The Garmin Forerunner 235 was one of those products that I found last Fall, researched, stalked for months, and hoped it would be exactly what I wanted. If only I could find one for sale. Turn out, the best wife ever picked one up at the local running store and it landed under the Christmas tree.
So, after much anticipation, trial and error, and continuous tinkering, I've pretty much decided, it's almost perfect.
I wear it all day, every day. Tracks steps, monitors my heart rate, syncs wirelessly to my phone, and posts alerts. All things I expected. It also displays the time of day. Handy feature in a watch.
Garmin has an app store that allows you to download watch faces and features. After a week, I decided to try a new face, which added step count to the home screen. Turned out to be ok, but not what I wanted, so I tried to go back. What I learned was, the factory home screen is not saved on the watch or user profile. I can download any new screen I want, or switch among screens I downloaded. But the original screen is gone. Not to be outwitted by software, I did a factory reset, wiped everything, and went back to start.
The home screen does its job well. The resolution is nothing impressive, but saves battery life. Garmin kept this in mind with their graphics, something other designers didn't consider with their apps. When I'm at work, the lazy bar starts to grow along the left side of the watch. If I don't move, eventually, it buzzes and tells me to get off my butt. A short walk gets rid of the bar. It's a good reminder, but it only seems to come on the hour.
Another interesting feature is the step goal. Everyone seems to have gravitated to the magic 10,000 steps a day. Hey, at least it's a number. Garmin has a system that adapts to my step count, and adjusts that goal according to my recent history. It's a little more realistic, and personalized to what I actually do. I'm not sure if I could get it down to 1,000 steps by just loafing for a week, but I do know the more I walk, the higher the goal climbs each day.
Garmin steps do not equal an iPhone step. I can push Garmin steps to Apple Health, but have to turn off all other sources to prevent double counting. Not sure how to fix that, but it's not really a big deal, since I just keep the watch on all the time anyway.
The Garmin Connect app wirelessly syncs over BLE in a regular interval, or whenever I open it up. In the app, I can view my steps, runs, sleep patterns, and weight. In order to get my Withings scale to send weight to Garmin Connect, had to get the MyFitnessPal app in the middle. So much for data standards.
The big reason I wanted this watch was for the wrist-based heart rate monitor. No more chest strap to worry about. Have to say, I've had mixed results. I'm guessing my pulse at rest, sleep, and light activity is accurate. The watch only checks over some interval, but picks up when I move more. Once I start an activity, such as timing a run or at the gym, it seems to track continuously. I found it to be low while running, at least compared to my last watch, the Forerunner 210 with the chest strap. After a few miles, it seems to catch up to where I expect my heart rate to be, but I really need better accuracy, especially durning warmup. I've read it gets better over time, so I will keep trying. I've also worn it to the gym, with mixed results. Riding a bike, it matched the handlebar readers the whole time, but lifting weights, it dropped to what I thought has half my pulse and stayed at that level, consistently reading half my effort. Again, I really need to have a good number to keep an eye on my effort in whatever I'm doing.
In the Connect app, all day heart rate is buried under a few menus, but it is interesting to review. I almost wish I could tag the data points to recall what I was doing during certain spikes. Another gripe, Garmin heart rate does not sync to Apple Health, and I can't find a middle app to send it there.
The watch syncs with my phone to display whatever alerts pop up on my home screen. I can read texts, see who is calling, and any other alert I get. Turns out, I never minded all the alerts on my phone until they landed on my watch. I wish there was a way to select which ones buzzed to my wrist.
Battery life is good with me. Although it is waterproof, I clip it in the charger when I take a shower in the morning or after a run. This keeps the battery up all week. I do wish the cord were longer. It's about 24 inches. Not long enough to reach from a wall plug to a bedside table top.
The watch doesn't come with a full manual, but there is one available through Connect and online. Maybe I'll read it someday.
All in all, I like the device. I'm hoping the heart rate monitor function improves over time, and would love some developer to paste this number on a new home screen. I'll keep wearing it and keep on running.
While there did appear to be some argument as to exactly what those sports might be—for example, there is a big difference between football, hockey, and rugby compared with low-impact sports like cycling and soccer—the two researchers agreed that most of these athletes can engage in sports without harm.
The debate, which included Dr. David Cannom (University of California, Los Angeles) and Dr. Rachel Lampert (Yale University School of Medicine, New Haven, CT), took place recently at the American College of Cardiology 2014 Scientific Sessions .
"The most important factor to consider is the underlying diagnosis," Cannom said. "If there are other reasons, the diagnosis is far and away the most important. I think it's also important to make sure the athlete wants to participate. Sometimes they're getting pushed into it by their parents and they're looking for a way out. It's important to get the mother, the father, the kid, and me in a room and make the decision together."
