Somehow this is trending on Reddit: Sudden death during triathlons higher than expected.
The first graph, showing participation rates, is perhaps more concerning to people around here. :o
I like the delicate phrasing of a negative health impact rather than just saying died. That is the ultimate negative health impact.
Also, for anyone with a grasp on math, what are they correct in saying that it is more deadly by a factor of 1,000? My basic math seems like 0.5 to 1.74 is about 3.5 times more likely.
The 0.5 number is per year; the 1.74 is recorded only during competitions. The 1,000 comes from the issue arising on a particular day of the year versus any day in general (perhaps any other day during the year). 0.5 / 365 = 0.00137 They probably left it at 0.5 for the article because decimal places and scientific notation frighten less geeky people.
And, to the other question, 135 has perfectly reasonable statistical significance. The denominator is somewhat irrelevant. The better question would actually be where the data for the baseline population comes from and whether or not they controlled for appropriate factors including unreported incidents.
Also worth noting that performing regular exercise is not mutually exclusive to the occurrence cardiovascular disease. There is a correlation that regular exercise can slow the progression, but if you eat like crap, it’ll still catch up to you. I’ve seen a lot of triathletes, cyclists, and runners eat total garbage…must be all those endorphins making them feel invincible.
Also, for anyone with a grasp on math, what are they correct in saying that it is more deadly by a factor of 1,000? My basic math seems like 0.5 to 1.74 is about 3.5 times more likely.
0.5 per year vs. 1.74 per day.
The differences for men vs. women and older vs. younger are remarkable, but maybe that just tracks cardiovascular disease overall. Men over 60 have about a 1 in 5,000 chance of dying in any given race!
You also have to keep in mind that this list of deaths does not include the dozens and dozens of people that die in training for triathlon. I know personally of over a 1/2 dozen(friends) that died in workouts, and in all 3 different sports. I’m guessing that this number may dwarf the actual dying on race day ones, so the %'s are really a lot higher than these studies lead us to believe…
Also, for anyone with a grasp on math, what are they correct in saying that it is more deadly by a factor of 1,000? My basic math seems like 0.5 to 1.74 is about 3.5 times more likely.
0.5 per year vs. 1.74 per day.
The differences for men vs. women and older vs. younger are remarkable, but maybe that just tracks cardiovascular disease overall. Men over 60 have about a 1 in 5,000 chance of dying in any given race!
Thanks, I knew I was reading it wrong. The italics were throwing me off.
It would be interesting to know the level of fitness and health history of those dying. Just because they signed up for a tri doesn’t mean they are healthy. There is a lot that can be learned as well as many conclusions to jump to.
It would be interesting to know the level of fitness and health history of those dying. //
**Don’t think you would learn much from that as it spans the spectrum. Newbies to seasoned athletes. All my friends that died in workouts were all world class, many ex pros. I have a suspicion that the more novice you are, the less likely you will die in the water. People that are slow and scared usually don’t blast out the swim, they sit back and relax more than the podium chasers. **
I was under the impression that it was the newbies that died during the swim because they panicked and their heart sped up and then exploded. Their panic being caused by the fear of water, wetsuit constriction the closeness of others in the water. And they also didn’t warm up and just went blasting in the swim. This last part would make sense for the data they have. Maybe a better question would be did they warm up.
I was under the impression that it was the newbies that died during the swim because they panicked and their heart sped up and then exploded//
You are under the wrong impression…
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I was under the impression that it was the newbies that died during the swim because they panicked and their heart sped up and then exploded//
You are under the wrong impression…
It could definitely be a story I created in my head (I do that some times) as a plausible justification for the deaths.
A quick search turned up this article with the doctor quoted as saying the potential explainations for the high number of death could be: “first, the adrenaline surge and pure number of athletes entering the water at the same time; second the fact that I suspect many athletes come from a background in running or other sports and may be less adept at swimming; third, swimming in a triathlon is totally different sport than doing some laps in the pool due to variability of extremes of waves people swimming around you and on top of you; fourth, the inability to rest properly if needed (or call for help) as you could do in the marathon and bike ; and, fifth, the difficulties in being noticed if the swimmer is in trouble due to the number of athletes in a body of water, which is not transparent. I think these are some of the factors that are related.”
His reference to the adrenaline surge and the number of people in the water are what I remembered from when theorizing why an athlete died at IM CDA in '12.
All you referenced is true, just not the newbie part of it. Anyone, and I mean anyone can panic in the water, I have on occasion myself. The trick is to recognize it and then deal with it. Most people don’t do that and the really unlucky ones end up dying. There are also other reasons for the swimming deaths, but safe to say they all end up with heart attacks/heart anomolies or strokes and then drown…People just don’t drown for no reason, not in races anyway.
