Heart damage from cardio endurance?!

[Mikkel Ravn]

I did not know this, it's pretty shocking news. I've never been an endurance athlete, except for some very long days in the mountains. After hearing this, I'm glad I didn't do marathons and triathlon.

 

This will surely upset many, many people.

 

[Alessandro Mainente]

for that reason i think that at certain level of fitness is ALWAYS and repeat ALWAYS necessary perform a medical certification for agonist activity with ECG under effort.

[Toni Laukkavaara]

I wonder how good strenght training is for my health.. hmm

[Dimitar Grozev]

From what I've read strenght and endurance training have opposite effects on the heart. Strenght training that uses the valsalva maneuver makes the heart wall increase in thickness which is called concentric hypertrophy. Endurance training increases heart volume which is called eccentric hypertrophy.

The way I see it concetric hypertrophy(as a result of strenght training) makes the heart stronger but also reduces its volume. On the other hand eccentric hypertrophy improves the hearts volume but stretches it out and makes it weaker.

[Josh Schmitter]

Only got a few minutes right now, but there's a crazy long cardio thread in here somewhere with tons of talk about this. Will try to find it in a bit. 

 

I believe this is where Slizzardman(Naterman) talks about how both strength and endurance training are necessary for heart health. Too much of one will negate the positive effect of the other...pretty much like everything .

 

Also Kurt Harris talked about a study of marathon runners indicating the same thing...will also come back with that hopefully.

[Christian Sørlie]

Yeah, I think what is important here is that he is not talking about endurance training or running in general. But the extreme end of it, like multiple marathons and excessive distances and frequency of training.

Doing a 20-30 min run a couple of times a week, or trying to get 10K in less than 50 min is not going to put you into this category.

 

But you know it's gonna pop up articles on internet saying: "Endurance training is proven bad for you!"  or "Stop running immediately!"

Then they will go on how 3 hours of strength training where basically 10 sets of 2 reps is done is the ULTIMATE way to health.

 

This is another great benefit with Foundation, the minimal rests and keep going mentality (while keeping quality) is not only making you stronger but increasing endurance.

 

I remember a time ago, before Foundation and before I was doing GB training, but doing other type of bodyweight training, following 2 times a day, 1-3 reps and max rest between sets, I was on vacation and stopped by a normal gym to do a session. Feeling a little stupid doing my assisted OAC training and negative only HSPU combo, I decided to try a "normal" weight training session. So planned to do 3 sets of 10 DB bench presses alternated with DB rows. I got one round in and got so sick to my stomach and had extreme lactic acid buildup from so little, I had to go sit down for 30 minutes to get back to normal. Needless to say that was a slap in the face wake up call that my current training was not doing it. Even though I could do 10 sets of 1 rep pinkie assisted OAC.  (Still had to start on F1...)

 

But a great video about the dangers of overdoing it. I have a friend who does ultramarathons who could use to see this one.

[Josh Schmitter]

Here's some links for ya'll. 2 good long threads on the forum: 1 and 2.

 

...and also from  Kurt Harris a while back:

 

"The perfect example of hormesis is exercise. Exercise creates oxidative stress, and resistance exercise in particular literally destroys muscle tissue. Hormesis explains the “paradox” (which is no paradox at all) that marathon running and other extreme endurance sports could be quite bad for your health, but that more moderate exercise is much better than no exercise at all. This explains why I write posts like this and this, yet I continue to run about 8-10 K per week in addition to strength training twice a week.

 

Are you starting to see a pattern here? Run 10-15 K/ week. Don’t run 100 K/week. Lift weights 1-2 x per week. Don’t lift weights every day. Go hungry or fast now and then. Don’t be in ketosis 24/7. Eat a moderate variety of colorful plants. Don’t take Resveratrol pills. We can extend this principle to some other areas once we understand hormesis. Don’t freak out about dental or medical xrays if you need them. Don’t obsess about unavoidable “microtoxins” in the food supply. The natural ones outnumber the unnatural ones, and we are designed to deal with them. Focus on the macrotoxins – the NAD (Neolithic agents of disease). And more speculatively, we might think about other environmental exposures that are, or could be hormetic. A little is good, lots more might be bad."
 

