Runner Down

George Spears used to tell his kids that the human heart has only so many “ticks” and when it’s used them all—well, to apply a metaphor the avid marathoner might have approved— its owner’s race is over. By that reckoning, Spears approached his own mortal limit at about nine o’clock on Sunday morning, October 1, during last fall’s Twin Cities Marathon. He had passed the six-mile mark on the south side of Lake Calhoun when, according to witnesses, he faltered and fell forward on his face. He was treated at the scene and rushed to Hennepin County Medical Center, where he was pronounced dead.

The Twin Cities Marathon involves more than 8,500 runners, 5,000 staff members and volunteers, and 250,000 spectators and follows a famously scenic, serpentine course that begins at the Metrodome in downtown Minneapolis and concludes 26.2 miles later below the Saint Paul Cathedral on the edge of downtown St. Paul. Given the dimensions of the annual event, not to mention the level of concentration of serious runners, it’s not surprising that Bradley Huckle had no idea that Spears had gone down on that sunny autumn morning. Huckle didn’t know about his own heart attack until the next day, when he woke up in the intensive care unit at Regions Hospital with virtually no knowledge of anything that had transpired during the previous thirty-six hours.

Spears and Huckle didn’t know each other, though they had run in some of the same events prior to last year’s TCM. Spears was an inner-city social worker with a wife, seven children, eight foster children, and several grandchildren. Huckle was the president of a $200 million suburban bank, divorced, and a single father of an eleven-year-old boy. All things considered, the two men had little in common except their middle age (Spears was forty-nine, Huckle forty-seven), a deep-seated passion for running long distances, and—presumably—the sturdy, healthy hearts they needed to take their bodies to the borders of endurance.

But Spears and Huckle would unwittingly figure in a flurry of local news stories that sent a chill through Twin Citians of a certain age. Even those who couldn’t care less about marathons took notice. The question abruptly and uncomfortably on many minds was the obvious one: How could two comparatively young, reportedly experienced, fit, and rigorously prepared runners suffer a heart attack while participating in their chosen sport? Aren’t heart attacks what happen to persons who are not so young, fit, or well-prepared when they exert themselves?

So why did their heart attacks—in medical terms, myocardial infarctions—happen? Were there warnings? And, maybe more to the point for most of us, what do those MIs say about the threat to others in the prime heart attack years—forty to sixty for men, sixty and up for women—even, or especially, those who eat righteously, exercise religiously, and visit their doctors regularly?

A marathon is not for the faint of heart, nor the flabby or infirm, much less the obese and hypertensive. Showcases of physical fitness and mental steel, hundreds of marathons around the country challenge the world’s best competitive distance runners to cover the standard 26.2 miles in under three hours. (Mbarak Hussein and Marla Runyan won last year’s Twin Cities event with times of two hours and fourteen minutes and two hours and thirty-two minutes, respectively.) For most participants, finishing the course in less than four hours would be a significant achievement, requiring discipline, focus, and countless hours of preparation,  Still, though grueling in the extreme, marathons—in part because they’re run by marathoners, a self-selected cohort of  people in peak condition—have rarely been fatal.

William Roberts is a St. Paul–based physician who specializes in family and sports medicine. Not a marathoner himself, he’s worked with the Twin Cities Marathon since its inception in 1982 and has been its medical director since 1985. Roberts recalls that thirty years ago, during the early years of the modern popularity of the sport, some expert was loudly quoted as saying that no one who trained for and competed in a marathon could possibly have a heart attack. “That’s since been disproven,” Roberts says with a wry smile. Just not, historically, very often.

Roberts and Barry Maron, a  Minneapolis doctor, have collected records from the TCM and the annual Marine Corps Marathon in Washington, DC, dating back three decades. Among almost 442,000 finishers between 1976 (the Marine Corps event’s first year) and 2004, there were a total of nine heart attacks, five of them fatal. That breaks down, at least in these two annual races combined, to a decidedly undaunting rate of 1.1 fatalities per 100,000. What’s more, the ratio of fatalities to total heart attacks has decreased over the past ten years, an improvement Roberts, Maron, and others attribute to the increased presence of medical personnel and automatic external defibrillators that nowadays are as visible along race routes as cheering loved ones and water stops.

