"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Saturday, August 24, 2013

Cardiovascular Damage From Extreme Endurance Exercise

This post is a slight rest from policy and reimbursement issue for physical therapists on this blog.

I include this 21-minute video by cardiologist James O'Keefe called Cardiovascular Damage From Extreme Endurance Exercise because the implications are so surprising, to me, at least.

The evidence is starting to 'coalesce', in Dr. O'Keefe's words, that greater than 2-hour endurance races by older athletes may lead to permanent scarring and stretching of the myocardial (heart) muscle which can increase the incidence of arrhythmias, stoke and sudden death.

I have always tried to promote exercise to my patients with strictly orthopedic considerations. In other words, I've never considered an upper limit on the time or intensity of exercise from a cardiovascular standpoint. Again using Dr. O'Keefe's words, I've always subscribed to the 'more is better' paradigm. Perhaps now is time to reconsider my assumptions.

Since this is a controversial issue, it seems my assumptions are not mine alone - many athletes, coaches and laypersons probably subscribe to the 'more exercise is better' paradigm.

Sudden death is in the media lately.  Google is investigating how the new Google Glass can be used to properly treat athletes drop dead on the court or playing field.

Also, an August 8th post on the ADVANCE for Physical Therapy and Rehab Medicine website also discusses sudden death in younger athletes.

I've competed in over 50 triathlons, ultra-distance races and extreme endurance events in the last 20 years. In setting myself as an example I hope I've not done a disservice to my patients. I don't think so because my advice and example was based on the best evidence available at that time. Now, with new evidence, perhaps physical therapists (including me!) can incorporate better advice.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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