Understanding DNF: Perspectives from Age Groupers and Professionals and Exploring Cardiac Events in Endurance Sports: A Critical Discussion
The central theme of this podcast episode revolves around the nuanced differences between the experience of "Did Not Finish" (DNF) in triathlon for amateur athletes versus professional competitors. We delve into the psychological and situational factors that influence the decision to abandon a race, highlighting how age groupers often strive to finish at all costs, while professionals may prioritize their long-term performance and health. This conversation is enriched by personal anecdotes, revealing the emotional weight and varying implications of a DNF for each group. Additionally, we explore recent professional race results, including significant performances that could shape the upcoming championship season. Lastly, we discuss a compelling study published in the Journal of the American Medical Association regarding cardiac events during endurance races, emphasizing the importance of awareness and preparedness for athletes.
Links to topics discussed:
The TriDoc Podcast
Matt's Instagram
Jeff's Instagram
Email Jeff: tri_doc@icloud.com
Email Matt: Matt@thetemponews.com
Signup for the Tempo News
Signup for The TriDoc Podcast Supplement form
Transcript
What would happen if you brought together a professional triathlete and producer of one of the most widely read triathlon newsletters.
Speaker B:Together with the tridoc medical contributor for Triathlete magazine, age group winner and coach at LifeSport coaching.
Speaker A:Let's say you had the makings of a pretty good podcast.
Speaker B:Welcome to Tempo Talks.
Speaker B:Two perspectives, one sport.
Speaker B:All things triathlon.
Speaker A:Hey Matt, it is so good to be back with you here again.
Speaker A:How are you doing today?
Speaker B:I'm okay.
Speaker B:I'm okay.
Speaker B:We were actually talking before the podcast about.
Speaker B:I was dealing, been dealing some bike issues.
Speaker B:Not necessarily bad, but just getting on a new bike and all the accoutrements, the bits and pieces, you gotta new.
Speaker A:Bike, new bike day.
Speaker A:It's funny, my, my son Adam is.
Speaker A:He's great runner, but he is super into biking.
Speaker B:Nice.
Speaker A:And he has gotten the bug where he has now been like sending me reels about how he needs a new bike to be faster and yeah, it's like which will be.
Speaker A:Which will make me faster.
Speaker A:Putting in all the work or getting a new bike?
Speaker A:Clearly it's getting a new bike.
Speaker A:Yeah.
Speaker A:So it's been pretty funny how he's been seduced at a young age.
Speaker B:But we all have this, no matter what age.
Speaker B:I think the new bike.
Speaker B:Yeah.
Speaker B:Thing that will make us faster.
Speaker B:Debatable, if true.
Speaker B:But Adam, it's definitely true.
Speaker A:He'll appreciate you saying that.
Speaker A:And there's no question, let's face it, the just the moral, the psychological bounce that you get from the shiny new wheels is always going to help.
Speaker A:So tell me, you've.
Speaker A:You're what we're two and a half weeks now away from Boulder.
Speaker A:What's it like getting on new, a new ride this close to a race?
Speaker B:It's definitely not, I would say, not perfect.
Speaker B:Not the perfect situation.
Speaker B:There's some sponsor stuff that went on this winter that kind of made it so I'd have to get this bike later on.
Speaker B:And I'm thankful to have it.
Speaker B:I'm looking forward to debuting it soon.
Speaker B:I would say the fit is going to be the same and I have the measurements, so that's standard.
Speaker B:It's just more like the handling, getting used to that.
Speaker B:Although on a course like Boulder, there's not really too many crazy turns or anything.
Speaker B:So there's not a big technical challenge that way.
Speaker B:It's more just getting comfy on the bike and getting to know each other and working together.
Speaker B:That's not a long time, a couple weeks to really find a rhythm.
Speaker B:But it felt pretty good today.
Speaker A:You're gonna have to spend some time identifying who else on the circuit has an Orbea, in case you know, because Mark Dubrick can't be your go to guy.
Speaker B:I actually one of his teammates, he's got a friend, a female triathlete, Lisa Picaris.
Speaker B:She also, she rides.
Speaker B:It's an Orbea and that's going to be the new bike.
Speaker B:So I'll hit her up for sure if I have issues, which I won't.
Speaker B:I know I won't.
Speaker A:Now, I was reading in the Tempo news that you have a house guest.
Speaker B:Yes, we do.
Speaker B:So it was funny in St.
Speaker B:George, I got a message from Jake Burwistle, who is an Australian olympian now doing 70.3 racing and definitely tearing it up, getting a bunch of podiums.
Speaker B:He was sixth in St.
Speaker B:George, which in that field is a great result.
