No time to quit
Older endurance athletes can
and do survive heart disease
by Teri Dwyer 
| Heart trouble survivor Tim Zbikowski (#2474) runs the Melpomene 5K road race along St. Paul's River Road in May. Photo by Teri Dwyer |
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Tim Zbikowski of Maple Grove, Minnesota, received an awful present for his 51st birthday a year and a half ago a heart attack. Although Zbikowski had a harsh family history of heart disease, he said, "I was naively assuming, because I was the most fit person in my family, I would somehow get past that."
Looking back, the former president of the Minnesota Distance Running Association and former chairman of Men's Long-distance Running for USATF-MN, said he received no physical
forewarning. But his 51st birthday surprise put him in the unwelcome category of physically active people who suffer the effects of heart disease.
Prior to that day, Zbikowski hadn't felt anything like the sudden pressure in his chest he experienced while watching his nephew's cross-country ski race. In fact, Zbikowski was fit enough to complete, without difficulty, a 5K snowshoe race and a five-mile running race the previous weekend.
Even when the tightness and chill overcame Zbikowski, he said he didn't suspect the symptoms were heart-related. "I thought maybe it was something I ate the night before," he said.
After driving himself home and taking a shower, Zbikowski still wasn't feeling well. He called his wife, Carol, who urged him to seek immediate medical attention. Zbikowski took her advice and drove himself to Maple Grove Urgent Care and then was taken by ambulance to the
University of Minnesota Hospital. En route, the ambulance climbed a long hill on River Road where Zbikowski, years before, had frequently run workouts with his track and cross-country teammates at the University of Minnesota, Twin Cities.
| Bob Durband frequently runs the trails at Vadnais-Snail Lakes Regional Park in Shoreview, Minnesota.
Photo by Teri Dwyer |
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"The joke was that if we had a heart attack doing these hill repeats, we'd be right by the
hospital," he recalled thinking. "And here I am, all these years later, going up the hill in an ambulance."
Zbikowski ultimately found out he had had a plaque rupture in his artery. He had to have an angiogram and angioplasty.
The fit but unfortunate few
Zbikowski's close call brings to mind individuals of a similar age and fitness level who were much less fortunate. Among the most recent was Greg Marr, the founding editor of this magazine. He was 52 and
cross-country skiing last December when a fatal heart attack claimed his life.
Martha Fullmer, Marr's wife, said he did have a family history of heart disease but had received a clean bill of health from a cardiologist shortly before his death. She said his heart attack was caused by a piece of plaque breaking away and blocking a main artery.
"Greg knew the odds were stacked against him," Fullmer said. "I believe
that he believed he extended his years by living the very healthy way he lived. I do believe he'd want folks to learn and be aware."
In March of this year, PowerBar founder Brian Maxwell died at age 51. In 1977 Maxwell was ranked third in the world for the men's marathon by Track & Field News. He was a Canadian Olympian, part of the 1980 team that boycotted the Moscow Olympics.
Experts say it's these unusual cases preceded by the deaths of Jim Fixx
and Ron Daws, both in their early 50s that make headlines. These stories, they say, unnecessarily scare active adults and falsely convince others that aerobic activity is no help in the fight against heart disease.
But are distance runners and skiers putting themselves at risk? That risk must be compared to the alternatives, say physicians such as Dr. William O. Roberts.
"A sedentary lifestyle is dangerous," Roberts said, summing up his
thoughts on heart disease. Roberts is the medical director for the Twin Cities Marathon and a physician in the department of family medicine at the University of Minnesota. He's also the president-elect of the American College of Sports Medicine.
"Heart disease happens in the scope of things," said Roberts. "A lot of people die every day who are sedentary. That never makes the paper."
Jim Fixx's death was big news, however. Fixx is credited with playing a
significant role in starting the U.S. running boom in the 1960s that continued into the '70s and '80s. He wrote the best-selling book The Complete Book of Running. He died of a heart attack at age 52 while running in 1984.
Fixx, however, had a known family history of heart disease, had been experiencing symptoms for a while before his death and had, previous to his running days, been a heavy smoker. All of these factors had disastrous results for Fixx.
Ron Daws, a 1968 Olympic Marathon participant, lived and trained in Minneapolis. He died of a heart attack in 1992. Running partners of Daws' now point to symptoms he may have been experiencing. It's unclear whether he recognized these symptoms for what they were. He was only 55 and still a very active athlete when he died.
The unfit & unreported majority
In the book The Lore of Running, Dr. Tim Noakes concurs with Roberts. "If only those sudden deaths occurring in athletes are reported in the press, the public may develop a distorted impression of the relative dangers of exercise, as was the case in the past. Fortunately, the overwhelming evidence for the cardiovascular benefits of exercise ensure that the distortion is no longer possible."
Noakes quotes cardiologist Joseph Wolfe: "The heart of the athlete is a
better developed, physically more adequate organ that functions more economically than the heart of the physically untrained."
Roberts said studies have shown an active person has a one in 50,000 risk for a heart episode while they are running. A sedentary person's risk is one in 100,000. However, an active person at rest has a one in 200,000 risk.
"What this means," Roberts said, "is your risk may be elevated for 30 to
60 minutes out of some days of the week. The rest of the time your risk is so much lower. Exercise is definitely worth the investment of time."
