Chapter 21 "Running Life" - 20 heart patients and long-distance running

20 The World's Most Ill Running Club Sometimes a heart attack turns out to be the best thing One day in 1965, a tall, athletic-looking Mort Hirschfeld, an insurance agent in New York City, was sitting in his room watching television when suddenly he began to feel something strange in his chest. . At first, he said, it seemed someone had tightened the bars with a screwdriver.It was a heart attack, and it was serious, but Hirschfeld was lucky: He didn't die, and heart attacks kill two out of every three people. Hirschfeld was hard working and serious about his sports, skiing in the winter and doing a lot of what he set his mind to.Now, suddenly, he was a patient, so he was taken aback when, a few weeks later, his doctor asked him to exercise."How can I be physically active? I just had a heart attack!" he said.

The doctor said, "That's true, but that's a thing of the past. You can't be inactive forever." Hirschfeld followed his doctor's advice and signed up for the Westside YMCA, which is right next to Central Park.With his doctor watching warily, he began exercising, something he thought he would never be able to do again.Hirschfeld recalled afterwards: "He asked me to try to do some activities like this and that. They were very light activities. I ran a lap or two on the track and he took my pulse. I worked out about ten minutes. You have to stop for five minutes and take a shower." Hirschfeld insisted on doing this, and after a while, he saw some results.To his surprise, he soon felt as well as ever."Now I can easily work out for forty-five minutes and feel really comfortable. I don't know what I'm going to do if I don't go for a run," he said.

A specialist studying Hirschfeld's electrocardiogram signal revealed that he had had a heart attack at one point.But it was also evident that his heart was now functioning normally.Hirschfeld, now in his late seventies, still works full time, does whatever he wants in his spare time, and goes to the youth association three nights a week to take a physical-training class for heart patients. I recently visited one of these physical exercise classes, and I would never have guessed in that direction if I hadn't been told that the attendees had been seriously ill at one point.Two or three were in their thirties, and the others were men in their forties, fifties, and sixties. (The majority of heart disease patients are men, although, as noted in Chapter 8, heart disease among women begins to increase after menopause, when they lose their mysterious natural immunity.) Those who attend physical exercise classes They were all running and laughing, their good-natured jokes, often with the taciturn coach.

Twenty or thirty years ago, people like Hirschfeld and those who exercised with him would have been advised not to exercise, not to be nervous, to minimize losses in adversity.Many of these people would have died years later.My father had a heart attack at thirty-five and lived as a patient until his death eight years later.During those eight years, I remember seeing him throw a soccer ball only once—and only once.The rest of the time he sat quietly reading, listening to music, and attending to his funeral (the last of which I learned much later). "In the years since then, cardiologists have learned that their patients are not doomed to die slowly like this, they have learned how to help their patients overcome their disease, and that one of the most effective weapons in such a battle is the Running. Even an ailing heart has amazing resilience. The heart is not weakened by the stimulation of physical exercise, but is greatly strengthened, in many cases, strong enough to easily withstand the strain of running a marathon (Dr. Lorraine Rowell of the University of Washington recently called running a marathon "a grand assault on the cardiovascular system that a man voluntarily launches.") The psychological benefits of such a restoration of physical fitness are enormous. People Feeling less scared, more confident, less depressed.* And almost everyone's sex life improved.

Note: *Depression is common after a heart attack.Such emotions are particularly difficult to overcome because most patients do not admit that they are depressed. It would be of little general interest if only occasionally a person had a heart attack, but we now see that heart disease is common.In 1975, the last year for which we have figures, nearly one million Americans suffered from heart disease, with an average age of just thirty-five years and nine months, and the average age of those affected is declining dramatically.If this trend continues, the average age will fall below thirty by 1980 and only twenty-eight by 1985.Of patients who survive a heart attack, only 4 to 6 percent die each year.But if they started participating in a doctor-supervised running program and other physical activity, the death rate could drop to well below 2 percent.In addition, Dr. Terrence Kavanagh, director of a highly regarded cardiac rehabilitation program, said: "From the perspective of quality of life, people have even more reason to be optimistic. A survey report showed that among our patients sampled , one-third become overly depressed after a heart attack. In most cases, patients get better and become less depressed."

