Feature: State of the heart

Feature: State of the heart

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Marin General Hospital’s new performance center prepares athletes for greatness

Dr. Brian Keeffe (left), medical director of Marin General Hospital's Cardiovascular Performance Center, and Exercise Physiologist Taylor Valentino (right) work with patient Chris Hobbs. Photo courtesy of Marin General Hospital.

By David Templeton

The year 2016 will surely be remembered, among other reasons, as a year when a remarkable number of famous people died, many of them suddenly. Several of those—most notably, and recently, the Star Wars actress and Postcards From the Edge author Carrie Fisher—died of apparent heart failure. Such occurrences cannot help but make us wonder at our own life expectancy, and such musings are the perfect motivation to get ourselves off the couch and onto the trail.

Exercising, after all, is something every one of us ought to do more of.

Or is it?

“There is a weird kind of a dichotomy with exercise,” says Dr. Brian Keeffe, director of Marin General Hospital’s recently opened Cardiovascular Performance Center in Novato. “If you do regular moderate aerobic exercise, your overall cardiovascular risk—your morality risk—is definitely lower, over the long-term.”

That sounds pretty good. So we should all strive to become athletes, right?

Keeffe cautions, “The truth is, during the actual time that you are exercising, whether it’s 30 minutes a day or 60 minutes a day or whatever it is for you—and certainly if you are training for a three-hour marathon—your risk is higher during that period of exercise.”

This, he notes, is why people are always shocked when somebody has a heart attack during a triathlon or some other endurance race like that. It’s one thing to have a cardiac event on an airplane, when one is in dubious health, but for a fit-as-a-fiddle athlete to have such an attack while in the middle of a run—how can that happen?

“It makes sense,” Keeffe says, “because your risk is actually higher when you are exercising hard, than when you are sitting on the couch or in a movie theater. That said, your overall risk is definitely lower by being active and by regularly exercising, than it would be if you don’t exercise at all.”

For those who do value the lifestyle and health benefits of regular exercise—and Marin County has a demographically high number of folks who do—Keeffe has built a medical specialty around sports cardiology, caring for those who want to push their bodies hard, and want to do it safely.

It’s to assist such “extreme athletes,” and even more casual exercisers, in achieving their goals, that Marin General Hospital, back in November, opened the Novato center. Among its many services is an array of high-level cardiac tests.

The major point of such cardiac testing, of course, is to make sure that there are no “occult heart problems”—medical speak for hidden cardiac complications—which an active athlete or other health-conscious person is not yet aware of. Many of the center’s clients are those preparing for a particularly grueling upcoming competition, or those planning on stepping up from doing half marathons to tackling their first full marathon.

“Basically, if someone is going to do some extreme exercise,” Keeffe says, “getting tested first can help you have the confidence that it’s safe to do so.”

The new facility provides such testing from an athlete’s perspective. Keeffe himself is a regular runner, having competed in the grueling Dipsea Race five times in the last eight years. Though cardiac health is the bread-and-butter of countless hospitals and clinics around the country, there aren’t that many which specialize in sports cardiology.

“There are places that do some of these things,” Keeffe says. “You can even go to some gyms and do a VO2 max test, but they are purely looking at exercise parameters. They are not really looking at it from a medical perspective. So there hasn’t been specifically medical testing of what’s called cardiopulmonary exercise testing, or CPET, in Marin—at least not in the 12 years I’ve been here.

“In Marin,” he continues, “you have a lot of older people who are competitive athletes and they either have concerns about their risk of developing heart disease, or they could have symptoms that they are concerned could be related to the heart, but also are interested in their performance and training. Taking advantage of the innovations in sports cardiology is a way you can combine cardiac evaluation with a performance evaluation.”

The primary lesson here is, if you are going to exercise, and exercise hard, that’s probably a good thing. But you should make sure you have no “occult” heart problems waiting to drop the flag on your fun.

Mark Liebert—founder and operator of Western Espresso Coffee & Tea—is the creator of the annual Marin County Half Marathon (coming up on April 30, 2017) and the Marin County Triathlon (October 28 and 29, 2017). A competitive athlete since his late 40s, Liebert is also the founder of the Sustainable Sports Foundation, a nonprofit that promotes local athletic events encouraging healthy lifestyles, with particular emphasis on providing opportunities for underprivileged Marin County students to learn to swim.

