Before getting into Multisport

Know the sport. Train wise. Live healthy. Know your body.

As you know, we sometimes read and heard in the news some incidents involving participants died while racing in triathlon.  Coach Rick Ledesma of Firstwavetri, a tri community forum, initiated a collective information what causes the unfortunate events.

Coach Rick consulted Dr. Randy Molo on questions & theories that occurred in that moment. Dr. Randy Molo practices as an orthopedic surgeon, member of Phil. Center for Sports Medicine working with RP athletes and the Azkals, consultant for one shoe brand, and also a member of multisport team.

The interview made happen so that the multisport community will be more aware of the health issue that go with triathlon sport.

Here are some general information that Coach Rick asked.

1)     What are the check-ups necessary to ensure ones fitness capability before joining races

First things first –the sport that we all love (Multisport) is categorized as an endurance form of sport. What that means is that it is designed for us to go Faster, farther, further by pushing our physical bodies and the processes it’s capable of doing to its limits. This limit is our physical and physiologic  threshold. This actually varies from individual to individual, hence some people are actually faster than others or why there’s huge performance gains in another while some are near or at their limit already. Our performance thresholds are more or less dictated by our genetics and the ability of our heart and lungs to adapt to the various demands of the progressively more difficult things that we do as we participate.

With this in mind, there is absolutely no single test that can be done to quantify or put into context what our actual threshold is. Indirectly, doctors can do various tests that give you numbers and exercise indicators like a STRESS TEST or a CARDIOPULMONARY EXERCISE TEST (CPET) but if you think about it, we never really test you to absolute exhaustion or to the point of inducing a cardiac event like a heart attack.

Doctors would like to think of it as a RISK ASSESSMENT or STRATIFICATION that would best identify red flags concerning medical issues and try to limit the unknown/unassessed medical concerns that can potentially put your multisport participation at risk. You are then classified as low , moderate, high risk or Class I to IV depending on your actual assessment.

At St. Luke’sGlobalCity– We are in the process of forming a team of Sports Specialists  (i.e. Sports Physician, Sports Surgeon, Sports Cardiologist, Exercise Pulmonologist, Rehab MD) who will make a thorough sports related assessment.

Actual tests may include a physical assessment, a pre-participation form that an athlete will answer, an ECG, a 2D-Echo. Other options may include a stress test, or a CPET…The tests are geared for sports participation and not for office work participation and are thus probably not part of an annual physical exam.

Once assessed, you may then know actual risks for participating in sport and that should guide you in your training and eventual participation.

2) What health signs should we be aware of that can be early detection:

    – during training

There is a free online available form from theAmericanCollegeof Sports Medicine called a pre-participation in sports form. It is answerable by yes or no. Generally, they cover for issues related to the heart and lungs like chest pain, dizziness, light headedness, difficulty of breathing. If you frequently collapse while training or racing it might be worthwhile for you to have yourself evaluated. Some things are not necessarily just caused by nutritional issues or exhaustion related events.

      while racing 

as above. A safe guide to pull over is if in a particular circumstance

1.)  you think you cannot safely protect yourself as you participate

2.)  you think you cannot orient yourself properly  to time, location, and getting back to someone /some place where someone can provide help

3.)  you think that taking a 5-10min. pause or break does not improve a situation

4.)  When in doubt –use extreme caution and call it a day. 

3) Is a heart rate monitor a good tool for training/racing to avoid the unfortunate? 

A heart rate monitor only shows you 1 thing and that is HEART RATE (or heart beats in a minute). What’s more important as a source of cardiac events or medical issues is the rhythm of the heartbeat. Things like irregular heartbeats, pauses or fast and slow beats or even murmurs are not obviously assessed by a heart rate monitor. An HRMs use is therefore used to indirectly measure exertion as measured only by training zones calculated either in the lab or based on ones’ age. It may be used as physiologic guides for training improvement but not for looking for a cardiac event.

