More from Dr. John on Ironman and heart health

Triathlon Forum
1

My first episode of a-fib occurred a month after fininshing my first and only IM ten years ago. I think the evidence is catching up that there is a connection.

CW: Is the Ironman triathlon heart-healthy?
Posted: 07 Sep 2011 08:27 PM PDT
Before I even start, let me say this to my triathlete friends…
I really like you all. And…I am sorry for how I feel about your sport’s pinnacle, the Ironman triathlon. But I was poked into writing this post. When asked the question of whether the Ironman is safe for the middle-aged heart, what was I to do? Lie?
http://www.drjohnm.dreamhosters.com/wp-content/uploads/2011/09/images-1.jpgEach August, my hometown, Louisville, KY, gets overrun, over-swum and over-ridden with “Iron people.” No, these humans aren’t rust colored, or all that hardened, but they are indeed a determined lot. Triathletes, or iron people if you will, wake up before sunrise to swim, bike or run. Then they eat; some go to work (barely), and then they do the training thing again in the evening. Calling these athletes focused would surely be an understatement.
So it is each summer that I endure the same question: “Dr Mandrola, did you do the Ironman?”
“No…I just ride bikes.”
But this year was different. Before I could launch into my usual dissertation on how training for Ironman-length triathlons causes excess inflammation, coronary calcium, atrial fibrillation, divorce, etc, etc, another question quickly popped up.
“What did you think of that guy who died during this year’s race?”
It’s true; unfortunately, a middle-aged competitor suffered sudden cardiac death during the swim portion of this year’s race. The press reports were sparse, but the consensus was that he had a heart attack and drowned. Sudden death is not all that uncommon during triathlons. (A warning: don’t Google “sudden death and triathlons” if you are on the fence about starting up this hobby.)
I hate to hear about people dying during exercise. Not only is it sad, but it sends the wrong message.
But when asked about the heart-health of Ironman-length races, I have to answer truthfully.
Here’s the first thought that popped in my mind:
What’s even sadder to me, as a cardiologist and competitive athlete, is my suspicion that the possibility of dying during the Ironman will only heighten the race’s allure. I hope that I am wrong about this, but as a former triathlete (disclosure: only a half-ironman finisher), and an AF-doctor to many an over-achieving endurance athlete, I doubt that the possibility of death will serve as a deterrent.
So what do I think of a young man–with years of good living left–dying prematurely in the Ohio River?
It’s awful.
And for what did he die?
For a finisher’s tee shirt…or the prestige of having “Iron” status.
It perplexes me that people think emulating the whims of a few Southern California endurance-junkies is a good idea. That the strong-mitochondria-endowed Mark Allen, Dave Scott and Scott Tinley thought it was cool to swim 2.4 miles, bike 112 and run 26.2 in the 1980s doesn’t make it wise for the over-scheduled and middle-aged of today. These guys, like professional triathletes, own bodies that actually allow them to race each other over that distance. This is clearly not the case for the majority of people “doing” the Ironman now. Most regular iron people are slogging—or some would say flogging–through race day. (I know I did, and over only half the distance.)
I don’t get it. Call me jaded, envious, slow, snarky, or anything else you wish, but why is slogging through an inflammatory soup held in such high regard? Why is it surprising that doing so causes heart attacks, arrhythmias and divorce? This is healthy, really?
We all know that daily exercise is good, great even, but geez. And we also know that each of triathlon’s sports are compelling in and of themselves. But together, in one day, over that ridiculously long and whimsical distance? Why can’t we enjoy each of the three sports for their own elegance? For instance…
Swimming rocks! I swam regularly for years on a Masters team. The challenge of trying to master the craft of the four strokes keeps you coming back. Swimmers can also satisfy their fitness craving by working towards going faster. And who doesn’t revel in the perfect flip-turn? Or this hard to beat visual: diving in an outdoor pool that’s clouded by a pre-dawn morning steam. But swimming 2.4 miles before a bike ride and run? Wouldn’t breakfast afterwards be better, or healthier?
And the bike…you all know I love bikes! I couldn’t imagine not riding. The sensations generated on that human-powered machine are simply beautiful. Cycling is an infection that some catch and simply cannot rid themselves of. But riding in a straight line for five hours at 200 watts–with goo-bars stuck to the top-tube? Nope. I can’t imagine pedaling that long without a cookie stop that had a folk band playing.
And the run…Okay, I too was a runner that idealized the idea of a marathon. Here I see your point, as you can actually “race” a marathon. Though clearly, training to run a faster 5k or 10k would be healthier, a marathon can be achieved—by most–within the bounds of wellness. But who thinks it intelligent to prep for the marathon by swimming and biking immediately before?
Want a heart-healthier idea?
Start with not idealizing inflammatory endeavors that threaten your life. Just because the majority don’t die during the Ironman doesn’t make it healthy. I believe there are simpler feats that not only impress those of us athletes in the know, but might also make you live longer and better. Cool things like:
§ Swimming a fast and smooth 400 IM.
§ Riding me off your wheel in a 45-minute criterium. (Not that hard.)
§ Training your body to run a 10k one-minute faster than your best time last year. (Really hard.)
§ And why isn’t the Olympic-distance tri long enough? (It takes most mortals more than two hours to swim 1500 meters, bike 40k and run 10K.)
And if you could do all this and still need a challenge…
§ try touching your toes without bending at the knees,
§ or writing a blog without a grammatical error,
§ or this elusive challenge…sitting still long enough to read a book.
My friends and colleagues, I submit to you that these seven softies would surely make for a happier, healthier, albeit less Iron heart.
JMM
Related posts:

