Medical Clearance

author : TriDoc5280

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It is inadvisable for some people to begin an intensive exercise program without first consulting a health professional for advice, monitoring, and in some cases, tests.

Taking up triathlon can be an overwhelming experience. Once you make the leap from contemplating doing a tri to actually deciding to do one, the sense of excitement about the challenges ahead are often besieged by newfound anxieties. Can I actually do this? (You can!) Do I need a new bike? (Not necessarily.) How do I handle the open water swim? (Practice, practice, practice…) And there are many others. For most beginner triathletes, anxieties such as these are normal and in the end, not worth the amount of sleep that they will rob you of. For some, though, other, more pressing concerns should be pondered pertaining to health. While a new career in triathlon is in general a beneficial step towards good health, depending on your background, special consideration needs to be given to the potential risks.

It has long been known that maintaining an active lifestyle confers important health benefits. Exercising a minimum of three times a week may prevent high blood pressure, heart disease and obesity along with all of the other ailments associated with those problems. However, it is inadvisable for some people to begin an intensive exercise program without first consulting a health professional for advice, monitoring, and in some cases, tests. This article will review what the risks are and who is at risk, as well as what you can do to minimize those risks and make your triathlon training and racing lifestyle a healthy endeavor.

The populations at risk and what they are at risk for
Just who needs to consult a physician prior to embarking on triathlon training is a subject for debate. A very conservative approach would be to have everyone do so. However, this is greatly overstating the potential problems. A more realistic approach would be for anyone from the following groups to see a physician prior to starting their training regimen:

-People of any age who are obese
Obesity can lead to many health problems if left unchecked. The most important of these relate to the cardiovascular system. The risk of heart disease and early death from myocardial infarction (heart attack) are dramatically increased for obese individuals. High blood pressure is also seen more frequently in association with obesity and this compounds the risk of heart disease. Obesity may also cause obstructive sleep apnea that may lead to sleep disturbances and eventually to serious lung and heart problems.

Another important risk of obesity is the development of type 2 (non-insulin dependent) diabetes. This in turn can lead to blindness, kidney failure and worsening heart disease.

There are various definitions for obesity and although they are not uniform, they may be used to help determine if an individual is obese. The two most common of these are:

1. Body weight > 20% higher than suggested ideal body weight for height, gender and bone structure &
    

2. A body mass index (BMI) of > 30 kg*m2. Body mass index is a calculation based on a height to weight ratio. There are many web-based calculators for ideal body weight and BMI. For ideal body weight try http://www.halls.md/ideal-weight/body.htm, and for BMI, http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm

Obese individuals who begin a strenuous exercise program need to be aware that they are putting a significant stress on their cardiovascular system. In some, the stress that longstanding obesity has placed on their heart, along with any already established heart disease makes this a potentially risky endeavor. For this reason, prior to beginning their training, they should have a complete physical with measurement of cholesterol and lipid levels and stress testing to evaluate for any silent cardiac disease. Furthermore, in the first months of training, any chest pains or unexplained symptoms of shortness of breath with minimal exertion should prompt a cessation of exercise until a physician has been consulted.

-Smokers
Smoking causes more disease and suffering amongst Americans than obesity. Fortunately, cigarette smoking is simply incompatible with training and racing triathlon. It is thus assumed that in embarking on a new fitness lifestyle smokers will choose to first quit their nicotine habit. That being said, the ravages of cigarette smoking on the lungs and heart cannot be undone quickly. For this reason, anyone who has smoked consistently prior to starting an exercise regimen should first be seen by a physician to screen for heretofore-undetected cardiac or pulmonary disease.

-Anyone with any pre-existing medical conditions
It is prudent for anybody with any pre-existing medical condition that requires medication to see his or her physician prior to beginning any exercise regimen. Depending on what the condition is, a change in medication or dosage may be needed. At the very least, monitoring of the condition is required to watch for any untoward effects and to determine if medication requirements change over time as fitness and overall health improve.

Those with chronic conditions such as insulin dependent diabetes or any pre-existing heart problems need the most intensive monitoring, while those with less severe ailments such as chronic hypertension, high cholesterol levels or asthma need only occasional medical supervision. Nonetheless, while there may be risks associated with exercise in some individuals with chronic health problems, the benefits of their new lifestyle are far more important in the long run.

-Men over 40 and women over 45
This is a broad recommendation and does not necessarily apply to those individuals who are already active and in good physical shape. Nonetheless, the risk of developing a serious medical condition that could be impacted by physical activity increases consistently with advancing age. A percentage of men over 40 and women over 45 will have already developed silent heart disease or hypertension, and a screening physical examination may be useful to detect and preventatively treat these conditions before they worsen to the point that they cause problems.

Certainly, this is a good age for everyone to have important screening examinations for high cholesterol, breast and colon cancer, diabetes, and hypertension, no matter what your level of pre-existing health.

-Those with a strong family history of sudden death at a young age
There are many causes for sudden death at an early age, but almost all relate to hereditary disorders that affect the heart or brain. Thus it is of the utmost importance for anyone with a family history of unexplained sudden death at a young age, especially for those starting an exercise program, to be seen by a physician and undergo any tests deemed necessary to rule out a potentially fatal condition.

Whatever your background level of fitness and health, the decision to start training and racing triathlons is a positive one. The impact on personal well-being is immeasurable as are the benefits conferred to self-confidence and a general outlook on life. While this decision should be carefully considered amongst the groups of people mentioned in this article, the take home message should still be that the net results of this new lifestyle still confer important health benefits that far outweigh any risks that may be present.

Train hard, train healthy.

Next month: understanding injury. When to listen to your body and stop rather than risking further harm.

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date: November 27, 2005