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Your Heart:

It was three winters ago, as he was arming himself for one of his usual men's recreational hockey nights in Montreal, that Mitch Shulman donned an unusual piece of equipment.

As someone who had grown up with the fanaticism and fantasy that is our national pastime, Mr. Shulman knew enough to gird his vital parts against impact: shin pads for the lower legs and knees, shoulder and elbow pads for the upper body, a cage to protect the face and eyes against errant sticks and flying pucks. Oh, yes, there was also an armoured cup for the genitals, the piece of paraphernalia from which weekend warriors derive their identity as "jocks."

Then there was one more piece: a sensor that he strapped around his 49-year-old chest, to listen to the things Mitch Shulman's heart was saying that couldn't be heard over the din of panting middle-aged guys pretending they're still boys at play. The data screen attached to Mr. Shulman's wrist displayed its numbers silently, but he heard an alarm bell loud and clear. "In 2002, one of our friends suffered an event at the rink that ended up being diagnosed as a heart attack, and it set off a little bell in the back of my brain. I wondered what was happening to my body out there," said Mr. Shulman, who plays hockey once a week, but might see a fallen weekend warrior on any day, as an attending physician in the emergency room of Montreal's Royal Victoria Hospital.

His friend survived, but each year, 12 to 15 of the estimated 10,000 Canadian men who play recreational and pickup hockey for fun, die with their skates on. Those are cases reported from incidents at rinks. They don't necessarily include those who make it home and then collapse or have heart attacks in the night after a strenuous game.

Mainly the fatalities are middle-aged men, driven by passion for a game they remember playing as kids from sun-up to sundown. Studies show that Canadian men playing hockey easily launch themselves into a cardiac danger zone, keeping their heart rates above the target zone designated for aerobic activity for prolonged periods of time. No one opens the business pages of a newspaper and suddenly thinks he's Warren Buffet, "yet they lace on a pair of skates and think they can be Wayne Gretzky," observes Sheldon Persad, a certified strength and conditioning specialist with the Canadian Sports Centre and co-founder of Personal Best Health and Performance Inc.

So Mr. Shulman found out. "I did a normal warm-up, and I went from a resting heart rate of 70 beats per minute to 90," he recalls of his first self-test. "Then I played a shift and looked at the monitor and it said 188 [beats per minute]." According to rule-of-thumb guidelines for safe exercise, Mr. Shulman's target zone should have been around 120 to 130 beats per minute. His maximum heart rate should have been no more than 171. Yet shift after shift, he climbed out on a limb. "I didn't believe the monitor, so I tried it again. I got the same thing. Then a third time. Same again. After that, I figured it was accurate and I stopped looking. It was scary and I never told any of my fellow players to try it," he said of a league that comprises men from their 40s to their 60s, with a smorgasbord of occupations from garment industry executives to architects. "They're not all in really great shape, but hockey is their form of athletics. A couple of the guys run on a regular basis, but a third of them don't work out at all in terms of staying in shape." Mr. Shulman engaged in a little soul-salving rationalization.

"That 188 was certainly above where my heart rate should be. What saves you is that it's a short burst of anerobic activity," he reasoned. "But having said that, it's still not smart." Mr. Shulman was discovering first-hand what research doctors Sanita Atwal of Dalhousie University, Jack Porter of the University College of Cape Breton and Paul MacDonald of the Cape Breton Regional Hospital cardiology department learned in 2000 during a three-month study that focused on 113 recreational hockey players. They monitored a generally healthy group of players, ranging in age from 24 to 62. Sixty per cent exercised three times a week in addition to playing hockey. Half could be considered overweight. With our monitored subjects, all 113 players exceeded target heart rates and this was for an average of 30 minutes per game. More than three out of four players experienced heart rates above 100 per cent of their predicted maximum heart rates," the researchers wrote . Most players, about 70 per cent, also had poor heart rate recovery after exercise, they noted.

There's little wonder players' heart rates soar, given the emotion and bursts of activity in the game. Combine that with the intensity of competition and the macho sense of invulnerability men display in front of each other and you've added another danger factor. As well, most recreational teams don't have enough players to ice two or three separate lines, and you have a problem of players taking double and triple shifts. It's a recipe for cardiac catastrophe.

In the Ottawa area, where there were seven reported hockey deaths from March, 2004, to March, 2005, the Healthy Heart Hockey civic campaign was launched last February. The campaign, organized by the city and the University of Ottawa Heart Institute, emphasizes the necessity of keeping in shape year-round if one wants to play hockey in the winter. It features the slogan "Don't Deny! Don't Delay!"

"It's important to get in shape to play hockey rather than playing hockey to get in shape," said Andrew Pipe, medical director of prevention and rehabilitation at the Ottawa Heart Institute.

Those who don't heed the warnings may find themselves in for a shock -- as in an electrical zap from an automatic external defibrillator (AED). That's the kind of life-saving machine used in conjunction with cardiopulmonary resuscitation that helped revive Detroit Red Wings player Jiri Fischer two weeks ago when he collapsed and his heart briefly stopped.

Heart-healthy Hockey

• Appoint one or two members of your team to learn and be competent in the life-saving techniques of cardiopulmonary resuscitation and/or use of an automatic external defibrillator, now on-site in many arenas.
• Warm up before playing. Public rinks are notorious for allowing no time to get your heart in gear before the first shift. If necessary, cut the first period short to skate a few laps.
• Don't sit down between shifts. Sounds like hockey heresy, but certified strength and conditioning specialist Sheldon Persad advises: "Stand and keep the legs moving between shifts. Avoid creating peaks and valleys in the heart rate. When coming off an intense shift of a minute or two, sitting can produce too abrupt a drop in heart rate. Also, by standing or walking, the removal of the lactic acid is enhanced and you'll have a fresher shift the next time you go back out on the ice."
• Expand your roster. Playing a game with only eight or 10 players means too many back-to-back shifts, and too much time with your heart pounding at above the safe target zone.
• Warm down after playing. Bring your heart gradually down to its resting rate. Again, cut the last period short and skate off the accumulated lactic acid.
• Stop being so macho and expending all your testosterone trying to impress other men. Consider a co-ed game. You might redefine pickup hockey.

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December 07, 2005