Go with the flow, free flowing thoughts, slowly drifting on a 13 km per hour pace. An easy first half marathon in 1:39.
Passing the 21 km point, waky waky, no more go with the flow, concentrate. At every 5 km post, eating concentrated banana paste and drink, else “the wall” may hit too soon.
A marathon starts past 21 km, the wall tends to hit you at 30 km. The point of garantueed success is 35 km.
This year I finished in 3:22:09, again faster. At 55 and still improving my best time.
Unexplorer talent? Or was it technology, the latest high tech Asics Cayano running shoes, a toe blister preventer!
Or was is it a radical new training schedule? You run the long 35 km trainings spread over the three days in a weekend, Friday night, Saterday and Sunday, and not in single day. In theory if your body can run 10-15 km every day without sour muscle in the morning, you can also run 3-4 times longer in a single day, but perhaps with sour muscles at the end (of the marathon).
Amsterdam marathon number 3, after 2007 (nr 1) and 2008 (nr 2). All below 3.5 hours. Rotterdam was a bad experience, “bridge city” with the 18 m high Erasmus bridge, crossing twice, resembles the bridges of New York.
It is a beautiful day, blue skies, 10 degrees Celsius, little wind. Yesterday there was rain for much of the day.
Today I decided to go with the flow, do an easy first half, a “half empty glass”, and just finish, not thinking of the end time. The 30 km and 35 km passing poiints are crucial, these dictates the end time. Should be able to stay below 3.5 hours.
Last weekend I did fine, radical chaned training schedule, final runs on Friday (10 km), Saterday (15 km) and Sunday (10 km). In total 35 km but spread over three days instead of in a single day. Felt very good, like after a week of hiking. All muscle in excellent shape. No sour muscles in the morning. The body has adapted, in balance.
n theory if your body can run 10-15 km every day without sour muscle in the morning, you can also run 3-4 times longer in a single day, but perhaps with sour muscles at the end (of the marathon).
Remains a puzzling question. Is it risky?
It seems that “a 6 km running a day, does keeps the doctor away". See the paper by Amby Burfoot in the December 2008 issue of Runner's World:
" Are Marathons Dangerous?"
Some highlights form the paper:
1. Over the last 30 years, more than 80,000 subjects, male and female, have been poked, prodded, and treadmill-tested at the Cooper Center. Every year, Blair and colleagues issue a handful of new reports that slice and dice the data, officially known as the Aerobics Center Longitudinal Study (ACLS). The results are eye-popping. In general, the most-fit subjects have heart-disease death rates 50 percent lower than the least fit. They're also much less likely to have strokes, or to develop diabetes or high blood pressure. They have a lower incidence of many cancers. And now, in the latest and most startling development, they are showing lower risk for senile dementia and diseases like Alzheimer's.
2. It's crucial to note that these "most fit" individuals are not super athletes. They're not the winners of the Boston and New York City marathons. Most exercise the equivalent of 15 to 25 miles of running per week at about 10 minutes per mile.
3. The fit-but-fat are nearly as healthy as the fit-of-normal-weight. In other words, regular exercise offsets many of the dangers of being overweight. For that reason, Blair believes American public-health leaders should stop screeching from the rooftops about obesity and instead switch their message to the benefits of exercise.
One hour before the start I took a banana. Had some muesli and bread this morning, not really hungry. The night before I had pasta but no fish. This ensure near empty bowels in the morning as it passes the body in 10-12 hours. Official recommendation is not to have fibre rich food but to “pack hydrocarbons”. I feel this would hinder throughput. Near empty bowels are more important.
This year there are paid lockers for which you buy a special coin. Now you can finally store your valuables like a mobile phone. I try to get an easy number as the key has no number, I try 400, but put the coin in the locker above, my mind being somewhere else. Still, should be able to remember this.
Most runners are already in their running gear, some wear a singlet, some wear a sheet of plastic from the last run. Temperature must be around 8 Celsius and it is cold in the shade. I even were gloves and a cap.
I am wearing an old jogging paints and a sweater which I intent to dump at the start. I see some people putting their stuff on the side near the finish line. Good idea, should be able to pick this up, no fear for suspicious lonely packages, “verdacht pakketje”, like in trains and airports with nervous petit-bourgois calling the police and upholding all trafic for two hours. In the stadion there are simply too many “suspicous” packages.
I walk around to stay warm, another toilet stop, must be number 10 this morning. 10 minutes before the start I enter the starting area for runners with an end time of 3 to 3.5 h.
The bright sun is just out in my start area and in front of us where the top runners are, some 1000 people are warmed up by the sun. Behind us, in the cold shade, there are some 9000 people. I walk up to the front, to mix even closely with the crowd, seeking body heat. Each runner produces a 100 Watts per person which radiates from a thinly dressed body. This really makes a difference.
I feel very relaxed, a marathon feels like a routine, I will just go with the flow, wearing another T-shirt with long sleeves which I will dump after 4-5 km. I am confident I will will get only very few blisters using a new type of running shoes, the Asics Cayano, which are made for long distance runs..
