimming competition is very different from marathons in duration and aerobic versus anaerobic, perhaps marathons are not very relevant at all.

Although unrelated by anything more than involving stats, I was recently looking at some stats from Statistics Canada on sports participation. Apparently there are about 750,000 Canadians over the age of 15 that swim at least once per week. About 10,000 of those are registered masters. 1 in 75. If the per capita numbers hold there are about 7.5 million Americans that swim regularly, and about 46,000 registered masters, that's about 0.6% market share. One could guess that the other 99% swim for fitness, health, and relaxation instead of competition. Interestingly, relaxation was the #1 motivation given for participation in sport (all sports) in the survey. Also interesting, swimming was the number one sport among women, golf was number one among men with swimming way down the list.

I wrote a blog entry with some of the charts from the report here:
http://mymsc.ca/blogs/ops/entry/sports_participation_in_canada_2005

jaegermeister
November 10th, 2008, 01:19 PM
Because of Lindsay’s question, I dug up the quote I remember seeing on “Risk of Death while Marathoning”. It is in the December 2008 Running World p98 with the original source being cited as the “American Journal of Medicine and Sports, 2005”.

“According to data from three large research studies dating back to the mid-1970s, the risk of dying from a heart attack in a marathon is about one in 75,000 (Twin Cities Study), one in 89,000 (London Study) or one in 126,000 (Toronto Study); the first two estimates are based on marathon medical reports, the third on newspaper reports. Your annual risk of dying in a car accident is one in 6,535.”

That's all that was said for what it's worth.


The running community has always been very defensive about the risks involved in exercising. Why they have taken this stance is beyond me. I believe everyone implicitly accepts some risk. The only ones who are deterred by the reports of sudden death are likely people who are looking for an excuse anyway.

I haven't looked up the original citations that are referenced here, but there are a lot of details in study methodology that have to be considered before we believe the numbers.

I'm with gull. Know there is a risk, make sure there is an AED in your facility, know where it is and be able to use it if needed. You might also pester your facility to make sure the AEDs are maintained, tested, etc.

Redbird Alum
November 10th, 2008, 03:03 PM
I'm with gull. Know there is a risk, make sure there is an AED in your facility, know where it is and be able to use it if needed. You might also pester your facility to make sure the AEDs are maintained, tested, etc.

Does USMS require an AED be present/available along with trained personnel as part of their meet sanctioning process?