For several years, there were no reports of heart attack deaths during American marathons. Then, for a reason or reasons that no one seems able to explain, 2006 proved to be a weirdly lethal year, at least by marathon standards. In 300-plus U.S. events, seven racers died: two in Los Angeles, one each in Chicago, San Francisco, Washington, DC, and Tucson, and one—George Spears—in the Twin Cities. Finally, in early December, The New York Times made marathon MIs an official national concern with a long story under the bannered question: Is Marathoning Too Much of a Good Thing for Your Heart? Pointing out that marathon fields have grown by 80,000 runners during the past six years, the Times quoted the Marine event director saying that, “statistically, maybe, it was inevitable.” But the paper also cited a pair of fresh and extensive studies—one from Boston, the other from Duisburg/Essen in Germany—that suggest that runners’ coronary artery systems in “some baffling way” may be damaged during the long runs. While no one was advocating that distance runners hang up their Asics, the scientists were at least raising some disconcerting questions.

Inevitably, the unsettling news brought forth the iconic ghost of Jim Fixx, the most famous marathon fatality since Pheidippides—who dropped dead after running twenty-two miles with news of the Athenian victory at Marathon in 490 BC. Fixx, even nonmarathoners remember, was the guy who literally wrote the book on the manifold benefits of running and died practicing what he preached, while running alone along a Vermont country road, in 1984, at the age of fifty-two. When Fixx died, every couch potato in America raised his Bud and said, “I told you so,” while hard bodies who had followed Fixx’s lead felt a shiver of confusion and doubt.

What many people overlooked was that Fixx was running from heart disease. His father had died of a heart attack at the age of forty-three, and Jim himself had been fifty pounds overweight and a two-pack-a-day smoker when he started running at thirty-five. Thus the pertinent question was not  “Did running kill Jim Fixx?” It was “Would Jim Fixx be alive today if he had simply embraced his genetic inheritance and bad habits and not started the obsessive running—or did he live as long and as well as he did (nine healthy years longer than his father) because he staved off his fate by running?”

On October 1, closer to home, the collapse of two like-minded strangers struck the same fears, raised the same issues, and reminded the rest of us that what we don’t know about our hearts, which is plenty, could kill us.

George Spears had run almost all of his life. He had run as a boy on the Red Lake Ojibwe reservation in northern Minnesota and on his high school cross-country team in New Mexico. “He was always running as a kid,” says his widow, Melanie. He ran, she says, because of the spiritual and physical benefits (he was also a black belt in karate) and because he simply loved to run. As a father, social worker, and activist in the Native American community, he used running to set an example and help teach kids that a healthy life was a good life.

“He lost his father in a car accident when he was two,” Melanie says, “and his mother when he was sixteen. One of his grandfathers died of a heart attack, though not especially young, and beyond that, he just didn’t know much about his family’s medical background.” He was, in any case, well aware of the increased incidence of heart disease in Native people, correlating with serious levels of obesity, diabetes, and other contributing conditions. He ate healthy foods, avoided junk, and neither smoked nor drank. George and Melanie, who met as freshmen at Macalester College, had been married for thirty years.

George competed in twelve marathons, including his first TCM in 1987, and countless other events over the years. He told his four sons, all of whom are runners, that he had once run a spectacular two-forty-five in high school—his personal best. More recently, according to his twenty-six-year-old son, George Jr., he had been running in the high threes and low fours. “He’d gotten slower as he’d gotten older,” George Jr. says. George Sr. had developed problems as he’d moved into middle age—for instance, what his wife calls “sports asthma,” for which he used an inhaler when necessary—and he’d had surgery on a knee and biceps in recent years. Nothing, though, really slowed him down, his family insists. He had prepared for the 2006 TCM by running with another son, Chester, along the Mississippi River Road, a couple of times a week. “He kept to his routine and never complained of anything,” Chester recalls. “I didn’t notice any shortness of breath. He was just getting older, so he was running a little slower.”

Melanie says her husband visited his doctor for a routine physical a couple of weeks before the TCM and said he was told that everything looked good. He had complained about his hip when he came home after a karate workout on Saturday, but otherwise seemed ready for the marathon. George Jr. had seen him at a dinner on Friday, and his dad, when asked, said he felt fine.