For Cannom, catecholaminergic polymorphic ventricular tachycardia (CPVT), an arrhythmia that is most prevalent when an individual is under physical or emotional stress, and arrhythmogenic right ventricular dysplasia (ARVD), are two conditions that should preclude participation in sports. For individuals with coronary disease, he is less concerned as long as the patient is checked out periodically with treadmill testing.
During the debate, Lambert agreed, noting that it remains critical for physicians to distinguish between CPVT and idiopathic VT/ventricular fibrillation. Lampert quoted Dr Michael Ackerman (Mayo Clinic, Rochester, MN), saying that it's not that CPVT patients can't participate in sports, but rather that inadequately treated CPVT patients can't participate. For CPVT patients wishing to engage in physical activity, she recommends consulting an expert who regularly manages these individuals so they're treated appropriately.
Death of Hank Gathers Changed the Game
Speaking during the debate, Cannom said the safety of sports for athletes with ICDs is a relative new issue, one that is in the process of redefinition. During his talk, Cannom cited the case of Eric "Hank" Gathers, a 23-year Loyola Marymount University basketball player who collapsed and died on the court during a game in 1990. Gathers had a first syncopal episode a few months prior, and while an ICD was recommended for what was diagnosed as exercise-induced VT, he refused it because he wanted to play professional basketball in the National Basketball Association (NBA).
"This was tragic for the Gathers family, but it was also tragic for a generation of athletes that came just after him," said Cannom. "His death sent chills down the spine of every athletic director and every lawyer who was trying to certify athletes with cardiac problems."
Cannom also discussed the recent case of a 20-year-old Pepperdine University basketball player who had a syncopal episode. Diagnosed with hypertrophic cardiomyopathy, the physicians implanted an ICD. However, after waiving liability and receiving a supporting letter from Cannom, the player was told he could not play because the Bethesda Guidelines—the 2005 document on eligibility recommendations for competitive athletes with cardiovascular abnormalities—recommend restricting athletes with an ICD for primary or secondary prevention from participating in sports. The player eventually transferred to Texas Tech University where he was allowed to play, but even this required a signed waiver from a leading cardiologist in the state.
The Bethesda Guidelines, said Cannom, are based largely on clinical experience and expert opinion rather than on clinical trials. In fact, the data are scant supporting the recommendations in the document.
Given the limitations of the existing guidelines, Cannom and Lampert established a prospective registry to evaluate the safety of sports for athletes with ICDs. They identified 372 athletes participating in organized or high-risk sports (mean age 33 years). Long-QT syndrome was the most common cardiac diagnosis (20%), while hypertrophic cardiomyopathy was also common (17%).
Published just last year, the registry showed that over 31 months of follow-up, no patients died or had a cardiac arrest requiring resuscitation during sports. In addition, there were no arrhythmia- or shock-related injuries during the activity. In total, 37 athletes received 49 shocks during a practice or a game. There were 39 shocks in 29 participants during other physical activity and 33 shocks in 24 athletes at rest. There were eight ventricular arrhythmias picked up by the ICD, and these were all terminated by the device. After receiving a shock, four stopped participating in sports entirely, but the majority remained engaged in activity.
"This is a large sample size, and we found that most athletes who participate in sports can do so without harm or injury," said Cannom. "The ICD shocks occurred, but there were no tachyarrhythmia deaths. The notion that we developed is that sports are giving these patients back a quality of life they had lost when they received a diagnosis of, say, long-QT syndrome or hypertrophic cardiomyopathy. While shocks can decrease quality of life, so too can sports restriction."
Cannom told heartwire the registry includes some really "unusual" people, noting that more than half of those with an ICD had a previous cardiac arrest that led to the implant, yet they returned to sports. Lampert said the registry did not measure quality of life, but the participants "voted with their feet." Even the shocks did not hold them back, with two-thirds returning to their sport. Two runners had appropriate shocks while running a marathon, yet they finished the race. "That's the kind of crazy people in this study," she said.
Lead Survival and Different Sports
During the debate, Lampert tackled the issue of whether these data support participation in any or all sports. There were a large number of athletes participating in running, including marathons, as well as basketball, baseball, and soccer players. There were not a lot of high-intensity, contact sports, the type of sports where the "whole reason to buy a ticket is to watch these people bash each other into the ground and get carried off the field."
Lead survival in the registry—97% and 90% freedom from lead malfunction at five and 10 years, respectively—was in line with other data. It is unknown whether this would be the case with athletes participating in football, rugby, or hockey. In addition, every patient in the registry had a transvenous ICD, and while the registry is ongoing, there are no data yet as to how well leads for a subcutaneous ICD, which are not protected by the thorax, would hold up with more physical sports.