  1.   **Cycling Wed: Ironman isn’t that dumb…**

  2.   **Confused on what’s healthy? Just think about our biology**

  3.   **CW: That exercise has an upper limit makes perfect sense**

http://www.drjohnm.org/

2

What am I missing here? The doc makes a case for why he doesn’t like doing triathlons, and alternative goals / endeavors, but I see no evidence in his blog / article linking it to being unhealthy activity for your heart.

3

So the training for Iron Man caused “inflamation” that some how damaged his heart causing him to die in the first 500 meters of the swim?

4

I’m glad I read your post, 'cause I’m in a time of a lot of thought and some research over this sort of issue. My DW had a conversation with her chiro–good chiro, good guy, pretty smart, but comes up with stuff sometimes that doesn’t quite have the ring of truth–in which he said, in short, that if a person over the age of 50 does regular strenuous exercise for over 30 minutes, and certainly for over an hour, especially running, they are putting themselves at serious risk for heart attack and cancer. I called the chiro and discussed all that with him. He told me his info came from a lecture he heard from Dr. Kenneth Cooper and from a chapter in Cooper’s book The Anti-Oxidant Revolution. The idea put forth was, as he passed it on, that yes, exercise is good and prolongs life, but for a person over 50, only in small doses, limited to 15-30 min. There was something about how over 50 we don’t get rid of the free radicals as efficiently, and we harm ourselves rather than help ourselves if we do strenuous stuff for over and hour regularly. He said that some physician who has been Lance Armstrong’s personal physician confirmed all of that, saying that Armstrong has had cancer three times (wasn’t it only once?) and that he will die young of cancer because “he doesn’t know when to stop.”

At first, and to a lot of folks I’ve talked with, that didn’t make a lot of sense, especially considering there are thousands upon thousands of people over the age of 50 who train for and participate in strenuous activities that run well over 30 minutes, and well over an hour. That we know of, they’re not dropping like flies. And there is anecdotal evidence of great vitality in senior-age Ironmen, like “Iron Nun” Sr. Madonna Buder and Lew Hollander. Heck, most sprint triathlons take the fastest age groupers at least 70 minutes! And some of the activities you mentioned, Dr. John, take just under an hour, like a 10K race, and well over an hour, like an Oly tri.

The question I need to ask is where is the empirical, scientific, medical study-based evidence that strenuous activity for over 30 minutes or an hour or whatever time is harmful to a person over 50? There may be anecdotal evidence, but where is the evidence that can be published in a medical journal? If it’s there, I need to see it, and heed it, 'cause I want to be there for my 6 year old’s high school graduation/college graduation/wedding/children… (I’m 55, BTW.)

