By Kousik Krishnan, MD
For many people, the beginning of June is the start of marathon training season. The Chicago Marathon is in October, and many 18-week training programs begin in early June. Whether this is your first marathon, your first foray into an organized exercise regimen, or you are an experienced athlete, it is always prudent to take appropriate precautions before beginning any high-intensity workout regimen.
This year will be my eighth Chicago Marathon and my 10th marathon overall. Despite having done this for many years, I am always reminded it is important to listen to our bodies and get a thorough evaluation if needed. I am often asked what type of evaluation someone needs and what are the signs and symptoms that may require further evaluation. Regardless of how long one has been exercising, there are certain warning signs and risk factors that should be evaluated before beginning a workout program. In addition, if someone is starting a new program after a prolonged period of inactivity, it’s important to get back into shape slowly.
Who needs evaluation?
Below I have outlined what a person should look out for and seek medical attention for. In some cases, it is prudent to have an evaluation even if all you have are risk factors. This is based upon the American Heart Association 12 point pre-participation screening questionnaire.
Symptoms that should prompt physician evaluation prior to participation
- Chest pain, shortness of breath or excessive fatigue with exercise
- Unexplained passing out or near passing out spells.
- Prior history of a heart murmur
- Elevated blood pressure
Risk factors that should prompt physician evaluation prior to participation
- A first-degree relative who either dies or was disabled from heart disease prior to age 50
- Specific knowledge of a family history of cardiac disease
Risk factors for “older” athletes (over 35-40 years old) that should prompt physician evaluation prior to participation
- Family history of premature atherosclerotic heart disease
- Personal history of coronary artery disease
What type of evaluation?
The vast majority of people will not have any of the signs, symptoms or risk factors listed above and can engage in an exercise program without further evaluation. If an individual has any of the signs, symptoms or risk factors listed above, they should seek medical advice for a thorough history and physical exam prior to starting a program. Not all people will need further testing, but in select cases, an evaluation might include an ECG (electrocardiogram), blood work, an echocardiogram (heart ultrasound) or even a stress test.
My marathon training
I began my 18-week program last month, with a five-day-a- week running program that is a modification of the Daniel’s Running Formula and the FIRST (Furman Institute of Running and Scientific Training). I devised this program based upon my goals (qualifying for the Boston Marathon) and my propensity to get injured if I pushed my weekly mileage beyond 60+ miles/week. Here is a basic format of my training program.
- Monday: Lactate threshold run (5-7 miles), runs that are run faster than marathon pace (MP) to train the body to metabolize lactate
- Tuesday: Rest (A very important part of any training program)
- Wednesday: Speedwork (Repeats on a track) (5-7 miles). This is meant to improve your VO2 max and speed
- Thursday: Recovery run (3-5 miles) – Run at a slower pace to help recover from a hard workout
- Friday: Rest
- Saturday: Long run (12-20 miles) – run 30-45 seconds slower than marathon pace.
- Sunday: Recovery run (3-5 miles)
Fortunately, catastrophic events in casual sporting participants are rare. With the above listed guidelines, you should be able to safely begin an exercise program and gain the known benefits of regular exercise. I will check back in a few weeks with more tips on running, heart disease and my marathon training. I hope to see you out on the running path or a race this summer.
References: 1. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007;115;1643-1655; originally published online Mar 12, 2007. 2. Daniels’ Running Formula, Second Edition. 3. FIRST Program
Kousik Krishnan, MD, FACC, a cardiac electrophysiologist, is director of the Arrhythmia Device Clinic and associate director of the Electrophysiology Labat Rush University Medical Center. He is an assistant professor of medicine at Rush University.