The heart of a champion: Triathlon training with heart failure

Triathletes Ken and Dave.
Ken Lewis with his doctor and client, David Carfagno, D.O., C.A.Q.S.M., before a race.

Having a heart condition can make it difficult to participate in sports, but it doesn’t make it impossible. My patient Ken Lewis is a great example of that. He’s 72 and has heart failure, but he continues to compete in duathlons and triathlons around the globe – even after once suffering a heart attack mid-race.

My colleagues and I have done ample research to show that, with proper supervision, exercise can improve the health of heart disease patients. Guidelines are available to guide practitioners caring for athletes (the “Bethesda Guidelines”), though they must be interpreted in the context of individual patients and their athletic goals. Ken Lewis is a great example of the shared decision-making that must take place when athletes with heart disease want to continue to participate in the sport that they love.

Ken is a triathlete and coach in Scottsdale, Arizona. He shares his knowledge and trains clients – including his doctor – to achieve their athletic goals. I’ll let him share his story in his own words.

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A lifetime of competition

I did the first Ironman triathlon in England in 1983, which included a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile run. In fact, I competed in the first three triathlons ever held in England. For the next 30 years, I shifted my training to short-course triathlons: a 0.9-mile swim, a 25-mile bike ride, and a 6.2-mile run.

During this time, I developed some heart problems, including blockages in my arteries. During one race in 2006, I was leading by about nine minutes. Two miles from the end, I was exhausted and couldn’t figure out what was going on. I jogged to the end and went to the hospital. They’d told me I’d had a heart attack during the race – but I still won my age group. 

In 2012 at the World Championships in New Zealand, I had to be pulled from the water because I had a hard time. I found out I had a 90 percent blockage in my circumflex artery. Not fun. All told, I have six stents that have been placed over the years.

After the first Ironman, I swore I would never do another one for 30 years. I did not realize 30 years would roll around. So in 2014, I decided to give the Ironman another try. I raced in the Brazil Ironman in 2014 and managed to win my age group. That got me a spot in the Ironman World Championship in Kona, Hawaii. After I took part in the national and world short-course competitions that year and earned top 10 finishes I went out to Kona. But something wasn’t right.

I finished the swimming portion and started on the 112-mile bike ride. After about 35 miles, I was absolutely exhausted, and I knew I couldn’t finish. I pulled out of the race and went home.

A new opponent

After the Kona race, my cardiologist diagnosed me with a new heart condition: congestive heart failure. Basically, my heart only pumps at about 35 percent of the rate it should. If your heart’s not pumping enough blood, you can’t get enough oxygen to your muscles.

My cardiologist gave me medication, but I just didn’t feel well. I wasn’t sure what was going on, and I didn’t know what to do about it.

One of the guys from my Saturday-morning cycling group, Colin Conner, mentioned that he used to work with Dr. Levine at the Institute for Exercise and Environmental Medicine. He told me, “Ken, you ought to go down to Dallas and talk with him.”

So I called the hospital and scheduled an appointment, then made the trip from Arizona to Texas. Dr. Levine checked me out and ran some tests. I had another appointment with him later on for additional testing with some of the doctors and nurses from his team. They brought me to their extraordinary exercise lab, where they actually simulated a triathlon! They had me swim in a flume, ride a bike, and run on a treadmill, all the while monitoring my heart, lung, and muscle function. I had to laugh because I told everyone this was the first time I trained for a doctor’s appointment.

After that testing, Dr. Levine suggested to me and my cardiologist in Scottsdale that I should be on a different heart medication. When I went back home and started taking it, I began to feel a lot better.

Benjamin Levine, M.D.
Benjamin Levine, M.D., Professor of Internal Medicine at UT Southwestern and founder and Director of the Institute for Exercise and Environmental Medicine.

Get a little better every day

When I saw Dr. Levine the first time, I could barely run a mile in 12 minutes. That’s really slow for me, but it’s all I could do. Dr. Levine gave me the kick I needed. He told me, “You can do better. You can go harder.”

I’ve trained hard nearly every day for 35 years. Training after being diagnosed with heart failure was the hardest training I’ve ever done in my life. But I had to accept it and stick with it. I’d go out for a run and be out of breath after 50 steps, but I just had to chip away at what I could do.

My new medication and Dr. Levine’s encouragement made it possible for me to do that. I didn’t get tired as quickly. I ran a little farther and a little longer every day – just as I encourage the athletes I coach to do. 

Back to competition

In 2016, some of my athletes earned entries into the world triathlon championships in the Netherlands and the world duathlon championships in Canada. The duathlon is similar to the triathlon, but the event substitutes running for swimming.

I found out there was a race in New Orleans where, if I placed high enough, I could make Team USA for both the duathlon and triathlon. So for eight weeks, I trained for the race. I did a triathlon on Saturday and a duathlon on Sunday every week under the care of my doctor in Scottsdale, David Carfagno, D.O., C.A.Q.S.M., who is also my coaching client.

When I got down to New Orleans, the race officials had canceled the swimming portion of the triathlon because of rough waters, so both races were actually duathlons. My pace had improved a lot since the first time I saw Dr. Levine. I could run 3.1 miles at a 9 minutes and 50 seconds pace. That’s still not fast for me, but it was good enough to make Team USA for both events in my age group. I was amazed because I didn’t think it was possible for me to do that again after my diagnosis.

Running a better race

When I was diagnosed with heart failure, I didn’t think I’d be able to compete again. But I’ve been amazed to find out otherwise.

Since my new medication and advice from Dr. Levine, I’ve felt terrific. As of November 2016, I’m back up to running six miles without stopping. Everyone’s surprised at how well I’m doing, and I’m as shocked as anyone else! I’m definitely not taking this for granted.

Though I train a little slower now than before my diagnosis, I don’t tell myself, “I can’t do this because I have heart failure.” I just keep pushing a little farther, a little faster, and a little harder, and I’m able to enjoy the sport I love again.

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Ken’s story is one of courage and persistence in the eye of adversity. Though heart failure does change how you participate in activities you enjoy, it doesn’t mean you can’t find a way to be involved.

Athletes are not immune to developing heart disease, but competitive athletics – both the training and competition – does place unique demands on the cardiovascular system that must be integrated into an overall management and training plan for individual athletes. Their goals for their sport (participation, competition, “winning,” health, or just long-term enjoyment) must be calibrated against the limitations placed by the disease process. Every athlete is different, so caring for an athlete with heart disease requires a thorough understanding of both sport physiology and cardiovascular disease.

If you or a loved one has been diagnosed with heart disease, talk to your cardiologist about safe ways to stay active. It is important that you do not begin an exercise program on your own without your doctor’s input. With proper supervision, you can improve your body and quality of life with healthy exercise.

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