[Douglas Wadle]

Good questions and good points above.  The key in these studies is that they are dealing with extremes of endurance.  Even at those levels, patients tend to live longer, but they get conduction problems like a fib.  Studies even looking at tour de france riders show they live longer than age matched controls, so this is an issue of weighing risks.  There remains no study to date showing shortened life span even from excessive exercise, while there are many showing prolonged life span.  The issues dealt with above, namely atrial fibrillation and conduction problems are a nuisance, require medication in many cases, and may affect capacity to remain as active as you'd like.  If you want to mitigate your risks, then you should practice moderation as in anything.  Dont become an ultramarathon runner, don't become a power lifter, etc.  Specialists in most sports do sacrifice their health in many ways to be the very best in their narrow field.  Generalists are not as "elite" in any given sport, but will always be more healthy.  Elite gymnasts are not immune to this phenomenon either, and multiple studies are available that would point to back problems, neck problems, etc in elite gymnasts.  So this is not unique to endurance or to any individual sport, but is a price paid for specializing to an extreme level.  Those of us who are mere mortals do best to have a mix of a variety of things to keep us active and unsedentary, which is a much greater risk.  Some endurance training and speed training, some gymnastic strength work, some mobility, some dynamic power.  This is a good balanced program for anybody.  

[Douglas Wadle]

contractility does not decrease with eccentric or concentric hypertrophy.  Domz very accurately points out that the hypertrophy occuring from athletics does not correlate to the hypertrophy occuring from disease processes.  In hypertension, the heart also thickens concentrically, which sounds like a good thing (stronger heart muscle!), but in fact causes the heart to not relax well, and it loses it's compliance and can result in heart failure symptoms even though the heart is contracting normally and strongly.  The "athletic heart" hypertrophy doesn't cause these changes, but can lead to electrical/conduction problems.  It's more likely the conduction problems than the "stretching of the pericardium" that causes orthostatic intolerance in older athletes who've trained at a high level for many years. In other words, the heart rate doesn't pick up as much as it should when they change position or stand up.

[Patrick laughlin Laughlin]

No one ever said sports were healthy

[Coach Sommer]

At the world class level, there may indeed be issues with the pursuit of performance over health.  But for general fitness, for sport to be unhealthy is simply the result of improper progressions and programming.  

 

The issue arises when people engaging in casual fitness base their training protocols on that of world class athletes.

 

In regards to the endurance work, there is a very good TED talk where a cardiologist graphed the mortality rates with the following variables of complete inactivity to 20-25miles per week running.  This was also cross referenced with mph.

 

The sweet spot for maximum cardiac benefits was 9-12 miles per week at a 7:30-8:00 min per mile.  

 

Interestingly the mortality rate for those running over 25 miles per week at faster paces was only very slightly better than those who were completely sedentary.

 

Yours in Fitness,

Coach Sommer

[Mikkel Ravn]

Yes, about that U-shape... Funny how some people have a tendency to assign a linear correlation to everything. If exercise is healthy, then extreme exercise must be extremely healthy.

 

As always, the morale is to do everything in moderation. Even though that proverb is often criticised as promoting mediocrity, it seems to be accurate time and time again, not least as one ages.

 

I wonder if the triathlon and marathon community will take this seriously.

[Joakim Andersson]

No one ever said sports were healthy

 

Yes a lot of people said so.

[Patrick laughlin Laughlin]

Yes a lot of people said so.

Oh yeah, i suppose they did, didn't they. =)

[Karl Kallio]

If I had to pick (thank goodness I don't) I would choose to die of a heart attack on a long run, not of a heart attack during an episode of the vampire diaries.

