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Heart Problems Caused by Extreme Endurance Exercise?

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Heart Problems Caused by Extreme Endurance Exercise?

Postby SeanReedy » Fri Jun 08, 2012 8:24 am

I've run across several mentions of a new study in articles and on tv. Here's one article: http://www.kansascity.com/2012/06/03/3640410/extreme-exercise-may-carry-cardiac.html

I'm familiar with the concept of not bothering with exercise sessions beyond about an hour unless you are trying to improve at endurance sports that require more time than that, but I hadn't previously heard specific mention of heart problems possibly caused by regularly going well beyond that. I recall one article mentioning risks increasing when approaching mid-forties in age and when doing ultra distances/extreme endurance sessions more than once per week.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby ExcitableBoy » Fri Jun 08, 2012 12:52 pm

I do lots of endurance training and I am 43, and do endurance runs from 2 to 9+ hours twice a week in addition to long alpine climbs that may entail 30 hours of work over a two day period. Everytime I've been hooked up to an EKG the Drs about shit their pants and say things like 'Wow, I wish I had your heart.' I also set off the alarms because my heart rate is so low.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby nartreb » Fri Jun 08, 2012 2:07 pm

>not bothering with exercise sessions beyond about an hour

That's crazy. Somebody who took that advice wouldn't have the endurance to finish one game of soccer. I don't care if you're training for the clean & jerk, you need some longer periods of exercise a couple of times a week.

The linked article included one paragraph mentioning one un-named study which concluded that running is good. "The best results" were "one to twenty miles a week" at an easy pace (8-10 min miles) and runners as a group had a 19% lower mortality rate. There's no information about whether the extreme runners in that study had better or worse mortality than non-runners; that might mean that there weren't enough extreme runners for statistical significance (though with a sample size of 52,000 people, that seems unlikely) or more likely the author of the article (who apparently got all his info from the author of a review) didn't mention it because the result wouldn't support his thesis.

Also mentioned: one study in rats, and one case of a 58-year-old ultramarathoner with "idiopathic cardiomyopathy" - in other words, nobody knows exactly what was wrong with his heart.

I'm not going to lose any sleep over this.

Now if only I had several hours free every day in which I could run/hike/climb ... heck, I'd settle for several hours of uninterrupted sleep every night.

Edited to add: it's logical that there would be some limit to how much exercise the human body can take ... and it's interesting that (as suggested by the rat study) cardiac issues might be one of the limiting factors. But there's not enough info here to draw any conclusions. I'd like to know how intensely the rats were made to exercise, how soon the heart symptoms appeared, how gradually the length/intensity of the exercise was increased, whether the rats' symptoms would improve or not if the study went on for a longer period of time, etc.

The human study seems to indicate that twice as much is not necessarily twice as good, but their "best results" group is so wide that one has to wonder. More importantly, there's no indication in the (description given of the) human study that the people who ran too much to get the "best result" had heart problems. It could be that they ran so many miles that more of them died from being hit by cars, or more of them were part of an older demographic group that's starting to die off from cancer (one hopes the study tried to correct for age using statistical methods), or who knows.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby splattski » Fri Jun 08, 2012 8:42 pm

It's real. EB, you're just not old enough.
I started having arrhythimas in my late 20s, thought to be a de-training syndrome after I quit bike racing seriously (my wife at the time was a nurse, and did some research). I saw a cardio back then, but no EKG- no diagnosis. Over the years they would come and go. And never very severe.
A couple years ago, they came back with a vengeance. Bad enough that I could not remain standing. Cardio said "Not lethal. Nothing we can do. Just an inconvenience you'll have to live with." Inconvenience.
But the problem is that there is about 20 ways your heartbeat can be irregular, and without a proper EKG a cardio can't even begin to guess. They look at the shape and displacement of each curve (there are several per each heart beat) and where the curve is distorted. And each anomaly is classified differently. So my 'syndrome' might be different than that in the article. I'm not a doctor. Don't even play one on TV.
I'm pretty sure that the medicals quit caring when they saw I was fit and had spotless arteries- no disease, no worry. SOBs. Fortunately, I got mine under control without the worthless cardiologist.

http://www.sciencedaily.com/releases/20 ... 143221.htm
http://www.cardiolabel.eu/athletesheart.html
http://www.afibbers.org/faq.htm
http://www.lef.org/protocols/heart_circ ... ias_01.htm
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby SeanReedy » Fri Jun 08, 2012 9:34 pm

Keeping exercise to about an hour a day is crazy? I would not use that strong of a descriptor. An hour a day of exercise would be fine and great for most people and most people don't have reason to go beyond that. Most people aren't trying to be serious athletes and most people don't do what seems normal to a lot of SP members. I've gotten the sense that the concern raised was more for the increasing popularity of middle aged and older people regularly going far beyond an hour by competing in and training for marathons, ultra-marathons, long distance cycling, triathlons, etc. While not as easy of a read, this would provide more detail than the hodgepodge of mentions and headlines I've been seeing in the media: http://www.mayoclinicproceedings.org/article/S0025-6196%2812%2900473-9/fulltext

I do agree that more information is needed before my family starts telling me to stop dreaming about taking on triathlon training and to quit looking forward to multiple days of long, strenuous runs/hikes/rides as a nice vacation from only getting out for about 45-90 minutes 4-6 times per week during normal routines.

