Damage to your heart is one injury you definitely don’t want; you might not live through it. As a conclusion to the several articles I have written discussing heart damage and exercise, including the article I wrote two weeks ago,“Enough of the Aerobic and Endurance Bashing Fostered by ‘New Research’ and Personal Agendas”, I want to provide you with some ways you can lower your chances of being that guy (or gal) who died suddenly due to some “unforeseen” cardiovascular event. After all, it really doesn’t matter how healthy you think you are, or how fast, lean, or strong you or anyone else perceives you to be, if you’re a time-bomb waiting to go off. Rather than end up dying from something that could have been prevented, let’s learn how to tip the scales in your favor and pay attention to some warning signs so you can prevent a catastrophic injury to the most important muscle in your body.
Every time you train you should have some goal in mind for that particular training session whether it’s an easy recovery run, some mobility work, or a killer strength and conditioning workout. Training mindlessly as many often do can often lead to mediocre gains, or injuries of any type. How you progress in your training is also essential – you don’t want to run if your heart rate is high just from walking, or lift heavy with poor form. Training is also as much about working out as it is about recovery, so the harder you push yourself the more you have to rest, eat well, and lower other types of daily stress. Most who know very little about training, (unfortunately these are the same people who never discuss heart rate or how to implement exercise into an individual’s lifestyle), are the same folks who the general public looks to for answers. They’re the doctors and researchers who don’t evaluate each individual case, but give the same workout routine to each much like calcium is prescribed to any woman who receives a bone density test whether she has optimal bone density, osteopenia, or osteoporosis. It’s a one size fits all program for the masses based off generalities. Training smart means training your body efficiently and effectively.
Training smart, with respect to endurance training, is highly dependent on heart rate (intensity and duration) and recovery. It’s not about never running faster than an eight-minute mile and no more than 20 miles a week or your health will suffer as research gurus would like you to believe. It is all about your heart rate as well as your fitness level and your overall health. It’s also about your goals. Who is training smarter: an athlete running 60 miles a week whose average mile is sub seven minutes or another who is running fifteen miles per week averaging ten minute miles? I have no idea. It’s like that tricky equation you were given in math class that has no answer because they deliberately left out some vital factor needed to get the answer. You now know what’s missing (HR).
Training smart means building fitness over time and this will decrease the chance of thickening and scarring of your cardiac tissue resulting in cardiac damage. For more on this check out the Sock Doc Training Principles.
Inflammation which provokes or causes a cardiac event can also be a result of a poor diet. Many know the dangers of bad fats and processed carbohydrates on cholesterol levels. This can result in atherosclerosis which in athletes training hard or racing can lead to oxygen deficiency (ischemia) and even death from cardiac arrest. So an anti-inflammatory diet can provide further cardiovascular protection – that means consuming healthy fats, including those healthy saturated and arachidonic fats (coconut, butter, eggs, grass fed beef), limiting or eliminating refined carbohydrates, (sugars, flours, and processed foods), and eating lots of organic fruits, vegetables, and herbs which are loaded with free-radical fighting antioxidants. After all, it’s the oxidation of cholesterol that is more of the problem than the total amount you have.
We are always dealing with stress, it’s a necessary part of life, but you have to do what you can to keep it under control. Some stress can’t be changed – perhaps your current job or family situation – so you change whatever you can to lower your overall stress load. Maybe you can change your commute to work or change your hours so you’re more efficient and relaxed during the day.
Sleep is also an integral part of lowering stress and not only is seven to eight hours of sleep required for most, but getting to bed before 11pm (ideally 10pm), can do wonders to lower overall stress hormone levels and increase growth hormone required for repair and recovery.
It may sound cliché that stress can kill you, but if you’re at risk already due to poor training and dietary habits then you’re playing a game of Russian roulette with five of the six chambers loaded if you’re under significant emotional stress too. Deep breathing exercises, mediation, prayer, or any other relaxation method fits well here. And don’t forget that being in nature is a great way to reduce stress; a simple walk (barefoot!) in the woods is a great way to de-stress.
Consider Medical Tests:
There is a time and a place for medical tests but unfortunately you cannot rely on these to give you a clean bill of health so you can train crazy and eat junk. A standard ECG and blood markers measuring lipids (cholesterol), CRP (inflammation), and other lab tests only provide a piece of the puzzle if something is awry. Even blood pressure by itself isn’t indicative of a problem, yet just another risk factor, essentially a sign that something is stressing the body (if elevated).
Recently a patient of mine was having trouble breathing while out on his sporadic runs. He thought nothing of them at first since he was not an avid runner anyway and figured he was just out of shape. He was following my aerobic heart rate zone guidelines “most of the time”, though admitted to not using his heart rate monitor often. He would run/walk a few miles a few times a week for a couple of weeks, and then not exercise again at all for several weeks, repeating this cycle again over several months. He had been on a beta blocker for years due to a heart arrhythmia, and his diet often included refined carbohydrates and oils, and alcohol. Perhaps most importantly, he was under a huge amount of stress – family, work, and financial. So his cardiologist had him wear a Holter monitor for one full month to monitor his heart during sleep, work, exercise, sex, etc. It came back perfectly normal. His CRP and cholesterol levels were also normal, even by my strict standards. After several months his cardiologist decided to do an echocardiogram as a last-ditch effort to rule out any problems. It was here, during the stress phase of the echo, (the resting test phase was also normal), where the doctor found a 95% blockage of the left anterior descending coronary artery of the heart. This artery supplies much of the blood flow to the left ventricle and therefore the rest of the body. Blockage of this artery is called the “Widow Maker” for good reason – you don’t have long to live when the artery becomes 100% occluded. A routine ECG, which takes minutes, can sometimes find this problem or other heart abnormalities, but you can’t rely on them solely; in this case it was missed. And unfortunately it’s impractical for everyone to have a heart echo done, and even more a stress echo, which brings us to the very important number five on this list.
