Why Do So Many Middle-Aged Men Die During Ironman Competitions?

Thousands of triathletes jumped into a warm Tennessee river on Sunday morning during Ironman 70.3 Chattanooga. One didn’t make it out of the water alive.

The Chattanooga Times Free Press reported that the participant had to be pulled out of the water and given CPR before the race was fully underway. The open-water swim was the first portion of the Ironman 70.3 race, which consists of a 1.2 mile swim followed by a 56 mile bike ride and a 13.1 mile run.

“We are deeply saddened to confirm the death of one of our athletes participating in today’s Ironman 70.3 Chattanooga triathlon,” said Ironman spokeswoman Ellie Seifert in a statement. “Our condolences go out to the athlete’s family and friends, whom we will continue to support.”

On Monday evening, the United States Army Reserve Fitness Challenge identified the man who died as Colonel Gene Montague, a 51-year-old veteran who “had been training for months.” The nonprofit organization Medals of Honor, which supports athletes who compete in endurance events to memorialize fallen soldiers, said that Col. Montague was “weeks away from retiring” at the time of the race.

The circumstances surrounding Col. Montague’s death are tragic but they also fit a pattern identified by experts who have studied triathlon fatalities. Most triathlon victims are middle-aged men, often first-time competitors. And they almost always die in the water or shortly after finishing the first leg of the race.

“The swim is likely to be the most strenuous part of the day in a triathlon,” Dr. Lawrence L. Creswell, a cardiothoracic surgeon at the University of Mississippi Medical Center, told The Daily Beast. “For the typical triathlete’s heart, it’s the time when the heart rate is apt to be the highest because it’s the highest level of exertion.”

Dr. Creswell is the co-author of a new study recently highlighted by ESPN which analyzed the history of fatalities in amateur U.S. triathlons like the Ironman races. Eighty-five percent of the 109 deaths reviewed between 1985 and 2015 were men, with their average age hovering around 50 years old.

The other major pattern that emerged: a full seventy percent of the deaths, as ESPN noted, happened “during or upon exiting the initial swim leg.” Available autopsies showed pre-existing heart problems in more than half of cases, which likely contributed to fatal arrhythmias in the water.

Sunday’s death fits this profile almost exactly. In his profile of Col. Montague, Tyler Jett from the Times Free Press reported that doctors on the scene told the family that his heart “gave out” early in the swim and that he could not be resuscitated.

Three years ago, Ironman announced a SwimSmart Initiative designed to increase the safety of the swim portion. Many triathletes find the swim to be the most challenging portion of the race, both mentally and physically. To alleviate this challenge, Ironman began testing safety measures such as holding “a pre-race, in-water warm-up whenever possible,” and placing resting rafts and numbered buoys along the open-water course.

Seifert was not immediately able to comment on whether or not Ironman 70.3 Chattanooga took these safety precautions, which were tested in 2013. But race competitors and observers can confirm to The Daily Beast that there was no official in-water warm-up on Sunday for non-professional participants, which included Col. Montague.

“The pros are the only ones who get a pre-race, in-water warm-up,” said participant Jessica Rudd. “Everyone else is in charge of warming up themselves.”

Rudd did report that the course was patrolled by a large team of rescue vessels, and that there were plenty of resting rafts and numbered buoys along the way.

“It's a big river,” she said, “and I don't think I was ever more than 50 feet from a safety boat.”

Jim Tanner, a freelance writer and former assistant sports editor for the Times Free Press who covered Sunday's race, told The Daily Beast that it is “almost impossible to have a warm-up for 3,000 participants” at the current site because of the steep grade of the riverbank.

But while in-water warm-ups are ideal, there’s no proof that skipping them is a direct contributor to triathlon deaths.

Dr. Cresswell, himself a triathlete, is a strong advocate for warming up in the water, not only because it prepares the heart for the race but also because it can alleviate the anxiety that contributes to stress during the swim. But in the end, he says, there is no empirical research to suggest that fatalities are linked to a lack of warm-ups.

There is, however, hard evidence from the autopsy reports to suggest that triathlon competitors should closely monitor their heart health before competing.

Information about Col. Montague’s medical history has not been released but the USAR Fitness Challenge said that he was in “excellent physical condition.” His brother told the Times Free Press that the man was an accomplished athlete who would “often go into the ocean with [him] on vacations and just swim the coastline for miles.”

But often those who die in the water during triathlons are unaware of an asymptomatic heart condition before competing. That’s why Dr. Cresswell strongly advises that triathletes, especially middle-aged men, keep close watch over their cardiovascular health before signing up.

“I think that it behooves participating athletes to pay particular attention to their heart health before they participate,” he advised, noting that this would leave them in the “safest position possible” to compete.

Ultimately, there may be no way to fully eliminate triathlon deaths—Dr. Creswell suspects that some amount of death during strenuous exercise is “part of the human condition”—but more can certainly be prevented.

Update 5/24/16 7:45 PM: WRCB is reporting that Col. Montague's autopsy showed he died of a heart attack, which came as a shock to friends and family. Dr. Charles Campbell, the chief cardiologist at Erlanger Hospital where Col. Montague was treated, noted that "there aren't always warning signs" for a heart attack.Ironman spokeswoman Ellie Seifert has also confirmed to The Daily Beast that several features of the new SwimSmart initiative were in place at Ironman 70.3 Chattanooga including resting rafts, rescue boats, safety personell, and a rolling start rather than a mass start.

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