Marathon training ‘may pose a heart risk’
Here is the link from the BBC page : http://www.bbc.co.uk/news/health-16048121
Building up fitness/stamina slowly over many years is what I think is best, but hey that could also be challenged.
G.
This article needs to tell us about the individual athletes tested: Are they elites and pushing world record paces?
There is a difference between edurance training for fitness and stamina and training to test your physical limits.
Guess you could ask the people from European Heart Journal.
My thinking is that people may even harm their heart muscle even if they are not elite athletes. Someone who is not very fit pushing themselves well beyond the pain barrier for example. Better to slow down or even walk for a bit I think if you have chest pains. A few years ago when getting really fit for the 2nd time in my life I had a few chest pains and would slow down and walk (even though it was most likely intercostal muscle strains).
All of these articles always talk about the temporary heart damage it causes, but they never show any data about the damage actually causing illness/death as a result. If I lift weights, I’m tearing my muscles correct? But they repair themselves and become stronger. Is it possible that in a healthy person our hearts are able to take some damage with no reduction in life expectancy?
This study looked at 834 Tour de France cyclists and found that 50% of the riders had died by the age of 81.5 versus 50% of the average European’s had died by the age of 73.5. Those guys know heart damage.
I remember hearing somewhere that being sedentary and over weight causes some heart problems as well.
Pick your poison.
Cycling is pretty hard on the body, but I find running is much harder. Also it seems easier to overdo it while out running than cycling for me. I also find the same while swimming (hard to push such that the whole body hurt).
For example it really starts to ‘hurt’ somewhere along the way in all the half marathons I have done, whereas on the bike in a hard race I just start feeling energy/fluid depleted.
G.
I remember hearing somewhere that being sedentary and over weight causes some heart problems as well.
Pick your poison.
I am with you. Have been reading all the articles and perusing the photos of the Hawaii ultraman the last few years and wouldn’t mind doing it. I don’t think it is unhealthy if one builds up the endurance over many years and doesn’t ‘push hard at all costs’. Only thing holding me back is the motivation and the motivation is getting knocked a bit by the expenses I calculate to do it well. Always cost me over $100usd for running shoes every few months so bank account doesn’t go up. Eating really well isn’t cheap either compared from what I saw in the USA. You guys are lucky in that way.
G.
All of these articles always talk about the temporary heart damage it causes, but they never show any data about the damage actually causing illness/death as a result. If I lift weights, I’m tearing my muscles correct? But they repair themselves and become stronger. Is it possible that in a healthy person our hearts are able to take some damage with no reduction in life expectancy?
This study looked at 834 Tour de France cyclists and found that 50% of the riders had died by the age of 81.5 versus 50% of the average European’s had died by the age of 73.5. Those guys know heart damage.
http://www.ncbi.nlm.nih.gov/pubmed/21618162
Definitely agree. I remember my parents freaking out when I started doing tris and endurance events and would often talk about the “temporary heart damage.” I talked to my doctor and she just laughed and said basically what you just said. You cause temporary damage, which heals quickly and gets stronger. In the long run, as long as you’re not pushing too hard, you’re actually helping yourself. I also saw that study on tour de france cyclists. I think this is just an excuse for lazy people to not exercise.
I agree that in general running is harder on the body. However, competing in the Tour de France has go to be one of the biggest stresses someone could put on their heart. Also, this is just speculation, but my guess is if they compared the life expectancy of the top marathon runners in the world compared to the general population, they would live much longer as well.
An interesting component of this was they stated the athletes trained 10 hours a week. Top triathletes train more than that and seeing as we somehow included TdF pros, they train WAY more than that.
Then the article stated that there is enlargement of the heart after a Marathon event. Hmmmmm, I am somehow not surprised.
I would wonder if the observations were such that some kind of relationship could be found by the amount of training (per week) versus the length of the event. In other words, the longer the event, the more training you have to do so that your body is not damaged. Sounds kind of intuitive but likely needs a study.
