As a professor in the Department of Physical Therapy at the University of Alberta, Dr. Mark Haykowsky addresses questions related to exercise physiology. He examines the cardiovascular benefits of exercise training in individuals with heart failure. He seeks the biological mechanisms responsible for the decline in exercise capacity in heart transplant recipients. And he looks at how exercise training can play a role in reversing chemotherapy-induced ventricular function in breast cancer patients.
Lately, however, Haykowsky has also been pondering something else: Would it, he's wondered, have been possible for someone to have escaped from Alcatraz by plunging into the frigid waters of San Francisco Bay and swimming to freedom? It's a question prompted by his own Alcatraz experience earlier this summer when he was part of a team in the challenging Escape from Alcatraz Triathlon.
On June 10 Haykowsky, along with heart transplant recipient Dwight Kroening and Haykowsky's former graduate student Ken Riess, competed in the triathlon in the special section reserved for teams comprising at least one solid-organ transplant recipient.
Kroening, who works for a software company in Edmonton and resides outside the city in Strathcona County, has lived for 26 years-half his life-with a transplanted heart. While it is unusual for someone to live that long after receiving a transplanted heart (the International Society for Heart and Lung Transplantation maintains a database of more than 100,000 transplant recipients and fewer than 100 have survived to 25 years) Kroening's fitness level makes him even more exceptional. He is the first and only heart transplant recipient to have completed an ironman triathlon, finishing the 2008 Penticton Ironman).
"I'll never see another heart recipient with Dwight's level of fitness and athletic ability," says Haykowsky, explaining that the blood vessels and skeletal muscles resist returning to normal in a patient who has had a heart transplant. "Typically, a heart recipient's fitness remains at about 40-to-60 percent of someone who is of the same age and sedentary," he says.
Haykowsky joined the Faculty of Rehabilitation Medicine as a faculty member in Physical Therapy in 1999 and has worked with heart transplant recipients since 2004. When he recruited Kroening to be part of the study, he was astonished by Kroening's level of fitness. "I thought our machine wasn't working," recalls Haykowsky. "He had double or more the highest fitness ever recorded in a heart recipient."
Kroening, who is a native Albertan, was working as a physical education teacher in Arizona when he discovered that the symptoms he was struggling with-including extreme fatigue, nausea and difficulty breathing-were the result of a heart that had swollen to more than double normal size, likely as the result of a long-standing viral infection. That was in early June 1986, and Kroening recalls his doctors telling him there was nothing that could be done. "They told me to prepare myself to die."
Shortly after, as Kroening was struggling to make sense of what was happening, he was called back to the hospital and told there could be one option, a heart transplant. On August 4, 1986, after a fortunate chain of events, he was given a new heart by the University of Arizona organ transplant team. "Everything just fell into place," says Kroening.
Immediately after the surgery, Kroening resumed an ambitious exercise regime and, although he was hampered by the side effects of the immunosuppressant drugs he was taking and changes in his physiology, he persevered. And although he entered Haykowsky's study with unprecedented fitness levels, he welcomed the opportunity to push himself further. "I told Mark I would take part as long as he would allow me to go as hard as I can go," he says.
Over the years, Haykowsky, Kroening and Riess, who teaches in the personal fitness trainer program at NAIT, have evolved into a team. Usually, that involves Haykowsky overseeing the fitness monitoring and Kroening advancing his fitness through a training regime designed by Riess. For their Escape from Alcatraz, however, their teamwork involved Riess undertaking the 1.5-mile swim through the frigid waters from Alcatraz Island to shore, Kroening peddling the gruelling 18-mile bike race, and Haykowsky tackling the demanding eight-mile run through the rugged trails of Golden Gate Recreation Area.
Both Haykowsky and Kroening recall the start of the triathlon as being almost surreal as the ferry transported the swimmers through the early morning mist to the starting point and 2,000 contestants leapt into the water in the space of six minutes. Haykowsky says the run was as difficult as any he has ever done. It not only encompassed hilly terrain and running on sand-never easy-but it also involved 400 steps up a cliff. When Haykowsy crossed the finish line, he secured a second place finish for his team-they were mere seconds behind a team of kidney recipients.
Before the race, the three Albertans continued their teamwork at the Palo Alto Veteran's Administration Medical center, where they presented rounds to the cardiology department: Kroening sharing the details of his personal experience, Haykowsky talking about his research and Riess giving training insight and advice. Altogether, it was an experience that Haykowsky savours-despite the deep sand and those 400 stairs.
And as for that question he's been considering… He thinks that it just might have been possible for a prisoner to have swum to freedom through the waters of the Bay. "I think someone could have escaped that way," he says. "But everything would have had to align perfectly."
About the University of Alberta Faculty of Rehabilitation Medicine As the only free standing faculty of rehabilitation in Canada, the University of Alberta Faculty of Rehabilitation Medicine balances its activities among learning, discovery and citizenship (including clinical practice). A research leader in musculoskeletal health, spinal cord injuries and common spinal disorders (back pain), the Faculty of Rehabilitation Medicine aims to improve the quality of life of citizens in our community. The three departments, Occupational Therapy, Physical Therapy and Speech Pathology and Audiology offer professional entry programs. The Faculty offers thesis-based MSc and PhD programs in Rehabilitation Science, attracting students from a variety of disciplines including OT, PT, SLP, psychology, physical education, medicine and engineering.