Undiagnosed illnesses put even experienced runners at risk

Three weeks from now, thousands of runners will lace up their shoes and head down Bayshore Boulevard for the annual Gasparilla Distance Classic.

Most of the 20,000 participants will cross the finish line, completing distances from 5 kilometers to a full 26.2-mile marathon. Some will pull a hamstring or aggravate a bum knee and call it quits.

But there's another, much scarier, scenario few consider. In it, the runner grows short of breath, feels his or her chest tighten, grows dizzy and even collapses.

More than 300,000 Americans a year die from sudden cardiac arrest, an abrupt loss of heart function. A vast majority of those people have obvious risk factors, such as smoking or diabetes. But in rare cases it happens to presumably healthy persons, even pro athletes or participants in popular road races, who, undetected, have acquired heart disease or congenital conditions.

Simply put, running extreme distances or at an extreme intensity stresses the heart. It can reveal abnormalities with the heart's pumping action and heart chambers. And researchers say without knowing your heart health in advance, the exercise has the potential of simultaneously protecting you from and provoking acute cardiovascular events.

"Exercise is fantastic ... but it does put more strain on your heart. And if you have something underlying, and you just jump into something hard-core, you're going to unmask one of those problems," said Eric Coris, a sports medicine specialist and head medical team physician for athletics at the University of South Florida.

An apparent increase in the number of recreational runner deaths is a concern for avid runners and race directors nationwide. Media reports show that at least a dozen runners died during American marathons or 13.1-mile half-marathons in 2009. In October alone, there were seven deaths in long-distance events in Baltimore, San Jose and Detroit.

Research suggests that four to eight of every 1 million marathoners will die from sudden cardiac events, but that doesn't include the potential risk faced by the growing contingent of runners signing up for half-marathons and shorter races. Almost 8.9 million people completed road races in the United States in 2007, including more than 9,000 contests measuring 5 and 10 kilometers each, according to a Running USA industry analysis.

"People will die in marathons. People will die in training. People will die watching TV," said Joe Burgasser, a runner for 42 years and founder of the Forerunners Track Club in St. Petersburg. "But exercise doesn't cause people to die. Poor health does."

Poor health applies to both those who show obvious signs of physical inactivity and athletic individuals unaware they have deadly acquired or congenital conditions such as hypertrophic cardiomyopathy, or an enlarged heart, Burgasser said. The latter condition is the leading cause of death for young athletes in all sports, Coris said, including former Tampa Bay Buccaneer Gaines Adams, who died last month.

These diverse risks reflect the two deaths that have occurred at the 33-year-old Gasparilla Distance Classic, director Susan Harmeling said. The 1994 death of 55-year-old Gary Peacock happened soon after the overweight smoker finished walking the 5K with his wife. A decade later, avid runner Jimmy Hamilton collapsed at mile 7 of the 15K (9.3-mile) race, unaware he had the congenital heart condition that affects 1 in 500 Americans. Other cardiac attacks have happened over the years, but were not fatal.

"We all think we're invincible until something happens," Harmeling said.

Heart problems were nowhere on Mary Hall's radar when she started a Jacksonville half-marathon last year. She and her friends had completed a number of full and half-marathons together since 2003. But she started having difficulty breathing partway through the 13.1-mile race, something abnormal for a woman used to a low resting heart rate.

"I thought this is only a half, so something has got to be up," said Hall, 66, of Brandon.

A visit to the doctor discovered Hall had acquired an atrial fibrillation, a flutter found in about 2.2 million Americans, according to the American Heart Association. She underwent a procedure called a cardioversion, cut back on the intensity of her running regimen, and added yoga and a daily aspirin to her routine. Last month, she completed a marathon and a half-marathon in one weekend.

"I'm doing better in running because of the changes," she said of the adjustments, which include more regular monitoring of her heart.