Brad Huckle ran his first Twin Cities Marathon right out of college, then several Grandma’s Marathons in Duluth. He ran his first triathlon in the late 1980s. The son of a Marine Corps pilot, he ran cross-country at Appleton High School and was a varsity wrestler at the University of Minnesota. “I’ve always enjoyed running,” he says. “I love the competition, the socializing, and the healthy lifestyle that go with it.” After watching a friend run in the Boston Marathon, he was inspired to get serious again about marathons. He qualified for and ran in his first Boston in 2005. Last September, he and a friend competed in the Ironman Wisconsin triathlon. The Twin Cities Marathon was three weeks later. “I decided I would run hard enough—my personal record is three-fourteen—to qualify for Boston in the spring,” he says. “That was the plan.”

Huckle had no known medical concerns. Neither his parents nor his siblings have had any serious health problems; he had never smoked, had safe cholesterol readings, and maintained a trim, well-muscled 140 pounds on his five-foot, six-inch frame. As a nod to middle age, he saw a doctor once a year and, last spring, had passed a stress test that he’d taken to gauge his aerobic capacity and  training efficiency. “I felt great after the [Wisconsin] Ironman—actually better than I feel after a typical marathon,” he says. “I jogged a couple of days afterward, then had a decent-sized run—ten miles or so—maybe a week before the Twin Cities. The idea was to maintain my fitness level without aggravating the muscles from the ironman."

Sunday morning, the first of October, dawned clear and crisp, with a race-time temperature in the forties and a comfortable dewpoint. The temperature would rise to a warm but not oppressive sixty degrees by ten o’clock. Of George Spears’s four sons, only George Jr. was running that day and, arriving at the course from his own home, he had hooked up with a college friend and didn’t connect with his dad. Melanie Spears, Chester, and other family members had positioned themselves where they usually did for the TCM—on Minnehaha Creek near Portland Avenue in south Minneapolis, near the course’s ten-mile mark. Huckle was running with a pal with whom he’d run in the recent Ironman. The friend says Brad, wearing his cap and dark glasses, looked and sounded up to the challenge.

There were no reports of Spears having visible difficulty before he went down shortly after Mile Six. While other runners, including a registered nurse named Robert Schepers, and emergency personnel tended to him on the ground before he was rushed to HCMC, George Jr., who had been moving at a swifter pace but had problems of his own, was looking over his shoulder. “I had rolled my ankle at about Mile Sixteen and was running really, really slow, and I kept watching for him,” the younger man says. “When we were kids, my dad used to slap us on the back when he’d catch up to us, and that’s what I was waiting for. I kept thinking, ‘OK, Dad, where are you?’ ”

Melanie and Chester waited, meanwhile, at Mile Ten. Finally, Chester jogged back a way up the course. Returning, he reported, “There are no other runners, Mom.” The puzzled but not particularly worried family returned home shortly before noon to find a phone message instructing them  to come downtown to the hospital. When George Jr. reached the finish line in St. Paul, he was met by grim-faced marathon officials. “They were waiting for me with the news,” he says. “But my dad was the last person I thought they were going to tell me about. It never crossed my mind that something like that had happened to him.”

Huckle, meanwhile, passed members of Minnesota Red, his running club, along the second half of the course. Later, they told him he’d “looked great”—strong and focused and striding along at a low-seven-minute-per-mile pace, which would allow him to qualify for Boston. Coming down the hill from the cathedral less than a quarter-mile from the finish, however, runner Mike Fecht saw Huckle down on one knee off to the side of the course. Fecht, an experienced marathoner himself, happens to be a captain with the Metropolitan Airports Commission fire department so also has experience with distressed persons. At first glance, Fecht thought Huckle was suffering a muscle cramp. Up close, Huckle’s expression told him it was something more serious.

Someone asked Huckle if he was all right; Huckle said no. And that, apparently, was the last thing he said until he woke up in the hospital the next day.

Bill Roberts, TCM medical director, has more data than explanations for what happened last year, both nationwide and here at home. In 2006, he says, “there were about 440,000 finishers across the country and seven deaths, so the death rate was about 1 in 65,000, which corresponds pretty closely to the papers Dr. Maron and I have published. On the other hand, between the Twin Cities and the Marine Corps races, we had four heart attacks and two deaths.” He mentions something statisticians call a “Poisson distribution,” when rare events that are usually spread thinly over a long period cluster at some point. “That’s what happened here and in Washington—rare events clustered, which makes it look as though these events are more common than they really are. A coincidence? A blip? A fluke? I don’t know. We’ll just have to see if it’s more than that.”

