A friend and colleague, Bill Blewett, University of Oklahoma (1969) was one of the best walk-ons ever at that school. He is in the process of writing a book on training and it's effects both good and bad. He, along with many others of his day now realize that they may have pushed themselves too hard, not taking sufficient rest between hard days and thus ended their careers early with injuries, psychological burnout, and most destructively developing heart problems related to their physical activities as young and middle aged men. Bill is sharing a chapter of his book in development which we feel is worth taking a look at and considering some of the ideas that he has proposed in relation to ourselves.
The chapter is titled "Fear of Death on the Run". Reading this chapter and others that he has graciously shared have given me some cause to look at how long some of the top middle and distance runners in the world have fared in the longevity race. I'm using Olympedia.org to find the age at death of anyone who ran in distance races in the Olympics. I realize that for many it is too soon to start looking, because most of them are still alive. But when I go back to 1952 and earlier, not many of them are still standing. I will let you know my findings in a subsequent post. But for now, enjoy this chapter by Bill Blewett. But I warn you not to read it just before you go to bed.
Chapter 21: Fear of Death on the Run
There is a memorial run held annually in Bel Air, Maryland, honoring Scott Dana Smith, a good friend of mine who was a well-known runner locally, a popular grade-school teacher, and a mentor to many runners. Scott was a marathoner. He had completed 34 marathons before he suffered a heart attack while running a 5-mile road race in March 2010. Two miles into the race, Scott suddenly felt breathless. In his 30 years of running, he had never failed to finish a race, but this sudden distress alarmed him so that he stopped running and walked to the finish. In the emergency room later, he learned that he had suffered a heart attack. A blood clot had lodged in blood vessel serving his heart, causing permanent damage to a portion of his heart muscle. In essence, the damage reduced the maximum pumping power his heart could produce. The loss was irreversible, and unless he moderated his running, he was a candidate for another, more serious heart attack. This seemed a most unlikely result of his many years of running, which began on the track team in high school. He had not missed a day of training in 12 years and was running an average of 50 to 60 miles per week. He felt in perfect condition when he began the 5-mile race, just a day after an 18-mile training run in preparation for running the Boston Marathon. Scott remained hospitalized for a week. His level of fitness and self-awareness saved him from a much worse outcome and helped him resume exercising after the two months of rehab his doctor prescribed. First, he began walking, then a month later he ran an easy 5K. Eight months after his heart attack, he completed a marathon, the first of 11 he would run after the heart attack. He also ran 19 half marathons. “I still race a lot, but I don’t do it as competitively,” he told me. “I don’t take things for granted like I used to.” Five years later, Scott had a second heart attack in his sleep the night after a routine training run. This one was fatal. He was 46. Scott was not my first friend to suffer heart failure on or after a run. Over the years, there were six other runners in Harford County whom I knew and wrote about in a weekly runners’ column for the county newspaper, The Aegis. Two years before Scott died, Dr. Tom Jordan finished a workout on the recreation trail in Bel Air, got into his car to leave and died. He too was a good friend. The chief of surgery at the local hospital, he once performed skin cancer surgery on my forearms. During the procedure, he and I conversed constantly about running and runners. He looked perfectly fit and healthy before his death at age 54.
Rob March had decided to skip his workout the day he died. He wasn’t feeling well after running 13 miles the day before. Rob was a youthful, vigorous athlete who had logged more than 50,000 miles in 21 years of running. A year earlier, while wearing a heart monitor, he found that his heart rate would accelerate rapidly a few miles into the run. This induced him to undergo a treadmill stress test, and a month later catheterization to correct the cause of his irregular heartbeat. His doctors felt confident in the success of the procedure and placed no restrictions on his running. He died in his sleep at 43, the same age at which his father died.
Bill Barnholth came home after a jogging workout, laid down on the couch to take a nap before supper and never woke up. He was 57. A former college linebacker and power lifter, he had slimmed down from 255 to 180 with running and dieting. For 15 years, he was a back-ofthe-pack participant in scores of running events, never winning an award but always finishing the race. In the months before he died, he lost 25 pounds by dieting and running 25 miles per week.