Speaker B:And he messaged me out of the blue at the race, just being like, hey, coming to Boulder, do you have anywhere I can crash?
Speaker B:We have a spare room.
Speaker B:So I was like, yeah, come on over.
Speaker B:And it's great because he's a great athlete.
Speaker B:So for me, it's an opportunity to just chase down this guy who's.
Speaker B:Who's smashing it at the moment.
Speaker B:It's a little training camp thing for me before he competes at next weekend's.
Speaker B:Yeah, next weekend's T100 San Francisco.
Speaker A:Ah.
Speaker A:So he's just here for a short time, heading off San Francisco.
Speaker A:Is he coming back for Boulder?
Speaker B:He's not.
Speaker B:He's actually.
Speaker B:It's crazy because he was originally gonna do San Fran and then just go home and figure out what's next, but then he got another T100 wild card, which they're throwing them out these days.
Speaker B:He's going to Vancouver, but he's still going home in between.
Speaker B:And.
Speaker B:And it's like a two week period in between.
Speaker B:So I think he's going to be home for a week.
Speaker B:But home is where the heart is and maybe that for a lot of people that's good enough.
Speaker B:Even though you got to go to another continent to get.
Speaker A:That's a long flight to do in a short succession.
Speaker B:Yeah, he's from the short course world.
Speaker B:We know those long haul flights pretty well.
Speaker B:So I imagine it won't take as much out of him as maybe most other people.
Speaker A:All right, what do we have on tap for today's episode, Matt?
Speaker B:Today's episode we had, I think, a Tempo subscriber or a listener of the podcast talk to you specifically about doing a topic, talking about the differences between DNFing as an age grouper and as a pro and certainly some differences there.
Speaker B:We're going to be talking about some more pro results on the weekend and what it means for the championship season later on.
Speaker B:And you have an interesting cardiac arrest paper.
Speaker B:I'm not too fluent on what's going on with this paper, but it sounded quite interesting and maybe you can fill us in a little bit right now.
Speaker A:Yeah, it's a paper that came out from the Journal of the American Medical Association.
Speaker A:It's a paper I was asked to review and write an article for Runners Magazine and it looked at the rate and the survivability and who cardiac arrest was happening to in running races.
Speaker A:And it was a pretty interesting paper.
Speaker A:It's something we'll talk about once we get to those other two topics.
Speaker A:Why don't we dive into that DNF question that came from listener Shelly Parsons.
Speaker A:She is a life sport athlete.
Speaker A:I've known her for several years and she reached out to me privately and thought that it might be an interesting subject given that we are an age grouper and a pro.
Speaker A:And why not give our take on the dreaded DNF?
Speaker A:I will tell you that in 20 plus years of triathlon I have had one DNF and that happened when I was racing a sprint distance race.
Speaker A:I had flat on a tubular and I was not carrying a spare.
Speaker A:So the Christian Blumenfeld way of doing things.
Speaker A:So there was really no choice for me to continue.
Speaker A:I had to abandon.
Speaker A:That's the only DNF I've ever had.
Speaker A:And Shelley's comment to me was age groupers will do just about anything to finish their race.
Speaker A:They do not want to quit.
Speaker A:They do not want to have that dreaded dnf.
Speaker A:But pros frequently will.
Speaker A:And I can imagine just thinking about it why the approach and why the DNF means a different thing to each of us.
Speaker A:But tell me your perspective as a pro.
Speaker A:Have you had a DNF and what was the circumstances around it?
Speaker A:If you have and why would a pro consider a DNF in a race that they may have really worked hard to get to?
Speaker B:I'm actually definitely, I think in the same vein.
Speaker B:I think a lot of triathletes are the same where I don't want to know if it's death before dnf, but it's along those lines, right?
Speaker B:You want to give it your all on race day.
Speaker B:You've probably invested a lot to get to race day.
Speaker B:And I feel like I'm in this a Similar boat.
Speaker B:Like I've.
Speaker B:I remember when I was a junior athlete, went to Mexico for, I think it was Pan Am Championships, and came out of the water in a great position, lead group, and literally within the first 2K, I had a guy crash right in front of me.
Speaker B:I went down, busted up my wrist, but still got back on the bike and pushed it all the way to the end, finished.
Speaker B:I had actually a pretty good overall run time minus the crashes and the crash and whatnot.
Speaker B:Again, you just.
Speaker B:You want to push to the finish.
Speaker B:So I'm definitely someone who is happy to just continue on no matter what.
Speaker B:I would say maybe the dnf, that really stands out for me, I honestly haven't had too many, but the one that really stands out for me, we.
