Are Marathons Dangerous?

Special Report: Are Marathons Dangerous?



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


Grave Concerns


Special Report: Are Marathons Dangerous?


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


The Running Effect


"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."

Time on Newt

Sunday, November 20, 2011

November 9, 2011, 12:04 am

Gingrich Rises in Polls But Has Major Obstacles to Nomination

By NATE SILVER

I forget whether I posted something on Twitter to this effect or simply kept the thought to myself, but there was a point in time at which I would have given Newt Gingrich not more than a 1-in-1,000 chance of winning the Republican nomination.

That may have been foolish. This year’s Republican nomination process, if nothing else, has reminded us how often things don’t go to plan and how unpredictable the primaries can be. Lately, Mr. Gingrich has been showing some signs of life.


He has averaged 13 percent of the vote in polls conducted of Republican voters so far in November, his third straight month of improvement after he bottomed out at 5 percent in July and August. There’s also some evidence that Mr. Gingrich tends to be competing for the same types of voters as Herman Cain, so if Mr. Cain’s campaign begins to erode support, Mr. Gingrich could be the beneficiary of that.

Perhaps more surprising is the rebound in Mr. Gingrich’s favorability ratings among Republican voters. According to Gallup’s tracking poll, Mr. Gingrich is now viewed favorably by 55 percent of Republican voters and unfavorably by 23 percent, a big improvement from June when those numbers were 42 and 31 percent, respectively.


But there is much to consider in a primary campaign beyond the national polls. I would group these “fundamental” factors into five broad categories, each of which we will consider in the context of Mr. Gingrich:

Early State Polls and Positioning Somewhat contrary to the perception that Mr. Gingrich is running a national book tour rather than a serious campaign for the White House, he has spent most of his time in the key early-voting states. Based on Politico’s candidate tracker, I show Mr. Gingrich as having held 11 events in Iowa between Sept. 1 and Oct. 31, along with seven in Florida and five in South Carolina. He has spent very little time in New Hampshire, but overall he made 25 appearances between the four states during this period, about the same number as Mitt Romney

Polls suggest that Mr. Gingrich is right to concentrate on the other three states at the expense of New Hampshire: his numbers lag his national support by several points in the there, while running roughly in line with it in the others. It’s conceivable that Florida and South Carolina could turn into strengths for Mr. Gingrich. He is from Georgia, which neighbors both of them, and polls find that Mr. Gingrich runs relatively strongly among older voters, which will be helpful to him in Florida. But he will probably have to perform strongly in Iowa to get to those states in decent shape, and although recent polls show his numbers improving there, he lacks infrastructure in Iowa and fared very poorly in the Ames Straw Poll.

Endorsements and Party Support. Mr. Gingrich has a half-dozen endorsements from Republicans in the U.S. House, but almost all of them came toward the start of his campaign in May and all but two of them are from his home state of Georgia. (He also has the endorsement of Georgia’s governor, Nathan Deal.) Mr. Gingrich has very few endorsements in key early-voting states.


Some endorsements are better than none, and Mr. Gingrich has more from members of the Congress than candidates like Herman Cain (who has just one), Representative Michele Bachmann (zero) and Jon M. Huntsman Jr. (also zero). It’s important to remember that relatively few Republican party leaders have made endorsements of any kind so far, and it’s certainly not impossible to imagine the former speaker of the House finding support within the Republican establishment. For the time being, however, the low endorsement total qualifies as a weakness for Mr. Gingrich.


Fundraising and Campaign Infrastructure. Mr. Gingrich’s fundraising has been simply abysmal — just $2.9 million brought in through Sept. 30. Not only that, but as of Sept. 30, Mr. Gingrich had only $353,000 in cash on hand but $1.2 million in debt. There’s some question about whether fundraising is more of a lagging or a leading indicator; the money sometimes follows the polls. But it is hard to see how numbers like these are anything other than a huge problem for Mr. Gingrich.


What they may really point toward is his lack of a robust campaign infrastructure, caused in part by numerous staff defections early in this campaign. He may even be in something of a Catch-22: it’s hard to hire staff if you don’t have money, but it’s hard to raise money if you don’t have any staff. Whether Mr. Gingrich makes a credible effort to address these issues over the next several weeks will be a good sign of how seriously his surge should be taken.


Ideological Positioning. Mr. Gingrich got himself into trouble early on with his apostasies over Rep. Paul Ryan’s budget plan. But most every Republican candidate has one or two positions that they now find inconvenient, and Mr. Gingrich’s overall ideological positioning isn’t bad given the mood of the Republican electorate. We did not include Mr. Gingrich in our recent magazine feature on Republican candidates that rated their ideology from center to right on a 100-point scale, but his score would be fairly close to that of Gov. Rick Perry, which in my view represents something of a sweet spot for the Republican primary electorate: solidly conservative but not in Michele Bachmann territory. Mr. Gingrich is also fairly well positioned on what I call the establishment-insurgent axis; he can claim to know how Washington works while also seeming like an outsider since he has been out of it for some time.


This, overall, is one of Mr. Gingrich’s greater strengths: one can imagine him being acceptable in theory to a fairly broad array of conservative voters.


Electability and Personal Liabilities The downside to being acceptable to most conservative Republicans is that you may not be ideally positioned for the general election. I don’t place a lot of emphasis on horse-race polls this early out, but Mr. Gingrich trails President Obama by 11 points in recent surveys, about the same as Mr. Perry. Our forecasting model, which is based on ideology ratings rather than these polls, suggests that he might ultimately run a net of about 4 points worse than someone like Mitt Romney nationally.


Of course, in the context of a nomination race, the perception of electability may be more important than the reality of it. But those numbers are quite poor for Mr. Gingrich as well. In the recent ABC News/Washington Post poll, just 5 percent of G.O.P. voters identified him as the candidate with “the best chance to defeat Barack Obama in the general election,” well below the 11 percent support he had overall in the survey.


Meanwhile, although Mr. Gingrich’s personal favorability rating has rebounded a great deal among Republican voters, he has some image problems that could come back to harm him should he rise in the polls and receive more scrutiny from voters and the media. The most obvious problem is Mr. Gingrich’s two divorces, a subject that may receive more attention given the recent focus on the sexual harassment allegations against Mr. Cain. Mr. Gingrich may also not be as thoroughly vetted as candidates like Mr. Romney and Mr. Perry, who have run for office more recently.


Finally, there’s the fact that Mr. Gingrich is anything but a new face to voters and is associated with an exceptionally unpopular institution, the United States Congress.


Overall, I would read three of these factors, establishment support, personal liabilities, and (especially) fund-raising, as being clearly negative for Mr. Gingrich. This contrasts against one, ideological positioning, which is potentially favorable for him. He has both strengths and weakness in the key early-voting states, meanwhile.


That balance is unfavorable enough to suggest that his chances of winning the nomination are weaker than his polls alone would imply. That certainly does not mean that his chances are zero, or 1,000-to-1 against. If Republican voters decide that they really don’t want to nominate Mitt Romney, Mr. Gingrich could be the last man standing. But even if Mr. Gingrich continues to gain in the polls, he will have some major weaknesses to overcome.