Strenua's World» heart

Do recent deaths during races suggest marathon running is inherently dangerous?

Strenua — Tue, 20 Oct 2009 00:13:00 +0000

The three tragic deaths during the Detroit Marathon this weekend highlight the risks in running a marathon. Daniel Langdon, 36, Rick Brown, 65, and Jon Fenlon, 26, were competing in the half marathon and died within 16minutes of each other. Jon Fenlon collapsed just after crossing the finish line in 1:53:37. Although this follows the death last week of a 23 year old male competing in the Baltimore marathon, runner reported deaths in marathons are rare with these being the first in the Detroit event since 1994.

A study by Donald Redelmeier and Ari Greenwald published in the British Medical Journal randomly selected 26 marathons in the US with more than 1000 participants and followed each for up to 30 years from 1975- 2004. This amounted to 750 marathons and 3,292,268 participants encompassing 14 million hours of exercise. Over the 30 years there were 26 sudden cardiac deaths equivalent to 0.8 per 100,000 participants. The typical participant with sudden cardiac death was a middle aged man (average age 41 years, 81% men). 5 deaths were in individuals who had previously completed a marathon, with the most common location of death at or within 1mile of the finish. The risk of sudden cardiac death equated to about 2 deaths per million hours of exercise.

Whether due to the increase in popularity of marathon events or the increase in previously inactive people ‘wanting to have a go at one’ the incidences of deaths in marathons have increased in recent years. Deaths during marathon events are generally due to 4 factors:

Heart Disease - One of the common causes of death in marathon runners due to heart attacks brought about by underlying coronary artery disease. These attacks are brought on by a combination of the physical stress of the event combined with the person’s lack of cardiac fitness.
Sudden Cardiac Death - On average 12 young people a week die from sudden cardiac death. In 2007 the 28 year old professional runner Ryan Shay collapsed during the Olympic marathon trials. Ryan was young and highly trained and had previously run 7 marathons. His autopsy reported the cause of death to be Cardiac arrhythmia due to cardiac hypertrophy, meaning abnormal beating due to an enlarged heart.
Water Intoxication - This occurs when there is so much water in the body that it dilutes vital minerals such as salt to dangerous levels. It can lead to confusion, headaches and fatal swelling of the brain. In 2007 22yr old fitness instructor David Rogers died from hypomatraemia after completing the London Marathon.
Heat stroke - This is brought about by extreme dehydration. Learning to regulate body heat is important, rehydrating efficiently without becoming intoxicated by too much fluids. In the 2005 Great North Run half marathon four male runners died due to heat related illnesses.

Of the 24 autopsy reports available in Redelmeier’s study there were 21 cases of atherosclerosis, contributing factors included (2) coronary anomalies, (4) electrolyte abnormalities and (1) heat stroke.

People should not be discouraged from running full or half marathons as the health benefits of regular exercise by millions of people out weigh the tragic sudden deaths of a few participants. Whilst some deaths are medically related, a number of people who require emergency medical attention do so because they do not respect the marathon event.

My first marathon should have been a Golden Bond place in the London Marathon. The day before the race I awoke to my entire body and face swollen and red. A visit to the doctor revealed I just had a virus or allergic reaction to something and was advised not to run as I would be putting added to strain on my body attempting to complete a marathon while fighting an infection. Whilst being bitterly disappointed in missing the race I was persuaded that by running I was not only risking my own health but those of other runners if the medical teams had to treat me rather than another casualty. Three weeks later I was able to successfully run a different marathon, collect sponsorship for my chosen charity and I got a ballot place for London the following year.

Celebrities such as Katie Price, being praised for completing the race whilst still suffering from the effects of a miscarriage days earlier, or Jade Goody, admitting to have done no training but congratulated for making it to mile 18, just suggest to the public who ‘fancy a go’ that the marathon is not too much of a physical challenge and doesn’t need to be taken seriously. Thankfully there are celebrities such as Nell McAndrew, Tom Audenshaw and Gordon Ramsey who show commitment to their training, health and race performance.

Whilst deaths associated with marathons are rare, if anything can be done to reduce them even more, it should be implemented. In Italy before participating in a marathon runners are required to complete a medical sports fitness test including an electrocardiogram (ECG). Although it may seem an expensive inconvenience if this was extended to other countries this may identify those at risk of cardiac related conditions and save lives. Additionally if required to provide evidence that you have trained sufficiently or participated in at least a half marathon, runners will have at least experienced some physical stress of endurance exercise and had the chance to learn how to deal with heat and efficiently rehydrate.

Increase your ‘good’ HDL cholesterol through endurance exercise

Strenua — Mon, 27 Jul 2009 16:17:39 +0000

What is cholesterol?

Cholesterol is a type of lipid (fat), manufactured by the liver from the fatty foods that we eat and found in the membranes of cells. Cholesterol is insoluble in blood, so it is transported in the circulatory system within lipoproteins. There are five major groups of lipoproteins (Chylomicrons, Very Low- (VLDL), Intermediate- (IDL), Low- (LDL), and High-density lipoproteins (HDL)) which enable fats and cholesterol to move within the water-based solution of the bloodstream, transporting dietary lipids from the intestines to other locations in the body.

What is the difference between HDL and LDL?

People talk about LDL being ‘bad’ cholesterol and HDL being ‘good’ cholesterol. What they actually mean is that when cholesterol attaches itself to high-density lipoproteins it can then be transported away from your arteries to the liver to be eliminated—which is the main reason why HDL-bound cholesterol or HDL-C is sometimes called ”good cholesterol”, and why a high level of ‘good’ HDL is thought to be good for your heart.

