Having a Stent is Both Frightening and Enlightening; Endurance Training Ideal for the Stented

Hi folks,

My girlfriend/partner, Deb, has an autistic son, Rory, which can be challenging. Deb always says that Rory has brought many more positive than negative things into her life, especially in the form of wonderful and supportive people. I have always been surprised by such a positive attitude to what seems like such a difficult, and sometimes sad, turn of events. Now that I have experienced a truly life-threatening event in my own life, a whopping great big (7cm diameter) aortic aneurysm, and my life now depends on this tube of metal mesh and plastic sitting in my aorta, I am coming to understand what Deb has been telling me for several years. As a direct result of my stent surgery only a couple of months ago, I have started to encounter the most interesting and kind people, and each day is now much more precious than I ever imagined. I am coming to realize that my greatest challenge was fear of death (and of my triathlon training coming to an end, which it has not!), which I thought I was prepared for, but clearly I was not.

For a start, during my recovery from surgery people came by with food and companionship that I never did expect. I also found that the inspiration that I get from that odd but fascinating book, The Power of Now (by Eckhart Tolle), held me together through my post-surgical depression (brief though it was) leading to my creating this blog (which has also helped me a lot) and consequently finding great web sites and other resources, including people. What seemed like a disaster is turning out to be a blessing. How about them apples.

OK! That is enough emotional stuff, how about metabolism and training, and why I think endurance training is tailor-made for people with stents. Well!

(a) How did many of us end up with stents in our hearts or aortas in the first place – atherosclerosis combined with hypertension (though apparently not in my case, fortunately, except I think that my stent did induce hypertension, but that is another story!)? And how can we reduce our risks of atherosclerosis and hypertension, and even reverse what we have? Diet and exercise!
(b) How are we likely to displace our stents and put our lives at risk? Risky types of exercise, such as power-lifting, full-contact martial arts, and apparently enthusiastic rowing. Though clearly more research is needed, I would like to suggest that if we pursue non-risky sports we are unlikely to have a problem with this issue – if I suddenly go off-line maybe I will have proven myself to be wrong, but I doubt it, so I am now already continuing my Ironman training, preparing for the Kiawah marathon in December, and of course the Lake Placid Ironman, my annual pilgrimage, next July. For those with a coronary stent, I recommend that you take a look at the site angioplasty.org for advice and support on this issue.

For maximum benefit, and minimum risk, therefore, I strongly recommend the benefits of long-distance endurance sports, for which you have to be kind to your body simply in order to finish the race. One word of warning, however, it is critical that you avoid impact stresses and physical shocks, so train wisely, and keep yourself informed. You are your most important physician, remember!

Which brings me to metabolism. An important part of knowing your body is understanding how it stores and uses energy, in the form of the fuels we burn, including glucose, free fatty acids, and ketones, and the fuels we store. All of this is readably described in Harpers Biochemistry , which I strongly recommend, and partly in an interesting recent publication on metabolism and marathons. Basically it comes down to this – you take in fuel as carbohydrates, fats and proteins, and the form in which you take them and the rate at which you take them in, combined with your metabolic state, that can be dramatically modified by training, will determine whether they are converted into liver or muscle glycogen, or storage fat, or protein. You need the right balance of each at different times during a race, and for Ironman distance triathlons and other long-distance endurance sports getting this right is critical, and very personal. So! If you want to know more, or have specific questions, ask and I’ll research an answer for you as best I can.

As an aside, one book that is also changing my life is ‘The Four Hour Work Week ,’ by Tim Ferris, whom it turns out did a lot of work on the glycolytic index of foods. His book and website are worth a look if you want to take control of your life.