Asics Cayano no-blister running shoes, a very good fit. Note the asymmetric closings.
A start pistol shot at 9:45 h. Off we go, within 20 seconds I pass the start line, we run a bit slow, crowds are cheering, We exit the stadium and head for the West side of the Vondelpark.
The extra T-shirt with long sleeves is needed. It is cold in the shaded streets and especially in the tree covered Vondelpark.
In the park several runners stop and have a last pee against unresistable trees, a single lady runner as well in the bushes. One runner is trying a toilet cabin, thinking this is part of the marathon, no luck. I see this happening again at 13 km, a lonely toilet cabin is tried by a few runners. An idea for the organisation? You should put 2 or 3 toilet cabins at every 5 km stop.
I hope to give the extra T-shirt I wear to one of my running friends after 4 km at the Hobbemakade. Here I finally feel warm.
Alas, no friend, quick thinking needed, this is a nice T-shirt from the famous Vancouver Mountain Equiment Coop (MEC).
I see several transport bicycles with “bakkies” for transporting children. This area is “bakfiets” territory with 2.2 child per petit-bourgois family. They will not be used today, hopeless bikes, too heavy and a real effort to ride with two spoiled 5-6 year old children in it, “mommy, go faster!!!”. Watch your knee caps moms, especially at bridges, when you are again too late dropping the kids off at school.
I dump the T-shirt in one of the “bakkies”, no people watching this time and “bakkies” often have junk inside anyway. In a previous marathon I tried to hide a T-shirt in a bush on the same street but this taken by spectators. This time it worked, I picked up the T-shirt after the run.
Jut go with the flow, the thought that keeps on coming back, heart beat at a steady 150.
Target time is about 1:40 h on the half marathon. I clock 1:39, this feels good, so much less effort compared to doing it in 1:37, a distance of 400 m only.
Now the marathon starts, the first half marathon is a very empty glass, finshed in a single gulp, but the second is a very full half glass. Not easy to finish.
At 25 km I was running with a Scot of around 40 years old, His target end time was 3:20. He let the end time balloon man of 3:15 go. I kept up with him for a long time.
30 km is an infamous point, this is where “the wall” or in Dutch, “de man met de hamer”, could hit you.
A small blister on one of the small toes was developing. Watch the running style, it could get bigger, run more carefully. Sofar the new Asics Cayano shoes are doing fine, plenty of room in the front.
Normally the :man with the hammer” or the wall would hit me here. To my surprise nothing.happened, Only the “lady of the blisters” was there.
After 32 km a odler woman of a couple of the running group Heerlen was in trouble, she asked for paracetamol, he carried all drinks. They had a good pace, kept up with them from 21 to 35 km and then left them behind. Wasn't sure if they disliked me trailing them, using the slip stream.
The 30-35 stretch is crucial, not too fast, go again with the flow this time. I don't see many runners and some a walking already. Here we have two water stops..
35 km time looked good, around 2:45. In a flash I calculated that my endtime may be 3 minutes faster compared to 2008.
This called for the turbo and I increased my pace and kept a steady pace until the finish. This was tiring, the heart beat going up to 165 but still okay.
I passed many runners. Erben Wennemars was getting nearby, he totally collapsed past 30 km, finishing in 3:16, I could almost “spot” him in the distance.
A young couple with children on their bicycles crosses the street suddenly and runners nearly bumped into them, petit-bourgois mom and dad, they simply will not understand. Please, just wait for a safe crossing. “Eikels”, I shouted, which is rebuffed by something I didn't get. This gave me some energy.
At 38 km, the Wibbautstraat tunnel and right after the Amstelbridge creates a hill of some 10 meters. The top runners were spared the tunnel and only had to cross the bridge but us common runners had to go down and up again. Such a steep hil is very tiring, almost stopped dead on top of the bridge, we are all very slow here.
Entering the Vondelpark feels good, I know every curve and incline of the park. I keep my steady turbo pace which is an effort but not unreasonable.
Passing the 40 km point my time is very good, around 3:10.
I keep a steady pace, slighly
Vondelpark, after 40 km
The last 1.5 km from the Vondelpark to the finish in the Olympic Stadium passes by quickly. Runners increase their pace, some pass me, I do this as well as this may be my best time ever.
You are not suppose to do this as this carries a risk. Half the medical problems occure just before or after the finish. Never do a final sprint at a marathon as the body is already under an enormous stress which you can tell on the picture below.
Crossing the finish, I feel tired, very tired and the muscle quickly stiffen up. But, with 3:22:09 I should be very happy, 4 minutes faster compared to 2008. In the future, even 3:19:59 may be within reach.
Entrance Olympic Stadium
Finish on the athletic course in the Olympic Stadium
I climb over the low fence and find my bag on the side untouched and put on my old training suite. Nice and warm.
We are getting drinks and food outside the stadium, banana, oranges to stimulate the kidneys, and tea. Sitting around for 10 minutes I am getting cold and msucles are stiffening up. It is only 10 Celsius. I walk to my bike, stumbling, feeling two toe blisters but don't look.