In fact most heart doctors sometimes will make you wear a bulky portable device called a Holter monitor that is essentially a portable ECG that you wear for 24 hours and records all heart rates and tracings over a 24 hour period. This is a helpful tool but obviously not practical and feasible for training and involves an interpretation by an expert.

4) How long is a good rest/recovery period between hard races?

Tricky question as this has to be individualized. Ideally and generally, people can cycle their recovery periods in macro or micro cycles depending on their genetics, physiologic thresholds and even an unquantifiable thing called race experience.

Think of it this way…once a person recognizes his/her threshold (I probably would define it as going at a pace that is comfortable –bordering on being uncomfortable already)….to make it as simple as possible—no one wants to race as uncomfortably as often and as frequently as this creates changes in the processes and anatomy of your heart, lungs, muscles etc. Sometimes these changes are actually creating irreversible harmful situations already.

If one races/performs at “SUBTHRESHOLD” or below discomfort level –then that should be fine as you can have a shorter recovery period in between races…Remember –YOU SHOULD NOT PEAK EVERYTIME—and at EACH and EVERY RACE that you enter. That is not wise and obviously, virtually impossible as it will lead to a drop in performance at some point

5) Should there be steps other participants can do to help when a co-participant that is down?

It would be very nice (but not mandatory) to have a personal initiative to have BASIC FIRST AID or BASIC LIFE SUPPORT (BLS) training as it’s a 4 hour course offerred by various groups like red cross. Dictum id, if you know what you are doing, then by all means offer help –but if not, then the next best help you can offer is clearing the way and calling for a person who is capable of helping a downed person.

6)As organizers:

6.1)   Should we require medical clearance before an event?

No such thing as a foolproof clearance. As with any event all over the world, the better word to use is a sports participation risk stratification.

That being said—it should be a personal initiative by the athlete to not take short cuts in their personal health and to devote  a reasonable amount of time to get themselves checked for an added “peace of mind” as they participate.

As organizers – waivers concerning medical related events are mandatory but as it is –there are no standards as to the veracity of medical “clearances/notes” as well as how and what testing procedures the athlete took to obtain the “clearance”

6.2)   If yes, how long is a medical clearance good (3 months, 6 months etc)

Ideally annual assessments are required as our anatomic and physiologic parameters can vary , adapt, regress in that period. Obviously any medical event or complaint does not prevent anyone from getting tested at shorter intervals.

6.3)   What should we require each ambulance to have at the minimum? (medicines, doctor on board or just nurse)

O2, AED (automated defibrillator), and most importantly –a well trained staff versed in endurance sport related medical concerns. Paramedics are fine but have to be supervised by a race medical director.

      6.4) Any red flag signs we as organizers should be aware of when a participant registers with a past medical history?

These should be part of the pre-participation evaluation submitted by the athlete with due emphasis on answering them as HONESTLY and as thoroughly as possible.

Please add any info you can share just to give a heads up to the multisport community.

Well , among the many known causes of Sudden Death in Sports –majority of them are tied up with the heart and they can include: Arrhythmias (irregular heart rates/speed/erratic rhythm); M.I. (myocardial infarctions thickened heart walls, poor blood flow and oxygenation to the heart etc); Blood issues – clots from deep veins, hypercoagulable (“thicker than usual” blood concentrations) situations; Emboli – things that can be thrown or travel from the leg vessels and lodge/block an artery to the heart or brain. These emboli can be clots or fat globules. Then again—people can have a stroke event due to various stressors. At the end of the day – -there is no single predictor who will get these issues and when —-what people are after is trying to catch the red flags associated with this issues and advise people accordingly regarding possible risks as they participate.

Dr.Randy Molo:

He is a graduate of UP College of Medicine and finished his Residency training in Orthopedics at St. Lukes Medical Center as well as his Fellowship training in Sports Medicine. He is interested in the Arthroscopic diagnosis and surgery for musculoskeletal disorders and sports injury. Currently he is the head of the Arthroscopic Section of the CMS-Asia.



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