Speaker B: ace in China, and this was in: Speaker B:And it was funny because before the race I was questioning whether I needed to go because I'd had some good results before then.
Speaker B:I'd been getting some good points, but I felt like I had to continue to push just to hold on to this spot that I was getting for Canada at the time.
Speaker B:This course in Weihai, China, it's actually known as being incredibly hilly, incredibly difficult on the bike, and coming out of the water, I already knew things weren't really going to be spectacular.
Speaker B:Just fell between groups throughout the entire bike.
Speaker B:I think it got to about halfway and I had a race the next weekend after that in Europe.
Speaker B:And so I was like, I'm not going to keep going.
Speaker B:This is.
Speaker B:I'm going to finish, not even getting points.
Speaker B:So for me, it seemed like one of those things where it wasn't worth finishing just because I had more races on the horizon.
Speaker A:And when I think about it, that, to me, is the prime reason why it's different for us as age groupers versus pros.
Speaker A:I do four races a year, and so there's much less motivation to quit in a race because I'm not going to have another race for another six weeks or so.
Speaker A:Whereas for you, often pros will be racing the next week or maybe the week after that.
Speaker A:And the toll that it could take on your body to be pushing yourself for something that mentally, maybe you're just not in that much anymore because the podium's out, you're out of the money, let's say, what's the point, right?
Speaker A:You're doing it at that point.
Speaker A:You're doing it for pride, you're doing it maybe for your sponsors, but for the most part, you Want to be able to show up at the start line at your next race in tip top shape.
Speaker A:And if you're going to potentially risk injury or potentially take a physiological toll, it seems to me like it makes sense to weigh that into the equation.
Speaker B:It's definitely different as a pro and especially doing that short course racing that we were racing so frequently.
Speaker B:But that makes me think and wonder.
Speaker B:Back in the day with Ironman racing and long course racing, there wasn't these pro series like it was basically like you do one Ironman and then you go to Kona.
Speaker B:I think.
Speaker A:Yeah, I mean that that's a while ago.
Speaker A:I remember reading Mark Allen, Dave Scott saying things like hey, you had one shot.
Speaker A:You basically had to show up at that Ironman because there wasn't another one that you were going to be able to have a second chance.
Speaker B:I just wonder though if nowadays there's actually going to be less DNFs because these athletes, maybe they're not having a great day in an especially in an Ironman, but because this every second counts situation because there's points for finishing these races, maybe in a different era they would pull out because they say okay, maybe I'll do.
Speaker B:I won't do this marathon because in four weeks there's a different Ironman somewhere.
Speaker B:But now maybe they're just like oh geez, I need to get on this for the series because I need to qualify for the next one or something.
Speaker B:I'm curious to see how that maybe the trend of DNFing actually will go down just because of the nature of the series and actually still finishing especially a full distance race for the Ironman Pro series.
Speaker B:It'll still get you great points.
Speaker A:And there is also just in the calculus of why we do these races.
Speaker A:So many of us are parents, so many of us are spouses and we're doing it for fulfillment, self fulfillment.
Speaker A:And we really don't want to let ourselves down.
Speaker A:We don't want to let our kids down who might be there watching.
Speaker A:We don't want to set that example.
Speaker A:So there are these other ulterior motives that I think don't really sure they exist for you guys as pros, but that's not the main reason you're racing.
Speaker A:You're racing because it's your job and it's.
Speaker A:I'm sure you enjoy it and I'm sure you get the same kind of degree of self fulfillment but it's not.
Speaker A:There's not those pressures.
Speaker A:I think those external.
Speaker A:I could be wrong.
Speaker A:Tell me if I'M wrong about that.
Speaker B:About those external pressures as we've talked about.
Speaker B:Sometimes I do think it makes sense to dnf, really, if you have bigger things to.
Speaker B:Bigger fish to fry later on.
Speaker B:I would say, though, especially going back to my short course days, you would see athletes who maybe they would DNF if they're having a tough day, and there's almost this psychological barrier or psychological situation where, because you've DNF'd, you know, when things aren't going well, the next time things aren't going well or are perceived to not be going well, you'd shut her down.
Speaker B:And I think, yeah, that you can just see that kind of mentality creep in, and that's definitely not what you want to have, obviously, age grouper or pro in anything in life.
Speaker B:You don't want to quit when things are maybe not going your way.
Speaker B:Exactly.
Speaker B:But I just saw athletes who.
Speaker B:You're like, that's where they.
Speaker B:I could see where they're at.
Speaker B:They're not finishing today.
Speaker A:Yeah.
Speaker A:I almost wonder if that's a.
Speaker A:Oh, gosh.
Speaker A:Our Ironman world champion who's really struggled.