The half marathon (or an half empty glass) is about to start, I meet a colleague with his wife going to the start of the half marathon and say hi, meaning I am already finished, do your best.
Slowly cycling towards home, I first pick up the T-shirt at the Hobbemakade.
At the van Baerlestraat bridge crossing the Vondelpark I watch the slow runners, their finishing time will be past 4:15. Their running doesn't look good, bending forward, O-legs, they are in pain.
I did not hit the infamous wall and had very steady pace of 13-12.5 km/h.
Smart preparation, running 36 km in a single weekend split over three days, twice a leg massage, slow start, excellent shoes, the latest sturdy Asics Kayano, ideal weather, 10 Celsius and sunny, almost no wind, and smart running. Next time I could try a negative split.
I used only 2300 Kcal , 700 less compared to the marathon of 2008 with end time of 3:26.
Heartbeat average 156. First 15 km only 148, then slowly increasing to160 at the 35 km point. Last 7 km, with the turbo, 165. Above 160 this feels like an effort.
Only two blisteres on the small toes, a single, big one below a toe nail (this will come off 3 months later) and a small one. The running shoes, Asics Kayano with asymmetric closings, blister preventers, are excellent
Very tired and hungry, not really thirsty, muscles stiff, just the upper legs and calf. Walking is fine, given the circumstances.
A big meal around 15:30 h, salad, wild salmon, vegies and pasta.
The next three days hungry and stiff muscles, digestion disturbed and the first two nights an uneasy sleep. A bit high by the overdose of endorphines.
Not really more tired than a business trip to Nigeria or Siberia and less tiring compared to mountain climbing above 6000 m.
This marathon was surprisingly easy. After 4 years, I may be finally trained up. The heart beat monitor and calorie count tells is all.
An easy first half in 1:39 and a strong second half in 1:43 with an accelaration in the last 7 km did impress. Past 25 km you should also discount a loss of 10-20 seconds by the drinking stops every 3-5 km past 25 km.
Got very nice comments on again improving my best time, caused a bit of a stir, at 55 and still improving your best time? Must be unexplored talent.
Most comments were like, “I can't even run a half marathon in 1:43”.
Marathon average: 12.524 km/uur
One drinking stop at 25-30 km and two drinking stops at 30-35 and 35-40 km, losing 10-20 seconds each time.Total over one minute.
Average time per km and heartbeat build up.
Score Amsterdam Marathon 2010, personal position is 1284 out of 7883 finishing.
If running is so good for you, why do people drop dead during marathons every year? A lifelong runner, with help from the experts, finds the encouraging truth behind the scary headlines. By Amby Burfoot Image by Matt Mahurin From the December 2008 issue of Runner's World
Note: For more, including charts and useful tips, see "Grave Concerns" in the December 2008 issue of Runner's World magazine.
Most days, on my noontime run, I don't worry about dying.
Sure, my HDL ("good" cholesterol), which should be well over 50, is down in the basement (mid-30s), next to the late Tim Russert's. And my grandfather had his first heart attack in his 50s. And some people consider me a Type A personality. And I'm at an age, 62, where I've got decidedly fewer birthdays ahead of me than behind.
But my daily run offers so many pleasant distractions. I can check out my neighbors' gardens. Work through personal problems, consider a marathon, or simply enjoy the satisfaction of another workout in the bank. Running also taps deep into the brain's complex circuits-I never know what's going to pop into my head, the creative or the humdrum. (Notes to self: Start work on new book. Don't forget to pick up laundry.)
Still, a somber thought does intrude from time to time. I might remember the Saturday phone call I got almost 25 years ago. The speaker said he was a reporter for CBS Radio. He wanted a comment about Jim Fixx, whose best-selling 1977 book had done much to popularize running. "No problem," I replied. "He's such a great guy. Smart, humble, and hardworking, and I've never met anyone who appreciates running more than Jim does."
The reporter cut me off. "Maybe you haven't heard," he said. "Fixx passed away yesterday afternoon. He was running down a road in Vermont."
And then there was that tense moment last November when Ryan Hall faced the press after his magnificent victory in the USA Men's Olympic Marathon Trials in Central Park. "This was a dream come true for me, but first I want to offer my thoughts and prayers to Ryan Shay's family," he said. Moments later New York Road Runners CEO Mary Wittenberg stepped to the microphone, her face pale: "We have absolutely tragic news-Ryan Shay passed away this morning." Shay, just 28, was the first world-class marathoner to die from a heart attack while competing.
Last fall was a tough time for those of us who believe running makes us healthier. The day after Shay's death, Matthew Hardy, 50, died of an apparent heart attack an hour or two after finishing the ING New York City Marathon in 4:48:21. A month earlier, Chad Schieber, 35, who'd been diagnosed with a heart defect (mitral valve prolapse), had died in the unusually hot Chicago Marathon. These stories often get more attention than those of the race winners. And they always raise the question: If running is so damn healthy, why do runners keep dropping dead in their tracks? Statistically speaking, a handful of runners will die in a marathon this year-the vast majority from heart attacks (the others from heatstroke or hyponatremia). Is running-as the alarmists and cynics often suggest-a dangerous activity?