As noted in Chapter 4, physicians are cautious in asserting that running promises to make their patients live longer and better lives.Kavanagh has long advocated for physical activity and wrote a controversial book called "Having a Heart Attack?"Beat heart disease! "Although his plan has been in motion for a decade, it hasn't been long enough to make proper estimates based on statistics," he said.He said: "These results are only encouraging at this point, and we need to analyze the numbers more thoroughly to get more concrete results." Some doctors are even more cautious.Dr. Herman Herlestein, professor of medicine at Case Western Preparatory University, is an authority on heart disease recovery.He told a group of colleagues at a recent conference that long-distance running is potentially harmful and has raised unrealistic expectations; even if running has undeniable benefits for a patient, he said, it is not necessarily beneficial the best way he can.

It is not surprising that medical authorities disagree with each other.Running is a new therapy whose effects have not been fully estimated.But any tentative evidence that comes up at any time is invariably that running is likely to be of great benefit.So, Kavanagh insisted, even with his incomplete statistics, "you have to try your luck." (Attach the "Most Determinant Factors for Heart Disease" table) This table is modified with the consent of the New York Cardiometry Organization, and the factors used in the table are the factors that the American Heart Association believes are most decisive in determining whether a person has heart disease.This form provides you with a reliable estimate of the danger to yourself.Of course, this table will not make foolproof predictions about health, but it reflects current scientific research and is therefore a useful guide.You will notice that some factors such as genetics are beyond individual control, but others such as physical activity, body weight and smoking are in most cases within our own power to change.The important point is not to worry about the factors you can't control, but to make some effort to the factors you can control.To do the tally yourself, you identify the symptoms that apply to you for each risk factor, then use the indicated numbers to the left of each row to calculate the total score you get.A score of 10 to 20 indicates little risk; 21 to 40 indicates moderate risk; and 41 to 60 indicates high risk.

"The Most Determinant Factors of Heart Disease" Table ———————————————————————————————————— Inherited Blood Pressure Diabetes Smoking Weight Cholesterol Sports Emotion Age Personality and Situation Illness Alcohol Exercise Stress Body Shape ———————————————————————————————————— !Relatives (! High blood! Diabetes! Every day! Overweight! Excess! Complete! There is pressing! Sixty! Male! Parents and! Overwhelming! Band concurrent! Over! Fifty! 281! Lacking! Problems! Years old!! Just brother !The medicine is back! Syndrome (blood! Forty! Less than 1 pound! ! Physical education! Can’t cope! Up! Very fat! Brothers and sisters! Control! Fluid circulation! Support! Up!! Exercise! Pay, arrive!!

6! ) at six!no! ,kidney! ! ! ! !Mental illness! ! !From the age of ten! ! ,Eye! ! ! ! !Doctor's office! ! !Get ahead! !Wait for the disease! ! ! ! !Seek medical attention! ! !Dirty! ! )! ! ! ! ! ! ! !There are three people! ! ! ! ! ! ! ! ! ———————————————————————————————————— !Dear two!high blood!diabetes!every day!overweight! 256!Sit still!Frequently needed!Fifty!male!Belongs to six!Convince!Take pancreas!twenty!thirty!arrive!Work!To take!one year old! !From the age of ten!Medicine can!Insulin,!one!six pounds! 280!slight!drug or!to six!Quite 5!Get ahead!Start!No concurrency!to three!to five! !text!drink to!ten years old!fat!dirty!Sub-control!disease!nineteen!Ten pounds! !Live!Resist pressure! !

! !make! !branch! ! !move!force! ! ! !use! ! ! ! ! ! ! ! ———————————————————————————————————— !A pro!often!Take medicine!every day!overweight! 231!Sit still!Sometimes serve!forty!male!Belongs to six!There is light!Object control!Six!twenty!arrive!Work!Use drugs!one year old! 4!From the age of ten!High!in the urine!to two!a pound! 255!generally!Or drink!to five!ordinary!Get ahead!blood pressure!High in sugar!Ten!to three! !text!to boycott!ten years old!shape!dirty!Not added! ! !fifteen! !Live!pressure! ! ! !treat! ! !lb! !move! ! ! ———————————————————————————————————— !Sixty years old!only!Rely on moderation!every day!overweight! 206!Sit still!There are medium!thirty!female!Later!In love!Diet control!five!six pounds!arrive!Work!degree!It's age!

