Running, heart disease, and the ironic death of Jim Fixx. (History and Philosophy).

Jim Fixx was one of millions of Americans who started running in the 1960s, 1970s, and 1980s. Unlike other runners, however Fixx wrote a best-selling book about running and, ironically, died of a heart attack at the age of 52 years while running. Fixx and the authors of other running books believed heart disease resulted from overcivilization and recommended running as a cure. Running was not merely a physical exercise, according to those authors, but also a way of life. Moreover, those running authors, who were often doctors themselves, advised their readers to listen to their bodies, instead of their doctors. Fixx's adherence to that philosophy offers an explanation for his seemingly irrational behavior--running through chest pain and discomfort.

Key words: marathon, running boom

On July 21, 1984, best-selling author James F. Fixx collapsed and died of a heart attack while he was running (Gross, 1984). The irony of his death escaped no one. The 52-year-old Fixx had penned the single most successful running book of the era, The Complete Book of Running (1978). In the book he touted the health-giving benefits of running and claimed that regular running offered virtual immunity to heart disease. Fixx's book sold half a million hardback copies in the United States in less than 9 months reaching number one on the New York Times book list (Lehmann-Haupt, 1978; Pace, 1978) . (1)

Fixx, an overweight 35-year-old with a high-powered but stressful and sedentary job as a magazine editor, began running in the fall of 1968 after he had pulled a muscle playing tennis. He recalled, "my body had betrayed me, and I was angry" (1978, p. xvi). He began running, ostensibly to strengthen his legs, but the health of his heart was always on his mind. Fixx's father, Calvin Fixx, suffered a heart attack at the age of 35 years, and Fixx was determined to avoid that same fate. Moreover, he was determined to live his life to its fullest. The elder Fixx survived the heart attack, but, according to his son, "until he died eight years later he lived the life of an invalid.... He sat quietly, read, listened to music and...put his affairs in order" (p. 226). The image of his father as an invalid represented to the younger Fixx a life that was hardly better than death.

Running was Fixx's solution to the question of how to live a long and good life. Although noting that, "doctors are cautious about asserting that running guarantees a long life" (Fixx, 1978, p. 227), he also observed that the "proliferation of postcardiac exercise classes" was an indication that many doctors were convinced "regular physical activity is associated with...reduced morbidity and mortality from ischemic heart disease" (p. 230).

Fixx was equally convinced of the psychological benefits of running. To summarize his position, he cited Mark Hanson, a runner from New Jersey. "To run is to live. Everything else is just waiting" (Fixx, 1978, p. 15). Fixx also described his own psychological changes. "Something in running has a uniquely salutary effect on the mind," he said (1978, p. xix). He found he "was calmer and less anxious...could concentrate more easily and for longer periods...[was] more in control of [his] life...less easily rattled by unexpected frustrations" (p. xviii). These psychological changes gave Fixx a "sense of quiet power, and if at any time I felt this power slipping away I could instantly call it back by going out running" (p. xviii).

Puzzling information emerged following Fixx's death. Friends and family reported that Fixx had complained of "chest pains while running" (Schanberg, 1984, p. 23) and tightness in his chest (Cooper, 1985; Wallis, 1984).Yet he refused to have an exercise stress test, despite the urging of his former wife, Alice Cashman Fixx, and the invitation of Kenneth Cooper (Cooper, 1985; "Deadly Refusal," 1984). Apparently, Fixx preferred to heed the advice of another physician friend who told him:

Annual physicals are a waste of time. For runners, they're even dangerous. You're likely to run into a doctor who doesn't like your electrocardiogram, and before you know it you'll be in the Mayo Clinic having coronary artery studies. (Cooper, 1985, p.23)

Fixx's autopsy revealed damage to three parts of his heart--evidence that he had suffered milder heart attacks in the weeks leading to his death (Cooper, 1985).

Many Americans were as mystified by the incredible popularity of long-distance running as they were by Fixx's untimely death. Jogging and running had first entered the American consciousness in the 1960s with the publication of Bowerman and Harris's Jogging (1967) and Cooper's Aerobics (1968). Interest in running grew throughout the 1970s. In response to a 1970 Gallup Poll, 2 million Americans reported that they ran or jogged on a regular basis. When that poll was repeated in 1980, 30 million Americans replied that they were regular runners or joggers (Krise & Squires, 1982). Pundits of popular culture marveled at the sudden popularity of the sport (e.g., Amdur, 1978; Jackson, 1981; Kifner, 1975). Some observers dismissed running as an extreme response to mid-life crisis (Baker, 1978; Zinnser, 1968) or just a passing fad or fancy (Dobson, 1977; Jackson, 1981). But media commentators accepted the premise that runners were deeply concerned for their health, especially cardiac fitness (e.g., Henderer, 1968; "Jog ging for Heart," 1967; "Vigorous Exercise," 1973). Yet runners clearly had other objectives, too. Cooper, the National Aeronautics and Space Administration (NASA) scientist whose best-selling book spurred popular interest in aerobic exercise, said that anyone who ran more than 15 miles a week was running for reasons other than health and fitness. Runners who claimed to be interested in health often ran far more than Cooper recommended. Some members of the medical community predicted too much running would endanger runners' health (e.g., Kleeman, 1984; Kra, 1979). Doctors warned that running could actually cause sudden heart attacks (Heart Research, 1973; Libman, 1984). News reports and psychological studies alleged that at least some dedicated runners were not just committed but addicted to their daily run (e.g., Kotulak, 1979; Parachini, 1983; Reardon, 1983). According to these reports, addicted runners ran when they were hurt (Morgan, 1979) and when they ought to have been attending to their work (Joseph & Robbins, 1981). (2)

Fixx's behavior appeared consistent with the running addiction hypothesis. Perhaps he ran through the early warning signs of heart attack for the same reasons that other people ran through orthopedic injuries and marital problems. However, though his actions seem irrational, they were, in fact, consistent with his own definition of health. That definition of health can be found in the pages of his books and in other popular running books of his time. Those books offer a blueprint for the seemingly mysterious and fanatical devotion of long-distance runners like Jim Fixx.

The Meaning of Running

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