To find out, I visited the world's leading heart and exercise experts, reviewed stacks of medical research about exercise and death risks, and consulted with the statisticians who work in this field. I learned the reassuring truth that running and other vigorous exercise does dramatically lower mortality risks. But I also learned that there are surprising paradoxes, and no guarantees. Every workout is a bit of a crapshoot. Fortunately, if you run smart and fully informed, you should be able to keep going for a long, long time.
Fitness researcher Steven Blair is a bit of a fuddy-duddy. You notice this right away from the pristine condition of his house and landscaping in Columbia, South Carolina. When I arrive for a 7 a.m. run in mid-May, Blair is brushing a coat of dust from his porch banisters. Blair strives for order, clarity, and meaning in his life and work, traits that have helped make him arguably the world's leading exercise epidemiologist.
At 69, Blair doesn't look like most of the lifelong runners I know. He's as round as a beach ball, with a trim gray beard. Blair figures he has run 70,000 miles in the last 40 years, including 18 marathons, with a best of 3:28 at Napa Valley. But the miles haven't chased away the weight. He's gained 30 pounds through his midlife years, largely around the waist, and now carries 195 pounds on a 5'5" frame. He knows this is disconcerting to new acquaintances who expect a pencil-thin fitness fanatic. He often describes himself as "short, fat, and bald," in part because he has a self-deprecating sense of humor and in part to emphasize that not everyone is born lean and mean.
Our workout begins with a two-block walk in the leafy Shandon neighborhood where he lives. Then Blair breaks into a smooth jog-about 11 minutes per mile. Every minute or two, he exchanges greetings with another runner, cyclist, or dog-walker. "I do this run most mornings of the week," he says. "I still consider myself a runner, although I'm not sure my neighbors agree. They probably can't tell if I'm running or walking."
Blair, who holds a doctorate in physical education, returned to Columbia two years ago after 22 years at the groundbreaking Cooper Aerobics Center in Dallas, first as a researcher but eventually as CEO. He was the guy who did the work that helped Kenneth H. Cooper spread the word about the health benefits of exercise. Now a professor in the Arnold School of Public Health at the University of South Carolina, Blair continues his research while arguing at every opportunity that America's public health could be improved, and its medical bills reduced, if everyone would just get up and get moving for 30 minutes a day. He's got the studies to prove it, too-hundreds of them. Blair has also held leadership positions on committees of the American Heart Association and the American College of Sports Medicine. "Steve's probably our most famous faculty member," another University of South Carolina professor told me.
An exercise epidemiologist looks for connections between exercise habits and health outcomes, such as heart disease, stroke, diabetes, and high blood pressure. The going is tough, because it's difficult to conduct controlled experiments. People aren't mice; you can't lock them in cages for weeks on end and force them onto an exercise wheel. Most epidemiologists resort to questionnaires to quantify human behavior, a dicey prospect, since most people underestimate how much they eat (Ben & Jerry's- Not much!) and overestimate how much they exercise (At least five or six times per week). Yeah, right!
All of Blair's subjects, in contrast, have actually visited the Cooper clinic and taken a treadmill stress test, running to exhaustion. Years and even decades later, the same subjects are polled to determine their health. Some will be fit as a fiddle, some won't. Some will have died. Epidemiologists love dead people. You just can't find a medical condition more clearly defined than death. "I give Ken Cooper a lot of credit," Blair says. "He realized from the very beginning that we had to put our treadmill tests into a database, so we could follow these people and see what happens to them."
Over the last 30 years, more than 80,000 subjects, male and female, have been poked, prodded, and treadmill-tested at the Cooper Center. Every year, Blair and colleagues issue a handful of new reports that slice and dice the data, officially known as the Aerobics Center Longitudinal Study (ACLS). The results are eye-popping. In general, the most-fit subjects have heart-disease death rates 50 percent lower than the least fit. They're also much less likely to have strokes, or to develop diabetes or high blood pressure. They have a lower incidence of many cancers. And now, in the latest and most startling development, they are showing lower risk for senile dementia and diseases like Alzheimer's.
It's crucial to note that these "most fit" individuals are not super athletes. They're not the winners of the Boston and New York City marathons. Most exercise the equivalent of 15 to 25 miles of running per week at about 10 minutes per mile. Other studies have produced results that reinforce the ACLS research. Exercise doesn't just feel good and provide a mental break from our overstressed lives; it also produces measurable health benefits. "Our data probably show the strongest association between fitness and various health outcomes," says Blair. "That's because our treadmill tests come closer to the truth about someone's fitness than questionnaire studies."
Blair admits that if he were 30 pounds lighter, he would be healthier and would need fewer meds to control his cholesterol and blood pressure. While he has never had a heart attack, he has had angioplasty and heart-bypass surgery to clear clogged arteries. "I do what I can," he says. "If it weren't for my fitness, I might have needed the surgery 10 years earlier."