All you referenced is true, just not the newbie part of it. Anyone, and I mean anyone can panic in the water, I have on occasion myself. The trick is to recognize it and then deal with it. Most people don’t do that and the really unlucky ones end up dying. There are also other reasons for the swimming deaths, but safe to say they all end up with heart attacks/heart anomolies or strokes and then drown…People just don’t drown for no reason, not in races anyway.
Overheating is another way. The head gets too hot, body reduces blood flow to protect the brain and swimmer goes unconcious.
Swim racing is risky business. I posted asking does anyone ever feel/body signals it’s at risk with their effort? I swim a lot, open water all summer long. Recent racing there’s a little voice that says “back off dude you’re pushing it too hard”. Not panic, just effort in environment of racing.
The comments above are all good. This issue is vexing and thought-provoking, for sure. I appreciate the interest of Dan and Slowtwitch in this issue over the years.
On the bright side, there have been fewer fatalities here in the U.S. in recent years…and only a single death so far this year at USAT-sanctioned races.
There has been a fair amount of media reporting yesterday and today about our study and article Some of that reporting has been a bit sensational, particularly the headlines. Unfortunately, the journal article in the Annals of Internal Medicine is behind a pay wall and short articles in the mainstream press sometimes miss important details.
I wrote a blog piece yesterday that shares the important findings and makes some suggestions about how we might continue to work to reduce the number of race-related fatalities:
http://www.athletesheart.org/2017/09/more-on-triathlon-fatalities-a-scientific-report/
I’d be happy to hear suggestions about what else we might do to improve on race safety. I don’t think this problem is (completely) going away.
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I’m glad I’ve taken up skydiving and do fewer triathlons. Jumping out of an airplane is a lot safer per jump than doing a tri.
thank you Larry…
as a guy in my late 50s I find the graph a bit chilling…
Doug,
Gets your attention, doesn’t it?
That graph doesn’t come directly from our article, so I can’t take credit. It was developed by a (physician) reporter who used some of our tabular data to make a very important point: the fatality risk is not uniform for all participants. Far from it.
Thanks to USAT, which kept very detailed participation data for several million participants in recent years, we were able to tease out the effects of gender and age on the fatality risk.
For women, there is increasing risk with increasing age, but that risk is always very low.
For men, though, the risk increases very dramatically with increasing age. For those over 60 years old, the risk of dying was 18.6 per 100,000 participants. That’s a big number. Think about it…~1 per 5,000 participants. I’m not aware of any other recreational sports setting where the risk of dying is so great. I think you’d have to look at activities like serious mountain climbing to get to such a high level of risk.
In my view, men older than 40 years (and especially those older than 60 years) should give very serious consideration to their health before participating.
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This is a bit disconcerting as an M65 preparing for Kona. But I agree with Monty that backing off when the signs of a panic attack are appearing is the key. In my case, once I get through the first 10 minutes I’m OK and can start to go harder but until then I have to go nice and easy to avoid the adrenalin-fuelled excessive pace and associated breathing difficulties (hyperventilating). Some may not find it easy to back off and go so slowly.
Definitely concerning for this 58 year old too. It would be very helpful if someone could find and post detailed info on all the 60+ plus men who have died in tris included in this study. My hope is that they were less experienced triathletes than I am so I can theorize that my experience will mitigate my risk compared to my peers.
Thanks Larry. I will read your blog piece tomorrow morning, but not before bedtime. 
Definitely concerning for this 58 year old too. It would be very helpful if someone could find and post detailed info on all the 60+ plus men who have died in tris included in this study. My hope is that they were less experienced triathletes than I am so I can theorize that my experience will mitigate my risk compared to my peers.
Thanks Larry. I will read your blog piece tomorrow morning, but not before bedtime.
Not just experience - it would be interesting to find out what actually happened in these cases. Were the racers fit or “fit”? Did they have congenital defects that finally got to the point where they caused problems in the water? Or is it truly random? I doubt the latter, but that’s what people seem to be assuming. Could it be that men are more likely than women to train and race with poor diet and health practices and it manifests in the water, like when shoveling snow? That seems likelier than being driven primarily by age alone.
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For men, though, the risk increases very dramatically with increasing age. For those over 60 years old, the risk of dying was 18.6 per 100,000 participants. That’s a big number. Think about it…~1 per 5,000 participants. I’m not aware of any other recreational sports setting where the risk of dying is so great. I think you’d have to look at activities like serious mountain climbing to get to such a high level of risk.
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Freediving. 10 to 100 times more deadly than triathlon.
Sometimes, I try not to think about my personal risk factors between being a deep free diver, mountain climber, a big wave surfer, and a triathlete. Should have been dead years ago if stats say anything