Sports alert for death after 28km run

 　　In the middle of the night on October 7, Huawei issued an obituary saying that Ding Yun, an executive in charge of the company's two major business groups and the vice chairman of the company's board of supervisors, passed away unfortunately in the early morning of October 7, 2022, at the age of 53.

　　According to media reports, several people familiar with Huawei said that Ding Yun once participated in a long-distance running of about 28 kilometers in Shenzhen during the "November" holiday, but it is still uncertain whether his sudden illness is directly related to the long-distance running.

　　In the past 10 years, the number of people participating in high-intensity, high-volume sports has increased rapidly, including half-marathon/full marathon, triathlon, long-distance cycling, etc. Under this kind of national fitness fever, news about sudden death always attracts special attention. Why did sports that were originally participated in for the sake of health become a "deadly" behavior?

　　A number of doctors emphasized to China News Weekly that they should not talk about the "discoloration" of sports because of this, but should advocate appropriate and scientific sports.

Exercise-induced sudden death or underlying heart disease

　　Ding Yun registered on Sina Weibo in June 2013, and stopped updating in April 2016. His profile picture is "Gentleman Rulan". During that time, he posted only a handful of posts, many of which were related to the marathon.

　　According to media reports, during this year's National Day, Ding Yun led his employees to go for a long-distance run near Shenzhen Bay Sky. He set off before dawn and ran 28.55 kilometers. Before that, this business elite was a long-distance runner who loved marathon, and devoted a lot of his spare time to running.

　　In mid-June of this year, Megvii Technology, one of the "AI Four Little Dragons", issued an obituary. Chief scientist and Dean of the Megvii Research Institute, Sun Jian, died of a sudden illness and failed rescue efforts. Sun Jian, known as the "Godfather of Artificial Intelligence", was only 45 years old when he died. According to "First Financial", Sun Jian usually likes sports, such as cycling. Sun Jian's alumni and colleagues said that Sun Jian died in the early morning of June 14, and he also performed a night run on the evening of the 13th, but it is still uncertain whether the death was caused by sports. A senior person in the industry who is familiar with Sun Jian told the media that Sun Jian is more likely to die suddenly, and it is understood that he usually has no underlying diseases.

　　Exercise-related sudden death is a non-traumatic, unexpected sudden death that occurs during exercise or shortly after cessation of exercise. In April 2022, the "Journal of Forensic Medicine" in charge of the Ministry of Justice published the article "Epidemiological Investigation of Sports-related Sudden Death in Guangdong", which analyzed 374 sports-related sudden deaths in Guangdong from 2007 to 2021. , the number of sports-related sudden deaths caused by basketball, running and badminton ranks among the top three, with the proportions of 34.5%, 19.5% and 12%, respectively.

　　"Excessive-intensity exercise, especially sudden, unconventional exercise involving a high level of anaerobic metabolism, has certain hidden risks for those who have not received professional training and those who have potential cardiovascular diseases." In July this year , "Chinese Expert Consensus on Exercise-related Cardiovascular Event Risk Assessment and Monitoring" published in "Chinese Journal of Circulation" pointed out that although its absolute risk is very low, high-intensity exercise may also cause sudden cardiac death (SCD) and myocardial infarction and other malignant diseases. Increased risk of cardiovascular events.

　　Among all cases of sudden death, the proportion of sudden death caused by cardiac causes is the highest, reaching more than 80%, which is higher than that of cerebral hemorrhage and respiratory diseases. In the above study in Guangdong, it was also found that the most common cause of sudden death was sudden cardiac death, accounting for 67.11%, including myocardial infarction, arrhythmia, and myocarditis.

　　Zhang Ming, chief physician of the Department of Cardiovascular Medicine of Beijing Anzhen Hospital Affiliated to Capital Medical University, told China News Weekly that exercise-induced sudden death is generally divided into two cases. One is pathologically based, and I may not be aware of my heart health. Know yourself and think you are healthy. Because in the usual physical examination items, it is difficult to check the condition of the heart vessel wall, which requires more advanced examinations such as coronary CT and intravascular ultrasound to find out. Yang Jingang, deputy chief physician of the Fuwai Hospital of the Chinese Academy of Medical Sciences, also mentioned in a speech in June this year that among all sudden death patients, the largest proportion is actually people who do not appear to be at high risk.