Reams of research have shown that excess body fat increases mortality rates, but Blair is banking on his morning runs to protect him. His own findings offer much hope. Evidence from the ACLS indicates that the fit-but-fat are nearly as healthy as the fit-of-normal-weight. In other words, regular exercise offsets many of the dangers of being overweight. For that reason, Blair believes American public-health leaders should stop screeching from the rooftops about obesity and instead switch their message to the benefits of exercise. "When you look at me, you can tell I'm surprised and delighted by the fit-fat finding," says Blair. "But the point is, we're losing the obesity battle. So let's try something else. Let's focus on fitness."
Notwithstanding all the studies, Blair and other fitness proponents realize there are no guarantees. Heart attack rates inevitably climb with increasing age. Exercise is recommended, but it isn't a cure. There are no cures for heart disease. Blair knows he's just one errant heartbeat away from a newspaper headline: "Fitness expert dies on the run." The first sentence of the story almost always includes the word "ironically," as if Blair and friends believe running will help them live forever. They don't. They know the facts: Everyone dies, and some die while running.
I ask Blair why he continues to run almost every day. "It's a habit," he says. "It's one of the most pleasant parts of my day. I've done thousands of runs in different places around the world, and there were only one or two times when I didn't feel better afterward. Running makes me feel good. That's reason enough."
In their studies, Steve Blair and all modern exercise epidemiologists have built on the work of Jeremy Morris and Ralph Paffenbarger, the pioneering giants in the field. More recently, Paul Williams has expanded our knowledge of serious exercisers by using Runner's World readers to build his database. Williams's National Runners Health Study was launched in these pages in 1991. While all the studies have reached similar conclusions-regular exercise provides significant health benefits-each has made interesting and unique contributions of its own.
Great Britain's Morris spent the WWII years as an army doctor in India and Burma. His first big exercise study ("Coronary heart disease and the physical activity of work," The Lancet, 1953) investigated the different heart-health outcomes of London transport workers-the bus drivers who sat on their arses all day versus the ticket-takers who walked up 600 stairs a day on London's double-decker buses. Result: The ticket-takers suffered 30 percent fewer heart attacks, and their attacks were less severe.
Later, in his 27-year career as England's director of the Medical Research Council's Social Medicine Unit, Morris realized that physical activity had disappeared from most jobs. Everyone sat at a desk all day long. He decided to begin looking at "leisure-time exercise" and its impact on heart health. He followed 17,000 male civil servants between the ages of 40 and 64, and discovered that those who frequently burned about 450 calories per hour in exercise (roughly equivalent to an easy four-mile run) had only one-third the heart attacks of those who had little or no exercise. He concluded that "vigorous exercise is a natural defense of the body, with a protective effect on the aging heart against ischemia and its consequences." In 1996, Morris received the International Olympic Committee's first award for excellence in sport sciences-an honor he shared with Ralph Paffenbarger.
Paffenbarger grew up in Columbus, Ohio, and received a bachelor's degree from Ohio State before taking a doctorate in public health at Johns Hopkins in 1954. He later taught at Berkeley, Stanford, and Harvard, concentrating on the relationships between exercise and health. In his early work with San Francisco longshoremen, Paffenbarger showed that those with the most arduous jobs, the cargo handlers, had heart-attack death rates significantly lower than those with desk jobs.
In 1960, Paff, as he was widely known, helped create the influential Harvard Alumni Study, which produced and continues to yield valuable information about physical activity and health. Among its most important findings: that student sports participation at the collegiate level yields no long-term health benefits, but adult exercise does. Paff also found that while health benefits begin to slow beyond 1,000 exercise calories burned per week (approximately 10 miles of running), the benefit curve doesn't flatten. You still get more benefit at 20 miles per week and beyond, particularly if you do some harder workouts.
Paff was so impressed by his own findings that, after a previously sedentary life, he took up running in 1967 at age 45. In the next 25 years, he ran 151 marathons and ultras, including 22 Boston Marathons (5:05 his first; 2:44 his best). In 1977, he became, at age 54, the oldest-yet finisher of the Western States 100-miler, in 28:36, persuading Western States organizers to extend the cut-off time to 30 hours. One of the great unsung heroes of the running boom, Paff died on July 9, 2007, at age 84.
Most epidemiologists struggle to find subjects who burn more than 2,000 calories a week in exercise. Paul Williams, Ph.D., has made his mark by exploring the health outcomes of serious runners, some of whom exceed two or three times that amount in their weekly training. From his results, he insists on a simple but important message: More is better. Other exercise epidemiologists don't disagree; they just think Williams is mostly irrelevant, since so few Americans are willing to exercise as much as Runner's World readers. These scientists point out that the biggest public-health benefits come from getting more people to simply walk a few miles a week.