Speaker A:I want to say Sam.
Speaker B:Oh, Sam laid low.
Speaker A:Sam Laidlow.
Speaker A:Yeah.
Speaker A:Like, he had that reputation for a while there where he would finish the bike, he would get on the run, and you could tell pretty early on that he doesn't look like he's going to finish today.
Speaker A:And sure enough, he wouldn't.
Speaker A:But he did in Kona.
Speaker A:Right.
Speaker A:He pushed himself through that run in Kona.
Speaker A:That was just brutal.
Speaker A:I'm almost wondering if that was a mistake, because now, look, he's having real trouble.
Speaker A:That's really interesting.
Speaker A:And it's a.
Speaker A:And I really thank Shelley for sending that question in because it's something that I think I.
Speaker A:I may have given some thought to previously, but not in a serious way.
Speaker A:And it's interesting to hear your perspective on that.
Speaker B:And honestly, I'll tell you, during that St.
Speaker B:George race a couple weeks ago, like, there was times where I think.
Speaker B:I.
Speaker B:I don't know if I told you this or told other people, but the course went by like, my hotel, like, literally a block away.
Speaker B:And, geez, I was pretty close at one point to being like, I'm just gonna pull over and be done, because, again, things really were not going my way.
Speaker B:But at the end of the day, I think my criteria for doing a dnf, hey, if you're, like, actually injured or say you crash and hurt yourself and, wow, this doesn't make sense to keep going or you Maybe you came in with an injury and it's clearly not going to get better as time goes on.
Speaker B:I think that's totally acceptable to stop racing for sure.
Speaker B:But I didn't need that.
Speaker B:I didn't have any of that.
Speaker A:It's so interesting that you mentioned that because I remember Peter Reed.
Speaker A:One year he came back to Kona as the defending champion and he was doing pretty well.
Speaker A:And then he got out on the run and he just, he ran past his condo and then he was like, I'm done.
Speaker A:And then he just walked right into his condo and that was the end of his day.
Speaker A:And I think that's a danger.
Speaker A:Right?
Speaker A:I know I sometimes I'm on a long training run and I make a plan to go by my house to pick up more fuel or more fluids.
Speaker B:Yeah.
Speaker A:And I know that's a danger point because the second I walk in the door, it's going to be super hard to walk.
Speaker B:If it's a hot day and you go inside for a second, it's air conditioned.
Speaker A:So I could totally understand the sort of the warping of space time to, to drag you towards the door of the condo to get you off the course.
Speaker A:I could totally see that.
Speaker B:It was.
Speaker B:The gravitational pull of that hotel was quite strong that day.
Speaker A:Well, kudos to you for somehow being able to break free and find the escape velocity.
Speaker B:I wanted to, I wanted to ride Snow Canyon, so I got to do that.
Speaker A:Excellent.
Speaker A:Excellent.
Speaker A:All right, let's move to our second topic which is to revisit some of the really interesting and fun professional races we saw this past weekend.
Speaker A:We had one over on the Canary Islands in the form of Ironman Lanzarote which was completely dominated by Lucy Charles Barkley.
Speaker A:And we had the 70.3 race in Aix en Provence, a city that I absolutely adore and was pretty exciting event with a lot of big names and a really exciting finish with Christian Blumenfeld pulling out the win.
Speaker B:It's funny that Ironman Lanzarote like a lot of these pro races now they're getting covered up by maybe the pro series of the T100.
Speaker B:But the thing that stood out for me about Lanzarote was obviously Lucy Charles Barkley going, I guess she had to like because she's won Kona in the past.
Speaker B:So in order to go to an Ironman world championship, she has to still validate.
Speaker A:Correct.
Speaker A:She just has to finish.
Speaker A:She doesn't have to win.
Speaker B:No, she doesn't have to win.
Speaker B:But she's a winner.
Speaker B:Winners win and she certainly did that I think second place was 20 minutes behind, which I'm not even going to read that much into, but I think that was just important news.
Speaker B:It's important in the context of the women's race is going to be in Kona this year.
Speaker B:Clearly she's going to be in back in Kona.
Speaker B:Now, obviously, fingers crossed everybody's healthy, but adding her into the mix, it just sets things up for a pretty exceptional day in Kona.
Speaker A:Oh, absolutely.
Speaker A:So we've got Cat Matthews going.
Speaker B:We have Matthews.
Speaker A:Did Taylor get a slot from Texas?
Speaker B:Yeah, yeah.
Speaker A:So we've already got Kat Taylor, Laura, Lucy.
Speaker A:Lucy, right there, you've got four of the best in the business and it's going to be a sensational day.