Doug Anderson was a state champion runner when he was in high school. In the 15 years after high school, he gained a large amount of weight, topping out at almost 300 pounds before he made a remarkable comeback as a runner slimming down to 195 pounds. At age 37, he finished a mile race in 5 minutes, 15 seconds and died soon after crossing the finish line. He had recently undergone a routine physical examination.
Paul Perkovich, the athletic director at C. Milton Wright High School in Bel Air, ran the first of his 15 marathons in 2003 in 5 1/2 hours then improved steadily to a personal best of 3:25:10 four years later. He ran the Boston Marathon three times, in 2010, ’11, and ‘12. The fastest time of the three, 3:41:49, came at age 47 in the brutal conditions of 2012 – a sunny day in which the temperature rose to 87 degrees. It was one of the hottest Boston Marathons on record. Six and a half years later, he was training for another marathon when he went for a routine run alone one September morning. He did not return. He was 53 years old.
I lost another good friend, Dave Starnes, to a heart attack that happened after an easy walking workout. winning the North Carolina state championship in cross-country in 1962 and 1963 and in track in 1964. He developed into a record-setting middle-distance runner at the University of Maryland, twice winning the Atlantic Coast Conference Championship in the 2-mile run, setting a school record of 8:55. He also set the 3-mile run record of 13:50. He died at 73. He was always active, and when the knee replacement surgery ended his running, he turned to hiking, biking, and golfing. It is uncertain, but the artificial knees could have caused thrombosis that killed him.
When I was in my sixties, I looked back on the deaths of these vigorous, seemingly healthy runners in our community and worried that I too might be a candidate for heart failure. It seemed an irrational fear, as I had no family history of heart disease and had passed recent physicals involving electrocardiogram testing of my heart. For years, I had felt fit and healthy in my training even though my pace had slowed considerably. But I realized that these seven runners who had died probably felt the same way. I began wearing a chest-strap heart monitor in my interval workouts on the treadmill. It gave me some assurance that my heart was responding as it should to these moderate-intensity workouts.
But the more I learned about runners suffering heart failure, the less confident I became in the health of my heart. Accounts of some world-class runners’ heart failures worsened my fears. I had watched Peter Snell on television win three Olympic gold medals for New Zealand in 1960 and ’64. He set world records in the middle distances with a formidable kick and remained active after his international racing days ended. In 1988, at age 49, he ran a masters mile race in Madison Square Garden. He won the U.S. orienteering championship in the over-65 age group, and he competed in table-tennis events at the World Masters Games six years after he was diagnosed with dilated cardiomyopathy, a condition in which the heart’s left ventricle is enlarged and weakened by thinning walls, limiting the ability to pump blood efficiently. This led to his fatal heart attack at age 80.
Ron Clarke was perhaps the greatest distance runner of all time. He, set 18 world records, 12 of them in one six-week tour of Europe in 1965. In the 1968 Olympics, held in the high altitude of Mexico City, he finished sixth in the 10,000 meters but collapsed unconscious from lack of oxygen. He sustained permanent heart damage in the race and eventually had a heart valve replaced. He died of kidney failure at age 78.
Alberto Salazar was a three-time winner of the New York City Marathon. In 1982, he set American track records in the 5,000 and 10,000 meters and won the Boston Marathon in 2:08:51, beating Dick Beardsley by 2 seconds in what became known as the Duel in the Sun. It was a classic race in which temperatures climbed into the 70s. Salazar, severely dehydrated from failing to take water, collapsed at the finish and was given six liters of saline solution intravenously. The victory, however, is seen as the turning point of Salazar’s career in which he adhered to the more-is-better training regimen (running up to 200 miles per week). Fifteen years later, at age 48, he suffered a heart attack while coaching. His heart stopped for 14 minutes before he was miraculously revived (ref, his book 14 minutes) These tragic endings affirm that the heart is not infinitely durable, not even with the dividends of being constant and faithful to daily aerobic workouts.