I have to say that some of what you say makes sense. No, a person doesn’t have to do an Ironman to be fit. And you might have a point, that it doesn’t make a lot of sense for a “duffer” (my word) like me to slog and suffer through the IM training and through an IM race just to have the t-shirt and to have an announcer intone on the PA, whilst I limp through the finish, “A— B----, you are an Ironman!” But Lord, wouldn’t I love to give it a try! (Especially in IMWI, in Madison, WI, one of the coolest cities in the US and in the lake where I learned to swim as a kid.)

On the other hand, I have to point out the fact that, as I understand it, the man who died at IM KY went down early in the swim, not toward the end, and certainly not toward the end of the run. And to be honest, I haven’t heard of people dying during or soon after the run portion of any Ironman, or any length of tri, for that matter. All of the deaths that I know of in tri’s have happened on the swim. There could have been some, but I’ve never heard of them. The case can certainly be made, to be fair, that everyone who does any tri should have the OK from their physician and should be certain that they are strong swimmers.

Thank you!

5

Sounds like “Dr John” likes to listen to himself a lot … amusing;-)

Dave

6

Between 2003 and 2009, there were 21 deaths in the swim portion of a triathlon. Only 2 occurred in an Ironman (Florida in 06 and 07).
Also, if it were so bad for the heart, we’d actually see numerous reports of deaths during the bike leg and run leg, in conditions where there
is a heavy load on the heart, i.e., not during the swim…
I find it ironic to see how an electrophysiologist jumps to conclusions that seem to be based more on his not understanding why
people want to do IM than anything else. As an MD, he could have made an effort to provide actual data to support his blog post, rather
than a simple belief. I guess that’s one more MD who was sleeping during biostats and epidemiology.

7

X 10.

What evidence is there that Ironman or triathlons for that matter show that during the swim, bike or run cause heart failure or heart damage??

Is there 110% pure evidence of this? Or, could this guy have been walking down the street, sitting on his coach reading the Sunday news collapse and die one day? We will never know.

One thing’s for sure, maybe this guy would have died years ago had it not been for the fact that he picked up a sport and got out there and did something he loved…but there’s also the couch option…sheesh

Doc’s get yer head outta yer arse!

8

*What evidence is there that Ironman or triathlons for that matter show that during the swim, bike or run cause heart failure or heart damage?? *

Actually, there is a growing body of evidence that endurance training may not be all good.

See the link below for a general discussion. Or search the internet. Last May I had an episode of atrial flutter that required defibrillation (not much fun) so I did research this a little. There are dozens of research papers looking at these, see a few below.

Francois in Montreal

http://www.expert-reviews.com/...df/10.1586/erc.10.69

Heart. 2011 Jun;97(11):918-22. Epub 2011 Mar 12.
Long-term endurance sport is a risk factor for development of lone atrial flutter.rce
Claessen G, Colyn E, La Gerche A, Koopman P, Alzand B, Garweg C, Willems R, Nuyens D, Heidbuchel H.
Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium Europe; hein.heidbuchel@uzleuven.be.
Abstract
Objective To evaluate whether in a population of patients with ‘lone atrial flutter’, the proportion of those engaged in long-term endurance sports is higher than that observed in the general population. Design An age and sex-matched retrospective case-control study. Setting A database with 638 consecutive patients who underwent ablation for atrial flutter at the University of Leuven. Sixty-one patients (55 men, 90%) fitted the inclusion criteria of ‘lone atrial flutter’, ie, aged 65 years or less, without documented atrial fibrillation and without identifiable underlying disease (including hypertension). Sex, age and inclusion criteria-matched controls, two for each flutter patient, were selected in a general practice in the same geographical region. Methods Sports activity was evaluated by detailed questionnaires, which were available in 58 flutter patients (95%). A transthoracic echocardiogram was performed in all lone flutter patients. Main outcome measures Types of sports, number of years of participation and average number of hours per week. Results The proportion of regular sportsmen (≥3 h of sports practice per week) among patients with lone atrial flutter was significantly higher than that observed in the general population (50% vs 17%; p<0.0001). The proportion of sportsmen engaged in long-term endurance sports (participation in cycling, running or swimming for ≥3 h/week) was also significantly higher in lone flutter patients than in controls (31% vs 8%; p=0.0003). Those flutter patients performing endurance sports had a larger left atrium than non-sportsmen (p=0.04, by one-way analysis of variance). Conclusion A history of endurance sports and subsequent left atrial remodelling may be a risk factor for the development of atrial flutter.

