Exercise: It’s At The Heart Of The Matter

Ocean County Observer

July 12, 1984

Jim Fixx was found dead under the shade trees of a Vermont running path. He died of a heart attack during a workout, and autopsy revealed that he had enough coronary artery disease to warrant coronary bypass surgery. He came from a family prone to heart problems. His father died at age 43, having had his first heart attack at age 35.

Mr. Fixx is largely responsible for popularizing jogging as an exercise that would change one’s way of life and enable one to live longer. He was joined in this exposition by Dr. George Sheehan, who gave up almost everything except jogging and running to popularize the sport. These two alone are probably responsible for the swollen ranks of men and women who pound the pavements in every large city and byway of the world during weeks and weekends; people from six to sixty and older. Jogging and exercise in general have become rituals intended to increase life-span on earth and postpone as long as possible that vaunted life after death, the heart of which, good deeds on earth the heart of which life (good deeds on earth) is not prone to coronary artery disease.

The death of Jim Fixx prompted Fred Lebow, president of the New York Road Runners Club and maven of the N.Y. Marathon to state “Sure we have people dying in Central Park, one or two a year while running. But I’m sure more people die on the golf course pr watching the Yankees play baseball. Maybe if Jim Fixx didn’t run he’d have died five years ago.” The fact is that if watching the Yankees play baseball hasn’t done in George Steinbrenner it will not prove dangerous to the casual observer.

Since coronary artery disease became identified as the cause of heart death at the start of this century by doctors George Dock and Herrick (although John Hunter recognized this 200 years before) the treatment of the problem has gone through a number of phases. For prevention, Dock’s son William was one of the first proponents of cholesterol as a dangerous substance related to coronary artery sclerosis. Since he first promoted this concept little if any progress has been made with respect to cholesterol, although certainly it seems that a doubling of this fat in the blood streams of young people is a significant risk factor. But there are older people around with cholesterol levels over 300 mgm % who have done very well. So the cholesterol story is still shrouded in supposition. The treatment of coronary artery disease 40 years ago required 5 weeks of bed rest, complete sedentary bed rest, and several months of recuperation after that. (TO REST TGHE HEART)

There is truth to the medical dictum “ret an injured part” but there is no way to completely rest an injured heart. If the victim of the heart attack is to live, the heart must beat. Levine of Massachusetts was considered a heretic when he got his patients out of bed early after a heart attack and sat them in chairs. Currently victims of infarctions (attacks that damage heart muscle) are allowed out of bed earlier and hospital stays in uncomplicated cases have been reduced to 12 days or so.

Heart death is caused by either mechanical destruction of heart tissue to a degree that makes it a useless pump, or by minute punctate damage that causes disturbance of electrical conduction throughout the heart so that it either stops completely, (pacemaker country) or runs so quickly that the beats are ineffective and the victim dies of this arrhythmia. Obviously electrical disturbances of the heart can be triggered by significant mechanical damage and Jim Fixx seems to have been a victim of this.

The fact is that any heart can be damaged when asked to do more than its blood supply will allow. Rats given adrenalin-like substances which make their hearts race and crimp their blood supplies, develop numerous small infarctions. Obviously a diminished blood supply to the heart will be a contraindication to vigorous exercise that makes the heart race.

Of course the newer drugs, the beta blockers like Inderal and the calcium channel blockers all tend to lower the work load of the heart and diminish the amount of oxygen necessary to perform a chore. Hearts are protected when the oxygen requirements are balanced by the oxygen supplied to the heart.

It has been demonstrated recently that people frozen or supposedly drowned in cold water can be resuscitated after long periods of time. Why? Because in the frozen state of suspended animation the body requirements for oxygen drop to an irreducible minimum and the lucky ones make it provided they are warmed properly.

No one has proved that exercise has prolonged life span, but makes life enjoyable for those that enjoy exercise. There are virtues to jogging and swimming long distances. These activities are so boring in the long run that they become virtually mindless activities, and one returns refreshed as after a bout of transcendental meditation. Muscles become toned up and there is a mild euphoria that lasts perhaps throughout the day, or at least until reality rears its uncivilized head.

So just remember those of you out there who believe that a day of inactivity is dangerous and will shorten your life, that the people who seem to live longest are usually sedentary, inactive nonagenarians doing absolutely nothing in nursing homes. Post mortem examinations of many elderly vegetative people revealed coronary arteries so obstructed that channels for blood to the heart were virtually invisible. Yet they lived for years in that condition only because they were inactive.

Of course the value of post heart attack rehabilitation programs must also be questioned in the light of what we know. The heart of the heart attack victim will continue to beat. It needs time to heal. (It takes a tissue 5 weeks to 3 months to heal), followed by a sensible increase in activity. Your body and your pains will tell you when enough is enough. There seems no need to do this with wires and monitors at expensive salons.. ***

In the long run addictions are bad, compulsions are bad and obsessions are bad. Exercise for other and athletics are salutary and make life worth living. As obsessive compulsive substitutes for other obsessive compulsive activities their value is soon lost to the mental toll exacted.

I believe Jim Fixx enjoyed his life for the years that he lived it, and that’s all any of us can ask, or should expect. That’s the heart of the matter.