This doesn't discourage Williams. In one 1997 study of 8,283 male runners, he compared those running more than 50 miles a week with those running less than 10. The high-mileage guys were 2.5 times as likely to have heart-protective levels of HDL, the "good" cholesterol, and 50 percent less likely to suffer from high blood pressure. Just six months ago in the Journal of Hypertension, Williams updated his information on running mileage and high blood pressure, now using data from more than 24,000 male runners. He looked at runners doing more than 25 miles a week versus those doing less than five. Depending on age, the higher-mileage runners had a 57 to 80 percent lower rate of high blood pressure, a major contributor to disease and death.
"I feel a little awkward about meeting John Fixx," says heart specialist Paul Thompson, M.D. "His father made me famous." It's a gray, drizzly afternoon three days after my run with Steve Blair. Thompson and I are jogging from Hartford Hospital, where he's chief of cardiology, toward nearby Colt Park. I've arranged for Fixx, an old friend, to meet us there for a five-mile run.
A month earlier, Thompson, 61, had finished the Boston Marathon in 3:24:01. He's slight-5'7" and 144 pounds-with a boyish face, a forehead that goes on forever, and a respectful manner. Thompson completed his first Boston 40 years earlier, in 1968 (34th place, 2:49:22), while still a Tufts University undergrad. Several years later, he improved his Boston best to 2:28:25, his PR. He ran 14 straight Bostons, but a move to Pittsburgh, four kids, and increasing hospital responsibilities will put a dent in anyone's schedule. More recently, with the kids grown and a move to Hartford, he's run the last nine Bostons.
By the time of Jim Fixx's death at age 52 in 1984, Thompson had graduated from medical school, done some advanced studies at Stanford, and published two papers on heart-attack deaths in runners. That made him the go-to expert for hundreds of TV, radio, and newspaper reporters chasing down the Fixx story. Over the years, Thompson has remained everyone's favorite expert for insights on exercise and heart disease. He has also worked as a TV commentator at the Seoul Olympics and the New York City Marathon, and his name turns up frequently in publications like The New England Journal of Medicine.
Thompson has had a lifelong fascination with the workings of the heart, in particular its response to exercise. "Sometimes I wish I could read heart studies all day long instead of attending to administration details," he says. "Think about the overweight guy who's totally out of shape until he begins exercising. A couple of months later, he's a different person. The heart is so amazing, and so damned good at what it does."
Thompson runs with the quick, light stride of the veteran marathoner, and has already covered eight miles in the early morning. "It's the one time of day I get to focus on myself," he says. "This makes me a much better person when I get to work and have to focus on staff and patients."
I ask Thompson why some runners keel over and die from heart attacks. He explains, first, that the young ones, mostly under 30 or 35, generally have structural defects in their hearts, such as the heart scarring that apparently led to Ryan Shay's death. These include a bewildering variety of rare conditions, and one-hypertrophic cardiomyopathy-that gets mentioned much more than the others for two reasons. First, it's the most common cause of sudden heart death in young athletes. Second, it results from an enlarged heart. This leads to widespread confusion, because endurance athletes like marathoners also have enlarged hearts. But the two are completely different. The marathoner's heart is large, healthy, and efficient; it's like a car that gets 40 miles per gallon. The hypertrophic cardiomyopathy heart is misshapen, malfunctioning, and dangerous; it results from a physical defect, not from hard endurance training.
When an over-35 exerciser dies on the run, Thompson continues, the cause is almost always artery disease-that is, cholesterol deposits that rupture and provoke a heart attack. He describes it like this: Imagine a garden hose with a modest flow of water moving through it. That's your arteries when you're resting. When you begin to run faster, the flow of blood increases dramatically. The hose begins to twist and flail. You've felt this with your own hose, or noticed how firemen must brace themselves to control a high-pressure hose. "So your arteries are flexing and bending," says Thompson. "Now if you've got a cholesterol deposit in the artery, the movement can crack the deposit open. Your blood mixes with the cholesterol to form a clot that blocks the artery. A few minutes later, you've bought the farm."
In Thompson's classic 1982 study of runners' heart-attack deaths in the state of Rhode Island, he found that a runner's relative risk of dying during a workout was about seven times that of dying in front of the TV. It amounted to one death for every 396,000 hours of running, almost exactly the same rate found decades later in several marathon studies (see "Risk of Death While Marathoning," page 98). This doesn't mean that running caused the deaths. It would be more accurate to say that artery disease caused the deaths, and running was merely the trigger. Here's why: Another Rhode Island study showed that the blizzard of February 1978 touched off a mini-epidemic of snow-shoveling deaths. A week later, however, heart-attack deaths dropped below normal levels. In other words, after all the people with advanced artery disease had died, there were few diseased hearts left.
Like other heart experts, Thompson notes that regular exercise offers no sure protection from heart disease. Three hundred and twenty-five thousand Americans suffer an outside-a-hospital heart attack every year, often without warning, and 40 percent of these events end in sudden death. "Exercise is not a savior," Thompson says. "The risks are very low, the benefits are real, and the benefits outweigh the risks. But there are no guarantees. Regular exercise is like investing in the stock market. You hope that your stock will improve over time, but every once in a while you catch a Bear Stearns."