Speaker A:Now, like you say, the big question is, are they gonna stay healthy?
Speaker B:Yes, we all hope that's the case because you just want people there firing on all cylinders because all those athletes have.
Speaker B:I don't know if actually different skill sets, different strengths.
Speaker B:Lucy Charles, obviously pushing from the front, probably will have Taylor nib with her, I would think, at some point on the bike anyways.
Speaker B:So maybe those two could work together.
Speaker B:Meanwhile, behind, you've got obviously Kat Matthews.
Speaker B:So showing she's one of the best runners, obviously.
Speaker B:Laura Philip, also an incredible runner.
Speaker B:So just the different dynamics, you just want to see all them there.
Speaker B:And it would make for an incredible race day.
Speaker A:Yeah, I think it's shaping up already.
Speaker A:And we're only end of May.
Speaker A:I think we can really look forward to a really great powerhouse feel.
Speaker A:I think it's going to be pretty cool.
Speaker B:And then moving over to that.
Speaker B:How do you say it?
Speaker B:You say it much better.
Speaker B:My accent isn't as good as yours, but I didn't grow up in Quebec.
Speaker B:Anyways, one of the things that I noticed.
Speaker B:Wow, it's hard not to notice from that race was Blumenfeld taking the win and then jumping into the lead of the Iron Man Pro series.
Speaker A:It's pretty surprising this early on, but I guess you win Ironman Texas and that's going to happen.
Speaker A:Gets a lot of points.
Speaker A:He was really.
Speaker A:He was biting his time on the bike when I was watching.
Speaker B:Yeah, he watched those moves, huh?
Speaker A:I was dropping in and out of the telecast and I was seeing him on the bike and I was thinking to myself, oh, it's interesting.
Speaker A:He's not really putting much into the leaders and not establishing himself the way he frequently does.
Speaker A:But then once he got onto the run, there was five of them kind of running together, trading off on the lead, and then at about 15k.
Speaker A:He just was like, okay, I'm done.
Speaker A:And there's Hammer.
Speaker A:He just dropped the hammer.
Speaker A:And he's pulling away from the guy who's in second.
Speaker A:I'm blanking on his name right now.
Speaker B:And you, the Norwegian guy.
Speaker A:And you could see that he kept looking at his watch and I could hear it.
Speaker A:I could hear his thoughts.
Speaker A:He's.
Speaker A:Are you freaking kidding me?
Speaker A:Seriously, like, that's his face and I can't do this.
Speaker A:Like.
Speaker A:And yet they both looked.
Speaker A:Look, Christian is as impressive as he is normal looking and right.
Speaker A:It just.
Speaker A:He just looks like a normal dude.
Speaker A:He doesn't look like the super.
Speaker A:He doesn't look like Magnus.
Speaker A:He doesn't look exactly.
Speaker A:He's not the super or like you like super tall, super slim.
Speaker A:He just.
Speaker A:He's got this like barrel chest.
Speaker A:He's.
Speaker A:And he's just so fast.
Speaker B:He's incredible.
Speaker B:Setting up, you know, his Iron man pro series campaign, I think that's his focus this year is getting the win in the pro series from what I imagine, and probably trying to win both the world championships based on the form he's in.
Speaker A:But again, we always have or we have seen this in the past.
Speaker A:Guys who peak too early, of course.
Speaker A:And you wonder Lionel, is Lionel peaking too early?
Speaker A:Is Christian peaking too early?
Speaker A:Sometimes we've seen the guys like Sam Laidlaw is a great example of a guy who didn't do much during the season but peaked at exactly the right wing weekend and showed up in Kona and that was his peak.
Speaker A:I don't think Lionel is doing anything wrong.
Speaker A:I think that he.
Speaker A:His season is such that he seems to have this sort of ebb and flow kind of thing going now.
Speaker A:He missed Ironman Texas, so I'm not sure which.
Speaker A:Do you know which Ironman is it?
Speaker A:Placid.
Speaker A:He's going to go to try and get a Kona slot.
Speaker B:I would think Placid would make sense.
Speaker A:And that would make sense for his bike prowess as well.
Speaker A:So I guess we'll see.
Speaker A:And that gives him a good springboard because July race, you can recover a little bit through August and then start rebuilding back in through September.
Speaker A:October, I don't know.
Speaker A:It's going to be an interesting year as it plays out.
Speaker A:I hate looking forward already to the fall.
Speaker A:I just want to enjoy the summer for sure.
Speaker B:But definitely some interesting storylines coming out of these.
Speaker B:The weekend for sure.
Speaker A:So you mentioned the T100 in San Francisco.
Speaker A:That race is what, two weeks away?