Long term immunity from heart disease does not accrue in proportion to running mileage, certainly not if the heart is abused in overtraining and over-racing. It can beat reliably for a century if cared for properly, or it can be damaged by exceeding its redline redefined by muscle damage and enunciated by pain, breathlessness, or collapse when the heart is stressed. I had dreamed of becoming like these world-class runners in performance, but I wondered: was my fate instead to suffer heart disease as they did? Was there hidden within me a flaw that would one day be fatal. Would it be a tiny clot that would break loose and lodge in a blood vessel serving the heart. Or would there be a gradual narrowing of an artery through atherosclerosis, a disease that afflicts almost every person without their knowledge, until the physics of fluid flow drastically alters the equation of blood supply -- a reduction of 50 percent in the open area (diameter) of the artery reduces the flow to one-sixteenth its original flow (1/2 to the fourth power) strangling a portion of the heart muscle to death when it’s called upon to support strenuous exercise.
Such was Jim Fixx’s fate. He had lost a portion of heart muscle to heart attacks on the run and ignored the loss of power it caused, probably thinking that running would cure it. It was one factor that led to his fatal heart attack on what was to be a routine 10-mile run one summer afternoon in Vermont in 1984. When Dr. Kenneth Cooper learned of Fixx’s death, he felt compelled to explain it to the world. Fixx was the author of The Complete Book of Running, which sold over a million copies. As the title implied, Fixx knew all about running, its best practices, benefits, detriments, hazards and how to avoid them. He practiced what he taught in the book, though not completely. That became apparent after July 20, 1984. In his 50s, he routinely ran 10 miles a day, seven days a week, and on that date he went out to run his usual 10 miles on an 80-degree summer day. He turned around after only 2 miles due to some discomfort and ran slowly back toward his motel. He stopped after 4 miles then collapsed and died of a heart attack on the side of Highway 15. He was 52 years old.
“Little did I realize the impact Jim’s death would have on my life and on joggers and runners all over the world,” wrote Dr. Cooper. (REF: Cooper, K.H., Running Without Fear, Transworld Publishers, London, 1986.) “The press, the media, Jim’s followers, non-exercisers, and the merely curious came to me or called from everywhere and they all asked the same question: “How could Jim Fixx die while jogging?” Cooper is the author of "Aerobics", and 18 other books which together have sold 30 million copies and been translated into 41 languages. A physician, he coined the term aerobics and established the hugely successful Aerobics Center in Dallas, Texas. He was a miler at the University of Oklahoma a few years before I ran there, and he has, as of age 90, logged over 38,000 miles of running. He arranged for an exhaustive investigation to be conducted by his friend William Proctor, an attorney, author, and former reporter. The product of his investigation was Running without Fear, a thoroughly researched, well-written book that should be a must-read for coaches and runners of any age.
Here are some of the findings about Jim Fixx. His autopsy showed he had extensive blockage of three vessels of his two coronary arteries resulting from the buildup of fatty substances. He had suffered at least three mild “silent” heart attacks, as evidenced by scar tissue on the heart. One occurred two weeks before his death, another 4 weeks before, and another 8 weeks before. He had been a heavy smoker for years before he started running. Smoking can lead to heart attacks by interfering with the blood supply to the heart. His lifestyle before he began running was sedentary, and he became as much as 60 pounds overweight before he slimmed down to about 170, his weight at the time of his death. His family history was ominous. His father had suffered a massive heart attack at age 36. His heart was abnormally large, and probably had been so since childhood. He did not undergo regular, comprehensive medical exams and had never submitted to a maximal stress test. Four years before his death, he had a medical exam in which the electrocardiogram showed significant abnormalities, which were never followed up on. He had been under a great deal of stress for years. He had experienced angina chest pain in the previous month. Running Without Fear was published in 1986. Though I was well aware of Jim Fixx’s death when he died, I did not read the book until three decades later, when I was looking for assurance about my own heart’s durability. One very important finding described in the book is that Fixx likely did not cool down at the end of his fatal run. He simply stopped his run abruptly. This may seem trivial to experienced runners, who usually delay their cooldown or don’t run one at all, but cool down is extremely important. Done properly it might have allowed Fixx to run another day, although he would not have escaped his fate for long without medical intervention. “The basic, guiding principle is never stop exercising suddenly,” wrote Dr. Cooper. “Don’t stand still. Don’t sit. Don’t stand motionless while taking your pulse. Keep moving, keep moving, keep moving!” How does failure to cooldown adversely affect the heart? When a runner finishes a race, workout, or strenuous repetition, both the heart rate and blood pressure are very high. They remain high for several minutes, but in stopping, standing still, or sitting down, the muscle pumps in the legs, which are auxiliary pumps for the heart, stop pumping blood upward to the heart.
