The autopsy revealed that despite being physically active, Fixx had advanced coronary artery disease: one artery 99 percent clogged, a second 80 percent clogged and the third 70 percent clogged — in sum, a heart attack waiting to happen.
In the course of nearly every marathon, one or more runners keel over with a heart attack, and some die. Heat and dehydration are often contributing factors. In a 1987 study of heart attacks and sudden deaths in marathon runners, 81 percent of the victims had ignored warning symptoms.
The lesson here is to take reasonable precautions against sudden death:
* Make sure all cardiac risk factors — especially smoking — are absent or under control.
* If you have been sedentary for years or have any doubts about your cardiac well-being, get checked out beforehand. But keep in mind that passing an exercise stress test is not a guarantee of cardiac health.
* Establish a sensible training program, especially long before an event. All your muscles, not just your heart, need to be up to the stress.
* Run or walk at your own pace (the marathon is a race for only a few young, elite athletes).
* Stay well-hydrated with water at first, then with a sport drink if you sweat heavily or exercise for two or more hours.
* Pay attention to warning signs. If you experience upper body discomfort or pain that could be a symptom of
coronary insufficiency during the activity, stop immediately and seek medical attention.
Symptoms that should not be ignored include palpitations; pain, pressure or discomfort in the chest; dizziness or lightheadedness; shortness of breath; and nausea.
In addition, if you find during your normal workout that you are getting more winded or fatigued for no apparent reason, that is a signal to get yourself examined.
People with advanced heart disease are at risk of dying suddenly whether they exercise or not. But while vigorous exercise can precipitate a heart attack during a workout and for about an hour afterward, regular physical activity is an important preventive of sudden cardiac death.
For example, a study in Seattle of all people who died suddenly in one year showed that those with undetected heart disease were more likely to die during exercise, but they lowered their overall risk of sudden death if they exercised regularly. In other words, if those with heart disease avoided all exercise, their overall risk of sudden death would increase, not decrease.
And from a study of 7,620 joggers in Rhode Island, it was calculated that a middle-aged jogger with no known heart disease who ran for one more year was considerably less likely to die suddenly than was a middle-aged nonrunner who drove during that year.
In the long run, various studies have found, jogging adds years to life. Over all, each hour spent exercising (up to 30 hours a week) adds about two hours to a person's life expectancy, according to the Harvard Alumni Study, which has tracked deaths among 17,000 men for more than two decades.
Even those who did not start exercising until midlife had a 23 percent lower risk of death over the next 20-odd years. Endurance activities like running, cycling, lap swimming, brisk walking and cross-country skiing conferred the greatest benefit, adding six years of life expectancy over that of a couch potato.
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