Speaker B:Not this weekend, next weekend.
Speaker B:So like 10, 11 days or whatever it is.
Speaker A:Right?
Speaker B:And that'll be great.
Speaker B:That'll be fun watching them jump off.
Speaker A:The boat right now.
Speaker A:Besides Jake Birtwistle, who else are we looking for in that one?
Speaker A:I know I'm catching you off guard because we haven't really rehearsed.
Speaker A:We haven't really looked into that one yet.
Speaker B:I think it's the usual suspects.
Speaker B:In the T100, you have Martin Van Real, who won it last year.
Speaker B:Sam Long's gonna be there.
Speaker B:You're gonna have Kyle Smith from New Zealand.
Speaker B:Rico Bogan, the German kid who's fantastic.
Speaker B:And then folks like Jake Bear Whistle.
Speaker B:You actually have.
Speaker B:One of the interesting ones who I saw as a wild card is his name's.
Speaker B:Oh, gosh.
Speaker B:Panagiotis Betados.
Speaker B:I don't know if I pronounced that right.
Speaker A:Awesome name.
Speaker B:And he won the most.
Speaker B:One of the more recent 70.3s in Venice.
Speaker B:It was a pro series race.
Speaker B:Great field.
Speaker B:And he took it to them.
Speaker B:Another wild card there.
Speaker B:I think you got yellow.
Speaker B:Well.
Speaker A:So shaping up to be a grayfield for sure.
Speaker A:And you mentioned Sam.
Speaker A:We should throw in that Chattanooga happened this past weekend, and Sam won the shortened race.
Speaker A:Unfortunately, no swim for that race.
Speaker A:But he.
Speaker B:I don't think he was too sad when they.
Speaker A:I don't think he.
Speaker A:Although that swim is to his advantage with the current, he probably would have done just fine, but definitely not having a swim didn't hurt him at all.
Speaker B:It was going straight to the bike.
Speaker B:He'll be.
Speaker B:He was happy about that for sure.
Speaker B:That was.
Speaker B:I don't think it was too difficult to win for him on that day.
Speaker A:No.
Speaker A:All right, let's move to our third topic of the day.
Speaker A:And that is a recent article that came out in the Journal of the American Medical Association.
Speaker A:And the title of said paper was Cardiac Arrest during Long Distance Running Races.
Speaker A:And it's an interesting paper.
Speaker A:It looks at the incidence.
Speaker A:So the incidence is how frequently something happens in a year or over time.
Speaker A:And in this case, they were looking to see how frequently cardiac arrest happens during these running events.
Speaker A:And they compared it.
Speaker A:They compared two time periods.
Speaker A: They compared: Speaker A:So not exactly equal time periods, one of them being nine years, the other one being about 14 years.
Speaker A:And what they found was on an annual basis, that earlier time period compared to the later time period.
Speaker A:The later time period had a threefold increase in participation in both half marathons and marathons.
Speaker A:So a very significant uptick in people who are running and what the authors wanted to know was, when you see all those more people running, are we seeing a higher incidence or a higher rate of cardiac events?
Speaker A:Because we're bringing in more people, are we bringing in more disease and are we seeing more cardiac events?
Speaker A:And then also, who are these people who are having cardiac events and then how are they doing when they have them?
Speaker A:And basically what they found was the rate of cardiac events was essentially unchanged.
Speaker A:So you're.
Speaker A:Yes.
Speaker A:With more people, the rate is the same.
Speaker B:So, yeah, there's probably, obviously, more total incidence in the later group, but the rate.
Speaker B:So overall, there's not more relative to the other group.
Speaker A:Yeah, exactly.
Speaker A:So if you look at the absolute number, because you had three times as many people, you had about three times as many cardiac events.
Speaker B:Yeah.
Speaker A:But when you look at the rate per hundred thousand runners, that rate was essentially unchanged.
Speaker A:What they did is they reported it as one cardiac event per approximately 185,000 runners in the earlier cohort, and in the later cohort, it was one cardiac event per 170,000, which statistically is about the same.
Speaker B:Yeah.
Speaker A:So that was interesting.
Speaker A:We were seeing that despite the fact that you're increasing the number of people running, you're not necessarily pulling in people who have a more likely poor outcome.
Speaker A:So that's good.
Speaker A:There is this thing, you've probably heard of it, Matt, this idea that the more you train, the more likely you are to run into trouble with your heart.
Speaker A:Familiar with that idea?
Speaker B:Is there a certain threshold of, like, training hours?
Speaker B:What does that look like?
Speaker A:So it's called the reverse J curve, and it's basically the reverse J curve says that the more you train, your risk of cardiac disease goes down.
