A few weeks ago I ran (and walked more than I care to admit) 2,550 vertical feet up the Mt. Mansfield toll road as a competitor in the Catamount Trail Association’s 2011 Race to the Top of VT. There were hundreds of us participating. Some were elite athletes but many were like me: middle-aged with busy careers and families. We get outdoors when we can, finding only limited time to run, bike, hike, and cross-country ski. We are not by any stretch of the imagination well-trained and it makes us wonder just how hard we can safely push ourselves in a race or even when out for a few hours on the Catamount Trail. What are the dangers of pushing ourselves beyond our accustomed level of exertion? How safe is it to act like our younger selves on the weekends?
I am 53 years old and hadn’t competed in a race in more than 25 years until skiing in the 4th Annual Catamount Trail Backcountry Challenge Race last February. This cross-country ski race, like the Race to the Top of VT, features outsize vertical, rising 2300 ft. You’d think I’d have started with flatter races but I do love those mountains! Despite finishing towards the back of the pack, I finished as the second fastest racer over the age of 50 – albeit in a total field of only 23.
Having been humbled by some elite skiers in last winter’s race, I had no illusions that I was a serious contender at Mt. Mansfield. My goals were modest, so I thought:
- Have fun
- Challenge myself beyond my usual level of exertion
- Enjoy the company of like-minded people
- Get to the top in less than an hour
- Run the whole way up
- Not get hurt
I am glad to say that I met all but one of those goals. I actually had a lot of fun pushing myself harder than usual but still able to chat it up with some interesting men and women (and a few kids) on the way up. I did summit in less than an hour (barely) but quickly realized that goal 5 was not going to happen, especially if I wanted to meet goals 1, 2, and 3!
What about goal 6? Was it possible to get hurt if I pushed too hard? I don’t mean muscles even sorer than what I got; I’m talking death or disability.
Can Exercise Kill?
Exercise can kill, but how often? On one hand, there have been some recent deaths of triathlon racers. In August, two competitors died during the swim event of the New York Triathlon. Another died in a Louisville, KY triathlon, also during the swim. Closer to home, two competitors died this summer during the swim events of separate Vermont triathlons, Lake Elmore and Shelburne. A recent study of nearly 3,000 triathlons found 14 deaths in nearly one million participants. Of these 14 deaths, 13 happened during the swim portion. Only one death occurred during the bicycle phase. In that case, the competitor crashed and died of neck injuries. Review of the deceased swimmers’ medical records and autopsies found that most had cardiac abnormalities that placed them at greatly heightened risk for sudden cardiac death. There is something about water immersion that triggers fatal cardiac rhythms in these people.
A study of millions of marathon racers over 30 years found a death rate of 8 per million marathon entrants. I find these numbers reassuring; death during long, very strenuous endurance events is rare, despite the media hype. Furthermore, these rare events are more than offset by the much longer-term protective effect of high fitness levels. Epidemiologists substantiate this point fairly well. However, caution is still warranted.
A high level of fitness cannot compensate for poor diet. Jim Fixx, the running guru of 30 years ago, is a case in point. He operated under the paradigm of that era in which high levels of fitness were thought to be absolutely protective against heart disease, allowing one to eat bad foods with impunity. He and many others were proven tragically wrong. Ignoring a family history of heart disease and premonitory symptoms of chest pain, he died on a training run in Vermont in 1984 at the age of 53. Autopsy revealed severe atherosclerotic blockages in 3 major coronary arteries.
How does exercise kill?
Experts in exercise medicine believe a healthy heart easily tolerates the significant stress placed on it during endurance races. However, this same stress can precipitate a heart attack or a fatal cardiac rhythm in people with underlying heart problems. Many victims have symptoms preceding their fatal event which, if heeded, could have led to life saving interventions. These sentinel symptoms include chest pain, excessive shortness of breath, fainting or near fainting either during or shortly after exercising (see article at http://www.drterwilliger.com/exercise-intolerance.html) Unfortunately, there are many people who are asymptomatic before their fatal event. At autopsy, many of these victims had blockage of a coronary artery by a clot that formed on a sticky, ruptured arterial plaque. Many of these plaques are so thin they didn’t cause obstruction to blood flow until rupture and, therefore, did not cause prior symptoms and wouldn’t have even shown up on a stress test or imaging studies. These people are the exception but are worrisome because their risk seems undetectable. I believe they were destined to have a bad outcome in the near future even if they had never competed. The race was merely the spark to the tinder of their bad disease. Their deaths were likely inevitable without intervention.
Steps to Ensure Your Safety
The only way I know of to prevent the formation of diseased arteries is to control risk factors: eat well, get regular exercise, reduce stress, and don’t smoke. The safest diet is plant-based, has little or no animal-derived foods, and is low in refined foods. For more information visit my web site: drterwilliger.com
- See your doctor if you have risk factors for sudden death: diabetes, smoking, high cholesterol, hypertension, obesity, other serious medical problems, or a family history of sudden death.
- Do not take ibuprofen and other NSAIDS immediately before or during competition. These drugs can trigger a heart attack, induce dangerously low sodium levels, or precipitate kidney failure.
(see article at http://www.drterwilliger.com/vitamin-i.html)
- Begin all races and other events properly hydrated and drink during long events (see article at http://www.drterwilliger.com/hydration-on-the-trail.html)
- Reconsider the wisdom of competing when it is very hot and humid. If you must compete, reconsider your goals.
- If you are swimming, have a partner with you or a spectator who will spot you from shore or a boat.
- Be flexible with your pace. Reaching exhaustion before the end of the event can necessitate an evacuation from the racecourse or could result in a fall with injuries resulting. Grim, inflexible determination to achieve an unrealistic goal can result in a miserable experience from which recovery is difficult. Remember, this is supposed to be fun. Adjust your pace so that the event is pleasant enough that you will return to race another day.
Harris KM, Henry JT, Rohman E, Haas TS, Maron BJ. Sudden death during the triathlon. JAMA. 2010;303(13):1255–1257
Redelmeier DA, Greenwald JA. Competing risks of mortality with marathons: retrospective analysis. BMJ. 2007;335(7633):1275–1277
This article provided by Dr. George Terwilliger an ER physician who lives in Brattleboro and is a lifelong Vermont resident. He is an avid backcountry skier and has skied many sections of the Catamount Trail.