Ironman

Some Great New Videos from WTC SwimSmart Initiative

July 21, 2014 By Larry Creswell, MD Leave a Comment

Here’s a quick update from the World Triathlon Corporation (WTC) SwimSmart initiative. They’ve put together a YouTube playlist called “SwimSmart Saturdays,” a 9-part series of short (~1-2 minute) video clips that illustrate their 9-point checklist for race day swim safety:

This is all great advice for triathletes looking to have a safe day at the race.

Related Posts:

1. Swim safe in 2014

2. USAT and race safety

3. Triathlon fatalities: 2013 in review

Triathlon Safety Initiatives

May 13, 2013 By Larry Creswell, MD Leave a Comment

In recent weeks, safety initiatives have been announced by two of the largest event producers in Triathlon–Rev3 Triathlon and Ironman. I thought I’d review here what they’ve planned.

Rev3 Triathlon

Rev3 Triathlon has produced triathlon events throughout the United States since 2009 and is expanding their offerings in the area of adventure racing starting this year.

In an April 2nd press release, Rev3 announced that, due to fatalities in the swim portions of triathlons, they would be starting an initiative that focuses on water safety and athlete education. Elements of the initiative include:

1. Increased training for event staff
2. Offering pre-event heart screenings
3. Adding additional safety personnel to monitor the swim portion of the events
4. Educational offerings for athletes.

As part of the program, professional triathlete, Malaiko Homo, will be writing a 4-part series on swim safety and best practices and offering pre-race swim clinics designed to help athletes of all abilities swim safer on race day.

Ironman

The World Triathlon Corporation (WTC) organizes and licences the Ironman brand triathlon events, including the Ironman Triathlon, Ironman 70.3 series, 5150 triathlon series, among others.

Last week, WTC announced a SwimSmart Initiative for its North American Ironman and Ironman 70.3 events in 2013. Elements of the initiative include:

1. Modified swim starts at selected races. A variety of start methods will be tested for safety, logistical practicality, and athlete acceptance.
2. Pre-race warm-ups, whenever possible
3. Attention to extremes of water temperature, either cancelling or shortening races when the water temperature is 88F degrees52f>
4. Swim course additions:
a. Numbered course buoys to facilitate communication and rescues, if needed
b. Anchored resting rafts along the course
c. Increaesed professional swim course personnel
d. Additional rescue boats and other water craft

In addition, a second phase will provide educational offerings to athletes that focus on reducing anxiety during the swim portion; screening for potential health issues; pre-race training; and race week preparation.

My Thoughts

I’m pleased to see these two large event producers embrace athlete safety. Their leadership in this area will undoubtedly help to set a higher standard.

Many of the elements of these initiatives are found in the recommendations from last year’s USA Triathlon Fatality Incidents Study. The entire set of recommendations for athletes, event organizers, and USA Triathlon itself are worthwhile reading for any triathlete.

I very much liked an article earlier this year at Slowtwitch, written by Dan Empfield, entitled Dare to Move. In the article, Dan urges us to “do something” about the issue of triathlon-related fatalities. The initiatives by Rev3 and WTC are what we need.

Ironman and Heart Health: My Take on Things

September 15, 2011 By Larry Creswell, MD 5 Comments

For those of you who don’t already know him, let me introduce you to Dr. John Mandrola. You can read his musings at his Dr. John M Blog and follow along with his Twitter feed. John is a cardiologist in Lexington, Kentucky, who specializes in electrophysiology; he takes care of patients who have all sorts of abnormal heart rhythms, offering diagnosis and the entire spectrum of treatments available to these patients. He’s also a competitive cyclist and, at some point, was a triathlete, as well.

I particularly enjoy reading his Cycling Wednesday blog posts that are usually devoted to the “intersection” of medicine and cycling. These posts would be recommended reading for most athletes regardless of their sport. What I enjoy most about these blog posts are John’s skill at human observation, his ability and willingness to describe our follies (both physicians’ and athletes’), and his seeming general skepticism about many things. We often see things the same way.

The week before last, Dr. John wrote a blog piece entitled, “Is the Ironman triathlon heart-healthy?” Needless to say, this caught my eye. And, judging from the many comments I received afterwards, it caught the eye of a good many other triathletes as well. I also saw that there was a lively discussion on the Slowtwitch forum, with many triathletes weighing in on Dr. John’s thoughts and offering some personal accounts of various heart ailments as well. I also see that Dr. John received many replies and comments at his blog and felt obliged to issue “An Iron response….” at his blog a couple days after the original post.

Dr. John offered some important thoughts about endurance training and racing and their impact on heart health. These issues are important. His blog piece contained both opinion and fact. And, while it might be easy for me (as another medical professional) to see the difference, I can tell that many readers weren’t able to make that distinction. They got upset about some of the opinions and lost track of the facts. I thought I’d take a moment to separate out the opinions and facts–at least, as I see them–so that our readers might be in the best possible position to draw their own conclusions.

DR. JOHN’s OPINIONS

1. Ironman is the pinnacle of triathlon. No doubt, some people hold this opinion, but I’ll bet that many triathletes don’t. Olympic-distance (draft legal) racing is probably also a contender for being the pinnacle of our sport in many people’s eyes.

The participation rate for Ironman distance triathlon is relatively small. With about 25 Ironman-branded races worldwide each year and some number of other races of iron distance, the number of participants each year worldwide is probably less than 75,000. To put that into perspective, USA Triathlon recently reported that in the United States alone, there were 2.3 million triathlon participants in 2010. I’ve raced in 6 Ironman races over the past few years and each of those races held a pre-race dinner a couple nights before the race. At each of those dinners, 40-50% of the crowd stood up when the first-timers were introduced. With that statistic, it’s obvious that many Ironman participants are “one-and-done.”

