Walk away from marathons, some doctors advise
Jim Rohm said he doesn't know for sure whether the heart attack he suffered more than two years ago following a long run was due to the stress that 35 years of marathons have placed on his heart.
He also can't rule that out as a possibility.
“Am I a walking time bomb?” said Rohm, 67, of Baldwin Borough said. “My doctor says no, but I don't know if I believe him.”
Though marathon participation is at an all-time high, some doctors believe too much running can actually become a bad thing, placing an inordinate amount of stress on the heart, knees, shins and back.
How much is too much? It depends on who you ask.
Dr. James O'Keefe, a clinical and research cardiologist at Saint Luke's Mid American Heart Institute of Kansas City and one of the country's most prominent voices on the topic, teamed with Dr. Robert Schwartz of the Minneapolis Heart Institute to produce a study that was released in April and found high-mileage runners are 62 percent more likely to develop coronary artery plaque.
In Rohm's case, there was a buildup of plaque on his heart. A piece broke off and shut down three valves. Rohm, who had just finished showering after a 10-mile run, went into cardiac arrest before his wife, Nancy, could revive him.
“If there's no one there, it's over,” said Rohm, who now alternates walking and running for much shorter distances, fearful of raising his heart rate over 90 beats per minute. “Guess it wasn't my time.”
Over 35 years, Rohm ran 15 marathons, averaged 15-30 road races a year and logged 50-60 miles per week training.
He quit marathons, though, not only after his heart attack but because he came down with infected kidneys after Nos. 13, 14 and 15 from all the pounding.
“There's no bigger high in the world than when you finish (a marathon),” Rohm said. “But there is a wear and tear on the body.”
O'Keefe believes less is more: one to four miles at a time, two to five runs per week. He understands the obsession with completing the 26.2-mile race but thinks one marathon should suffice.
The heart, which suffers small tears by pumping the amount of blood necessary for endurance sports, simply gets worn down over time.
“If you want to run a marathon or a full-distance triathlon, it won't kill you,” O'Keefe said. “Highly unlikely. One in 100,000. Those are pretty long odds. It's just not a pattern that appears to be associated with ideal cardiovascular health.”
THANKS, NO THANKS
Chris Borsani doesn't deny that high-mileage running can take a toll on his body.
The 31-year-old Upper St. Clair resident simply enjoys doing it too much to care.
“I convince myself that the science must be wrong,” Borsani said. “That it's not as bad as they make it out to be.”
Borsani isn't alone. Many hardcore runners think what O'Keefe and others are finding is more the result of manipulated numbers and skewed sample sizes than actual medical discovery.
Dr. Moira Davenport, an emergency and sports medicine physician at Allegheny General Hospital and herself a veteran of 12 marathons, admits marathons are taxing. But she worries more about dehydration and kidney problems.
The heart is a muscle, Davenport argues. It can be stretched out and manipulated. Running can also have osteological benefits than one can't gain from living a sedentary lifestyle.
“Strengthening a muscle is good — in moderation,” Davenport said. “And there have been a lot of studies that show if you have reasonable biomechanics, it's actually protective for your joints.”
A few recent tragedies have given the debate new life. Kyle Chase Johnson, a 23-year-old from Wexford, died a mile shy of the finish line during last year's Pittsburgh Half-Marathon. In April, two men in their 30s died during a half-marathon in North Carolina, and a day later a man in his 40s died while running the London Marathon.
Tragic? Sure. But a small drop in the bucket compared to the total number of people running marathons.
In 1980, 143,000 people completed a marathon, according to Running USA. From 1990 to 2000, those numbers went from 224,000 to 353,000.Last year, 1,110 U.S. marathons produced a record 541,000 finishers. According to a 2010 American College of Cardiology Study, the risk of sudden death during a marathon is 0.8 per 100,000 people.
Sunday's Pittsburgh Marathon was sold out for a sixth consecutive year, with more than 30,000 people set to participate, an event record. Further, there are 3,611 entrants age 50 and older, more than double the 1,529 who ran in 2009.
“I've never thought of it too much from a negative or a taxing standpoint as much as the benefits: increasing my cardiac output and oxygen-carrying capacity,” said Erica Cappabianco, 34, of Ellwood City. “I've looked at it as a positive thing and a healthy thing.”
TAXING THE HEART
So how could running, long seen as a pillar of good health, become a bad thing?
According to O'Keefe, the heart pumps five liters of blood per minute at rest. Intense running increases that total to 25 or 30, he said.