When Liebert first began considering upping his game and competing at a high level, he visited his own doctor to make sure his body could take what he planned to be putting it through.

“I did have a complete physical, CT scan and everything, maybe 15 years ago, before I started doing endurance events,” says Liebert, who will turn 65 in March. “I checked out fine. Since then, I work out hard, but I keep things in moderation. I generally run three days a week, usually about 20 miles when I’m training for a marathon, and 8-to-10 miles when I’m not. I enjoy it. It feels good, it clears my mind and it puts me in a good headspace.”

Liebert, who says he runs a marathon about every four years or so, actually began as a cyclist.

“I decided I wanted to do a triathlon,” he explains, “but I’d always hated to run and I didn’t know how to swim.” He learned to swim, forced himself to start running and finally did the triathlon, at which point he realized that he actually preferred running to cycling and swimming. “Now,” Liebert says with a laugh, “I just run. It’s helped me. I feel strong and it gives me a good attitude, and a good excuse to get out onto the trails.”

Asked what advice he’d give to others who, like him, have considered running, swimming or cycling to get in shape, but haven’t quite found the motivation to kick things off, Liebert says that right now is as good a time to start as any.

“It’s the beginning of the year, after all,” Liebert says, “time for New Year’s resolutions. There’s not a better resolution I can think of than to get yourself fit and feeling strong. If you don’t exercise, you should start. If you do, but don’t compete, sign up for a race, because they are lots of fun and force you to stay fit while you’re training.

“And while you’re at it,” he adds, “you should definitely sign up for our race in April.”

This leads to another question for the doctor. Are marathon runners healthier than casual joggers?

“That’s a hard question to answer,” Keeffe replies with a laugh. “There’s been this debate in the medical profession about whether extreme exercise is beneficial. There are studies looking at it both ways. Some studies say that all you really need to do is 20 minutes of good aerobic exercise three times a week, or 30 minutes at a lower level. That’s where you get your greatest benefit. And then there are also studies that look at blood tests and imaging of the heart right after a marathon or triathlon, that suggest there may be some negative effect on the heart from that very extreme kind of exercise.

“But then,” he adds, “there are other studies, mostly out of Europe, looking at people who’ve been long-term competitive athletes, which show that there is actually a lower risk for those ‘endurance athlete’ kinds of people. When I go to some of the exercise cardiology conferences, there’s often a bit of a debate amongst the attendees, because there really isn’t a clear answer to that question.”

It is certainly assumed that if you do a significant amount of exercise, you are immune to cardiovascular problems, but that, Keeffe points out, is definitely not the case, especially for older folks.

“As people get into their 40s and 50s, they are more inclined to either start developing symptoms, or to start thinking about the possibility of heart issues,” he says. “Not that people in their 20s and 30s can’t have heart palpitations or other symptoms, but percentage-wise, as people get older, there tend to be more cardiovascular issues.”

For runners, swimmers and cyclists, the risks are more than just potential heart attacks. Cardiac issues could mean that they’re not running a mile as fast as they once did.

“Some people do come in with symptoms related to their exercise regimen,” Keeffe says. “They might come in and say, ‘My mile time dropped by a whole minute over the last year. Is that because of my heart?’ Or they might say, ‘My heart rate is going up higher than I think it should during exercise. Is that a problem?’ Or, ‘I feel short-of-breath sometimes. What’s going on?’ Or just, ‘I’m 55 and I’m thinking of doing my first-ever marathon. What are the risks for me?’ All of those are concerns people do have.”

In regard to the aforementioned deaths of well-known people, Keeffe says such events do send some folks to their doctors for a check-up, but it’s usually not celebrity deaths that motivate a person to have a physical.

“I more often see people for the first time when a friend or relative has had a heart attack or other heart problems,” he says. “Sometimes it has to hit close to home. If your friend who is 48, who was in great shape, just had a heart attack, it’s easier to imagine that happening to you, maybe, than when it’s some legendary figure. Though it does happen that a prominent, unexpected death can cause people to start wondering how healthy they are themselves.

“It’s a wake-up call,” Keeffe says, “and if you have any concerns about your own health, you should probably answer it.”

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