-k @FitOldDog



  1. I’m curious as to an update on your training/races. As a former triathlete who left to play pro in a much different sport, I was just returning (a few weeks) to training for tris, the goal being my first ironman next year. That was abruptly stopped when I was given the “we can’t explain why you’re alive” coronary stent, and am in cardiac rehab now. While it is an excellent group of RN’s and experts, a few who do tris (sprint mostly) and marathons, neither they nor the doc have anything specific on someone i my situation – so we are all out scouring sources/people in the know for information. I had no previous risk factors other than an unknown family history, but as someone under 40, this is something I want to get to as aggressively as possible…so anyone’s experiences are welcome…

  2. Hi! Dan,
    Concerning my races: I am getting ready for Eagleman and Lake Placid IM (5th time), both of which are qualifiers, and both of which I will be doing with my youngest son (a real triathlete). Recent lactate threshold-testing shows that I am back in my game, but I lost some time with the surgery and subsequent hypertension issues, all of which are talked about in my blog somewhere.
    I’ll give you my thoughts and recommended approach based on my experience of a surprise AAA and subsequent ‘stenting.’
    1. Sorry you have to go through this, but you will come out the other side, and if you are like most people there will be some fear or uncertainty to deal with, but that fades.
    2. You have to be your own medical advocate, as you can get advice from lots of people but it is you that makes the final decisions. Most MDs have absolutely no idea how to deal with conditioned athletes!!!!
    3. Read “It is not about the bike” and “Barefoot in November” for inspiration and encouragement. Helped me, anyway!
    4. Try to find an MD who understands your situation, and better still a coach who is that too – I fortunately have Eric Bean who is perfect in this regard.
    5. Do what you are doing to find resources. I have some listed on useful links on this blog. Clearly The Athletes Heart Blog, Cardiac Athlete, Heartosaurus, and Angioplasty.org are appropriate places to start, and I am sure there are more. Burt Cohen at Angioplasty.org is a great guy and you could contact him for ideas.
    6. Post your questions on forums.
    7. Become intimately familiar with the underlying biology of your situation. Where is your stent, and why is it such a big deal? Did you have 90+% blockage or something?
    8. Carefully design your training to improve your health whilst reducing the risk of killing yourself to a minimum.
    9. Make sure your family is happy with this, as they will be critical for support as you go along, however independent and macho a person you might be.
    10. Ask people very specific medical/training questions and they will often do their best to research them and give you answers. Which brings me to ‘what is your training?’ I am a veterinary pathologist with years of research experience, including extensive training in fluid mechanics, disease pathogenesis, and molecular biology. I use these strengths to my advantage. What are your strengths in this regard, and how can you fill in the gaps. We all have gaps in our knowledge. IM is complicated.
    11. Make a plan, and please work on body awareness, which will be critical for a safe and successful IM with or without a stent.
    Don’t know if that helps, but it is the way I think.
    If I can help in any way please let me know.

  3. Monty Gershon says

    Hi, I have come across your post. I am a 52 year old Age Group Team GB triathlete who has been doing standard distance triathlons. Having just been booked in for a stent procedure, and having been told that after the stent I should avoid activities that cause my heart rate to peak, due to the risk of rupturing/shearing any plaque build ups, am considering my options for future competition.

    I am not sure if longer events is an option?

    I would welcome your thoughts?

    • Hi Monty,
      I assume your having a cardiac stent? If so, just read this, and last time I saw Bob he was doing a full Ironman, in Louisville.
      It’s all a matter of intelligent thinking. I wrote a blog post about the process I recommend. You can’t fully trust doctors, just one input variable for your decision, because (a) they’re guessing, based on the average patient, who is not an athlete, and (b) they are concerned about litigation, which a couple have actually admitted to me.
      I’ve been asked this question a number of times, so I wrote this blog post a while ago:
      In fact, I have to apply it to myself again, due to expansion of my right common iliac artery, found on the last scan.
      That said, my favorite mantra: “A life without risk is no life at all.”
      Oh! Yes! You can also talk to Larry Creswell, a great guy, who will respond, an MD athlete:
      Kind Regards,

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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.