don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

Are marathons and Ironman events, like cigarettes and toxic religions, hazardous to your health? Evidence is accruing about the risks of exercise that has alarmed some and heartened others looking for an excuse not to do it. While exercise may, as most of us fervently believe, be the closest thing there is to a magic bullet or wonder drug equivalent for good health and a long, quality life, it seems it can also make you sick--or dead, when pursued to excess.

For some medical experts, a word that represents a good example of excess is "marathon." For uncommon, extreme and ludicrous exercise excess, two other words are preferred: "Ironman Triathlon." Both marathons and Ironman triathlons are suspected contributors to sudden heart attack deaths and the onset of varied cancers. The latter is attributed to the production of free radicals generated in the course of repeated bouts of high intensity exertions of long endurance. Such concerns bring to mind an observation by P.Z. Pearce: "If God invented marathons to keep people from doing anything more stupid, Ironman triathlons must have taken him completely by surprise."
 
So, you might wonder, what's the rap against marathons and Ironman races? A recent Wall Street Journal piece by Kevin Helliker "Can Exercise Kill: The Answer: Yes, And Probably More Often Than You Think" (October 11, 2004; Page R7) offers a good summary of the concerns. It's a long article; I'll summarize. 

• A recent American Medical Athletic Association Journal contains this scary statistic: "Present research reveals that vigorous exercise is responsible for triggering up to 17% "of sudden cardiac deaths in the U.S." The author of the NY Times piece adds, "This means that vigorous exercise is triggering tens of thousands of U.S. deaths a year." That's almost enough to make some folks want to lay down and rest until the urge to exercise passes. 
   
  
• Three physicians under age 51 who maintained healthy lifestyles died in a seven-month period in 2002. All expired while exercising and all worked at Johns Hopkins Hospital in Baltimore, where lots of studies on the effects of exercise were underway. Thus, hypotheses about the dangers of exercise started flying! One unfortunate consequence of the exercise deaths, as happened when Jim Fixx died while doing what made him rich and famous (jogging)--doctors and others started warning people not to exercise until they have been tested and approved to workout by medical experts. Doctors love to do testing--it's easy and lucrative. The worried well who submit to cautionary prodding can expect an electrocardiogram, an exercise stress test and an echocardiogram, for starters. Maybe they'll toss in a full body CAT scan, too---can't be too safe, you know, especially if it seems someone else is paying for all the attention you're getting (health insurance companies, in other words). I agree with the late Dr. Sheehan and others whose response to such caution was this: The only folks who need testing are those who do NOT plan to exercise--to assess how long their hearts and other parts might last before giving out due to ills associated with sedentary living!
   
  
•  The big concern, particularly to the Ironman types, has to be evidence that excessive exercise (whatever that is--no study that I know of has even attempted to define how much is enough or optimal or too much) damages the immune system. This, of course, leaves the heroic-distance triathlete who looks super fit (and is, at least physically--but he/she could be a stressed-out lunatic, a menace to him/herself and others) wondering if aerobics guru Kenneth Cooper and others who issue such warnings are on to something that should concern them. 
   
  
•  Non-hard core types who get into marathons and Iron-level races to raise money for a cause, to wow and amaze their friends or to prove something to themselves (not that these motives are not as good as most others) are often not quite ready for marathon/Ironman prime time, heavy duty exertion. If some disease process is already present, the risks are high. During a marathon or Ironman, the blood is more clottable; a competitor with coronary artery blockage faces cardiac death. Also, muscular injuries can bring about hormonal responses that trigger water intoxication (excessive fluid intake). This in turn could lead to acute brain swelling. Staying hydrated is a mantra that can be taken to excess, leading in some documented cases to hyponatremia. (Ignore the announcements--drink when thirsty, not nearly continuously!) 
  

After a few hundred million or so is spent on double-blind, cross-over trials of a longitudinal and horizontal nature, my guess is that researchers who study marathon and Ironman veterans are going to come to this conclusion: The risk of such events depends on the individual! Some people, most likely those who win the awards due to genetic as well as proper conditioning, nutrition, recovery and all the rest, will be shown to have little or no adverse consequences from their super endurance feats. Others, those who consider any finish before the course closes an epic feat, will probably be the ones whose immune systems turn against them, unless they keel over first. Naturally, there will be exceptions to this and all other rules. Never forget that people keel over all the time from heart attacks that could not spell the words marathon or Ironman, let alone think of attempting such a thing. According to the World Health Organization, there were an estimated 32 million heart attacks in 2002 worldwide; of these 12.5 million were fatal and not more than a fraction (figures not available but my guess is less than twenty) were participants in marathons or Ironman races! Of course, there would be a lot more if 32 million attempted to run marathons or do Ironman events, but that's beside the point!  
 
Personally, I think the health risks for marathoners and Iron-types are miniscule compared with the serious risks faced by three quarters of Americans who are overweight or obese and exercise averse. Consider that the risk of sudden death during a marathon is one in 50,000. Getting out of bed is more dangerous than that for the overweight smoker who hates his/her job, spouse and life in general. Just as with "sensible" distance races, marathons and Ironman races can give a huge boost to self-confidence, burn tons of calories, relieve stress, give added meaning and purpose, lead to valued social contacts and much more. If you like that kind of self-abuse, then be not deterred by a bit of added risk. If you think you might have risk factors, go ahead and do the testing, but don't delay any workouts while trying to make up your mind about testing or waiting for an appointment. Be sure to eat well (for example, Cooper recommends lots of foods loaded with antioxidants such as green vegetables and vitamin C and E supplements to bolster the immune system) and don't take your racing or yourself too seriously.
 
Whether you want to do marathons or Ironman races is a matter of taste (and mild insanity), in my view. What really matters is to do regular, vigorous exercise while living a wellness lifestyle, and don't worry about dying. Nobody is going to live forever, though I'm kind of hoping an exception might be made in my case (so far, so good). Just do it, whatever "it" might be for you, and keep the Monty Python message in mind at all times, especially when someone tries to scare you about the risk of becoming and remaining exceptionally fit: "Always look on the bright side of life."

(Note: This essay will be filed in the archives in the PHYSICAL DOMAIN under the skill area of exercise and fitness. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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