!heart disease!no!Urinating!the following!to two! 230! ,Enter!work or!forty!Menopause 3!relatives!Hershey's!Sugar! !Ten pounds! ,or!Very good!Personal matter!age!Expect to!There are two people!blood pressure! ! ! !I don't know!active!pressure! !rear!or two!high! ! ! !Yes!text!force! ! !above! ! ! ! !How many!Live! ! ! ! ! ! ! ! ! !move! ! ! ———————————————————————————————————— !Sixty years old!blood pressure!Blood sugar is positive!just suck!overweight! 181!conduct!rare!twenty!male!Later!normal!Often, or!cigar!five pounds!arrive!appropriate!work or!one year old! !heart disease! ,or!have no idea!or smoke!the following! 205!Activity!Personal matter!to three!Skinny 2!relatives!I don't know! !fight! ! !Quantitative!pressure!ten years old! !one person!road! ! ! ! !Work!force! ! ! ! ! ! ! ! !And Wen! ! ! ! ! ! ! ! ! !Entertainment! ! ! ———————————————————————————————————— !In the family!blood pressure!low blood sugar!don't suck!weight! 180!conduct!Not true!ten years old!female!Nobody gets it!Low! !Smoke or!Bizheng!or!physical strength!real job!to two! !heart disease! ! !long!Very heavy!Lower!Activity!Make or one!ten years old!Fertility 1! ! ! !stop!Lightweight! !a lot of!people affairs! !age! ! ! !smoke! 5 pounds! !work!pressure! ! ! ! ! ! !above! !make peace! ! ! ! ! ! ! ! ! !Entertainment! ! ! ———————————————————————————————————— have to! ! ! ! ! ! ! ! ! ! Minute! ! ! ! ! ! ! ! ! ! ———————————————————————————————————— total score! ———————————————————————————————————— Explaining what constitutes heart disease can help us understand how physical activity can benefit heart patients.A heart attack may appear to be sudden, but it is not.The conditions that lead to a heart attack usually develop decades ago, as a buildup of cholesterol and other substances narrows the blood vessels in the heart arteries, limiting the blood supply.This narrowing of arterial vessels, called atherosclerosis, is a common phenomenon in civilized countries.Atherosclerosis afflicted many Americans who died in the Korean War, with an average age of twenty-two, and is often found among schoolchildren.Sometimes an early warning of this condition is angina, pain in the chest, usually brief, that indicates the heart is not getting enough oxygen. This usually occurs during exertion, and the symptoms disappear once the activity ceases.Some people with angina live years without a heart attack, but if the arteries continue to narrow, the likelihood of clotted blood clots that could one day cause blockages increases.When this happens, the blood supply to part of the heart muscle is cut off.Muscles feel pain in an instant, which is how sick people feel.Later, the muscle tissue without oxygen supply stops contracting, the pain stops, and the heart attack stops, leaving a part of the dead heart muscle.The severity of a heart attack depends on how much of the heart muscle is dead. If a person survives, no matter how much the heart attack affects the blood supply to the heart—called a myocardial infarction in medical circles—the heart can quickly begin to recover.During recovery, white blood cells are able to rid the heart of dead muscle tissue, and new blood vessels replace those damaged during the heart attack and begin to distribute to the muscles.Eventually, within a month or two, the damaged tissue scars over.At this time, physical activity can begin to work its magic on restoring health. As mentioned above, physical activity that requires oxygen supply has many benefits for a healthy heart.Among other things, this kind of physical exercise can slow down the heartbeat, increase the amount of blood sent after each contraction of the heart, reduce blood pressure and blood lipids, and increase the ability of muscles to excrete oxygen from the blood.It has exactly the same effect on the hearts of people who have suffered from myocardial infarction.Something else of great significance also occurs: Under the influence of physical exercise, there is a massive increase in the density of the heart's accessory vessels (or collateral vessels, as doctors call them).This remarkable adaptation was first brought to the attention of the scientific community some twenty years ago, when a researcher named R. W. Akers experimented with dogs by taking various coronary arteries Ligated up, thereby artificially inducing a heart attack.After a period of time, he began to give some of the dogs physical exercise, and the rest stayed in the cage to live a static life, just like the head of a large company.The results of this experiment became a milestone in the study of physiologists.The dogs that exercised grew new coronary arteries to make up for the vessels lost after the ligation, while the dogs that stayed still did not.Physical exercise can do something that can't be done in a state of stillness: it can repair the damage caused by artificially induced heart disease. It is precisely because of this situation that many places today hold physical exercise classes for heart patients.A few years ago, some medical experts participated in the National Physical Activity Experimental Group in Myrtle Beach, South Carolina. They published an article saying: "Research on epidemics and other diseases shows that regular physical activity can improve health and life. Quality, significantly reduces the