BYPASSING HEART PROBLEMS

TWO MONTHS AGO I had a bicuspid valve replaced, at age 58, and I am now wishing to return to normal aerobic functioning. I have been a recreational runner for many years, but for the past three to five years had suffered gradual degradation of capacity and finally had the aortic valve problem diagnosed.

I now sport a tissue valve and have begun gentle jogging as part of my recovery program.

Are you able to refer me to studies or exercise programs that are designed to get someone back into serious recreational running? (If that is not an oxymoron.) Specifically, I would like to run another marathon and want to gradually build so that I can do so when I am 60 years of age—20 months or so from now.

Anything I have been able to find locally has been too cautious for my liking and ends with a return to normal functioning that is well below the degraded state I enjoyed when I went into the hospital.

—L. Geddes
Victoria,
British Columbia,
Canada

I AM not a cardiologist or a cardiovascular surgeon, so my first suggestion is to consult with your physicians. I would be concerned about the stress on the valve and the increased demands of long-distance running or, more specifically, prolonged running. It is probably an irrational fear, but I would want to know the life expectancy of the valve and whether training at the marathon level would fatigue the valve in my expected lifetime. If the risk to the valve is acceptable, I would gradually increase the training as outlined and go for it.

Dr. Bill Roberts
practices medicine with the MinnHealth Family Physicians in White Bear Lake, Minnesota, and is medical director of the Twin Cities Marathon.

I AM not a great fan of repetitive stress on valve replacements. If Mr. Geddes has his heart set on it, well, there’s no strong contraindication, but I am not a fan. Since he has a tissue valve, I wonder whether the repetitive stress might cause it to deteriorate quicker, but that is based on no great science. He can try it, but I would prefer he did not. On the other hand, I do try to help people live their lives as opposed to what I think is medically best.

Dr. Paul Thompson
is a professor of medicine at the University of Connecticut and a many-time finisher of the Boston Marathon, where he placed 34th in 1968.

MY GENERAL feeling is that runners should not give up easily if they are advised to cut back on exercise after some medical/surgical happening. Sadly, physicians and surgeons often are not up with the play so far as runners are concerned—a lament that George Sheehan was always making. On the other hand, I think Mr. Geddes should work with a cardiologist who is well informed in this rather narrow area of running marathons with a recent valve replacement. The potential level of cardiac function he now has, with the replacement, is very relevant. So I think his task is to link up with such an exotic cardiologist who can assess his capacity and work closely with him as he endeavors to regain the fitness required to attempt a marathon. Of course, the doctor should ideally be a running enthusiast and certainly not all against the idea.

Ideally, such a person would be located in Victoria, but this may not be possible. I can suggest two people who should know about this. Dr. Paul Thompson [see previous response] may be able to recommend someone in British Columbia who could advise Mr. Geddes. His e-mail address is cbthomp@aol.com.

Dr. Terence Kavanagh was very well-known for carefully training postcoronary runners for the marathon (usually Boston) and ran with many of them in the race. I believe he went on to train postbypass runners, and perhaps also some heart transplant patients, to run the marathon. This was all regarded as quite amazing in medical circles at the time—back in the 1970s. He worked at the Toronto Rehabilitation Centre and if he is still active would be an excellent resource.

Peter Wood, Ph.D.,
is the chairman of the Science Advisory Board of this magazine and a former professor at Stanford University—and a many-time Boston finisher, where he ended up one place behind Dr. Paul Thompson in 1968.

ASSUMING THAT you have had medical clearance to exercise and increase your heart rate, then a gradual systematic approach to your training will allow your muscles to adapt appropriately. I suggest you read the book by Jeff Galloway (Galloway’s Book on Running) in which he describes a training program that incorporates regular bouts of walking interspersed with running. He points out that the key to this approach is to start walking before you fatigue in a training run or a race. I know several runners who have adopted this approach and who have run several ultraraces successfully, with surprisingly fast times.

Mike Lambert,
associate professor at the Sports Science Institute of South Africa, is on the M&B Science Advisory Board.