[Keilani Gutierrez]

If I had to pick (thank goodness I don't) I would choose to die of a heart attack on a long run, not of a heart attack during an episode of the vampire diaries.

what if you ran casually while watching an episode of vampire diaries? 

 

(and this is the moment where we began to see a decline in cardiac failure in runners and began to see a rising curve in people spraining ankles and netflix subscriptions.) #innermonologue

[Coach Sommer]

... I wonder if the triathlon and marathon community will take this seriously ...

They should, the information has been available for a number of years now.

Mark Sisson (former professional triathlete) has previously spoken about the preponderance of heart disease and required pace makers in former high level professional triathletes.

The TED cardiologist simply further refined the information by quantifying the potential for damage associated with various training mileages and intensities.

Yours in Fitness,

Coach Sommer

[Joshua Krasnow]

There is a plethora of bad quality data in this field.

About the best that can be said is that moderate exercise is clearly beneficial, and the benefit accrual per additional unit of exertion may be lower. More than that is controversial.  Dr. O'keefe (in the video above, and I believe in the TED talk referenced by Coach) clearly has a point of view and is doing research and the talk circuit to support this.

 

It's most important to note that NONE of the studies really address the kind of mixed exercise that is done by people on this forum. Cardiovascularly it's a black box. In fact even the popular HIIT protocols have essentially no long term outcome data for cardiovascular health.

[Coach Sommer]

Also interesting that I have not noticed swimmers, who do massive amounts of cardio training, encountering the same issues as the runners.  My suspicion is that swimming, being primarily interval-training-based, avoids that long exposure to the same elevated, steady, repetitive heart rate for hour upon hour. 

 

Yours in Fitness,

Coach Sommer

[Tristan Curtis]

If I had to pick (thank goodness I don't) I would choose to die of a heart attack on a long run, not of a heart attack during an episode of the vampire diaries.

 

Me too. Unless it was during an episode of Archer. In that case... dear god... don't make me choose.

 

 

My suspicion is that swimming, being primarily interval-training-based, avoids that long exposure to the same elevated, steady, repetitive heart rate for hour upon hour. 

 

That would make sense. The idea of endurance in competitive swimming is 1500m, which takes elite freestylers 15 minutes. Endurance in running is the marathon, which takes elite runners over 2 hours.

[Karl Kallio]

There are open water events, 5k and 10k.  But the population of athletes that do them is quite small compared to how many people do marathons, especially in cold water countries. 

 

Around here the kids who do open water train maybe 5 days a week in the pool and 1 in the ocean, in the pool they do things like 100 series of 100m. But it doesn't look like the interval training of pool swimmers, where you arrive to the wall halfway panting wait 10 seconds and then go again. it's more continuous.  The coach told me that he doesn't worry about making sure they complete every set, he just monitors the time and velocity to make sure that they get the right duration of training.  The adult open water swimmers around here all do triathlon and train with the marathon group on their runs so they would probably show up as runners in the statistics.  (Of course around here with the thieves, kidnappers, drunk drivers and blazing sun the primary factors for mortality in that group is not heart attack)

[Douglas Wadle]

Here again, I have to interject.  I disagree with the sense that endurance sports are bad for your long term cardiovascular health. These folks, while raising  interesting scientific questions for further research are in fact promoting bad science when they portray it as clearer than it actually is. 

 

I did a formal literature search on this subject because I was curious if O’keefe had access to research I wasn’t aware of.  It turns out, the only articles I could find in the last 5 years that propose that endurance sports are bad are authored by, guess who…O’keefe.  Even in his own research, he proposes that this is just a “possibility” based on animal models and that it warrants further research.  (Mayo Clin Proc. 2012 Jun;87(6):587-95. Potential adverse cardiovascular effects from excessive endurance exercise. O'Keefe et al.).

 

We know for a fact one thing, that atrial fibrillation is more common in endurance athletes, but atrial fibrillation does not shorten lifespan.  (Scand J Med Sci Sports. 2013 Nov 21. Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Myrstad, et al.)