Europace. 2009 Jan;11(1):11-7. Epub 2008 Nov 6.
Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter.
Mont L, Elosua R, Brugada J.
ce
Thorax Institute, Hospital Clínic, University of Barcelona, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Villarroel 170, Barcelona 08036, Catalonia, Spain. lmont@clinic.ub.es
Abstract
Although the benefits of regular exercise in controlling cardiovascular risk factors have been extensively proven, little is known about the long-term cardiovascular effects of regular and extreme endurance sport practice, such as jogging, cycling, rowing, swimming, etc. Recent data from a small series suggest a relationship between regular, long-term endurance sport practice and atrial fibrillation (AF) and flutter. Reported case control studies included less than 300 athletes, with mean age between 40 and 50. Most series recruited only male patients, or more than 70% males, who had been involved in intense training for many years. Endurance sport practice increases between 2 and 10 times the probability of suffering AF, after adjusting for other risk factors. The possible mechanisms explaining the association remain speculative. Atrial ectopic beats, inflammatory changes, and atrial size have been suggested. Some of the published studies found that atrial size was larger in athletes than in controls, and this was a predictor for AF. It has also been shown that the left atrium may be enlarged in as many as 20% of competitive athletes. Other proposed mechanisms are increased vagal tone and bradycardia, affecting the atrial refractory period; however, this may facilitate rather than cause the arrhythmia. In summary, recent data suggest an association between endurance sport practice and atrial fibrillation and flutter. The underlying mechanism explaining this association is unclear, although structural atrial changes (dilatation and fibrosis) are probably present. Larger longitudinal studies and mechanistic studies are needed to further characterize the association to clarify whether a threshold limit for the intensity and duration of physical activity may prevent AF, without limiting the cardiovascular benefits of exercise.

ur J Appl Physiol. 2010 Oct;110(3):459-78. Epub 2010 Jun 17.
Cardiovascular function and the veteran athlete.
Wilson M, O’Hanlon R, Basavarajaiah S, George K, Green D, Ainslie P, Sharma S, Prasad S, Murrell C, Thijssen D, Nevill A, Whyte G.
ce
ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, PO Box 29222, Doha, Qatar. mathew.wilson@aspetar.com
Abstract
The cardiovascular benefits of exercise are well known. In contrast, the impact of lifelong endurance exercise is less well understood. Long-term high-intensity endurance exercise is associated with changes in cardiac morphology together with electrocardiographic alterations that are believed to be physiologic in nature. Recent data however has suggested a number of deleterious adaptive changes in cardiac structure, function and electrical activity, together with peripheral and cerebral vascular structure and function. This review serves to detail knowledge in relation to; (1) Cardiac structure and function in veteran endurance athletes focusing on the differentiation of physiological and pathological changes in cardiac remodelling; (2) Cardiac electrical activity and the veteran endurance athlete with attention to arrhythmias, the substrate for arrhythmia generation and the clinical significance of such arrhythmias; (3) Peripheral and cerebral vascular structure and function in ageing and endurance-trained individuals; and (4) directions for future research.
PMID: 20556420