morbidity and mortality of heart disease due to insufficient blood supply. Therefore, the comprehensive care of the patient should include the enhancement of physical fitness." Many physicians support this and similar claims for physical activity in heart patients.For example, at Barnes Hospital in St. Louis, cardiologist Dr. Jon Cooksey runs a running program for heart patients.He said: "I tested, and 35 percent of people have improved. The heartbeat has decreased by an average of 17 times, and the blood pressure has decreased." The case of Howard Patiz, a patient just over fifty years old, is representative sexual.When he started the program shortly after his heart attack, he managed a meager seven laps of the track, but within six weeks that number had grown to 34. In Greenwich, Connecticut, the Institute of Hospitals and Health Care hosts a physician-supervised program for heart patients.They recently reported a patient who was unable to walk two blocks while on the program was able to run a mile in eleven minutes. In La Crosse, Wisconsin, the La Crosse Cardiac Rehabilitation Program has been in place since 1972.When I spoke recently with Philip Wilson, the director of the program, he said that since the classes began, hundreds of patients have attended, and their results are consistent with those achieved elsewhere.The La Crosse project is one of several to self-publish a publication called The Electrocardiogram (see Appendix A) that covers everything from foot ailments to heatstroke to sex after a heart attack Both. One of the most ambitious and successful cardiac rehabilitation programs in the country is in Hawaii.There, Dr. Jack Scaff, a physician and cardiologist in his early forties, had long promoted a program for heart patients to exercise three times a week.In 1974, Scarfe and another cardiologist, Dr. John Wagner, had the idea to expand the program to people who did not have heart disease but were at risk of heart disease because of their sedentary lives. also participate.So they started a Sunday morning training class to teach non-runners how to run a full marathon.Wagner said: "The Honolulu marathon training class makes it possible for middle-aged, stationary, non-runners to learn how to run a marathon without being seen running all over the city by those excellent runners. young, skinny runners.” The Honolulu project led to similar classes in San Diego, Los Angeles, and Reno.Still, it will probably be a while before these cities become a threat to Hawaii's dominance, since the average national average is nine runners per 100,000 people, compared with eighty-two in Hawaii. (No. 2 Oregon has 19 per 100,000.) One of the best-known places to do recovery work is Toronto.There, Dr. Terrence Kavanaugh, a small, wiry Dublin immigrant who served as the medical director of the Toronto Rehabilitation Center, introduced a program that aroused the interest and envy of the world.Kavanaugh, a former physician, athlete and sporting group leader (he is passionate about Canadian amateur sports), began researching endurance exercise as a way to rehabilitate heart patients more than a decade ago.Within five years, three of his seven patients who had run and completed the Boston Marathon had suffered not only one but two heart attacks.Interestingly, the idea of ​​trying to run the 26.2-mile race was not initiated by Kavanaugh himself, but by one of his patients.The doctor described what happened in his book: One day, while we were changing after a five-mile run, someone half-jokingly said what an achievement it would be to run a marathon.For a second or two no one said a word, a couple of people looked suspiciously, a person gave an unnatural smile, and finally one or two people let out a disbelieving laugh.And so it was over.As time goes by, week by week, this idea grows in our minds.What started out as absurd jokes turned into serious consideration, and later into firm determination.For me, this is a pivotal moment in a way.I mobilize these people to run, and in my opinion, they've recovered, so I don't hesitate to ask them to do it.They trust me.In short, the time to decide whether to do it or not to do it has come!I decided we were going to give it a try. Kavanaugh has been criticized by colleagues and has been accused of being, as one person put it, "unconventional."Nonetheless, all seven patients completed the full marathon and are doing well.No wonder they presented him with a special trophy engraved on it, to "Dr. T. Kavanaugh, Special Coach of the World's Most Ill Running Club". Kavanaugh's recovery plan is not as dangerous or reckless as it appears.First, the plan is based on careful study of each patient's situation; second, it is gradual, with some people beginning by walking a mile in thirty minutes, almost on a crawl; Now that he can run, Kavanaugh does not advocate a speed of more than ten minutes a mile. (His plan is described in detail in his book.) While some cardiologists are horrified by the idea, some heart patients simply make their own plans.Tex Moore, author of "Running With Hurts," was a Sports Illustrated contributor when he had a heart attack a few years ago.Not only was Moore always with the athletes, he was always active himself; therefore, it was only natural that he would begin to run whenever he