This can happen even to fit runners with low cholesterol who've passed a stress test in the last 48 hours. Still, the occasional exercise death doesn't change the advice for healthy living. "If you want to live a long, vigorous life, you should do an hour of moderate exercise a day," says Thompson. "If your only goal is to survive the next hour of your life, you should get into bed-alone."
In the mid-1970s a California pathologist named Thomas J. Bassler, M.D., advanced the alluring theory that marathon runners might develop a sort of immunity from heart disease. He likened marathoners to the Masai warriors of Kenya and the Tarahumara Indians of Mexico-groups with little or no heart disease. "Marathon runners have much in common with these primitive populations," Bassler wrote. Runners everywhere repeated Bassler's tale to friends and skeptics alike. Then a trickle of case studies proved Bassler wrong, and the party was over.
Since the mid-1970s, three independent groups have collected data on heart-attack deaths during marathons. When the results are pooled together, we're looking at more than 4.5 million marathoners over the last 30 years. Of these, 41 runners died of heart attacks, a rate of one in every 110,476 marathoners. However, the two best of the three marathon studies have produced death rates somewhat higher than this average.
Family doctor and University of Minnesota Medical School professor Bill Roberts, M.D., has been medical director of the Twin Cities Marathon since 1985. Along with Barry Maron, M.D., a sudden-cardiac-death specialist also from Minneapolis, Roberts has gathered death statistics on both the Twin Cities and Marine Corps marathons going back to 1976. During that time, the combined marathons have had 525,700 finishers and seven cardiac deaths, an average of one death per 75,000 runners. Roberts and Maron have also found that this rate is declining, no doubt due to the increased availability of portable defibrillators. At Twin Cities, Roberts has established a goal of reaching any fallen runner with a defibrillator within five minutes. "If you're going to have a heart attack, a marathon is a great place to have one," he says. "Your chance of surviving is about 50 to 75 percent, versus five to 15 percent anywhere else on the streets."
In London, cardiologist Daniel Tunstall Pedoe served as London Marathon medical director from the inaugural 1981 marathon, which he ran in 3:19, through the 2007 event. Pedoe has studied marathoner deaths during all 27 London Marathons. Almost 712,000 runners have completed the race, with eight dying from heart attacks, a rate of one in every 89,000. The eight London deaths included five attributed to artery disease (cholesterol deposits) and three to structural heart abnormalities such as those that killed Ryan Shay and Chad Schieber. The deaths have occurred all along the course-at miles six, 10, 11, 12, 18, 19, 24, and in the finish chute. "Marathon running has a comparatively low, but not negligible, risk, and it's not surprising that people are frightened when they hear about a marathon death," says Pedoe. "That's why we have to keep educating everyone about the lifetime benefits of exercise."
Last December, barely a month after the deaths of Chad Schieber, Ryan Shay, and Matthew Hardy, the British Medical Journal published the biggest-by-far study of deaths during marathons. It was less definitive than the other two, however, since it relied on a search of newspaper articles to determine marathon-related deaths. Nonetheless, the BMJ study, conducted by Donald Redelmeier, M.D., from the Department of Medicine at the University of Toronto, surveyed 750 separate marathon days that were taken from 26 marathons over 30 years. The total number of runners in these races was 3,292,268, and Redelmeier found newspaper articles noting 26 heart-attack deaths. Hence, his ratio is one death in 126,000 runners. Redelmeier's most striking finding was that nearly half of all deaths occurred in the last mile of the race, or after the finish. This conclusion led Redelmeier to advise runners not to sprint at the end. In fact, in his one marathon, he deliberately jogged over the finish in 4:17. "I just tried to finish with a smile," he says.
Overall, Redelmeier concluded: "Clinicians interested in preventing sudden cardiac death might be surprised by the low risk associated with marathon running. [It's about] the same as the baseline hourly risk of death for a middle-aged man."
As Paul Thompson and I finish our first lap of Colt Park, we spot John Fixx clambering from his car. I've known Fixx for 25 years, but haven't seen him recently. Right away I notice that he's grown a little chunkier. He's 47 now, carrying 180 pounds on his 6' frame, with short hair, a lively face, and the friendliness of a college student. Married, with two teenage children, Fixx has worked the last six years as headmaster of the private Chase Collegiate School in Waterbury, Connecticut.
Over five laps of Colt Park, Fixx does almost all the talking. Several weeks earlier, he tells us, a teammate had a heart attack after an adult soccer game and died while his family drove him to the hospital. Thompson breaks in: "It's probably smarter to call 911. They've got the defibrillators and other equipment you need."
Fixx was just 8 or 9 when he started running with his not-yet-famous father in the late 1960s, and a fourth-grader when he ran his first road race, the Greenwich (Connecticut) Memorial Day Five-Mile. "I enjoyed running from the very beginning," he says. "At first it gave me a chance to spend time with my father, a typically busy New York editor. Later it kept me in good shape for all the other sports I liked. I used a quote from Doctor Samuel Johnson in my high school yearbook--How much happiness is gained, and how much misery escaped, by frequent and violent agitation of the body.'"