Eur J Cardiovasc Prev Rehabil. 2010 Feb;17(1):100-5.
High prevalence of atrial fibrillation in long-term endurance cross-country skiers: echocardiographic findings and possible predictors–a 28-30 years follow-up study.
ce
Grimsmo J, Grundvold I, Maehlum S, Arnesen H.
Department of Cardiac Rehabilitation, Feiringklinikken, Feiring, Norway. jostein.grimsmo@feiringklinikken.no
AbstractBACKGROUND:
Lone atrial fibrillation (LAF) seems to be more common in endurance-trained male athletes than in men in the general population. The reason for this has not been found.
AIM:
To determine the prevalence of LAF in long-term endurance cross-country skiers and to examine possible predictors.
METHODS:
Of 149 healthy, long-term trained cross-country skiers from three different age groups who were invited, 122 and 117 participated in the studies in 1976 and 1981, respectively. At follow-up in 2004-2006, 78 men participated, with 33 in age group I (54-62 years), 37 in group II (72-80 years) and eight in group III (87-92 years), whereas 37 individuals had died and seven could not be tracked. The examination programme applied in 1976, 1981 and 2004-2006 consisted of an electrocardiographic monitoring during rest and exercise and a maximal exercise test. Echocardiography was performed in 2004-2006.
RESULTS:
A high prevalence (12.8%) of LAF was found. The only predictor from both 1976 and 1981 associated with LAF was a long PQ time (r=0.38, P=0.001 and r=0.27, P=0.02, respectively), whereas bradycardia was another predictor from 1981 (r=0.29, P=0.012). At follow-up, left atrial enlargement was a marker associated with LAF (P<0.001).
CONCLUSION:
Long PQ time, bradycardia and left atrial enlargement seem to be important risk factors for LAF among long-term endurance cross-country skiers.

Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes.
Calvo N, Mont L, Tamborero D, Berruezo A, Viola G, Guasch E, Nadal M, Andreu D, Vidal B, Sitges M, Brugada J.
e
Cardiology Department, Thorax Institute (ICT), Hospital Clínic, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain.
AbstractAIMS:
Long-term endurance sport practice has been increasingly recognized as a risk factor for lone atrial fibrillation (AF). However, data on the outcome of circumferential pulmonary vein ablation (CPVA) in endurance athletes are scarce. The aim of the study was to evaluate the efficacy of CPVA in AF secondary to endurance sport practice.
METHODS AND RESULTS:
Patients submitted to CPVA answered a questionnaire about lifetime history of endurance sport practice. Endurance athletes were defined as those who engaged in >3 h per week of high-intensity exercise for at least the 10 years immediately preceding their AF diagnosis. A series of 182 consecutive patients was included (51 +/- 11 years, 65% with paroxysmal AF, 81% men, 42 +/- 6 mm mean left atrial diameter); 107 (59%) patients had lone AF, and 42 of them (23% of the study population) were classified as endurance athletes (lone AF sport group). Freedom from arrhythmia after a single CPVA was similar in the lone AF sport group compared with the remaining patients (P = 0.446). Left atrial size and long-standing AF were the only independent predictors for arrhythmia recurrence after ablation.
CONCLUSION:
Circumferential pulmonary vein ablation was as effective in AF secondary to endurance sport practice as in other aetiologies of AF.
Comment in

Med Hypotheses. 2006;66(6):1085-92. Epub 2006 Feb 28.
Atrial fibrillation in athletes: implicit literature-based connections suggest that overtraining and subsequent inflammation may be a contributory mechanism.
Swanson DR.
e
Division of the Humanities, The University of Chicago, IL 60637, USA. d-swanson@uchicago.edu
Abstract
Research on atrial fibrillation (AF), a common heart arrhythmia in the elderly, over many decades has resulted in a literature of more than 16,000 articles indexed in Medline. An exploratory Medline search was conducted in which the subheadings for epidemiology and etiology of AF were combined to form a small subset of the initial records. Further computer-assisted selection led to a few articles that reported an unexpectedly high prevalence of AF in groups of otherwise healthy middle-aged endurance runners and other athletes. Why athletes should be unusually susceptible to AF is mysterious and puzzling. Because relatively few articles are about both AF and endurance exercise, a computer was used first to create a list of important terms that these two separate literatures had in common. Several inflammation-related terms, including C-reactive protein (CRP) and interleukin-6, were on that list. Further searching and literature analysis revealed that excessive endurance exercise or overtraining can lead to chronic systemic inflammation and, separately, that there is a solid association between CRP and AF and that anti-inflammatory agents have been reported to lower CRP and ameliorate AF. No articles were found that brought together all three concepts - AF, inflammation, and exercise. The following hypothesis is plausible, readily testable, and apparently novel: Older athletes diagnosed with AF but otherwise healthy who have engaged in rigorous aerobic endurance exercise for more than a decade will have CRP levels that are higher than those of a similar population of athletes without AF. Corroboration of this hypothesis would then justify a prospective clinical trial of anti-inflammation therapy. It is of particular interest to extend recent studies of inflammation in AF to athletes; athletic behavior that can induce inflammation may contribute to understanding the origins of AF.

