Not Too Much and Not Too Hot

Life-Threatening Events During Endurance Sports: Is Heat Stroke More Prevalent Than Arrhythmic Death? In the Journal of the American College of Cardiology (2014) a study was done In Tel Aviv to determine if more life-threatening events during endurance sports were caused by heat stroke or directly related to events of the heart. Lior Yankelson MD PhD and his associates studied 137,580 long distance runners from March 2007 to November 2013.

Heat, Not Heart, More Likely Culprit When Runners Collapse. The Tel Aviv study was followed by a review in Medscape, calling attention to the significant role of heat rather than heart in fatal and nonfatal marathon events.

Neither Too Fast nor Too Hot: Keeping Marathoners Hearts Alive During the Race. Finally, two brilliant and respected Cardioloists, Brian Olshansky M.D. and David S. Cannom M.D., wrote an editorial for the the Journal of the American College of Cardiology (2014), commenting on the original Yankelson Tel Aviv study. They entitled their editorial to acknowledge both dangers — too fast (intensity) and too hot. For the 137,580 runners in the 14 Tel Aviv marathons between 2007 and 2013, there were two non-fatal cardiac events, two heat stroke fatalities and 19 heat stroke survivors. All were aggressively treated.

No Comparison. Severe overheating can cause multiple organ failure during a race; but for those who repeatedly run the intense marathons, the heart itself can kill at any time and irrespective of the temperature. Life-ending arrhythmias due to electrophysiological and anatomical remodeling of the myocardium secondary to repeated and intense cardiac overload and stretching over time provides the mechanism. And that death need not be while actually participating in a marathon, as in the Tel Aviv study. Thus, the comparison of life-ending, overheated, multiple organ failure to arrhythmogenic death during the race is not meaningful. Although, certainly, too much overheating of body organs is in itself significant and alarming.

Marathon runners, triathletes, and Strong Man participants who overload and stretch the muscle fibers in their heart chambers with the demands their sport makes for more and more cardiac output to supply the oxygen hunger of their hard working skeletal muscles, should not be misled by the title of the article, "Heat Not Heart", nor should they feel empowered by an over simplistic, normal stress test. The athlete's history counts!


Yankelson L, Sadeh B, Gershovitz L, et al: Life-threatenng events during endurance sports: Is heat stroke more prevalent than arrhythmic death? J Am Coll Cardiol 2014; 64:463-469.

Michael O'Riordan (a senior journalist for and a Medscape Cardiology journalist), Heat, Not Heart, More Likely Culprit When Runners Collapse, July 29, 2014

O'Keefe JH, Patil HR, McCullough PA: Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise http://www.mayoclinicproceedings, Jun 2012;87(6):587-595

Olshansky B, Cannom DS: Neither too fast nor too hot: Keeping Marathoners' hearts alive during the race. J Am Coll Cardiol 2014; 64:470. Ed

Mary Boudreau Conover mc/8/15/2014 

Diagnostic Imaging for Injured Children

Much has been printed about the ongoing damage to NFL players who bash their heads on each other or on the ground. The NFL's immediate and long term problem is huge, especially since brain damage has been shown to be still there when the next NFL season rolls around. However, the NFL is for another time. This is about our injured kids in sports, play, or other, their extreme vulnerability to diagnostic ionizing radiation, and important alternative diagnostic choices. 

Click here to see the full article. 

- Mary Boudreau Conover


Regular Exercise and Recovery from the Ravages of Second Hand Smoke

This article is addressed to nonsmokers who are, because of their work or their living environment, unwillingly exposed to second hand smoke. Smokers may also find motivation here to quit pulling smoke into the very vascular, reactive, and sensitive environment of their lungs. We will first review the terms, problem, resolution, and lastly, the damage done by second hand smoke, not only to the lungs, but also to the heart – every breath, every beat.

Click here to see the full article.

- Mary Boudreau Conover

A Fight Gone Bad

He's alone on the beat, 2 a.m. – on duty since 2 p.m. and about to check out, drive home and sleep. The suspect is 19 years old, muscular, and very fit. The cop is strong, experienced and well-trained; a regular at barbell training, with a deep and varied athletic history across the years, including Brazilian Jiu-Jitsu and CrossFit. He is also 46 years old, a husband and a father. His age is tipping the scale. The suspect, about to be questioned, turns and sprints. It's run like hell, fight like hell, a close-in battle, strike hard, hit the ground hard - suspect on top. GET UP!! FAST! Tactically! Quick moves coming at him and from him a dirty fight, too close, too fast; no help, everything-anything but pull the gun; breathing fast, digging deep for the moves, the training, the life-saving reserves — O2, stamina, strength and power to finally finish it.