　　Another situation, Zhang Ming pointed out, is that the athlete himself is healthy, but the vasospasm caused by excessive exercise intensity, overwork, and overstimulation causes transient cardiac ischemia, hypoxia and malignant heart rhythm. Abnormal. Even at the same intensity, if a person is overworked, stays up late, and drinks alcohol before exercising, it will lead to vascular endothelial cell dysfunction and myocardial infarction is more likely to occur. In Zhang Ming's view, there should be very few people who have no heart disease at all and die suddenly just because of running.

　　Mao Daqing, the founder of Ucommune, is a representative figure among corporate executives who loves long-distance running, and is also a "serious runner" who has completed the six major championships of the world marathon. On October 8, he posted some views on long-distance running and sudden death on his social account, and shared some "safety rules" that he summarized in long-distance running. He mentioned that heart rate is the most important dominant indicator for safe running. When the heart rate soars to a very high value, it is necessary to forcibly maintain a high pace, which will inevitably increase the burden on the body, and the possibility of heart accidents will suddenly increase. . The so-called pace is the time it takes to run 1000 meters.

　　However, exercise is not the main cause of sudden death, and the probability of sudden death during exercise is also very low. According to the statistics of the American Heart Association in 2020, the overall probability of sudden death of 100,000 people in various sports for a whole year is 0.31 to 2.1; for comparison, the incidence of sudden cardiac death unrelated to exercise is about 43 to 55 per 100,000 people.

　　"Exercise causes sudden death, which is easy to attract media attention, but it is not that the more people who exercise, the more sudden death. More sudden deaths occur in people who do not exercise." Famous cardiovascular disease expert, director of the Department of Cardiology of Peking University People's Hospital Hu Dayi emphasized to China News Weekly. People with stronger aerobic exercise ability have higher quality of life and longer life expectancy. In addition to controlling body weight, lowering blood sugar, and lowering blood lipids, exercise can also increase the secretion of endorphins, which brings a sense of pleasure and reduces the Stress and anti-anxiety effects.

　　In recent years, experts from the American Heart Association have examined the effects of moderate-intensity exercise to vigorous-intensity exercise on cardiovascular health. Potential Maladaptation". The article pointed out that exercise, as a stress, will temporarily increase the risk of sudden death and myocardial infarction. This risk is most likely to occur in people who are not accustomed to exercise, and the probability of such dangerous events in regular exercise people is higher than the former. to be low.

　　There is a lot of evidence that physical activity is inversely related to cardiovascular disease morbidity and mortality, that is, the more physical activity, the lower the cardiovascular disease morbidity and mortality; regular exercise people The risk of cardiovascular disease is significantly reduced, cardiopulmonary Those with the best endurance were associated with an 80% reduction in all-cause mortality. The so-called all-cause mortality refers to all deaths regardless of the cause and type of disease. In addition, from the perspective of life expectancy, the most active people can live 7 to 8 years longer for every 50 years they live.

How does science exercise?

　　The World Health Organization put forward in the famous "Victoria Declaration" in 1992 that the four cornerstones of health are: reasonable diet, moderate exercise, smoking cessation and alcohol restriction, and psychological balance. In 2021, the State Council issued the "National Fitness Plan (2021-2025)", which proposed to widely carry out national fitness sports events and improve the level of scientific fitness guidance services.

　　A paper published in Circulation in July by researchers at the Harvard School of Public Health in the United States showed that 300 to 600 minutes of activities such as brisk walking, aerobics, and weightlifting per week can reduce the risk of cardiovascular death by up to 38%. %; Spending 150 minutes to 300 minutes a week for aerobic exercise such as jogging, running, swimming, etc. can also reduce the risk of death by 21% to 23%.

　　Since there are many benefits of exercise, how should exercise be carried out in a safe manner?

　　The "Chinese Expert Consensus on the Assessment and Monitoring of Risk of Exercise-related Cardiovascular Events" released this year by the Cardiovascular Health and Scientific Sports Branch of the China Medical and Health Culture Association pointed out that for people who initially participate in exercise training, prepare to improve their exercise levels, or combine cardiovascular risk factors , Pre-exercise medical screening, cardiovascular disease risk screening and risk stratification are very important.

　　Risk stratification is the identification of the risk of cardiovascular events associated with exercise. According to the expert consensus, advanced age, clear cardiovascular disease, type 2 diabetes or kidney disease are all core risk factors; while lack of exercise habits, smoking, high blood pressure, high cholesterol, and over 40 years old are also risk variables.