9

Although I understand what is is saying and it is technically correct, I believe it is a little misguided and unfair.

Looking at some of the hard facts regarding heart attacks

It is the leading cause of death in developed countries… 1 in every 5 Americans die from Coronary Heart Disease. This is a pretty important statistic to keep in mind while discussing the risk factors in relation to triathlon - Myocardial Infractions happen A LOT!

Now consider the most common risk factors.
Diabetes Tobacco smokingHypercholesterolemiaLow HDLHigh TriglyceridesHigh blood pressureFamily history ObesityAge: Men 45, Women 55B2, B6, B12 and folic acid deficienciesStressAlcohol
For the athlete their age and family history are the only risk factors completely out of their control. Plenty of us have Stress, drink, and possibly smoke but that is a life style choice similar to doing triathlons.

Given the risk factors alone - It is clear physical fitness reduces the risk factors for a MI

I don’t quite have the time for thorough research - and I don’t know if the numbers are easily assessable, but one should be able to take the number of people participating in Ironman and other various distance triathlons and the number of deaths… Compare that to any other activity - bowling, tennis, golf, whatever and I am going to hypothesize that the rates are very similar and probably favor Ironman events for less chance of MI.

There is a harder statistic that should be accounted for, and that is how many people are dying at any other time other than a race? If there is a correlation between Ironman and MI - then it would be do to the volume of training and not the race per se. When that happens, unless they where on their bike, I doubt the ER even draws a connection for reporting purposes. Even if we could flesh out these numbers, it would be unfair because the volume of training increase the chance that the MI happens while training.

The studies, involving thousands of subjects, showed that the risk of having a heart attack is between 2 and 6 times greater during, or immediately after, physical exertion than at rest. Subsequent studies added that sudden death, a fatal cardiac arrhythmia caused by a heart attack, is far more likely to occur during, or in the 30 minutes following, physical exertion than at rest.

But on the other hand

More than 50 mutually reinforcing epidemiological studies have linked physical fitness to the prevention of cardiovascular disease. In large studies with thousands of subjects, people who report regular exercise have a lower risk of heart attacks. Similarly, in studies that measure exercise capacity with a treadmill test, a high level of fitness is associated with a lower mortality from cardiovascular disease. Even in patients who have already suffered a heart attack, an exercise program decreases the risk of another heart attack.

Risk vs Reward clearly favors triathletes for heart health.

Now the question is if Ironman is health?
Hell No . It is an extreme endurance event. No different then how a glass of red wine can be beneficial to your health but a box a night will eventually harm you. Anyone can overdo any “healthy” activity and turn it into a form of self abuse. I don’t know anyone personally, but I am sure there is someone out there that has brushed their enamel or gums right off their mouth from over zealous brushing.

Moderation in all things people, and Doing an Ironman is the farthest thing from moderation.

However, having said that, WHO CARES! A habit of doing Ironmans vs a habit of crack? Sky diving? Polar Bear wrestling? Who is to judge ones ambitions, desires, and interest on terms of health alone? Far more people have a much more health adverse addiction to fast food and television than athletes do to Ironman events, but not as big of deal is made about that.

Swim, Bike, Run and be marry for tomorrow we exercise in Hell !

10

**
Actually, there is a growing body of evidence that endurance training may not be all good.

I certainly can’t back this up with any study, but for quite a while I’ve felt that all my intense (bike) training and racing is not particularly healthy. I may be race-fit, but overall not sure it is really healthy. I think I would be more “healthy overall” with less intensity, less volume, and more diversity. (and less caloric requirements everyday)

11

Thank you for sharing this article. The author is a doctor, but we can’t accept everything we read even from doctors. There are many holes in this article. Again, I do appreciate you sharing. Hope we get some feedback from some tri/doctors on Slowtwitch.

12

But, but, but… last year, Dr. John thought Ironman wasn’t that bad after all (first link at the bottom of the story you posted).