Despite the known risks, the U.S. Department of Health and Human Services and American Medical Association don't recommend pre-participation physical evaluations for people embarking on an exercise regimen. Any exercise is better than none at all, even when the participant is pushing the body too hard too fast, the groups maintain.

However, many trainers and race directors urge people who plan to work their body harder than usual to get a cardiac checkup in advance. If you're not used to running at all, go to a doctor or cardiologist and plan to take your time building endurance and speed, said Dror Vaknin, a University of Tampa track coach and private running trainer.

"I think the hard part is that people don't realize their body does have limitations," he said.

The intensity of the race increases the importance of cardiac tests such as echocardiograms and electrocardiograms, and stress tests, said Dave McGillivray, longtime race director for events including the Boston Marathon and Women's Half Marathon in St. Petersburg.

McGillivray, who counts among the running deaths six personal friends, said he undergoes medical exams each year in order to continue running marathons. Unfortunately, he said, not every runner who aspires to higher levels of fitness does the same.

"I think people recklessly set goals," said McGillivray, who in 1978 ran 3,400 miles across the county in 80 days. "The goals you set, you need to earn the right to set them."

The increasing popularity of running and its relative simplicity is a blessing and curse, UT coach Vaknin said. It's great that so many people are out exercising, but it can attract people who think they can run 26.2 miles with little more than a few weeks of training.

"They think, 'If he can do it, I can do it, it doesn't matter,'" he said. "And I think that attitude is kind of a little bit insane."

Adding to the risk is the growing popularity of extreme running races, called ultras, or long-distance triathlons that involve swimming, cycling and running for a total of 70.3 or 140.6 miles. Those Ironman races push an untrained heart to true extremes, said University of Tampa professor Linda Musante 55, the current age-division world champion in the 70.3-mile Ironman.

A 2009 study found that the risk of sudden cardiac deaths in triathlons is almost double that of marathons: 15 out of a million.

"There are a lot of people who are not prepared, and it's dangerous for them and for everybody," said Musante, who works out with Vaknin's Progressive Training Team.

Most recreational runners focus their misery on sore knees, muscles and ligament damage. But heads turn each time an elite runner drops, such as the 2007 death of marathoner Ryan Shay during the U.S. Olympic trials, and the death of running guru Jim Fixx in 1984.

Fixx, author of "The Complete Book of Running," and a forerunner in the recreational racing phenomenon, declined a chance to check out his heart just months before his death, said Jeff Galloway, a fellow running advocate, author and friend.

"He definitely was in denial," said Galloway, who promotes a walk-and-run marathon method that keeps heart rates and pressure on other muscles at a minimum.

Galloway operates running groups and online training programs across the country, including the Tampa Bay area. In 35 years, he said, only one person that he knows of died of cardiac arrest while using his method.

Race directors Harmeling and McGillivray said they must depend on runners taking personal responsibility for their health. It's not practical to check each runner's heartbeat with a stethoscope at the starting line, as was the protocol at the Boston Marathon 40 years ago, McGillivray said.

Today nearly every race registration includes a health liability waiver. Gasparilla doesn't require proof of a physical, but participants run at their own risk and are warned: "if in doubt as to your physical condition to engage in an event as strenuous as these races, it is strongly recommended that you seek the advice of a competent physician."

Logistics to add emergency personnel also vary by each race, but most large ones have paramedics on golf carts for each mile of a race. That's the case at Gasparilla, which this year will have between 20 and 40 medical staff on hand for each race, and carts equipped with automated external defibrillator (AED) devices.

Gasparilla also divides racers by estimated speed, and issues a warning to runners to start slow. Harmeling said a major help was adding a walking division for people taking 45 minutes or more to complete the 5K.

Still, Harmeling knows that won't prevent someone from getting out of bed on race day and entering completely unprepared. Most often, that happens in the 5K; the 3.1-mile race attracts roughly 8,000 participants.

Harmeling is getting good at picking those newbies out in the crowd.

"I'll eyeball somebody at the start," she said. "You can spot a medical condition waiting to happen."