The numbers Roberts and Maron have collected comprise some interesting details. “Historically, [heart attacks] seemed to happen more often along the latter part of the course—Mile Nineteen or Twenty and on,” he says. (The only previous heart fatality at the Twin Cities Marathon was forty-year-old Thomas Becker of Bloomington, who collapsed and died after he finished the race, in 1989.) “But more recently they’ve occurred about a hundred yards from the start and at or after the finish and places in between. The fastest runners get out ahead of the pack, and, for the most part, they’re younger people and not the ones who usually have problems. Nationwide, there have been a few deaths in people under thirty who have congenital heart problems. But atherosclerotic heart disease—the most common cause of heart attack—usually becomes evident in people around the age of thirty-five or forty, and that’s the group we’ve been most concerned about.”

Ironically, a serious marathoner’s focus and experience may actually work against his or her awareness of a cardiac threat. “Marathon runners, as a rule, are pretty fit and in tune with their bodies,” Roberts explains. “If things are going pretty well, they don’t think about their hearts as a problem. Most folks who arrest during a run probably haven’t had much of anything in the way of symptoms. Some may have had mild symptoms, which they’ve ignored, which is always a mistake. But a lot of the surviving runners I’ve talked to say they haven’t had any real symptoms at all. It turns out that they’ve had changes in their coronary circulation, but those changes haven’t been enough to show with normal activity. Maybe there’s a 50 or 60 percent obstruction, but the blood flow to the heart has been adequate. Then for some reason during the race a clot blocks off the blood flow and initiates the cascade of problems that lead to cardiac arrest.”

Jay Cohn, founder of the Rasmussen Center for Cardiovascular Disease Prevention at the University of Minnesota, says that the “dynamics” differ from heart attack to heart attack. He also notes, “Most heart attacks do not occur during exertion—I think more occur in bed than at any other time.” In most cases, no matter what the victim is doing, a clot is involved. “We’ve learned that it’s the clot forming on atheriosclerotic plaque that builds up in a coronary artery,” Cohn says. “We call them unstable plaques because they release a substance that causes the blood to clot as it passes, and the clot forms suddenly and you have a heart attack.” In some cases, Cohn adds, blood flow restricted by a plaque-narrowed artery causes such notorious symptoms as angina; in other cases, however, the individual doesn’t experience chest pain until he actually suffers the heart attack.

“There’s also the possibility that during intense exertion a plaque will rupture,” Cohn says. “And there are such things as blood-pressure changes during exercise that may aggravate the plaque and make it rupture, and then it becomes the site for a clot.”

Roberts says he knows of no major marathons that require medical screening for their participants. But he and other medical professionals say screening would be impractical and ineffective. “We have almost 10,000 entrants in the Twin Cities, and trying to screen and keep track of that screening would be difficult, to say the least,” he says. “Besides, I don’t know if it would make any difference. At least two of the people in our data base who suffered cardiac arrest had normal stress tests within a month of the marathon, and one that died had a normal stress test within the past year. There are some screening tests that hold some promise—the rapid CT scan, for instance—but it would also be an expensive proposition to screen everybody with that kind of technology. I say if you’re feeling pressure in the chest or you’re short of breath, you should see your doctor. But I’d say that whether you were planning to run a marathon or not.”

As technology advances, the discussion of cardiac screening will grow more intense, Roberts acknowledges. “But for the average person in generally good health, who’s never smoked, who eats well and maintains a lean body mass, who has no family history of heart problems—I’m not sure we’d gain much from screening,” he says. “The greatest risk is ignoring symptoms. If you’re having symptoms, see your doctor. If you’re having symptoms during a race, stop. Don’t keep going.” Which, he concedes, may be the most difficult decision for any marathoner to make.No one knows if George Spears experienced a heaviness in his chest, an ache through the shoulders and down an arm, or difficulty breathing while running the final six miles of his life. His wife says she worried only about his sore hip. Later, she objected to a medical examiner employee’s suggestion that “lifestyle” may have played a part in his death, saying his careful diet, rejection of tobacco, and rigorous exercise regime were living arguments to the contrary. The cause of death on his death certificate says only “arteriosclerotic heart disease.”