13

Very interesting reading, and closer to the data I’m looking for than anything I’ve seen before. So, in layman’s terms, what does it mean that middle-aged endurance athletes are at higher risk for LAF? Is there evidence of increased incidence of MI’s amongst the populations studied? Did I get the wrong impression, or did I understand that there is a treatment for LAF that is proven to be quite effective? It looks as though the “jury is still out” on what the findings of those studies mean, or again, did I get the wrong impression?

And the question then remains: Which puts a 55 year old male at higher risk for early death due to heart disease: sitting on my ass eating ice cream and buttered popcorn (my two weaknesses) or getting off my ass and swimming, riding and/or running, sometimes for well over an hour, and maybe someday entering an endurance event that will take hours to finish?

14

I think it’s important to note that he is arguing that ironman distance events are bad for the heart, not the lesser events. It’s worth a discussion. Having a-fib sucks and I would not wish it on anyone.

15

Curious what you think: Could race anxiety & intensity be more of a factor with “a-fib” and not the duration or length of the event?

I also can hurt more after an intense 5k race vs. an Ironman or endurance event. It seems intensity and race jitters could be factors. With Ironman training & endurance racing, you learn to keep your heart rate low so you can race longer (Just a thought!).

16

Very interesting reading, and closer to the data I’m looking for than anything I’ve seen before. So, in layman’s terms, what does it mean that middle-aged endurance athletes are at higher risk for LAF? Is there evidence of increased incidence of MI’s amongst the populations studied? Did I get the wrong impression, or did I understand that there is a treatment for LAF that is proven to be quite effective? It looks as though the “jury is still out” on what the findings of those studies mean, or again, did I get the wrong impression?

And the question then remains: Which puts a 55 year old male at higher risk for early death due to heart disease: sitting on my ass eating ice cream and buttered popcorn (my two weaknesses) or getting off my ass and swimming, riding and/or running, sometimes for well over an hour, and maybe someday entering an endurance event that will take hours to finish?

As I mentioned before, I am no doctor and I too wrestled with all these questions. The fact that I had atrial flutter may have nothing to do with my 10 years of Ironman training. It may just be bad luck of the draw. Endurance training simply seems to increase your likelihood of at least atrial flutter and LAF as you increase in age. I have none of the usual risk factors except for an enlarged atria (result of endurance training). Since these studies are based on population studies, we will likely learn a lot more as the thousands of Ironman repeaters get older and enter the databases. According to my cardiologist, there is indeed an invasive cardiac procedure that can be successful in many cases. Hopefully, this will never happen to me again, but if it does (I am 47) this will be the likely path.

Nevertheless, reasonably, if your main goal is to be healthy, in my opinion, it would be wise to limit aerobic exercising to a few hours per week and do core work, weight lifting and yoga instead of all these extra swim/bike/run sessions. Practically, I hate weights and don’t care much about yoga. I like long distance triathlons and i hope that the benefits outweigh the potential problems. I just don’t kid myself into thinking that Ironman training is a healthy endeavor.

Francois in Montreal

17

*I certainly can’t back this up with any study, but for quite a while I’ve felt that all my intense (bike) training and racing is not particularly healthy. I may be race-fit, but overall not sure it is really healthy. I think I would be more “healthy overall” with less intensity, less volume, and more diversity. (and less caloric requirements everyday) *

I totally agree with all of the above.

Francois in Montreal

18

Excellent article. Just not what most on here want to hear. Especially those who don’t actually “race” the IM distance - like me- then again I’m retired from IM so I’m a little more open to this line of thinking.

19

Interesting.
We have a knowledgeable medical professional, athlete, stating something people don’t want to hear (and he seems reluctant to say), and the people hearing it (who have a vested interest) saying he must be wrong.

Popcorn at the ready.
As a mid-40’s newbie both sides of this interest me.

Do tell, doc, I’d like to hear more.

20

Interesting.
We have a knowledgeable medical professional, athlete, stating something people don’t want to hear (and he seems reluctant to say), and the people hearing it (who have a vested interest) saying he must be wrong.

Fair enough. Speaking for myself, no, I don’t want to hear what the good doctor is stating. I’m questioning what he’s saying not only because I have a vested interest–again, fair enough–but because it doesn’t make sense. I, and others, are asking for the studies, the evidence and the data, the sort of stuff that our Montreal friend posted.