 

There are, however, numerous studies, over many years, that actually would promote that endurance training lengthens your lifespan. 

 

Tour de france riders live longer (Eur Heart J. 2013 Oct;34(40):3145-50. Mortality of French participants in the Tour de France (1947-2012).  Marijon et al).    Another study found the same results (Int J Sports Med. 2011 Aug;32(8):644-7. Increased average longevity among the "Tour de France" cyclists. Sanchis-Gomar et al).

 

Ex Olympic athletes live longer and have less cardiovascular complications as they get older (BMJ. 2012 Dec 13;345:e8308. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Clarke et al). 

 

Another study evaluated cross country skiers (the epitome of endurance athletes) and found that they lived longer and had fewer cardiovascular health related problems as they aged. (Scand J Med Sci Sports. 2011 Dec;21(6):e351-8. Mortality and cardiovascular morbidity among long-term endurance male cross country skiers followed for 28-30 years. Grimsmo, et al.)   

 

I believe this is a case of people believing what they want to believe.  The short answer is that you cannot extrapolate animal models to humans.  Time and again data found in animal studies has been found not to correlate with what happens in people.  Am I an endurance athlete..yes.  But I am also a scientist and do not get hung up on my own sentimental concerns.  We should base what we do on human studies and on long term studies, both classes of which are presented above.  Lacking these, as we are in many areas of sports science, we will have to make do with what we have.  Not always are we able to have prospective, double blind, placebo controlled, studies, unfortunately! 

[Coach Sommer]

How does your research explain Sissone's noted incidence of problems amongst the professional triathletes?  Perhaps the numbers involved were statistically insignificant given the total population of professional triathletes or perhaps the long cardio effects are different for high mileage running compared to either biking or swimming.

 

I seem to remember the recent death of a famous ultra marathon runner, found dead on a training run.  If I am remembering correctly, there were substantial issues with the stiffness of his coronary artery.  Worth looking up to confirm.  

 

Sorry, out of time to look it up myself.  Currently in Asia and loaded with meetings.

 

Yours in Fitness,

Coach Sommer

[Douglas Wadle]

It is true, Micah True (pun intended, sorry) died of heart problems out on a trail run.  It is also true Jim Fix died during running.  Ryan Shay died during the olympic trials marathon a few years ago.  It is also true that Fix had a strong family history of very early CAD (in the 30's).  Ryan Shay and Micah True had Hypertrophic Cardiomyopathy, a genetic condition, that is the most common cause of young athletes dying during competition, and is unrelated to endurance training.  I don't believe the real issue is dying during the sport, but what happens years later.  Weight lifters die of hypertrophic cardiomyopathy, and multiple cases are in the literature of gymnasts dying of hypertrophic cardiomyopathy (in fact it was the 3rd leading sport for deaths from this after cycling and football in one study).  

 

Sisson has the same research that O'keefe has cited, and also some anecdotal stories.  Mostly based on animal studies (particularly the data about energy expenditure over 4000 cal/day = shorter lifespan)  If we were rats I'd be worried  .  He also cites the atrial fibrillation research, which as I mentioned is very true and is a well estabilished problem with long term endurance sports, but again does not affect longevity.  Another factor in his opinion is the biochemical changes with exercise, and then translating that to an assumption of what happens down the line.  Important stuff, and fodder for research, but not by a long shot an indication of causality.  Sisson is also not an expert in this field.  His background is mostly in nutirition.

 

Have fun in Asia, It's a half of a world away from here, and I expect much better weather!  

[Daniel Burnham]

Excellent review MT Nordic.  While I won't make judgement until I actually get around to reading the papers (probably never) you have brought up some good points.  I would also like to know how healthy the people Sisson knew were before and after training.  I don't think any amount of cardio will completely make up for damage done before becoming healthy.  Also youre right, rat studies cannot be directly taken as fact in humans but do give some good, and very often times, accurate accounts of the extremes.  Of course we are not allowed to take human subjects to these extremes so a truly controlled experiment is not going to be possible.