Last week, Bloomberg published an online article by Natasha Khan and Shannon Pettypiece, entitled “Men Over 40 Should Think Twice Before Running Triathlons,” that opened with the line, “For men competing in triathlons past the age of 40, the grueling slog to the finish line could be their last.”
I can tell from inquiries I’ve received and from online and Twitter chatter that this article received a lot of attention. Of course, there are a lot of male triathletes older than 40!
I don’t ordinarily think of Bloomberg or BusinessWeek as a source for information about personal health. That Bloomberg would publish this article speaks to the current general interest in the intersection of health and endurance sport. And men older than 40 must certainly be an important demographic for Bloomberg.
At the outset, let’s agree that the headine and lead sentence–probably furnished by an editor for the sole purpose of garnering attention–are sensational. The rest of the article is more balanced, though, and there’s a fair amount of factual material that should interest male athletes. Let’s take a look:
1. A personal account. As a jumping off point, the article shares the sad story of 55-year-old business executive and triathlete, Michael McClintock, who died of cardiac arrest after a training session. When athletes die at high-profile events like marathons or triathlons, the incidents capture the public’s interest. When athletes die on the treadmill, the high school track, or the local swimming pool, they receive little attention. A handful of athletes die at running races or triathlons in the U.S. each year; several thousand athletes die each year in non-race settings. The story of Mr. McClintock is typical. One of my heart surgery partners died on a hotel treadmill a while back.
2. Sports-related sudden cardiac arrest (SCA) is truly much more common in adult male than adult female athletes. Like the article suggests, men older than 40 should think twice about exercise. Men in this age category should due diligence, with their physicians, to their heart health and any potential risk of participating in an exercise program or training for and competing in events like triathlon. That’s only common sense. Sports-related SCA can happen with any sport, regardless of how strenuous it might appear. But other forms of heart disease are common in athletes and non-athletes, alike. Prevention is worthwhile. Finally, it’s important to remember than women and younger men are not immune from the problems of SCA or heart disease in general.
3. Triathlon swim. In triathlon, the greatest risk for SCA does indeed occur during the swim, for reasons that are not entirely clear. The article mentions one potential theory related to the body’s neurohormonal systems that has been proposed by British physiologists. I’ve written about this possibility here at the blog. This is just one theory. The truth is that we don’t yet know enough about SCA during the triathlon swim. USA Triathlon prepared a checklist that may help athletes reduce their risk.
4. The experts are triathletes. It’s nice to see the article quoting expert cardiologists who also happen to be triathletes. Dr. James O’Keefe is a very capable triathlete and Dr. Andre La Gerch is an exceptional runner (think 1:10 half marathon) and triathlete (think ~4:10 half Ironman). Perhaps some extra credibility on these issues! Their advice is sound. In particular, Dr. La Gerche reminds us to pay attention to warning signs of potential heart disease: chest pain/discomfort, difficulties breathing, palpitations, unusual fatigue.
5. The long-term. Dr. O’Keefe introduces the concept of some sort of “sweet spot” for exercise and the idea that “more is not necessarily better.” We know very little at present, but there may well be important heart risks associated with prolonged involvement in endurance sport. We should pay careful attention as new information becomes available.
6. Competition changes. The article mentions the recent initiative by World Triathlon Corporation (WTC), called SwimSmart. I’ve written here at the blog about this initiative and a corresponding initiative by REV3 Triathlon designed to improve race safety. It’s encouraging to see major event producers work to promote better race safety. WTC just introduced a terrific short video about swim safety narrated by acclaimed triathlete, Paula Newby-Fraser. It’s worth watching.
I am a Family Physician, age 45. I’ve been in triathlon for 10 years and have completed twenty 70.3’s, 5 Ironman’s, and 20-30 shorter races. I train an average of 12-13 hours per week for 10 months of the year and do 4-5 races per year. Most of my training is moderate intensity at HR’s of 125-140. The most high intensity I will do is 30 minutes per week. My HDL is 80. My BP is normal. I have no major medical issues. At the request of my wife for peace of mind, about 3 years ago a cardiologist friend of mine put me on his treadmill for a stress echo. On the Bruce protocol I went 18 minutes with normal echo findings. The thing that frustrates me about Dr. O’Keefe’s article is the open-ended nature of the word “excessive.” I feel like there is minimal guidance in interpretation of that term. Is it volume of high intensity? Is it total duration without regard to intensity? Is it miles? The only advice he gives about risk stratification is an expensive test that most individuals will have to pay for out of pocket as most athletes will find themselves in such a state of health that their insurance will not be convinced that it is a necessary test. Do I cut back? Am I excessive? Do I continue on? His article raises more questions that it answers in my opinion.
What, if any, testing can be done to help stratify the risk of SCA and/or CAD in middle-aged, long-term (i.e., decades long), endurance athletes?
In order of priority, which tests provide the most important information on this subject?
What symptoms should raise the greatest concern in this category of athletes?
Lawrence L. Creswell, M.D. says
Each athlete’s circumstances will be different. They’ll bring a family history and a personal medical history to the equation. But….
Screening for CAD in a middle-aged endurance athlete….a stress test (and there are a variety of forms, including stress echocardiogram) or cardiac CT for calcium scoring.
For SCA….a careful medical history with attention to details in the athlete’s past and the athlete’s family’s past, an EKG, and an echocardiogram.
Check at my blog for an “Ask the Experts” post about how we might best approach this issue in some (fictitious) athlete examples.
Lawrence L. Creswell, M.D. says
I agree with you. The admonitions just seem sensational when there’s little factual basis for establishing some sort of safety threshold. If there is some threshold, it certainly must depend upon several characteristics of the exercise pattern, like duration, intensity, cumulative total, etc, but we just don’t know enough yet. I often think about elite swimmers who devote 10’s of thousands of hours to exercise and yet are not known as a group to have specific heart problems. Even typical avid recreational cyclists accumulate many, many hours of exercise. Yet most of the unusual heart problems have been noted in runners, who probably only exercise for a few hours per week. Much left to learn.
I would bet that you’re not “excessive,” but that’s just a bet.
I am a 60 year old female who has been training and racing triathlons for over 30 years. Anything women should worry about? Thanks!
Lawrence L. Creswell, M.D. says
The truth is that older men have a greater burden with heart disease than older women. There’s a reason the headlines talk about men over 40!
That said, women should just be very vigilant about warning signs of potential heart disease: chest pain/discomfortness/tightness, particularly with exertion; unusual shortness of breath; unusual light-headedness or blacking out; palpitations, etc.
But like all things, triathlon training can be done the right way…and it could be done the inappropriate way. If you don’t do it the right way, triathlon training will not give you whatsoever benefits just mentioned above. It could just lead you to suffer injury, pain, frustration and a nagging sense of failure. You must be aware of the do’s and don’ts during triathlon training if you want to do it the right way.
training for a triathlon