could.He hit the track not far from his office every morning, and he finally built up enough stamina to run the first few miles of the Boston Marathon without incident. Al Martin, a physical therapist in Houston concerned with restoring cardiovascular function, made his own plan against his doctor's advice.When he was thirty-one years old, he had a heart attack. Following the method introduced in standard medical books, he started to wear a running watch, and took turns running and walking within a certain distance.Whenever he felt pain in his chest, he slowed down.Martin said: "I focused on running long and slow, rather than fast sprints. I set a forty-five-minute run, starting slowly and gradually picking up the pace. Now I can run five miles a day in less than Forty minutes. When I was extremely tired—that is, when my heart was beating at one hundred and ninety beats per minute— No more angina.At first I was on nitroglycerin, but I don't need it anymore. " Cardiologists are less likely to advise you to follow the example of Moore and Martin.One reason is that most people can find one near them due to the abundance of medically-qualified cardiac rehabilitation programs.There is no reason to take unnecessary risks when qualified guidance is readily available for a reasonable fee. As people are more and more aware of the role of physical exercise on health, many companies are now formulating their own running plans so that important employees in the company will not suffer from heart disease. (One might view such a plan with sarcasm; the company would pay off in the long run if key personnel could always be at work instead of sleeping in hospital beds. But if the results are good, motivation What does it matter? Nearly all of the 200 employees of Bona-Bell Cosmetics outside Cleveland, Ohio, participate in a company-sponsored wellness program. (Participants get thirty minutes more time at lunch.) The company When I asked general manager Jes Bell, a tireless advocate of running, how he planned to measure the effect, he replied, "We're not going to evaluate the program . . . I think the effect will be significant. We're going to ask A part-time nurse who will help us administer the program, and we will advise people to get their doctor's approval before enthusiastically participating in the program. In the past, our practice has been to ensure that we run at least five times a week. We pay people a dollar a mile. It didn’t work out, so we stopped doing it. We spent too much for too little.” I think it's a waste. Bell made it clear that he doesn’t think running itself is wasteful—it’s just that paying people to run is wasteful. He describes his own completely unpaid program: “I run at least five miles a day, or more. .I try to run about fifty miles a week.I've run a few marathons.. After three years of constant running, while eating very little, I'm down to the weight I was when I was a paratrooper in 1951.A physical examination was done in Dallas, and I was judged to be in very good health for a man under thirty.But I am fifty-one years old. " Not all business executives are as enlightened as Bell.But lately there are more and more of them, perhaps because they know that the corporate world spends $700 million a year recruiting people to replace people who can't work because of heart attacks.New York Life Insurance Company has a physical activity program for workers who are found to be in poor health during their annual physical.When I spoke to Dennis O'Leary, the company's vice president of employee health, he said that physical activity is just one part of the master plan for living a sensible life.He said: "I advocate for people to move within a certain range in their daily social life. I am against being a grumpy person. To me, the joy of life is like a good meal, but if you eat twice a day Sweets, that's not good news." I asked O'Leary if he had any research showing that New York Life's plan was successful, but he brushed the question off."These guys feel so good physically," he said. "Just look at how energetic they are, and that's enough for me." O'Leary's quick ballpark estimate may be correct, but for some executives That's not enough.Pegasus Oil Company health care expert William Horne, who conducted a two-year study of executives who participated in a regular physical exercise program, including running on a treadmill, recently reported that exercise As a result, the most financially conservative corporate executives got what they wanted: fewer heartbeats, lower blood pressure, lower cholesterol—almost certain signs that they were more sedentary than their sedentary peers. Coworkers who don't move are less likely to get heart attacks. In the end, though, running may produce the most important changes not in these physical measures but in lifestyle.It has been determined that the people most likely to develop heart disease are those with what are known as Type A personalities, who are aggressive, competitive, angry and irritable.As mentioned in Chapter 2, the calm we get from running has a contagious effect that inevitably affects other areas of our lives.If this calming mood can transform Type A's into less competitive Type B's, the odds of avoiding heart attacks and living a more enjoyable life are greatly increased.