Is The Ironman Safe? FitOldDog Says, “Yes, If You Do It Right.” What Do The Experts Say?

John Mandrola cardiologist and blogger


Lawrence Creswell The Athletes Heart Blog Ironman Risk heart disease

Dr. Lawrence Creswell, of The Athletes Heart Blog. From:

Hi folks,

We live in a truly hostile environment, and we want to feel safe. The air we breathe is held on by gravity, and one good near miss by a large meteor could suck it all away. The solid ground isn’t solid after all (ever been through a small earthquake?), and the so-called solid bit is floating on molten rock (not friendly stuff for organisms made largely of water). We are surrounded by and full of other living organisms, many of which do not have our best interests at heart. Thankfully a significant number of them depend on our continued survival for their existence, so they save us daily. We are surrounded by creatures who would love to eat us for dinner, and we have to do business with the most dangerous of competitors, other people.

Fossil record of mass extinction rate

Fossil record of mass extinction rate. From:

It would appear that it has always been thus, based on the fossil record of mass extinctions. So, you want to feel safe? What an odd question. A sense of security has to be developed inside of us, as the only thing we have is now, and I plan to enjoy my now by continuing to train intelligently for the Lake Placid Ironman (#6).

All that said, is the Ironman safe?

I was cruising around the blog-o-sphere the other day and I came across another article on a death during the swim portion an Ironman race, entitled, “Is The Ironman Triathlon Safe For The Middle-Aged Heart?” The narrative was written by Dr. John Mandrola (avid cyclist and cardiologist) a month previously, and there were no comments, which surprised me. The bottom line of this story about the death of one of the athletes was, and I quote, “It’s awful. And for what did he die? For a finisher’s tee shirt…or the prestige of having “Iron” status.” The conclusion that this athlete died of a heart attack is speculation, as far as I am concerned. As a pathologist I can diagnose evidence of previous heart attacks, or occlusion of coronary vessels that would put the heart at risk, but not the postulated heart attack in a dead body. Are cardiologists too heart-o-centric? Sometimes, probably! Similar conclusions were drawn for the case of the New York triathlon, where two athletes died during the swim. This case drew a lot of attention. I was concerned that this would reflect inappropriately on our sport, so I responded accordingly in a blog post. During the swim an athlete’s safety is a matter of strength and cardiovascular training combined with essential skills in the water.

I couldn’t resist responding likewise to John Mandrola. I started my comment on his post thus: “Hi John, I agree that Ironman races are not for everyone. They have to be approached intelligently and somewhat scientifically. It is also essential to work your way up. The problem I have with news about people dying in races is that it makes news, whilst guys dying in their easy boy [Lay-Z-Boy] in front of the TV reaching for the next beer or their pack of cigarettes doesn’t make news, except in the form of health statistics.” You can read the rest of my response via the link to the article, above. A better course of action would be to read the blog of Dr. Lawrence Creswell (another cardiologist, but a triathlete), where he discusses the opinions of John Mandrola on this subject.

For me the real issue isn’t risk, it is risk-benefit analysis and choosing how to live my life. Dr. Mandrola misses the point if he thinks that we Ironman distance athletes race for a tee shirt and to say we did it. Again I quote from my response to the article, “The people who race Ironman just to say they did it are missing the point and they are usually the worst behaved on the course.” It has nothing to do with what other people think. Ironman is about training and exploring your limits. I train at least 70 hours for every hour spent in my annual Lake Placid Ironman race, which I completed very cautiously this year due to my abdominal aortic aneurysm that I found as a consequence of my sport. You could say that the Ironman saved my life (I do!).

I would hate to see our great sport threatened by the reasoning of Dr. Mandrola, cardiologist or not. However, there are a number of key guidelines (not rules) that should be in place for people aspiring to complete a full Ironman race, including but not limited to the following:

  1. Whether you are undertaking exercise for better health or just love the challenge, decide why you want to do an Ironman distance race, as it is more about training than racing.
  2. Work your way up to this distance gradually.
  3. Make sure you get a thorough physical, including cardiology, but go to a fit physician.
  4. Master the swim skills needed to stay safe and calm at all times in the water, including rough water, poor visibility, cold, and most importantly head up drills. Playing water polo is an excellent way to develop these skills.
  5. Learn every aspect of the race, and train for the conditions such as heat, cold, rain and slippery roads – honing your bike skills during training can save your life.
  6. Take great care when training on the roads, as we are generally disliked by motorists, some of which are extremely dangerous.
  7. Get an experienced coach. If you race Ironman without a coach behind you I think that you are asking for trouble.
  8. Learn to listen to your body, which is what much of my blog is about under the tag Feldenkrais.
  9. Take the race seriously but don’t take yourself too seriously. It isn’t about winning, it’s about exploring your limits.
  10. Read the article by Lawrence Creswell referred to above as it is excellent and well reasoned.
  11. Educate yourself, listen to the experts, including your body, and decide what is best for you. It’s your life!

Finally, I wish to thank John and Lawrence for taking the time to consider this issue. It is only through debate and discussion that we progress, and it is always important to remember that it doesn’t matter who is right, only what is right.

Thank you both!

Yours respectfully,

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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.