In college, in the heady period following the 1977 publication of his dad's unexpected best-seller, The Complete Book of Running, Fixx ran on the cross-country and track teams at Wesleyan University, and continued racing after graduation, achieving bests of 54:10 for 10 miles and 2:51 for the marathon.
A year out of college, Fixx was visiting a family friend, Todd Benoit, in Greenwich when the news arrived: His father had died that afternoon while running in Vermont. Other family members were scattered across the country; it fell to John to organize the funeral. He took time out only for an evening run with his friend. "The news about Dad's death was just devastating," he says. "But going out for a run also seemed like the right way to honor him. I remembered that he used to say, "I don't know if running adds years to your life, but it definitely adds life to your years."
Fixx and Benoit ran again the next day. This time they passed a country-club patio crowded with overweight golfers swilling beers after their 18 holes. The golfers couldn't have known who was running past, but neither could they restrain themselves. "Hey, you idiots," they called out. "Don't you know that running will kill you?"
A family-ordered autopsy showed that Jim Fixx had significant blockage in all three coronary arteries. The Vermont state chief medical examiner briefed the family and said that his heart muscle, strengthened by running, had probably extended his life by eight to 10 years. (Before beginning to run in 1968, Jim Fixx smoked and weighed well over 200 pounds. His own father had suffered a first heart attack at 37, and died at 41.) In retrospect, family members pieced together a number of warning signs. One night shortly before his death, Jim had awakened in a cold sweat, barely able to breathe. On a run with John, he had to stop uncharacteristically after a half-mile. He complained that allergies or something were leaving him breathless and he had tightness in his upper arm. He said he might go to the doctor if the allergies persisted. "He was a typical Yankee, a private guy who didn't like to bother others with his problems," says John. "After he died, my three siblings and I said that we would always check in with each other."
"Family history is such a strong risk factor, you can never ignore it," Thompson says. "And people need to understand that the warning signals aren't always a classic chest tightness or pain down the left arm. You can have pain in the right arm. You can have what feels like indigestion. I tell people: If you notice something very quick and transitory-bing! bing!-you've got nothing to worry about. But if you have a persistent sense of discomfort or breathlessness, you need to see your doctor right away. When in doubt, check it out."
Three months after his father's death, John Fixx accepted Ken Cooper's invitation for a complete stress test and workup at the Cooper Clinic in Dallas. "I was 23. I thought I could eat and drink anything," he says. "I didn't break Dr. Cooper's treadmill record, but I might have broken the record for sugar consumption." He has returned to the clinic three more times, and also sees a Connecticut cardiologist for a stress test every two years. After his last test, the good news was that a cardiac calcium scan gave him a zero score, indicating no calcified cholesterol deposits in his heart arteries. The bad news: He was a few pounds heavier, and couldn't run as long on the treadmill.
Since then, Fixx says he has worked a little harder to maintain his 20 to 25 miles a week of running, along with a regular blend of tennis, golf, soccer, and kayaking. But he admits that he should probably pay more attention to calorie control. He's now just four years younger than his father's age on his last run; he's six years older than the time of his grandfather's death. I ask if he's scared that he'll die young, maybe while running.
"My wife is probably more scared than I am," he says. "I want to live a long time. Running feels like the best 45-minute investment I make in a day. It's enjoyable, it makes me feel better, and it's probably paying dividends way into the future. Running is a really easy choice." Add Life to Your Years Most days, on my noontime run, I still don't worry about dying. But now I do find myself thinking more about my heart. Seeking reassurance, I try a Web-based cardiac risk calculator. It uses results from the famed Framingham Heart Study, and tells me-after analyzing my total cholesterol of 170, my HDL of 35, and my blood pressure at 120/80-that I have a 10 percent chance of dying from heart disease in the next decade. Ten percent! That sounds high. I react like a marathoner trying to qualify for Boston; I wonder, What can I do to get better?
So I check in again with cardiologist Paul Thompson. "We're not magicians," he says. "And heart disease is a really complex, unpredictable disease."
Thompson gives me a short list of strategies: Eat a mostly vegetarian diet, consume more fish (or a fish-oil supplement) rich in omega-3 fatty acids, take a daily baby aspirin (81 milligrams), and consider a low-dose statin to lower total cholesterol.
For a day or two, I'm depressed that I can't do more to lower my risk. Then Jim Fixx's words come ringing back to me: "Running might not add years to your life, but it definitely adds life to your years." Another maxim follows: We Live Too Short, and Die Too Long. That's the snappy title that irrepressible Walter Bortz II, M.D., gave one of his books. Bortz, now 78, plans to run the ING New York City Marathon this fall.
With a little more reflection, I realize I'm chasing a false prophet. Long life alone means little. An active, challenge-filled life, that's what I want. I need just one more nugget-Dr. George Sheehan's timeless "Listen to your body"-to form my own new mantra: Listen and live. When my body says "Go for it," I'll run like crazy. When it says "Rest," I'll slow down. When it says"Stop," I hope to pay particular attention. I'm looking forward to my next run.