EB, what you report would be what I would expect. It piqued my interest when I read that someone a tad older than you might begin to develop scarring. I'd be curious to know more about likelihood of problems, what constitutes a serious risk/problem as well as who should be checked, when, and how? I'm curious about what future studies may find, especially in regard to aging endurance athletes.

Splattski, interesting...sorry to hear about your problem, but glad to hear you've got it under control.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby jordansahls » Fri Jun 08, 2012 9:43 pm

Very interesting. I have been dealing with benign PVC's and PAC's for many years. It has never really affected my sports performance. However, there is an interesting case study where the subject, a doctor, wore a halter monitor on two separate climbs of Kilimanjaro when he was 65 and 75 (http://www.ncbi.nlm.nih.gov/pubmed?term ... llimanjaro). His conclusion was that exposure to strenuous exercise at altitude increased his sympathetic response which resulted in an increase in disturbances of his normal rhythm from his ascent when he was 65.

Anyway, while the OP's article doesn't have to do with altitude I doubt that SCD in athletes is simply the result of idiopathic cardiomyopathy. I don't doubt that too much endurance exercise can be bad for you (female athlete triad, for example) but there is a lot more going on. Age obviously has a lot to do with it.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby JHH60 » Fri Jun 08, 2012 11:17 pm

If you want to do any long runs or long days in the back country you have to train for more than an hour to do them comfortably. The article posted by the OP suggests that might entail some extra cardiac risk. So what?

The article seems targeted at a risk averse audience. If the only thing that's important to you is living a long time (vs. quality of life), and avoiding any activity that might reduce the chances of a long life, then in addition to "extreme" exercise you should probably also avoid dangerous activities like mountaineering or skiing, or even hiking on 3rd class terrain.

Even if the conclusions in the study are valid, I'm guessing the hard statistical odds of death on my next rock or ice climb (or scuba dive, or mountain bike ride, or driving my convertible on a twisty mountain road) are a lot higher than dying on my next long run.

Note that according to a study in the Journal of the American Medical Association:

http://jama.jamanetwork.com/article.aspx?volume=305&issue=12&page=1225

you are 2.7 times more likely to have a heart attack during sex than during normal activities. Are you planning to swear off sex for life to avoid a heart attack? Didn't think so.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby SeanReedy » Fri Jun 08, 2012 11:53 pm

JHH60 wrote:If you want to do any long runs or long days in the back country you have to train for more than an hour to do them comfortably. The article posted by the OP suggests that might entail some extra cardiac risk. So what?

The article seems targeted at a risk averse audience. If the only thing that's important to you is living a long time (vs. quality of life), and avoiding any activity that might reduce the chances of a long life, then in addition to "extreme" exercise you should probably also avoid dangerous activities like mountaineering or skiing, or even hiking on 3rd class terrain.

Even if the conclusions in the study are valid, I'm guessing the hard statistical odds of death on my next rock or ice climb (or scuba dive, or mountain bike ride, or driving my convertible on a twisty mountain road) are a lot higher than dying on my next long run.

Note that according to a study in the Journal of the American Medical Association:

http://jama.jamanetwork.com/article.aspx?volume=305&issue=12&page=1225

you are 2.7 times more likely to have a heart attack during sex than during normal activities. Are you planning to swear off sex for life to avoid a heart attack? Didn't think so.


Good points and funny ending. In the OP article,including the quote about a marathon being something to do once for a bucket list and never again did seem extreme to me. I tend to be someone who gets irritated by people always harping on things that are dangerous (often just because the activity is unusual or unfamiliar to them). At the same time, if you knew of ways to still be able to do all of the activities mentioned while protecting your long term health, would you take the safety measures or avoid safety measures? Do you use safety equipment? Do you ever make adjustments to behavior based on new knowledge? If the study holds true, it seems like the main take away is that some people might be better off not doing several hours of uninterrupted intense exercise multiple times per week at an older age. There are many activities one in that position could still safely do.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby Clark_Griswold » Sat Jun 09, 2012 2:22 am