As described in Chapter 20, with inactive muscle pumps, the blood settles in the veins of the lower legs and feet, forced downward not only by gravity but also by the blood pressure and velocity produced by the pounding heart. The one-way valves in the veins of the legs that comprise the muscle pumps cannot stop the downward flow through the arteries, and the very flexible walls of the veins expand to accept the fast-flowing blood. No longer flowing back to the heart, a substantial amount of blood collects in the veins of the lower legs and feet and is taken out of circulation. This reduces the flow of oxygen-rich blood to the muscles of the heart, and to the brain. Failure to cool down is thus the trigger for heart failure. After long and/or intense runs on warm days, it can become a hair trigger, as blood volume can be reduced not only by evaporative losses through perspiration and respiration but also by redirecting some blood flow to the skin for cooling. And if there is partial blockage in a blood vessel of the heart, even if it is causing only minor symptoms, the sum of the decrements in blood flow can reach the point of heart failure. I checked out my own trigger mechanism during an interval workout on the track one day using my chest-strap heart-rate monitor. After eight repetitions of a 100-meter fast run followed by 100-meter walk, I stopped abruptly and watched my heart rate drop. In the walking rest interval, my pulse had dropped from 160 to 120 in about 2 minutes, but when I stopped abruptly after the last rep, it dropped quickly past 100, then past 90, 80, 70, 60, and 50 at rather frightening rate and bottomed out at 40 before I began to walk to bring it back up. It was unnerving. I was seeing how the trigger works, but without the heart defect that would complete a fatal combination. I visited a cardiologist for the first time in 20 years, and submitted to a full series of tests on my heart.
The testing was not confidence-building, however. The doctor did not understand, though I told him, that I was a long-time runner, and I wanted specifically to know that if after 50 years of interval training I should continue interval training. I wanted to know If my heart was enlarged and if so was there a commensurate increase in its wall thickness. I told him what concerned me was still experiencing skipped beats, the same type I first noticed 55 years earlier. I said I could feel my heart stretching in my chest after arising in the morning or after going upstairs in the morning. Was it supposed to stretch so noticeably? I don’t remember this happening when I was younger. He seemed not to consider any of this information I presented to him. I believe that it didn’t matter to him that I was a long-time runner. He viewed me only as any 74-year-old male. Consequently, he prescribed the stress test not as maximal, contrary to what Dr. Cooper recommended in his book. It was sub-maximal, apparently for safety reasons, and consequently less stressful than my routine interval workouts. It was a nuclear stress test, however, and it did show that there was no blockage of the blood vessels of the heart. That gave me a little confidence. What did more to build my confidence in my heart was reading Dr. Cooper’s Running Without Fear. It provided powerful lessons that all runners and coaches should read.
Dear George:
For those who think running is a panacea that will let them live forever this article may be a wake-up call. All of us who run are acutely aware when we hear of fellow runners dying in or after a race or during a workout. I'm sure most, if not all, know just such a person.
The article speaks of death.............but not of quality of life. Whether yours is long or short quite probably depends most on who you chose as your parents and their genes.
What matters is not how long you live........but how you live. How often did you get to experience running all out in a race? How often did you spend time running with companions, talking, laughing, telling stories and feeling alive as the pack runs down a street or along a path? How often have you shed stress or unhappiness as your body adjusted to the pace and you felt alive and in command once again.
I'm 88 and much of my current running is around ten p.m. in the corridors of a retirement community. But, when weather permits, there is a woods trail with small hills, clean fresh air and Lord knows how many tiny animals and birds wondering who that bigger animal is walking or running by them. Will I die there some day while on a workout? Could be!
There are worse ways for your soul to leave this earth.
Stay well and
Take care,
Tom Coyne
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