Brad Huckle’s doctors told him that a 90 percent blockage of one of his coronary arteries had precipitated his heart attack. He remembers nothing about that day except a few seconds aboard the shuttle bus taking him from his parked car to the starting area and possibly—he’s really not sure—telling somebody, moments after his collapse, that he was not OK. He must rely entirely on other people and his previous experiences to recreate the event. Nearly three months later—a few days after he celebrated his forty-eighth birthday—he looks as though he’s the fittest, healthiest man in the world and ten years younger than his age. It’s easy to understand why he sounds like a man who can’t believe what happened to him.

“Aside from the short prep time between the [Wisconsin] Ironman and the marathon, there was absolutely nothing unusual about this event,” he says matter-of-factly. “The weather, or so I understand, was decent. I was an experienced runner, having taken part in close to fifty races in the past four years. I know how to monitor my body. I know how to hydrate. I wasn’t even trying to beat my PR. A guy I ran next to for seventeen miles said I looked fine and that I didn’t say anything about symptoms. I passed other people who said I looked good and one person on Summit Avenue who said I was flying. Now it’s conceivable that I glanced at my watch when I got up toward the top of Summit and saw I was off my desired pace, and I put on the afterburners. But even so, I wouldn’t have done anything I hadn’t done many times before.”

His short-term memory was sketchy for a couple of days afterward, but had pretty much returned by the time he left the hospital five days after his collapse. His recollection of race day may be gone for good, however—the result perhaps of an interruption of blood flow to the brain during the few minutes between his collapse and resuscitation.

Huckle, with no personal or family history of cardiac disease, insists he had never thought about a heart attack. Apparently, he says, when you successfully complete enough marathons and triathlons, “there’s a bit of the Superman syndrome that creeps into your mentality.” It’s part, he says, of your competitive spirit. “If you’re full of fear and self-doubt, you’re probably not going to sign up for an ironman or a marathon. If anything, you want to block bad things like that from your mind. You’re not interested in the what-ifs.”

So what if he had felt unfamiliar discomfort during his last run?

“Honestly,” he replies, “I probably would have attributed it to a poor nutrition plan, lack of hydration, maybe something that had carried over from Wisconsin. I don’t know what it feels like to have a heart attack. I guess I would have kept pushing, at least until something became very, very obvious. That’s what competitive people usually do—push on. My competitive nature, my experience as a runner, and the fact that it was race day would have all worked against me.” But, without cogent memories of the event, he doesn’t know if he had symptoms, much less how he responded or didn’t respond. Hypotheticals aside, he says, “I don’t know what I would have done differently. I had no reason not to do what I did, what I’d always done. I’d had a stress test. I’d seen a doctor.” He pauses and smiles. “Heart attacks happen, sure. I just never thought it would happen to me.”

He wonders how long he’d had that arterial blockage—and why it hadn’t brought him down while swimming, biking, or running in the ironman three weeks before the marathon. He says he has only a layperson’s understanding of what might have happened in his case. He had read with predictable interest the Times story exploring the possible connection between heart attacks and marathons, and speaks vaguely about a “possible perfect storm” of internal developments that may have laid him low.  But neither he nor his doctors can say for certain.

Huckle, like most survivors, sounds more grateful about being here than rueful about almost not. He has suffered permanent heart damage, he says. He’s in cardiac rehab and on multiple medications he will probably take the rest of his life. He will probably never run competitively again. He thinks often, he says, about George Spears and his heart attack, but is back to work at his Roseville bank, enjoying life with his son and his family, and even thinking about starting a little recreational jogging. “I’m glad to be alive,” he says softly. “I start from that point. Anything else, you feel you’re being greedy.”

Huckle acknowledges the irony and curiosities that infuse his and similar cases. The first person to reach him after he fell was a firefighter who was running a few moments behind him and was proficient with the specific make of AED that’s positioned along the course for just such an emergency. Interestingly, the runner who stopped to minister to George Spears was a registered nurse who worked in a cardiac unit. And in the Times story, following close on the heels of the surviving Marine Corps heart attack victim was a cardiologist. Which speaks to, if nothing else, the attraction of competitive running to persons with an interest in health and survival and adds credence to Bill Roberts’s observation that the “most likely person to respond first to a downed runner is another runner.”

And, unlike the legendary but ultimately luckless Jim Fixx, Brad Huckle had the good fortune to have his heart attack at a large urban marathon, not on a lonely country road. Why that didn’t matter for George Spears is another mystery of the heart.