2. Ironman triathlon….I don’t get it. Sure. Not everybody “gets it.” I could say the same for golf or tennis. To each, his own.

3. Heart healthier ideas: marathon or shorter running race, bicycle racing, shorter-than-Ironman triathlon. There is ample evidence that aerobic exercise produces long-lasting health benefits, including a longer life-expectancy. There has been speculation that, beyond some amount or intensity of exercise (or a combination of both), there might be some harm, including injury to the heart. I’m not aware of any credible studies, though, that address this issue in terms of the relative safety of 1 endurance sport over another….or race competition of 1 distance over another. In my view, it’s hard to imagine that half marathoners are somehow “heart healthier” than marathoners….or that half Ironman triathletes are somehow “heart healthier” than full Ironman triathletes. This issue about some threshold for harm remains unstudied….and therefore unsettled.

4. Can’t imagine riding for 5 hours continuously at 200 Watts. Obviously opinion. For me, it would be nearly 6 hours at 180 Watts. But BTW, I’m always willing to stop for a cookie break….on a training day OR at the race!

5. Long-term, low-intensity, ultra-endurance exercise (slogging, not racing) isn’t heart-healthy. Opinion. We know that long-term, low-intensity exercise IS heart-healthy. I’m not sure what qualifies for “ultra-endurance” and I’m not sure that “slogging” vs. “racing” makes a difference for the heart. Again, this issue simply hasn’t been studied.

6. The occurrence of fatalities during Ironman triathlong might entice others to participate. Perhaps. I suppose anything is possible, but I haven’t encountered that motivation. It’s important to remember that the small number of fatalities at triathlon races have occurred in races of all distances and the victims have spanned a large age range and ability level–from novice to veteran triathlete. In truth, most triathlon race fatalities have occurred in shorter-than-Ironman races.

THE IMPORTANT FACTS

1. Ironman triathletes are focused. True. Regardless of the particular hobby, anybody who spends 10-20 hours per week doing something is focused.

2. Daily exercise is good. Irrefutable fact.

3. Athletes are more likely to die of sudden cardiac death (SCD) during exercise (or competition) than non-athletes (who don’t exercise). Fact. SCD is not related solely to triathlon, though. A recent study of SCD in the general adult population showed that this occurs in (decreasing order of incidence) cycling, jogging, soccer, hiking, swimming, basketball, rugby, tennis, diving, judo, handball, alpine skiing, table tennis, and body building, among other sports. Cycling accounted for almost one third of the SCD events. Although most of the triathlon race-related deaths have occurred during the swim portion of the race, in the general population SCD while swimming accounts for only about 4% of the total number of episodes. On balance, though, the health benefits of exercise appear to far outweigh the small risk of SCD.

4. Endurance athletes are more likely than non-athletes to develop atrial arrhythmias. Fact. There is overwhelming evidence for this. Many references are included in Dr. John’s second blog post. This issue hasn’t been well studied in triathletes, but there’s no reason to think that triathletes are immune. The influences of exercise duration and/or intensity on the development of these arrhythmias need further study.

5. Scarring in the heart has been found in long-term endurance athletes (and laboratory rats). True. I wrote about the recent studies in a column at Endurance Corner. It’s important to remember, though, that scarring was only found in veterans of many, many marathons….and the clinical significance (if any) has not yet been determined. For now, there is no evidence that the scarring led to a shorter life or was associated with other heart problems in these runners, but these observations merit further study.

6. Heart damage can be detected after an endurance race. True. Studies have shown elevated levels of cardiac enzymes (indicating heart cell damage) in the bloodstream and altered (diminished) heart function by echocardiogram in athletes immediately after running and triathlon events. These abnormalities have not been shown to persist and so their significance (if any) is not clear. Some authorities have speculated that repeated episodes may be harmful.

ONE UNTRUTH

1. Sudden cardiac death (SCD) is “not uncommon” during triathlons. This simply isn’t true. SCD is actually a rare event at triathlons. There is a single report on this issue that showed SCD to occur at a rate of approximately 1 per 65,000 participants. USA Triathlon is convening a Taskforce to examine this issue in further detail and I’m certain that additional information may be reported in the coming months. To give this issue some context, it was reported earlier this year that the rate of SCD among NCAA athletes (in all sports) was approximately 1 per 45,000 athletes per year.

DR. JOHN’s SUGGESTED ACTIVITIES

Let me finish by saying that Dr. John’s list of 7 suggested activities at the end of his first blog piece are great ideas. I need to work on #2, #3, and #6. I’ll report back.

1. Swim a fast and smooth 400-yard individual medley (100 yards each of the butterfly, back, breast, and freestyle strokes

2. Ride a criterium bicycle race

3. Train to knock 1 minute off your best 10 km run time

4. Complete an Olympic-distance triathlon

5. Try touching your toes without bending at the knees

6. Write a blog without a grammatical error

7. Sit still long enough to read a book

Follow-up: Heart Transplant Recipient at Kona Ironman

October 13, 2009 By Larry Creswell, MD Leave a Comment

I was pretty excited for Kyle Garlett, who was trying to become the first heart transplant recipient to complete the Hawaii Ironman race. And just 3 years after his transplant. Unfortunatey, things didn’t work out….and Kyle wasn’t able to complete the 2.4 mile swim before the cutoff.

I watched the online coverage of the race on Saturday at UniversalSports.com and saw that there were a couple swimmers who just barely missed the cutoff time. So close….

Kyle’s follow-up story is detailed in this article at Silicon Valley MercuryNews.com.