Speaker A:But after you pass a certain tipping point, the risk of cardiac disease starts coming back up.
Speaker A:And so if you look at it, it looks like a J.
Speaker A:And the key to this is that your risk of cardiac injury or death never comes back up to what it would be if you weren't exercising at all.
Speaker A:And, of course, I think gets lost a little bit.
Speaker B:Yeah, yeah.
Speaker A:But people have been afraid that, oh, there's this issue and that the reverse J curve, the reason for it, is related to hypertrophy of the left ventricle.
Speaker A:So the more we exercise at high intensity, the more likely we are to get this overgrowth of the left ventricular tissue.
Speaker A:And therefore, that leads to cardiac dysrhythmias and sudden cardiac cardiac death.
Speaker A:And so the authors of this paper, as much as they could, they looked at people who died and they wanted to know how often did they die from cardiac hypertrophy?
Speaker A:And it turns out to be a very small number.
Speaker B:Interesting.
Speaker A:The vast majority of people were dying from coronary artery disease, and only about 7% of the deaths occurred from cardiac hypertrophy.
Speaker A:So now runners are probably not doing high intensity stuff as much as triathletes are.
Speaker A:So I don't know how much you could translate one into the other.
Speaker A:But it's still interesting to say that, you know what, if you're running, you could worry less about this idea.
Speaker B:And the participants in this study, they're doing running races, so 5Ks, 10Ks marathons.
Speaker A:So this looked just at a database that only compiled information for half marathons and marathons.
Speaker B:Okay, half marathons and marathon.
Speaker B:So it's strenuous, like it's on the upper end of an endurance activity?
Speaker A:Absolutely.
Speaker B:Would you say these folks who are doing these half marathons, do you think because of the barrier to entry of those endurance events is maybe less than a triathlon, do you think it's attracting people who are more amateur or maybe you don't have a history of training and like, people are like, oh, I just, I wanted to do a half marathon, so I signed up four weeks before.
Speaker B:Like, folks like that.
Speaker A:It's possible, and it's possible you're not seeing cardiac hypertrophy for that reason, because the training volume is much less.
Speaker A:It is very possible.
Speaker A:But they didn't, they couldn't get at that because they wouldn't survey the individuals to find out how much training they were doing.
Speaker B:And these coronary, like, incidences that people are having, that's kind of like heart attacks, would you say?
Speaker A:So these are cardiac arrests.
Speaker A:So cardiac arrest can be caused by a variety of different things.
Speaker A:But what they found here was the most common reason for cardiac arrest was a heart attack.
Speaker A:So in layman's term, a heart attack is anytime you get obstruction of a coronary artery and therefore you have ischemia of the tissue distal to that obstruction.
Speaker A:Sometimes when you have ischemia to that tissue, you can get a cardiac arrest.
Speaker A:But not every heart attack leads to cardiac arrest, Right?
Speaker A:Not every cardiac arrest is from a heart attack.
Speaker A:Does that make sense?
Speaker B:And so I guess comparing this study, do you have data on triathletes and these cardiac events?
Speaker A:Before we get there, though, I just want to say one important thing, that one of the things, one of the big findings they found in this study was survivability.
Speaker A: So in the initial group, the: Speaker A:If you had.
Speaker A:Sorry, if you had a cardiac arrest on course, you only survived 31% of the time.
Speaker A:Sorry, 34% of the time.
Speaker A:So not great odds.
Speaker A: latter half, when you got to: Speaker A:Which reflects a societal change in cardiac arrest survival rates and has to do with the fact that more people know CPR and we know that the faster you get bystander cpr, the more likely someone is to survive.
Speaker A:So a call out to learning this very basic, very life saving skill.
Speaker A:So if you don't know how to do cpr, I would encourage you to take a CPR class.
Speaker A:It's all of two to three hours and it can literally save a life.
Speaker A:And then the other thing is the availability and the planning of these race directors to have availability of automatic external defibrillators.
Speaker A:The two things that really cause survivability in cardiac arrest is early CPR and early application of an aed.
Speaker A:And both of those things were found to really increase dramatically in the latter part of these studies.
Speaker A:So really interesting there.
Speaker A:Now when we talk about triathlon, the deaths that occur in triathlon have been stubborn and they rate, while much quite low, is still higher than it is for running races.
Speaker A:Now part of that is a reflection of the fact that we have less people in triathlon than in running.
Speaker A:We're looking at a cohort of 25 million runners.
Speaker B:Yeah.
Speaker A:Whereas in triathlon we have much fewer.
Speaker A:A single cardiac event in a triathlon is going to look like a much higher rate than in marathon just because you have so fewer triathletes participating.
