Early next fall a 52-year-old airline pilot named Ray Thiele, who was grounded in September 1972 after suffering a severe heart attack, will apply to the Federal Aviation Administration for reinstatement. His appeal will be based on the contention that his ruptured heart is now as good as—or better than—new. As proof he will offer, among other things, the fact that he has run in the Boston Marathon. If he succeeds he will join a select few pilots who in recent years have won exemption from an FAA rule that denies recertification to post-coronary patients.
Although all of those recertified presumably had engaged in some form of rehabilitative therapy, none had ever run in a marathon. If the FAA examiners accept the theory of Dr. Thomas J. Bassler, an Inglewood, Calif. pathologist, and editor of the American Medical Joggers Association newsletter, Thiele's chances for recertification are good. Dr. Bassler says, "If a post-coronary patient gradually trains up to the marathon distance and then actually completes a marathon, I consider him immune to a fatal heart attack for the next five years, providing, of course, that he does not resume—or begin—smoking." Dr. Bassler says this holds even if the patient abandons subsequent exercise, but he also contends that a post-coronary marathoner who continues to run three hours a week (about 18 miles), eschews tobacco and keeps his weight down will never have another attack. Dr. Bassler would permit him an occasional beer, but he views more ardent spirits with suspicion.
Few traditional cardiologists accept Dr. Bassler's immunity theory, and none does if the patient gives up running entirely. On the other hand, most of today's heart specialists recognize the usefulness of supervised exercise in repairing a damaged heart. This represents a drastic change from generally held medical opinion 20 years ago. Remember the public alarm when Dr. Paul Dudley White decided to let the stricken President Eisenhower return to the golf course? But whereas Dr. White was then criticized as reckless, he now would be accused of excessive timidity. Golf simply does not provide enough exercise to effect heart repair.
While the merit of running as cardiovascular therapy is fairly well known, only two rehabilitation clinics have utilized the Olympic-distance marathon as a goal for post-coronary patients. One is the Toronto center presided over by Dr. Terry Kavanagh, a physiatrist whose 400 patients have been referred by cardiologists. The other is sponsored by the Honolulu YMCA and is under the direction of Dr. Jack Scaff, a cardiologist who also happens to be Ray Thiele's personal physician. Drs. Kavanagh and Scaff emphasize that no one is required to run in a marathon. "The race is really only a yardstick of a patient's progress," Dr. Scaff says. "It is a motivating event that will prove—both to him and to the world—that he has adopted a lifestyle and done the necessary training to fully restore his heart function." Both Drs. Scaff and Kavanagh acknowledge some debt to Dr. Kenneth Cooper's aerobics discoveries, but they feel no heart-attack victim should attempt an unsupervised aerobics program. "I have had three patients who suffered second coronaries doing aerobics on their own," Dr. Kavanagh says.
Dr. Kavanagh pioneered the marathon run for cardiac cases last year when a group of his more advanced patients appealed to him to set a goal beyond the pleasant one of being alive and well. "How about a marathon?" one of them asked. "The Boston Marathon is the only one I know of," said the doctor, a 46-year-old Irishman who emigrated to Canada in the 1950s but had not paid much attention to American track and field (about 130 marathons are held in the U.S. each year). "Then let's go to Boston," the patient said. After some inquiry, Dr. Kavanagh took eight of his patients to the 1973 race, and seven of them finished.
This success excited Dr. Scaff, who had run at Boston himself, and it had the same effect on two of his patients—Thiele and Val Nolasco, a 42-year-old caf� pianist who had been struck down in August of 1972. When Honolulu's Rim of the Pacific marathon, an AAU-sanctioned event, was scheduled for last December, Thiele and Nolasco were determined to run in it, the former to prove his fitness to the FAA, Nolasco to prove it to himself. Dr. Scaff invited Dr. Kavanagh to bring some of his runners to compete. The Canadian brought three, all Boston veterans. Just to be on the safe side, a sturdy registered nurse was assigned to bicycle along with the five cardiovascular runners, carrying water-replenishing refreshments and a packet of first-aid equipment.
The three Canadians finished the Hawaiian course in just over four hours, but only one of Dr. Scaff's two entrants made it. Val Nolasco finished dead last in 5:24:45, but vigorously alive in every other respect. Thiele, the man who wanted to most, did not finish—not because of any trouble with his heart but because his feet gave out after 24 miles. "What do you plan to do now?" the disappointed Thiele was asked.' 'Get ready for Boston," he said.
And at Boston this spring, Thiele made it—slowly and painfully, but all the way. Why slowly and painfully? "Not because of my heart," he said later. "My pulse never went over 140 during the whole race." The fact is, at 52 Thiele's long legs haven't yet caught up with his youthening heart. Thanks to the Boston and Honolulu events, cardiac patients have now completed the official marathon distance 11 times.
It may be a long time before a real test is made of Dr. Bassler's radical belief that the marathon heart-proofs a person for five years even without further exercise. Running seems about as addictive as heroin, and none of the cardiac marathoners has shown any inclination to quit. Although neither Dr. Scaff nor Dr. Kavanagh is quite prepared to endorse this aspect of Dr. Bassler's theory, both respect him, and Dr. Scaff suspects he may be right. "Tom is not a cardiologist," Dr. Scaff says, "but as a pathologist he has dissected hundreds of hearts and is well informed on cardiovascular problems."
Ray Thiele is not about to provide the inactivity test case for Dr. Bassler. "I think it's a pretty rare guy my age who has the endurance I have now," he says, "and I intend to maintain it." Dr. Scaff, who doubles as an aviation medical examiner, feels Thiele has a fair chance for FAA recertification. It seems a reasonable assumption that a man who has run in 1[12/13] marathons—and is training for another—is a better risk than those sedentary pilots whose exercise is limited to lifting glasses and chasing stewardesses.