Anyone remember the article about people who regularly spend time above 4000 meters suffering from brain damage in their executive function areas? Seems to me that just because some individuals can train their bodies to mountaineer at 5000 or 6000 meters or more, or to run 50 miles, or for that matter, to do any of the odd extreme type sports we see people do today like body building to massive size, or running ultra marathons, or whatever, these things are not normal over the course of human evolution and our physiology will respond by suffering long-term negative size affects if pushed continually to do them. Working 20 hour days for 5 days with 4 hours of sleep is considered bad, so why shouldn't running absurd lengths of time be? Running 1000 miles over a week with no sleep or food would be guaranteed to be bad, so why not accept that ultra marathons can be too, extrapolating out that not all people are derived from athletic stock with genetic potential to be athletic supermen, people who attempt to be will, over the length of their life, incur damage to their organs which suffer from over use.

Also, I have an uncle who collapsed at work and was told he needs a pacer due to his Atrial fibrillation, or so the story was told me. He is about 60, and has been a life long runner and cyclist, was always in excellent shape and probably ate very healthy for an American. Still, just as with a car that is kept in shape, parts wear out, so to speak. The heart is regulated by an electrical conduction system, and that can affect anyone. Abuse to the heart, like long term insult from over exertion could form fibrosis.
...
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby SeanReedy » Sat Jun 09, 2012 7:21 am

Also, in regard to the notion that one needs to exercise for more than an hour a day to be prepared for long hikes or to play soccer, etc., that is simply not true. It depends on the person. Long endurance exercise is something I only do occasionally. 30-90 minutes (usually 45-60 minutes) of exercise 3-6 days a week with intensity and strength training mixed in works well for me. If desired, I have always been able to pull off 15-20 mile + dayhikes with several thousand feet of gain at a decent pace. I used to be on the extremely fast side for a hiker, but would need to drop some weight by taking in less calories for awhile if I wanted to return to being more than just above average in speed. At 6'4", I've been as heavy as 240 and still out hiking strong, or 210 and running a 5 minute mile, but would be better off around 185-190 if I want to be as quick and as heart healthy as possible as age creeps in. Yes, longer duration of exercise could help me drop weight or be a faster hiker, but the time and motivation aren't always there with everything else in life.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby chugach mtn boy » Sat Jun 09, 2012 7:12 pm

There's been a long and pretty well-established correlation between serious (not necessarily extreme) endurance exercise and developing intermittent atrial fibrillation (a-fib). It's not usually a particularly dangerous condition but it's a hassle. For me, every couple of months it will kick in at the end of a long day in the mountains and suddenly uphills become a struggle--I have to slow waaay down. I know from observing my dad that a-fib is not a great thing to have in old age, and someday I'll probably get it fixed. Spattski, if a-fib is your particular issue be aware that there are huge, huge advances in the last few years in treatment, but they are beyond the scope of the average cardio. Lionel, your uncle should ask around about alternatives to a pacemaker.

I think the Mayo study was also looking at other, more serious arrhythmias and cardiac remodeling--fortunately I don't seem to have any of those problems, but then I don't quite fit their extreme profile.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby splattski » Sat Jun 09, 2012 10:23 pm

I raced bicycles and nordic skiing at a high level in my youth (from my perspective these days, 'youth' includes everything up to about 40). Two extremely demanding endeavors.
I don't actually have a-fib. I have something more like a delayed ventricular. Same situation, though. When it kicks, the blood stops moving like it's supposed to, I get light headed, and have to back it down or sit down. And at its worst, this has lasted for hours and hours. I was worried that I might have an episode on technical route, pass out, and fall off. And it always left me really tired afterward.
It's been almost a year since I saw the cardio so I'm a little foggy on exactly what he said. But as I recall, the usual drugs slow your heart, so that won't work for me cuz my resting pulse is already 35. There was something about the pacemaker that was contraindicated as well.
So I did some research and am having excellent results with diet, supplements, and more/regular exercise (I was not doing much during the week and then kicking it hard on the weekends). Downside: my wife says I'm boring with neither alcohol nor caffeine in my life.
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Re: Heart Problems Caused by Extreme Endurance Exercise?

Postby SeanReedy » Fri Jun 15, 2012 8:38 pm

splattski wrote: ...Downside: my wife says I'm boring with neither alcohol nor caffeine in my life.


:lol: Yep. Boring is certainly a word that can come up when avoiding alcohol, caffeine, or considering altering activities. My mom is otherwise healthy, but had to cut out the caffeine due to heart issues. Coffee can make me feel off, but usually is OK if I exercise soon after drinking it. I tend to just stay away from it now. I was brewing my own beer for awhile, but found that helped lead to excessive consumption. I feel best when off it altogether, but partaking every once in awhile still works for me.
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