The cop had 27 years on this 19-year old man and finally prevailed with no life lost. It's a wake-up call — he's usually "strong enough". This time it was way-too- close. He'll train harder now. He's looking at another decade, maybe more, to retirement and, as he ages, he's worried about his family and survival in terms of his life and life-altering injury when a fight goes bad.

Every time honest, smart, dedicated police officers everywhere put on their uniforms, strap on their gear and head out to work their shift, they never know what they will encounter. Every day is different — and special. They work hard to stay informed, alert, well-trained, fit and strong. They are ready to carry out their oath to serve and protect their community in spite of being demonized by the media, the residents who believe the media and, in some cities, the Mayor who inspires the media. 

- Mary Boudreau Conover

Transient Intensity Only

Dr. Mandrola is at it again with a superb well written article in response to a life-time survival study of participants in the Tour de France and a compelling title: INFLAMMED ATHLETES SHOULD TAKE NO COMFORT IN TOUR DE FRANCE CYCLING STUDY recently presented at the European Society of Cardiology.

Dr. Mandrola's message boiled down to an agreement that "normal" exercise, even intermittently intense exercise is beneficial, but watch out for the plateau, which is ignored by Masters-level athletes who just "keeps slogging on" for decades. Plus, scientific evidence strongly supports the notion endurance athletes have a fivefold higher risk of atrial fibrillation and coronary calcification.

Follow this link, which will also supply a little background on Dr. John Mandrola.

- Mary Boudreau Conover

Strength Gained Can Be Long-Lived

Good news for the young already into strength training: strength gained can be long-lived.  More good news: this is true even when interrupted by prolonged inactivity.  No more moaning during forced down-time about lost time and lost muscle strength!!

You've heard your coach say: "You'll get it back fast." That was knowledge gained from experience and you witnessed its truth.  I heard it 20 years ago in my swimming years. Now it's supported by science and the traditional concept of "muscle memory" has been put to rest in favor of proof that strength training actually makes physical and physiological changes in the muscle itself before overload hypertrophy.  

More info here.

- Mary Boudreau Conover

Regular Exercise – It's The Dosage That Counts

Athletes have known for a very long time that regular exercise is a powerful means of promoting good health, preventing and treating many common ailments including high blood pressure, obesity, depression, and even cardiovascular disease, to name a few. Thanks to a group of physicians, some of whom are cardiologists, and all of whom were extreme endurance athletes, we are beginning to understand that it is the word "extreme" that can turn the tables and result in significant damage to the heart.

Learn more in this short article and its references on the cardiac pathophysiology associated with extreme endurance exercise.

Download this article here.

- Mary Boudreau Conover


Coming Back from an Injury

Gretchen Bleiler is a "full-time snowboarder" on the USA Olympic team.  I was very impressed with her advice to others who may experience an injury serious enough to keep them from training. Gretchen was offered no tangible solutions and negative advice like "this is the best it's going to get".  Initially, she stubbornly struggled with her own over-inflated expectations. She shares her eventual approach to recovery in this important blog.  Her injury was profound and potentially life-altering, but her advice applies to all set backs in life big and small.  

Here is your link.  Don't miss it!

- Mary Boudreau Conover

CrossFit for Pregnant Athletes

This is a collection of reports from three CrossFit women, Annie, Tara and Jennifer. They were of varied physical proportions, personalities, and fitness levels going into their pregnancies, but all were and still are CrossFitters who continued with their workouts through their pregnancies and beyond. Their experiences, challenges and reactions are unique for each and honestly expressed. Jennifer reminds us that "everyone is different" and she's right. If you, as a CrossFitter, are facing pregnancy, I hope that you will find something valuable in these three different accounts.

I would like to thank Annie, Tara and Jennifer for the generous contribution of their time and their refreshing openness about that special prenatal and birthing time in their lives.

-Mary Boudreau Conover

See the full article here.

Exercise-Induced Tachycardia

By Mary Boudreau Conover


Your heart has kept you alive all this time with a nice normal rhythm at an appropriate rate. The structure responsible for such a dependable personal cardiac history is called the sinoatrial (SA) node or sinus node. It can only be defeated if invaded or overpowered. This article has been written to acquaint you with the function of this little node during all of the activities of your life, including your workout, when it protects your organs by supplying you with an appropriate sinus tachycardia. 




See the full article here.