Cholesterol that attaches to low-density lipoprotein (LDL-C) takes cholesterol from your liver to the body tissues. If there’s a high level of cholesterol in the blood it can build up in the walls of your blood vessels, causing them to narrow. To keep your heart healthy it’s important that your ‘bad’ cholesterol transporters (LDL) levels remains low and your ‘good’ cholesterol transporters (HDL) stays high.

How can you increase HDL levels?

There are a number of factors that can contribute to a high cholesterol level, such as a family history, getting older, being overweight, an under active thyroid gland, diabetes or kidney problems. The most common cause is eating too much saturated fat. Whilst there are a lot of dietary products on the market designed to help control your cholesterol level, recent research that suggests that endurance exercise training may help increase HDL-C levels.

Atherosclerosis is a condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol. When cholesterol is attached to High density Lipoproteins to become HDL-C there is an inverse correlation with the incidence of coronary artery disease, meaning that as HDL-C levels increase the occurrence of coronary artery disease decreases. HDL-C and in particular HDLC-2 have been shown to have a protective effect against atherosclerosis.

The benefit of HDL is due to the role HDL has in the removal of excess cholesterol from peripheral cells to the liver for excretion as bile. This process is known as reverse cholesterol transport (RCT). Acute exercise, exercise training and fitness can favourably affect the several key steps in RCT.

ABCA1 is a protein that also plays an important role in transporting cholesterol. Research involving ABCA1 deficient humans and mice has shown that ABCA1that has a significant role in plasma HDL-C levels and over expression of ABCA1 can favourably decrease the risk of atherosclerosis.

A study out this month in European Journal of Applied Physiology investigated plasma HDL-C levels and the expression ABCA1 in response to treadmill running training in rats. The rats were trained for 12 weeks, 5 days a week for 60mins a day.

The researchers from Iran found that the expression of the ABCA1 protein in the liver and intestine was significantly higher in trained animals compared to the control group. Previous research in rats has also shown that 6 weeks of moderate endurance training leads to ABCA1 expression in liver.

The paper’s author Behzad Khabazian also reported increased levels of plasma HDL-C and HDL2-C concentrations in trained rats following treadmill training. This was suggested to be due to the effect exercise had in inducing higher blood concentrations of other key elements involved in RCT and HDL-C metabolism.

So there you are, further evidence suggesting that exercise can help protect against heart and coronary artery diseases and more reasons to take up some form of endurance exercise.

Heart screening tour highlights risk of sudden cardiac death in young athletes

Strenua — Wed, 03 Jun 2009 23:02:27 +0000

This month sees the conclusion of a new national campaign aiming to reduce the number of undiagnosed heart conditions. Beginning last month in Durham, The CRY Philips Test My Heart Tour 09 is the first free tour of its kind in England and aims to test over 3,000 14-35 year old’s hearts to identify heart conditions which could potentially prove fatal if left untreated.

Its estimated that every week, 12 young people lose their lives to sudden cardiac death in the UK. Whilst sport does not cause the problem of sudden death syndrome, it can exacerbate an existing undiagnosed condition and the high risk group is the young. 80% of those that die have had no discernible symptoms. The only way to identify those young people that are “asymptomatic” is through screening.

Sudden Cardiac Death (SCD) is an umbrella term for a number of different heart conditions that affect fit and healthy people which, if not treated can result in a dramatic and or / spontaneous death. In about one in 20 cases of sudden cardiac death, no recognised cause can be found – even after post-mortem. This is then called Sudden Arrhythmic Death Syndrome (SADS). Many experts are now claiming that the actual number of deaths recorded could just be ‘the tip of the iceberg’ with many causes being wrongly recorded at post mortem as asthma, epilepsy or even drowning.

SADS has affected many families in the UK and also of world level athletes. In 2008 Neil Desai, a world ranked squash player died on his 22^nd birthday. Neil was the recipient of the TASS (Talented Athlete Scholarship Scheme) sports scholarship for a number of years, which provides funding, and prescribes athletes intense training programmers and diets, yet he was not given any health checks before embarking on these activities. His mother hopes that we will soon implement a nationwide testing policy, especially as we encourage youngsters to train for the 2012 Olympics.

The charity CRY aims to raise awareness of Sudden Arrhythmia Death Syndrome (SADS). As well as campaigning and lobbying and the provision of its subsidised cardiac screening programme for young people (35 and under), the charity also provides counselling and support to bereaved families as well as young individuals who may be diagnosed.

CRY’s honorary president Sir Ian Botham OBE, said: “The sudden death of an apparently fit young person is impossible for surviving families and friends to make sense of. Speaking as a parent and a grandparent, I am delighted that the issue is being addressed in this way through this screening tour where young people will be given the opportunity to be tested so that conditions identified can be treated. That is why the work that CRY is doing with Philips to bring about this tour is so important.”

The mobile unit, donated by Philips, consists of three rooms where Philips’ ECG and ECHO equipment will be used to test people. A team of doctors and cardiologists will be present at all locations throughout the tour. The tour has also been made possible by charity CRY, through the fundraising efforts of families whose lives have been affected by Sudden Death Syndrome (SDS) or Sudden Cardiac Death (SCD), and the Gwyneth Forrester Trust.

Free appointments are still available and can be booked online at www.testmyheart.org

For those wanting to support the work of CRY, July 26^th sees the CRY Heart of London Bridges 5 mile Sponsored Walk. The walk will start at Victoria Embankment Gardens and cross Golden Jubilee, Westminster, Waterloo, Blackfriars, Millennium, London and Tower Bridges – before finishing at Hay’s Galleria on the south side of the Thames near London Bridge. It will provide CRY families and supporters with an opportunity to get together and commemorate or support young people whilst enjoying a beautiful walk along the banks of the Thames

More information and details of how to enter can be found at www.c-r-y.org.uk/bridges_walk_2009.htm