Death by Exercise

by Zubair Ahmed
Hundreds of guys -- including some of the world's fittest men -- have taken their final breaths while wearing running shoes. Here's how to outsmart the reaper
Guy goes out for a run. It's just a 4-miler--nothing, really, to a seasoned marathoner who usually runs 10 miles a day, 7 days a week. Nobody knows why he stops 40 or 50 yards short of his front door--maybe he's checking his pulse, maybe he's tying a shoe--but everybody knows what happens next to Jim Fixx, the 52-year-old patron saint of running: He dies.

You've heard that story. But you may not know about Edmund Burke, Ph.D., who was to serious endurance cycling what Fixx was to running. He died on a training ride last fall, at age 53.

And you almost certainly haven't heard of Frederick Montz, David Nagey, or Jeffrey Williams, three brilliant physicians at Johns Hopkins University who died while running. The oldest of the three was 51.

You'd think that exercise icons should live to be 100. And yet, every year, a few of them go permanently offline at half that age.

Two questions arise. The first is obvious: Why do the hearts of such highly conditioned men fail during exercise designed to make their hearts stronger? The second is so radical it borders on treason against the health and fitness cause: Is there something wrong with the entire notion of endurance exercise as a healthy, life-extending activity?

I've been skeptical about the benefits of aerobic exercise for years. But the answers surprised even me. Pull up a chair--you'll want to be sitting down when you read this.

The Road to Nowhere
The idea that a well-trained endurance athlete could just drop dead was unfathomable a generation ago. Thomas Bassler, M.D., went so far as to say that anyone who could finish a marathon in less than 4 hours could not have serious heart problems. He conducted a study on 14 marathoners who had died of cardiovascular disease, and concluded that all were malnourished. Unfortunately, he reported this conclusion in the July 27, 1984, edition of the Journal of the American Medical Association. Fixx had died 7 days earlier.

Nobody today believes that endurance training confers immunity to anything, whether it's sudden death from heart disease or the heartbreak of psoriasis. Every time you lace up your running shoes, there's a chance your final kick will involve a bucket, and every expert knows this.

"I think the risk is inescapable, and it's bigger than we're letting on," says Paul Thompson, M.D., director of preventive cardiology at Hartford Hospital in Connecticut and a researcher who studies sudden death and exercise. One of Dr. Thompson's studies showed that 10 percent of the heart attacks treated at his hospital were exercise related. "Those heart attacks tend to be in people who aren't fit," he says. "But that doesn't mean that's the only group that gets it, unfortunately. There are these very fit guys who go out for a run and drop dead."

Dr. Thompson's studies and others show that the chances of sudden death are about one in every 15,000 to 18,000 exercisers per year. That comes to one death for every 1.5 million exercise bouts. Curiously, the most serious endurance athletes seem to be at the greatest risk. Here's how it breaks down, according to an often-cited 1982 study published in the New England Journal of Medicine: <* />
• One death per 17,000 men who exercise vigorously 1 to 19 minutes a week
• One death per 23,000 men who exercise vigorously 20 to 139 minutes a week
• One death per 13,000 men who exercise vigorously 140 or more minutes a week

I had to look at the chart twice to see its startling conclusion: The highest death rate is among the men who exercise long and hard, and is much higher than that of the men who exercise short and hard. Worse, the guys who do hardly any vigorous exercise had a lower death rate than the guys who do the most.

About a zillion studies -- I lost count in the millions -- have shown that aerobic exercise leads to a healthier heart and a longer life.
Exercise Caution
Stay Alive
You're young and you're extremely fit. Almost always, that's a good thing. But in rare cases, a high fitness level hides--and may even help cause--a heart disorder known as ARVD. It's a genetic condition in which the muscle of the right ventricle turns into fatty or fibrous tissue.

Signs of ARVD (arrhythmogenic right-ventricular dysplasia) and other stealthy cardiac disorders include the following:

• Passing out, especially during exercise
• Heart palpitations, especially during exercise
• Sudden death of a family member, particularly a sibling or parent, before age 60. A heart attack "out of the blue" might be an indication of a hidden genetic condition


In ARVD, as the right ventricular muscle changes, abnormal heart rhythms occur, leading to the symptoms. If you're worried, go to a doctor--a series of noninvasive tests can determine whether you have the disorder. The Web site arvd.com can give you more information.

Ironically, patients with ARVD can be very fit athletes; extreme exercise may trigger the condition in those with the inherited susceptibility, says Hugh Calkins, M.D., director of electrophysiology at the Johns Hopkins Hospital. Moreover, young, athletic men often shrug off the warning signs

ARVD affects about one in 5,000 people but may be the cause of up to 20 percent of sudden cardiac deaths in people under the age of 35.

Coronary artery disease and heart attacks account for about 80 percent of the sudden cardiac deaths in America each year. ARVD and other inherited conditions cause the rest, Dr. Calkins says. These disorders, which affect men more than women, include long QT syndrome and Brugada syndrome (problems with electrical impulses in the heart), and hypertrophic cardiomyopathy (thickening of the heart muscle