In fact, as Noakes writes, "A large number of people die each day from heart attacks, a point that is sometimes ignored. The vast majority of these people are sedentary, heavy smokers with uncontrolled high blood pressure and elevated blood cholesterol levels."
Running in itself does not provide immunity from heart disease. If you
have a congenital defect (a heart problem you were born with), or other risk factors (you're a smoker, have high cholesterol, or heart disease is part of your immediate family history) you will still have those risk factors.
However, for people who are fit and have been actively training the kind of people who, for instance, would line up to run a marathon the risk of sudden death is low.
Roberts has served on the medical team for the Twin Cities Marathon
for the entire 22 years of the race's existence; he's been medical director for 19 years. He said in that time, out of the tens of thousands of people who have taken part in the TCM events, four have suffered heart-related incidents. One runner had a cardiac arrest near the finish of the TCM 10-mile race. The other three were finishing the marathon. All but one lived.
"For some people, their first heart attack is a warning to change things,"
Roberts said. "If you're lucky, you get a warning."
Second chances
Sixty-year-old Bob Durband of Shoreview, Minnesota, says he is living proof of the benefits of early intervention and a little bit of luck.
Having done everything to avoid running in high school gym class, Durband said he was introduced to cross-country skiing 22 years ago. Long-distance running soon followed. Today he doesn't just run, he
completes marathons, trail races, ultra races and snowshoe races. Plus he still cross-country skis and does a bit of canoeing.
Durband had run every single TCM from 1982-1988. In 1989 he was forced to change his plans.
That previous spring, Durband recalled, "I was feeling just a twinge of something which I didn't recognize as anything. But it wasn't until late summer that I couldn't make it up this slight grade without feeling like I would black out.
"I made the foolish mistake of just ignoring that for a while. You know, you just don't really want to think there's something wrong with you. From what I know now I should have immediately gone to a doctor."
By the time he took that step, Durband said, "I was coughing up some frothy blood."
A physician diagnosed aortic stenosis a narrowing of the aorta. "Then they determined that it was a congenital condition," Durband said. "My
aorta had been narrowing since birth, and I was at the age where it would start to show up. And it did.
"I feel it's a sign God gave me. He looked past my foolishness for initially ignoring it. He gave me this miracle of aortic heart valve replacement."
The surgery was serious and forced Durband to forego the 1989 TCM. But just 10 months later, in June 1990, Durband ran Grandma's Marathon in 3:26:46 12 minutes faster than his 1989 time.
Now, 14 years later, he's still running, skiing and snowshoeing, albeit at a slower pace. But he credits that to getting older, not his heart problems.
Durband said his story should serve as a lesson for others to pay attention to what their bodies tell them. He said he's also an example of a rewarding life after a frightening heart surgery.
"If I can ease anyone's burdens or problems facing these things, I'd love
to do that. I'd do anything I can to ease people's minds because I've been through this."
Zbikowski said his similar experience almost immediately served to help save the life of his younger brother.
"He was with my wife that first night I was at the hospital," Zbikowski said. "When my cardiologist walked out of the OR, he pulled a card out of his pocket, gave it to my brother and told him to come in and get checked."
Just one month later his brother had quintuple bypass surgery for massively blocked arteries. "If he had not taken the doctor's advice to get checked, chances are pretty good that when he had a heart attack, it would have been all she wrote massive," Zbikowski said.
Zbikowski himself entered a cardiac rehab program after his surgery. He was a star pupil, ultimately burning out two treadmills because they couldn't keep up with him.
He remains active, even setting goals of running some fast master's races in the future. But he is a more cautious runner. Not because of his heart, but because he doesn't want to overdo it on his new hip he had hip replacement surgery in 2002.
As for his heart and his future, Zbikowski said, "I guess I'd rather go out and enjoy the running every day even if that means keeling over one day. I'd rather do that than sit (around) and get overweight and go that direction."
Symptoms to heed
Regardless of one's physical fitness, there are common symptoms many people experience that may be an indication of heart problems. Roberts listed them:
stomach upset,
chest discomfort or pressure (but not crushing pain) and
skipped heartbeats while exercising or running.
"Then there are more subtle ones that we look for, such as a loss of energy," he said. "People who normally run at a seven-minute per mile
pace suddenly are having a difficult time at seven and one-half or an eight-minute pace. Or they used to run for an hour and now have trouble with five minutes of running."
The bottom line for aging and would-be athletes? "Eat right, sleep right, train right," Roberts said. "One thing I would want them to come away with: exercise in itself is not dangerous. Exercise is critical. As Americans especially, we under-exercise and overeat. You don't have
to run marathons, but you do need to workout every day; burn some calories every day."
Roberts says there are a few essential points to remember:
Pay attention to your body.
Report any problems to your physician.
Get a running partner. If something goes wrong then there's someone to help out; sort of the buddy system.
Pay attention to the heat. Heat will put higher demands on your cardiovascular system. These include not only the demands of the work
(running) but also the demands of cooling your body.
Taking care of himself and listening to his body has brought Durband new rewards from running. He said his more recent TCM experiences are altogether different than what they used to be.
"Running down Summit Avenue (the last five or so miles of the race) people are treating me equally as well, maybe better, than when I ran faster," he said. "I get the feeling I'm in first place the way they're treating
me. How can I go wrong? I'm having fun."
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