Is it safe to start training?

Before beginning to read, please know that what follows is just a long-winded introduction to a post that featured me as an expert. You can can scroll down to the link if you wish.

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This is that time of year. It’s a nice time. Longer days, warmer temps and big doses of hope power us all. Throngs of newbies run or bike through our neighborhood. I study them as I ride by, wondering…”How many are going to stick with this business? Gosh, that guy is suffering. He’s just doing it because his wife is forcing him. He’s jiggling and panting while his wife is floating and chatting. But might he stick with it?”  More wondering: “Could that guy get so hooked that he starts a blog on his way back from near heart disease? “My-Journey-Back-dot-com perhaps?”

Though many of these early season ‘participants’ are one-timers, many are not. They are as I once was. This training plan, this particular race, might be their click. My life as a competitive athlete got started one day many years ago in Indianapolis. Someone dared me to run the Indy 500 half-marathon. I did, in basketball sneakers and a cotton tee-shirt. And the rest is history.

But is it safe? People want to know: Am I okay to train—and race?

It’s a good question. Can you just get out there and drill it?

Or should you see a doctor first? Or…an even harder question: If you see a doctor, what tests, if any, should be done? (Notice that I did not say what tests ‘needed’ to be done.)

These are really tough questions, and clearly one answer does not fit all. Let’s try to frame the issue. On the hand, it is clear that regular exercise, and the fitness that it brings, does great things for health. No one would deny that. Regular and smart exercise is the best elixir. On the other hand, it is also well-known that starting a vigorous exercise program imparts short-term stress and inflammation, which, in the presence of heart disease, might be dangerous.  And we all know heart disease can be silent. Sadly, but truthfully, sudden cardiac death can be the first sign of heart disease. Though sudden death during races is rare, it is always tragic. Questions are raised: Could it have been prevented?

Here is yet another place where Medicine gets tricky. When clinical events are rare, like in this case, sudden death in new exercisers, it’s impossible to know what interventions or diagnostic tests make meaningful differences. (How do you prevent being struck by an asteroid—an exaggeration, but you get the point.) What’s more, even if we discovered moderate heart disease, it’s not entirely clear how best to treat it, especially when no symptoms are present.

So you use clinical judgment. You balance the risk factors present in the patient, your knowledge of the limits of testing, the risks of over-diagnosis, against the knowledge that exercise is beneficial and that training for a race often induces a lifetime of living a healthy lifestyle.

Enter social media. Free-range discussions, written in normal language, on matters of clinical judgment rarely happen in the medical literature. And when they do, the prose is careful, edited, and quite sterile. Social media is different. Though not peer-reviewed, the prose is practical, real and may I even say, normal.

With that lengthy introduction, I want to point you to an incredibly useful post on pre-participation screening for heart disease. Dr. Larry Creswell, a heart surgeon, triathlete and prolific curator of useful information on heart disease and athletics has published yet another important addition to the knowledge base of screening athletes.

I was delighted to participate as one of four experts that considered four different screening scenarios. It was flattering to be included with such lofty company. Other members of Dr. Creswell’s ‘ad-hoc’ expert panel were Dr. Jonathan Dresner, a noted academic professor of Sports Medicine and NEJM-author, Dr James Beckerman, Portland cardiologist, team doctor of the Portland Timbers, and noted cardiac-screening activist, and Dr. Philip F. Skiba, Program Director for Sport and Exercise Medicine at The University of Exeter, UK.

The title of the post is Ask the Experts: Pre-participation Heart Screening for Adult Endurance Athletes.

As always, I hope you find it useful. You probably already know this, but there’s lot of other great stuff over at the Athlete’s Heart Blog.

JMM