The consequences of strenuous exercise

By DR. PAUL O. DAVIS, PH.D., FACSM

What exactly is a "morbid event?" In the medical field, a morbid event is something that physically happens to you, but you wish it hadn't. Acute shortness of breath is a natural consequence of physical activity, but for some extremely overweight people who avoid exercise at all costs (as evidenced by the spiraling explosion of Americans' girths), it's considered a morbid event.

GOING TO EXTREMES
Other consequences of extreme physical activity include nausea and vomiting. People who participate in amateur sports of an anaerobic nature, including many Combat Challenge competitors, have personally experienced these phenomena. The activity that can create the most post-event stress in track and field is the quarter mile race because most people can run that distance full tilt. When experiencing metabolic acidosis, which creates nausea, blood flow to the gut (or splenic circulation) shuts down, and the body must jettison the stomach contents because it simply can't deal with all the body's competing needs.

One pathological consequence of exercise can be chest pain. During my paramedic class, the cardiologist teaching the didactic portion of our training instructed us to pay close attention to any pain individuals might experience and treat the symptoms as though an acute myocardial infarction (AMI) were occurring in anyone experiencing pain within two feet of their chest. Said another way, it's nearly impossible to distinguish the origin of chest pain without a definitive diagnosis because classic chest pain is not always definitive; it may be sub-sternal or radiate to the jaw.

YOUR HEART & EXERCISE
While mountain-biking, long-time Combat Challenge competitor Bill Briggs died this past year of heart disease. Although he was physically fit, Bill suffered from coronary artery disease (CAD). He may have displayed warning signs, but given Bill's fitness level, logic would have precluded anyone thinking this guy had clogged arteries.

Physical activity does not produce heart attacks; heart disease, the gradual deposition of fatty materials under the lining of the coronary arteries, is the cause. However, exercise can exacerbate the already compromised blood flow since there is an increased need for oxygenated blood.

Many times, heart attacks occur at night while people are sleeping; others experience heart attacks while engaging in sex or even while answering the call of nature. (But no one is about to stop performing these activities for the risk of a heart attack.)

The lesson: Being physically fit does not make you immune to heart disease; however, the statistics are decidedly in your favor. The risk of a cardiac (morbid) event decreases precipitously with fitness. But as we see in Bill's case, you must pay attention to the warning signs. I don't know what risk factors Bill may have had. Regrettably, risk factors only explain about 50 percent of the incidents, leaving the balance to conjecture. Family history plays a pretty big role in determining your chances of developing heart disease (and certainly we know that smoking is beyond stupid). However, the biggest problem, particularly with men, is flat-out denial. Many victims of heart disease chalk up an MI to indigestion and subsequently die. Pain is nature's way of telling you something is wrong. And of course, some victims have no symptoms.

So, until we've unlocked all the secrets of DNA, go with the odds: Elevated blood pressure, high-fat diets and low levels of physical activity stack the odds against you. And by all means, listen to your body — if you have a weird sensation or pain somewhere in your body that's within two feet of your chest, check it out.

During the Combat Challenge, we've had some close calls; in our first year, one of our competitors, who had a very hard time recovering, was transported to a hospital where doctors discovered a blockage in one of his coronary arteries. Fortunately, they fixed the blockage, and he went on to bigger and better things.

CONCLUSION
By my calculation, since the inception of the Scott Firefighter Combat Challenge, approximately 20,000 firefighters have run the course. (Our injury rate is so far below softball, it's not even funny.) But one statistical theory called The Law of Large Numbers says that if you do anything long enough, something bad (i.e., a morbid event) will occur.

Every year, we decry the numbers of firefighters who die in the line of duty. I'm reasonably certain the underlying cause is, in large part, the lack of firefighter fitness. So, you exercise and do everything you're supposed to, but you still end up with heart disease. What then? Do you get your money back? No, but you'll be pleased to know that people who do exercise and succumb to heart disease are five times less likely to die suddenly from the disease — not too bad when you consider the first symptom for many people is sudden death.