　　In fact, there are three types of exercise. Hu Da, a well-known cardiovascular disease expert, told China News Weekly that the first type is natural physical activity, including physical education classes, housework, and walking out of the house. These were not originally for health reasons. The purpose of muscle activity, can bring about energy expenditure, good for health. However, as urban mobility and sedentary lifestyles prevail, physical activity is decreasing. The second type is exercise for the purpose of fitness, disease prevention and rehabilitation, such as jogging, brisk walking, cycling, playing ball, mountain climbing, going to the gym to practice equipment, etc. The third is called competitive sports, such as marathon, desert travel, plateau climbing, etc.

　　If you want to participate in high-intensity exercise and competitive sports, Hu Dayi suggested that for young people, congenital heart diseases, such as hypertrophic heart disease, congenital arrhythmia, congenital coronary artery malformation, etc., should be excluded first; In many cases, coronary artery stenosis is not serious, but there is unstable plaque on the inner wall of the blood vessel, known as atherosclerosis, which may develop into acute myocardial infarction if it ruptures. Therefore, triggers that may lead to plaque rupture should be avoided, such as heavy alcohol consumption, excessive fatigue, sudden participation in strenuous exercise in the absence of daily exercise, etc.

(File photo) First responders at the marathon scene. Figure / Zhongxin

　　Hu Dayi, now 76 years old, is a long-term exercising person. He has traveled to the Tibetan plateau many times, most recently from the end of July to the beginning of September. He told China News Weekly that he walked and ran 18-20 kilometers every day for 20 years.

　　In his opinion, even some young people may have problems if they don’t train regularly and think that they can participate in the marathon by signing up. In the past 10 years, in addition to promoting the establishment of cardiology departments and cardiac surgery departments in many hospitals across the country, Hu Dayi is also actively promoting the addition of cardiopulmonary prevention and rehabilitation departments in hospitals to evaluate individual cardiopulmonary function.

　　Among Hu Dayi's patients, there is a cardiovascular patient who is recovering through exercise. The other party was diagnosed with coronary artery stenosis in 2015, with 70% and 80% stenosis in the two blood vessels, respectively. He suggested that the other party start rehabilitation by quitting smoking, drinking alcohol, and exercising. On one occasion, the patient planned to join Hu Dayi on a walk in the Badain Jaran Desert.

　　He suggested that the other party first perform a cardiopulmonary exercise evaluation in the hospital cardiac rehabilitation center to find out whether there are symptoms such as myocardial ischemia and angina pain during exercise.

　　Secondly, according to international standards, when preparing for high-intensity and challenging sports, Hu Dayi suggested that patients should perform 36 adaptive training sessions in a medical gym equipped with sports therapists, medical monitoring equipment, rescue facilities and doctors. To understand the amount of stimulating exercise (that is, 80% of the extreme exercise) and extreme exercise for the corresponding age group, evaluate whether you can participate in long-distance desert trekking. Now, after three and a half years of training, the opponent has not only successfully completed the desert walk, but also a marathon Grand Slam runner, and his heart health is also stable.

　　Jia Dacheng, a senior first aid expert at the Beijing Emergency Center, told China News Weekly that as early as the late 1980s, he called on the whole society to make health education, first aid education and death education compulsory courses for lifelong education for all. The so-called health education is to advocate a healthy lifestyle, including how much exercise should be mastered.

　　Jia Dacheng pointed out that scientific sports should first choose sports that suit oneself. For example, if there is a problem with the knee joint, don’t run, but choose swimming, cycling and other sports; secondly, it should be done step by step to allow the body to adapt, not one "Breakthrough" yourself. If there are objective indicators, such as heart rate monitoring, you can refer to it; if not, you should reduce the dose when you feel dizzy, chest tightness, and shortness of breath.

　　Mao Daqing shared that recently, in terms of heart rate monitoring and control, he used the MAF180 running method, which is based on the number obtained by subtracting the actual age from 180. speed. Since learning the MAF180 running method, he started wearing a sports watch with heart rate monitoring and strictly controlled his heart rate between 127 and 135. But Hu Dayi said that this method is feasible for healthy people, and patients need to be evaluated, which varies from person to person.

　　The "Chinese Expert Consensus on Assessment and Monitoring of Risk of Exercise-related Cardiovascular Events" pointed out that wearable equipment can help self-monitoring risks. In addition, appropriate emergency response systems and reasonable first aid procedures should be constructed in relevant sports venues where mass and competitive endurance sports are carried out to provide a safer environment for sports participants.