Panic Attacks on the Run

Q I am convinced I am going to have a heart attack or faint on most runs; however, this is all in my head.

I started running six years ago mainly to combat anxiety and depression. I gradually built up endurance and have completed 12 marathons, four ultras and lots of shorter races. However, on marathon number 13 I had a very large and scary panic attack at kilometre 35. Like many suffers of anxiety and panic I was 100 per cent sure that I was about to die. This caused hyperventilating, which in turn caused my arms and jaw to go numb.

Since that race (about two years ago now) I have experienced a similar episode in nearly every race. I get worried and hyperventilate, arms and jaw get pins and needles, I end up stopping and DNF due to panic. This process happens in a few seconds. There is no history of heart problems in my family, my resting heart is 42BPM and my blood pressure averages 110-125 over 59-65. I am now in the situation where the exercise that saved me from anxiety and panic has become its cause. So I guess my question is how can I tell the difference between panic, anxiety and real heart problems when in the middle of a race or training session. Any and all advice much appreciated. – SIMON


A It is probably difficult for most readers to understand a panic attack; so to set the stage, a panic attack is like the immediate and sudden sensation you get when you are unexpectedly frightened. The same pathways as the “fight or flight” response are activated for no apparent reason and the result (all or some) is racing heart, rapid breathing, flushing, sweaty palms, trembling, shortness of breath, chest pain, dizziness, tight throat, and impending doom (including the “I could die here” feeling). When this response allows a person to escape a dangerous situation or fight off an unexpected attack, it is useful and promotes survival. When it happens for unknown reasons, it truly interferes with life and can lead to hyperventilation syndrome and other problems. When this happens in mid-race, it will likely end, as you have experienced, with a DNF.

It is difficult when the cure, running to relieve depression, becomes the culprit. It sounds like running helped turn your life for the better and now running has turned on you. The challenge is to reverse the process, so you can continue with the activities you enjoy.

Panic disorder can be treated and most people get back to their activities. You should meet with your physician to be sure there is no medical reason for your constellation of symptoms and to be reassured that your heart is fine (it sounds like you are at low risk from your story). Treatment can be with medications, cognitive behavioural therapy, or both. Learning relaxation or meditation techniques may be helpful. I had a coach who preached that a tense muscle was not as quickly reactive out of the blocks as a relaxed muscle. He taught some relaxation techniques that have helped me when I feel that sensation of panic rising. When I have time, I take three deep breaths with my eyes closed and feel my muscle tension relax. I had to practice this until it was second nature. Of course, one cannot always take that amount of time, but even a slow deep breath will help me. Panic attacks are not that simple, but a good therapist will be able to get you over the hump and back to the finish line.


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