The Dangers of Triathlon or any other Endurance Sports

There have been many reports of endurance athletes dying while racing triathlons or marathons. There are also reports of how endurance training may be more harmful than healthy for the heart.
So what are we going to do about it?
Train or don’t train? Race or don’t race? Perhaps we can train and race in a way that will mitigate these risks?
Of the 109 deaths reviewed in the Minneapolis Heart Institute Foundation study, which analyzed data from races between 1985 and 2015, 85 percent were men. The average age of the entire group was 47, and in a closer look at recent deaths (2006-15), the average age was 50 – twelve years older than the average age of all participants during that time.
76 deaths, or 70 percent of the total occurred during or upon exiting the initial swim leg. The bike leg accounted for another 19 deaths, mostly in crashes. The balance came during the running leg, which is last in the event. About half the total fatalities were in shorter “sprint” triathlons, which attract more newcomers to the sport and more participants overall.
From this, we can observe:
1. Most fatalities happen during the swim leg.
Another research article published by the Scientific American cited that swimming is the most dangerous leg of a triathlon. The study mentioned that the incidence of death was at about 1.5 per 100,000 participants.
From the interview with the author,
“Q: Nearly all of the deaths you studied occurred during the swimming events. Did this surprise you, given that swimming is the first leg of the triathlon and, presumably, the athletes are not suffering from the heat or from exhaustion at this point in the competition?
A: Yes, exactly. We were first surprised by this but I note this trend continues beyond the end of our study (also in several non-sanctioned races we did not formally look at). While at first I was surprised, it does make sense for a number of reasons.
First, the adrenaline surge and pure number of athletes entering the water at the same time; Second, the fact that I suspect many athletes come from a background in running or other sports and may be less adept at swimming; Third, swimming in a triathlon is a totally different sport from doing some laps in the pool due to variability of extremes of waves [as well as] people swimming around you and on top of you; Fourth, the inability to rest properly if needed (or call for help) as you could do in the run and bike [segments]; And, fifth, the difficulties in being noticed if the swimmer is in trouble due to the number of athletes in a body of water, which is not transparent. I think these are some of the factors that are related.”
2. The athletes were older than the average athlete.
It makes them more vulnerable to heart failure especially if they have a pre-existing condition and unaware of it.
If you are older, it may be beneficial to have more than your annual check-up done, for example, getting the 3D echo heart screening.
According to the same study by the Scientific American, “Just over half the autopsies revealed evidence of pre-existing cardiovascular disease, which is more apt to affect men earlier in life than women. It speaks to the fact that there may be a subset of triathletes who may benefit from screening.”
Cardiovascular health, not just the ability to train for long time, really is the heart of the question.
3. Most of it happened at the sprint distance race where there are more newbies to the sports.
If you are new to the sport, you have little experience of swimming in the open water with hundreds of people kicking and pushing. It is best to get yourself some training to prepare for it.
It is not the length of the race, but how experienced you are.
4. Fatal bike crashes.
Accidents happen. But you can do your best to reduce the chances of you getting into an accident with better handling skills and with the experience of cycling around people and under physical stress. Your brain processes information differently when you are driving with a heart rate of 100, when you are driving with a heart rate of 120 and when you are cycling leisurely. At 150bpm, your brain is functioning mainly on reflex.
5. Fatality at the run leg is 21%.
That is usually when exhaustion causes a heart attack. But if it happens at sprint distance races rather than ironman, then the issue would not be so much of exhaustion from the grueling race but rather, more of the lack of self awareness of one’s physical limits.
Training with intensity while monitoring your heart rate (rather than just by feel) will contribute to greater self awareness and teach your body to slow down before it is too late.
If you have trained at that intensity, the chances of you getting beyond that during a race and not knowing what to do would be much less.
Suggested actions to take:
1. If there is any training that you should do, it is open water swim training with a coach.
2. If you are older than 40 for male, 50 for female, please get a heart screening.
3. Learn and practice bike handling and not just cycle straight for the time trial only.
4. Practice pacing and have breaks through workouts at training to know when you should be backing off.