Speaker A:The other issue is that survivability in triathlon related cardiac arrest is very poor because of when it happens.
Speaker A:So when you look at these running races, people are having cardiac arrests towards the end of the race, towards the finish line, where there's tons of people around, lots of people watching, lots of access to CPR and AEDs.
Speaker A:And the reason for that is because it's towards the end of the race where runners really ramp up the intensity and really put a big stress on their heart.
Speaker A:Triathlon cardiac arrest tends to happen at the beginning of the race, in the swim.
Speaker B:So and I'm curious then, if the running race, it's more closer to the end, why wouldn't it be the same in a triathlon?
Speaker A:Triathletes don't tend to run with the same intensity generally because of the level of fatigue that has accrued from the swim and the bike.
Speaker A:And so they tend not to be able to increase their intensity quite as high and they tend not to get into the same issues.
Speaker A:Whereas in a triathlon, the place where you spike your heart rate and you spike your adrenaline, your internal adrenaline tends to be at the very beginning in the swim.
Speaker A:People tend to overreach, they tend to overdo it at the beginning.
Speaker A:And because they're in the water, they don't quickly get identified, they can't get bystander cpr, they can't get an aed and that's why the outcomes are so poor in triathlon.
Speaker B:Interesting.
Speaker B:Interesting, huh?
Speaker B:Crazy.
Speaker A:So we can hope that Ironman has done a lot of things to try and decrease the chaos at the beginning of a swim by allowing for age groupers to self seed to allow them to start five at a time to allow for a lot more supervision in the water to try and identify swimmers.
Speaker A:But unfortunately these things still continue to happen and we can only hope that it will over time.
Speaker B:And obviously none of us want to have to deal with that kind of situation.
Speaker B:What do you recommend athletes do?
Speaker B:I don't know if there's any kind of preventative stuff like getting your heart checked out.
Speaker A:Unfortunately, it's too bad, right?
Speaker A:There is this like I've seen a lot of ads recently on Facebook because somebody, one of my people I follow mentioned something and next thing your feet gets filled with it.
Speaker A:And there's this company out there that's like offering to do screening and they'll check your coronary arteries and they'll do a carotid ultrasound, they'll do all these things.
Speaker A:All of the screening in the world in asymptomatic people has been shown to be, be futile.
Speaker A:So save your money folks, there's no sense.
Speaker A:And if you don't have symptoms, if you're not a high risk individual, getting screening unfortunately has been shown to have a high cost financially without necessarily being very helpful.
Speaker A:The most important thing that you can do as an athlete is just be very body aware.
Speaker A:And I tell my athletes all the time, if you're having any degree of fatigability or shortness of breath at levels of exercise that don't seem commensurate with where you should be, then that is a warning sign and you must pay attention.
Speaker A:And of course any chest pain, what's, no matter what the discomfort is, if you have any discomfort in your chest, you have to take that seriously and get it checked out.
Speaker B:Definitely don't Want to put that.
Speaker A:I want to find out the hard way.
Speaker A:Yeah.
Speaker B:Interesting study, though, for sure.
Speaker A:Yeah, it really is.
Speaker A:And I think the most important thing to take away from it is, hey, if you're in a running race, they're very well staffed with good health professionals, and if something bad does happen, you're likely to come out okay.
Speaker B:Did you talk about before how you.
Speaker B:Have you ever stopped during a race to help another athlete with a medical issue?
Speaker A:I have stopped in two running events to resuscitate the people and stopped.
Speaker A:And I've stopped several times in triathlons to render aid until someone could come along and help.
Speaker A:That's.
Speaker B:Yeah, that's good.
Speaker B:We're grateful for people like you who are around to take care of everyone.
Speaker A:I prefer everybody stayed upright.
Speaker A:Yes, of course, Matt.
Speaker A:It's been another good episode.
Speaker A:We had a lot of.
Speaker A:We covered a lot of ground on this one.
Speaker A:This is a lot of different topics to discuss.
Speaker B:Yeah.
Speaker B:Quite enjoyed that, the study.
Speaker B:I always like it when you're breaking down all the science.
Speaker B:I.
Speaker B:It's.
Speaker B:I, if I can come away having learned something in this podcast, and it's a big one.
Speaker A:There you go.
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Speaker A:Matt, I will wish you a very pleasant Memorial Day weekend.
Speaker A:You got a big training block on plan on tap.
Speaker B:A training.
Speaker B:We're training down the house here, getting ready for the race.
Speaker A:Awesome.
Speaker A:Good luck with that and we'll talk to you next week.
Speaker B:Perfect.
Speaker B:Thanks, Jeff.
Speaker A:Sam.