A second issue involves free radicals, molecules containing oxygen atoms that attack cells in our bodies. More are produced when we run, but O'Keefe said the human body is equipped with only enough antioxidants to combat about an hour's worth of free radicals.
“When the volume stretches out like that and goes from five liters to 25 liters, when the free radicals start causing some tissue damage, you get some microtears (of the heart),” O'Keefe said. “The chambers (of the heart) are stressed out.”
Further, O'Keefe believes “veteran endurance athletes have a five- to eight-fold increase risk for atrial fibrillation,” also known as an irregular heartbeat.
“If you look at marathoners, you can see that at least half of them will have evidence for heart damage,” O'Keefe said. “If they came into an emergency room, and we didn't know they had just run a marathon, we'd say, ‘Oh geez, you just had a warning heart attack. We need to do an angiogram on you.' ”
Other than bone density, there does not appear to be many differences between males and females when it comes to who's more susceptible to serious injury, Davenport said.
Dr. Martin Matsumura, the co-director of the Cardiovascular Research Institute at the Lehigh Valley Health Network in Allentown, takes a softer stance. He knows that marathon running isn't harmless, but everybody's upper limit is different. “That may be five miles a week for some people and 50 miles a week for other people,” he said. “It's extremely variable.”
RACKING UP MILES
Matsumura raised a few eyebrows at the American College of Cardiology's annual meeting in Washington, D.C., at the end of March, when a study he's working on became public. The study found people who get either no exercise or are high-mileage runners tend to have shorter lifespans than moderate runners, though Matsumura and his research team found no definitive reason why.
Dr. Aaron Mares, a sports medicine physician at the UPMC Center for Sports Medicine, has seen plenty of older runners who suffer from joint and heart problems — yet he points out there's no way to pin them solely on running.
“It's a difficult question because we don't have great literature and studies to prove that there is an adverse effect with higher-mileage running,” Mares said. “It looks like (Matsumura) looked at several variables and concluded, without a cause, there's an increased risk. It's difficult.”
Rich Wright, 62, coaches cross country and track at Baldwin. He also works the finish line of the Pittsburgh Marathon and said people have a tendency to overtrain, obsessed with racking up miles — around 600 constitutes the average training for a marathon.
Wright would know: Come Aug. 2, he will have run at least one mile per day every day for the past 24 years, a stretch that also includes 23 marathons.
“You hear so many times people get injured because they go out and follow someone's book or philosophy on how to train,” Wright said. “Or they try to put in so much mileage before the race that by the time the race comes, their bodies are worn out.
“People feel they need to put in this ungodly amount of miles. It makes you susceptible to injuries.”
Incremental training is key, UPMC neurologist Dr. Joseph Maroon said.
“When I first started doing triathlons 25 years ago, I couldn't run a mile,” said Maroon, who completed the Ironman in 1993 and since has done eight at that distance. “I walked four times around the track, and I thought I was Roger Bannister.
“I started doing a little more each time, and eventually I was running like Forrest Gump through Bridgeport, Ohio.
“You can't go from 0 to 70 right away. You'll burn out the engine.”
BE SMART ABOUT IT
Bob Rummel leaves his Latrobe home and arrives at the Westmoreland Athletic Club before 8 a.m. five days a week.
Rummel, 68, will start with cycling, then run on a treadmill for an hour and a half to two hours.
That's followed by yoga and weights to strengthen his core and the rest of his upper body.
Rummel doesn't leave until 1:30 or 2 p.m., but he feels it's necessary for the 70 marathons he's run.
“I think I overdo it, but I feel good,” Rummel said. “I know how to work it so I don't over exert myself.”
Which includes taking cues from how his body reacts to a given workout — and stopping if things go south.
“I don't listen to music when I run,” Rummel said. “I listen to my body. It can tell you when you're overdoing it.”
Bruce McGlothlin, 67, of South Park, found an alternative for his balky knees: trail running. McGlothlin gave up road races about 10 years ago and hasn't looked back.
“I love the trails,” McGlothlin said. “It's easier on your joints. Plus, it's more interesting.”
Whether it's on limestone or cement, running for hours at a time can carry risks. How much remains unclear, as everyone's threshold is different.
And until something more concrete is learned, runners like Borsani aren't willing to cut back.
“We like challenges,” Borsani said. “Plus, a lot of people abide by the mentality that your body will tell you when enough's enough. If your body isn't stopping you, then it's not enough.”