Why Joggers Are Running Scared

By Claudia Wallis

Did Jim Fixx die from exercise or medical neglect?

His was a story that inspired thousands of flabby, middle-aged Americans to put on their Pumas and take to the streets.

After all, if a chubby, 214-lb., two-pack-a-day smoker like Jim Fixx could transform himself into a sleek, 160-lb. marathoner, then anyone could do it. Fixx's 1977 best seller, The Complete Book of Running, converted the masses with rhapsodic sermons on the physical and psychological benefits of his sport. "The most important single indica tor of overall health is cardiovascular endurance, which is what running develops," he wrote. Thus there was irony mixed with tragedy when Fixx died this month at 52 from a heart attack while pounding the road in Vermont. Last week his legions of disciples around the country were suddenly running scared and asking: Did jog ging kill Jim Fixx?

As doctors point out, there is no simple answer.

Fixx was fond of noting that regular aerobic workouts generally diminish the risk of heart dis ease; cholesterol levels, blood pressure, body weight and pulmonary function have all been shown to be positively influenced by exercise. A new study, conducted at Harvard and Stanford and published in last week's issue of the Journal of the American Medical Association, further confirms the benefits. According to its principal author, Dr. Ralph Paffenbarger, the study of 17,000 men ages 35 through 84 revealed "a direct relationship between the level of physical activity and the length of life." Fatal heart disease was found to be nearly twice as common among the most sedentary subjects as it among the most active, Concludes Dr. George Shee-the medical editor Runner's World magazine, who is a marathon runner was a friend of Fixx's:

"You are more likely to die you don't jog than if you do."

Athletes who do run into trouble on the road are in variably those who already have advanced coronary disease. That was true of Jim Fixx. An autopsy found that he had two coronary arteries that were almost totally clogged, and a third with a 50% blockage. Because the buildup of fatty material in the arteries is usually a slow process, Fixx probably had at least some coronary damage before he took up running at the age 35, and his history of smoking and be overweight probably contributed to problem. Significantly, Fixx's father a heart attack at 35 and was dead 43. Heredity plays a very important in heart disease, notes Cardiologist Winslow of Chicago's Northwestern Medical Center and medical director of the Chicago marathon. "You could say that Fixx was running with the cards stacked against him," he says.

For some 20% of heart attack victims, death comes without any previous warning. Fixx, however, appears to have had some warning signals. A few days before his death, he complained to a fellow runner of exhaustion. "Tremendous fatigue often occurs prior to a heart attack," says Sheehan. More important, Fixx told his family that he felt a tightness in his throat while running. This, says Winslow, was probably angina, a telltale sign of coronary trouble. Though commonly described as a gripping pain in the chest, angina can occur anywhere from the nose to the navel. Usually it occurs in the same place and disappears when physical activity stops. "Tightness" and "heaviness," says Winslow, "are two of the most common descriptions of angina."

If there is a lesson to be learned from the death of Jim Fixx, doctors say, it is that warning signs are meant to be needed. Fixx knew that his family history put him at high risk for heart disease, and yet the runner was "really negligent" about seeing doctors, says ex-Wife Alice Kasman Fixx. According to Dr. Kenneth Cooper, founder of the Aerobics Center in Dallas, Fixx may have been running from the truth. Last December, while testing a number of other runners, Cooper urged his friend to have his heart function evaluated with a treadmill stress test, but "for reasons known only to himself," Fixx refused. "The second most common symptom of coronary disease, after angina, is denial," observes Winslow. For long distance runners like Jim Fixx, it can be fatal.

--By Claudia Wallis.

Reported by Mary Carpenter/New York

With reporting by Mary Carpenter