“I know it sounds weird,” Huckle says, “but if I’d had that heart attack three months or years later, while I was running by myself in the woods or maybe shoveling snow, I could have simply fallen and died. Having that heart attack where and when I did saved my life.” 

Heart Attack: Changing Perceptions of a Potent Killer Heart attacks may be anomalous among marathoners, but they’re a frequent killer in the general population. More than a million Americans will experience a myocardial infarction this year, and half of those will be fatal. “Still,” says Jay Cohn, a University of Minnesota cardiologist and director of the Rasmussen Center for Cardiovascular Disease Prevention, “a heart attack is no longer an automatic death sentence.” The key, Cohn says, is what it’s always been—swift, appropriate medical attention, ideally in a hospital within an hour of the onset of symptoms, before the heart muscle can sustain permanent damage from the restriction of the blood supply. Besides a speedy response, changes in our understanding of heart attacks have improved victims’ outcomes. “The management of acute myocardial infarction is dramatically different from what it was thirty years ago,” says Cohn, an innovator in the diagnosis and treatment of heart disease during a fifty-year career. “It used to be, when people would make it to the hospital after having a heart attack, we’d put them to bed and let them recover slowly. They’d spend maybe four weeks in the hospital. Now they come in, are sent to the [catheter] lab, and have their artery opened with an angioplasty and stent. They’re often home again in as little as two days, and the survival rate is 95 percent instead of 80.” The change, Cohn says, reflects the updated understanding that most heart attacks are caused by the obstruction of a coronary artery by a clot. Also in flux is our recognition of who is having heart attacks. That cardiovascular disease, not cancer, is the leading cause of death in women still comes as a surprise to many people, including women. Women have as many heart attacks as men, according to cardiologist Anne Taylor, director of the U of M’s Women’s Heart Clinic, but generally they have them later in life. “You don’t see heart attacks appearing in women so much until about ten years after menopause—that is, in women in their late fifties and sixties and seventies,” says Taylor. That helps explain the relatively few reports of MIs among female runners, who now make up about 40 percent of a typical marathon field. The risk factors leading to heart disease and attacks remain the usual suspects—high blood pressure, elevated cholesterol, smoking, diabetes, obesity, genetic factors—but the relative impact of those factors differs between the sexes. Diabetes, for instance, increases the incidence of coronary artery disease, precursor of most heart attacks, by about five times in women, compared with about two and a half times in men. In addition, heart attack symptoms are often “more subtle” in women than in men. Instead of the crushing chest pain often reported by men, Taylor says, symptoms in women often include sleep disturbances, shortness of breath, and excessive fatigue. Perhaps the most dramatic change, however, is the growing belief among many doctors and scientists that heart attacks can be prevented entirely in all but the most elderly. “We now know that if we can detect the risk of atherosclerosis at an early age and start appropriate therapy,” says Cohn, “we can strikingly reduce the risk of having a heart attack. If we can identify a risk in a person twenty years before a heart attack is likely to occur and intervene with drugs to lower cholesterol and blood pressure, we could slow the atherosclerosis progression and thus prevent a heart attack during the most productive period of a person’s life.” Cohn concedes that this view is controversial. But the Rasmussen Center he established at the U of M six years ago offers a battery of ten noninvasive screening tests “that we think,” he says, “can pick up nearly everyone who is likely, in the next twenty years, to have a heart attack, so we can intervene and prevent it.” Most of the more than 2,000 men and women who have come in for the center’s tests have family histories rife with heart problems, though they themselves don’t have symptoms. “We call them the ‘worried well,’ ” says Cohn, who concedes that definitive proof of this approach will show only in long-term follow-up studies, which won’t be available for several years. While not everybody is as optimistic as Cohn, everybody seems to agree that many causes of heart disease leading to heart attack are obvious right now. Twin Cities Marathon medical director William Roberts runs down the list: “Smoking and secondary smoke, poor diets, inactivity—those are all weapons of mass destruction.” Roberts agrees that early detection and intervention have great potential to save people’s lives, but, in the meantime, “we can do a lot by changing people’s habits.” As last fall’s TCM made perfectly clear, anyone can have a heart attack. “But,” says Roberts, “that doesn’t mean that people shouldn’t run. A person who trains regularly is at much less risk than somebody who is inactive.”  —W. S.

Senior editor William Swanson’s Dial M: The Murder of Carol Thompson has been nominated for a 2007 Minnesota Book Award.