Listen To Your Body:
Listening to your body is perhaps one of the most important things you can do to prevent sudden death. Often there are warning signs that many will not pay attention to because they think they are simply normal or irrelevant. Consider Micah True – many of his friends have reported that he would pass out during runs. That’s not healthy, and definitely not normal. Shortness of breath as my patient had is also not normal, and luckily he got a second chance.
Pay attention to how you feel when you’re training and even when you’re at rest. Do you ever feel your heart skip a beat or “flip-flop” while training (or at rest)? Many times this can be due to electrolyte imbalances or stress hormones affecting the normal conductivity of the heart. An inability to catch your breath especially upon exertion, general unexplained tiredness, snoring or sleep apnea, or a diminished sex drive can be warning signs too. If any of these symptoms are a common occurrence for you, you should consider looking deeper into the reason why.
Are you on a medication, especially a blood pressure drug? These alter how the heart responds and reacts to stress – they’re a risk factor in my book and many take them for the wrong reasons, thinking they’re preventing a problem when essentially the drug is only making a number (your blood pressure reading) appear normal. A recent study (October 2012) in JAMA found that beta blockers are not associated with a lower risk of dying from a cardiovascular event. Common diuretics, such as HCTZ also used to control blood pressure, can cause dehydration and create an imbalance between sodium and potassium, which in turn can affect the function of the heart. Of course I’m not suggesting that you stop your medication, but realize that the medication can be masking some problem or even creating one that you’re unaware of; it’s something to look into with your prescribing doctor, especially if you’re active (and hopefully you are). This is why you should subtract five to ten heart rate beats when figuring out your aerobic training zone as many drugs, especially those which affect blood pressure, will alter your sympathetic tone, so your cardiovascular and nervous systems are actually working a bit harder at any given rate.
In addition to listening to your body, don’t forget to look at your body. Premature aging is a risk factor for cardiovascular episodes. In a recent Copenhagen Heart Study, researchers found that those who had three to four aging signs – receding hairline at the temples, baldness at the head’s crown, a crease in the earlobe (see photo), or fatty deposits around the eyelid – had a 57 percent increased risk for heart attack and a 39 percent increase risk for heart disease. Now to be fair here, the participants in the study were over the age of 40, with no indication of health or fitness level, and the risks of these problems greatly increased for those over 70 years old. But if you’re the guy who is 30 and everybody thinks you’re 40 – well, you might want to look into that, literally.
Lower Your Risk of Dying From Exercise
Lowering stress levels, training properly, and eating healthy ALL the time are changes you can take to drastically lower your chances of a life-altering or life-ending cardiovascular event. As with most health issues, balance plays a key role though unfortunately when someone is under a tremendous amount of stress they do the opposite of what they should be doing to help their body in this time of need. Rather than eat well to counter tissue inflammation and oxidation and exercise properly (not high intensity anaerobic), to help lower stress hormones, (cortisol and epinephrine), most do the opposite – they eat refined foods and consume excess caffeine to keep them going and they train intensely due to time constraints.
Though there will always be the case where someone is “doing all the right things” and they still end up with a disease, for the most part they probably were not doing the right things fully and often enough. (And yes I say that in part due to sufficient clinical experience seeing patients who think they are exercising and eating well when in reality they’re just a step better than the average person.) Be consistent, listen to what your body is telling you, and seek proper medical attention when and if necessary regardless of how healthy or fit you think you are because you may only have one chance at getting that second chance.
Thank you – good read.
For most runners, there are a couple of High Intensity Workouts done. Intervals and Tempo work is still aerobic and Reps (200-400 m all out) are anaerobic.
Tabata intervals are another example I can think of.
Do you believe a runner can get by without the anaerobic reps when you say, “…exercise properly (not high intensity anaerobic)…”
Sock Doc says
It depends on what the runner is training for. If just general health, then yes – mostly unnecessary. If the runner wants to be competitive especially in shorter distances, 10K or less, then I think anaerobic intervals are very necessary – but only at certain times in the training cycle.
Bill P says
Great article Doc. Thank you!
Very well written and informative. I have been very concious of my heart rate since visiting your site a year ago. I have made steady gains in time on the trail (2hrs) and recovery has also improved. I have asked Santa for a gps w/ HR monitor and im sure he wont let me down. ) Thank you for sharing your knowledge.
Some common sense advice in there. Just today I read (thankfully with a good outcome) another example of an athlete suffering heart attack http://www.stuff.co.nz/national/health/8391818/Cyclist-makes-pit-stop-for-heart-surgery
Like Maffetone says fit does not always mean healthy
Dr. Gangemi, love the article. Used it for a class of mine in cardiology. Keep on being the best in the business.
Eric Ng says