tom flemingHow could Tom Fleming have died of a heart attack at the very young age of 65, when at one time, he was one of the best marathon runners in the world?   Fleming won the New York City Marathon twice, finished second in the Boston Marathon twice, won the Jersey Shore Marathon three times, and also won the Los Angeles, Toronto, Tokyo, Washington, Cleveland and Jersey Shore Marathons.  His fastest marathon was 2:12:05 in Boston in 1975, and he once held the American records for 15 miles, 20 miles, 25 Kilometers, 30K, and 50K.  In the 1970s, he was competitive with Frank Shorter, the 1972 Olympic marathon champion, and Bill Rodgers, who won both the New York and Boston Marathons each four times. 
When he was training, he ran more fast miles than any of his peers. He kept a sign on his bedroom wall that said,  "Somewhere, someone in the world is training when you are not. When you race him, he will win."  When most top runners were working out twice a day, he worked out three times a day. When top runners were running 100 miles a week, he tried to run more than 140 fast miles per week, and even had a few 200-mile weeks.  Once, he worked out on the same day that he ran in the Boston Marathon. When he retired from racing in the early 1990s, he had more than 123,000 miles recorded in his diary. 
How He Became a World-Class Marathon Runner
Fleming came out for track as an underclassman at Bloomfield High School in New Jersey, and at first did not show great promise.  In those days, very few high school runners ran more than 40 miles per week.  In his senior year, he raised his weekly mileage so it was often over 100 miles per week and got faster and faster.  He won a scholarship to William Paterson College, where he ran more than 100 miles a week and was a four-time All American.  
• In 1972, his junior year in college, he ran in the Boston Marathon and was so disappointed with his 23rd-place finish of 2 hours and 25 minutes that he raised his weekly mileage beyond 130 miles per week.
• In 1973, his senior year in college, he won a college race on the track on Saturday and two days later finished second in the Boston Marathon to Olympian Jon Anderson.  That same year, he beat his good friend Norb Sander by almost two minutes to win the New York City Marathon.  Dr. Sander also died recently of a heart attack.
• In the 1974 Boston Marathon, he was so disappointed with his second place finish to Ireland’s Neil Cusack that he cried at the finish line. 
• In 1975, he ran 2:12:05 to finish third in Boston to Bill Rodgers' American marathon record.  He won the 1975 New York Marathon in 2:19:27.

Genetic Advantage to Be Able to Run So Many Miles
During his racing career, Fleming was 6'1" and weighed between 145 and 155 pounds.  That's heavy for a marathon runner.  His father was a burly 235-pound tackle for the Chicago Bears.  Fleming had very large bones and legs that looked like tree trunks, and his large bones were the main reason that he got away with so much training. Most  marathon runners have leg bones that would break from such heavy and continuous pounding.
Why Would a Marathon Runner Die So Young of a Heart Attack?
Fleming stopped competing and running in his late thirties and gained a lot of weight in the ensuing 25 years.  In 2011, he was reported to have weighed 210 lbs.  I would bet that his prodigious running program kept his weight down when he was genetically programmed to be much heavier.   I have not seen his medical records, but his later pictures show that he stored most of his fat in his belly, so it is very likely that he had diabetes which is a potent risk factor for heart attacks.  The genetic advantage that gave him strong bones and strong muscles is likely to have increased his risk for diabetes; see Families with Diabetes Produce Strong Athletes   
When athletes stop competing, they can no longer eat the huge amounts of food they took in while training.   They particularly need to restrict animal protein and refined carbohydrates such as pasta, sugared drinks and sugar-added foods, the staples of training tables that cause the highest rises in blood sugar and insulin. 
Reversibility: Benefits of Exercise are Lost When You Stop
Studies of Harvard and University of Michigan varsity letter-winners showed that they do not live longer than their less-athletic classmates (Human Biology, February, 1970;42(1)),  but people who exercise regularly as they age live three to seven years longer than non-exercisers (PLoS Medicine, November 6, 2012). Other studies show that athletes have no lower risk of heart attacks later in life than their less athletic peers unless they continue to exercise as they age (Am J Epidemiol. 1978, 108 (3): 161-175). Former athletes who continue to exercise have lower blood levels of the bad LDL cholesterol, total cholesterol, triglycerides and higher levels of the good HDL cholesterol that help to prevent heart attacks. 
Every benefit gained by exercising is lost soon after you stop. This is called reversibility.  Muscles enlarged by lifting heavy weights return to their previous size within a few months after you stop lifting. People who do aerobic exercise lose their slow heart rates and greater endurance soon after they stop regular workouts. Conversely, out-of-shape people can become more fit at any age when they start an intelligent and consistent exercise program.
His Later Non-Running Years                     
When he gave up competitive running, he applied the same dedication to teaching and coaching, serving for 17 years as head coach of the varsity cross country and track & field teams at the Montclair Kimberley Academy in New Jersey.  He was a top notch coach who helped Anne Marie Letko (1996) and Joe LeMay (2000) qualify for the Olympic Games.  He also coached the three-time USA National Cross Country Champions Nike Running Room's race team in Bloomfield, New Jersey (1990, 1991, 1992).  
He was inducted into the Road Runners Club of America Distance Running Hall of Fame (May 2013)  and the National Distance Running Hall of Fame (July 2014).  
Lessons from Tom Fleming's Story
•  Running or any other regular exercise helps to prevent heart attacks, but if you stop exercising, the benefits are soon lost. 
•  Keep on exercising as you age. When a regular exerciser has a heart attack, he is far less likely to die from it than a non-exerciser (European Journal of Preventive Cardiology, April 11, 2017). 
•  A healthful diet is important even for marathon runners and other heavy exercisers.  They can still suffer heart attacks, and their risk is increased by a diet that is loaded with  sugared drinks, sugar-added foods, meat and fried foods and low in fruits, vegetables, whole grains, seeds and nuts. 
•  Excess belly fat is an established risk factor for heart attacks (JAMA, Feb. 14, 2017).
July 23, 1951-April 19, 2017