In any case, we all die so it is the journey that is important. Sit on a couch and eat cheese doodles, train for a triathlon, do what you want to do.
I agree that in general running is harder on the body. However, competing in the Tour de France has go to be one of the biggest stresses someone could put on their heart. Also, this is just speculation, but my guess is if they compared the life expectancy of the top marathon runners in the world compared to the general population, they would live much longer as well.
“life expectancy of the top marathon runners in the world compared to the general population”
The above would be interesting. Can’t be too hard a study to do. Marathon was really big 30-40 years ago so it will be a few more years before that study could be done well. Defining who the top marathon runners were will take a bit of thinking. But I am sure that the statistics will be put together in the years to come.
G.
I remember hearing somewhere that being sedentary and over weight causes some heart problems as well.
Pick your poison.
I’ve never understood that cliched rebuttal to this argument, as if the 2 choices are 1.) sit on the couch and be 300 pounds 2.) train 15-20 hours per week and do 2 ironmans per year.
Its clear that one who eats well and has a healthy diet (some form of caloric restriction), has a healthy weight, and is generally active is not worse off than a fit endurance athlete. Its debatable whether the endurance athlete is actually worse off. The more I have researched, personally, I am starting to think if your goal is to have best long term health, endurance sports is not the way to achieve that.
Obviously comparing uber-ironman guy to 500 pound couch potato is a different argument. Somehow it seems this debate always turns into that.
I agree.
Overall, I believe it’s hard on the body if the athlete races harder than they train. Racing needs to match the training.
This report comes from a group of investigators at the University of Melbourne who have a keen interest in heart disease in endurance athletes. The report which appeared in this week’s edition of The European Heart Journal is worth reading. It’s well written and accessible, even for the non-medical reader.
The investigators have made some careful observations in a group of 40 athletes who trained and then completed an endurance race: 7 in a marathon, 11 in a half Ironman distance triathlon, 8 in a 207 km cycling event, and 13 in an Ironman distance triathlon. The average training load for the athletes was 16.7 hours per week, but ranged up to 21.1 hours per week for the Ironman distance triathlon competitors.
The study protocol included diagnostic studies made at baseline, immediately after the race, and again 1 week after each athlete’s race. The evaluation included measurement of cardiac enzymes in th blood, an echocardiogram (an ultrasound study of the heart), and a cardiac MRI.
The investigators made 2 important observations:
- Immediately after the race (regardless of WHICH race), there was elevation of the cardiac enzymes (suggesting acute damage) and reduced function of the right ventricle (RV), the chamber that pumps blood to the lungs. These changes were almost totally reversible, returning to normal by 1 week after the race.
and
- Unrelated to the acute changes, the cardiac MRI was abnormal in 5 of the athletes, showing fibrosis of the heart muscle that might be due to injury as a consequence of long-term participation in endurance sports.
The findings complement other studies that have shown elevation of cardiac enzymes in the blood immediately after running races and triathlons. The current study is the most careful analysis of echocardiograms immediately after racing…and the finding that the RV suffers more than the left ventricle (LV) may be important. As in previous studies, these changes were temporary.
The cardiac MRI findings agree with those reported earlier this year for a group of long-time marathoners. It may well be that there is some subgroup of endurance athletes who are susceptible to heart damage over the long term that manifests as fibrosis of the heart muscle itself.
All of these issues deserve further study so that current endurance athletes can be well informed about the possibility of temporary or permanent heart damage that might occur with training and competing.
Larry Creswell, M.D.
Blogger at www.athletesheart.blogspot.com
Columnist at www.endurancecorner.com
Thanks for the detailed reply. I like reading your articles on endurance corner and refer other people to them also. It will be interesting following developments in this area of research.
G.
My wife took great pleasure reading the highlights of this article to me last night. Its amazing that none of these articles below got any press. This is just a brief summary of what I was able to come up with on a quick lit search. My only disclaimer is that I have not had a chance to pull the full articles yet. While I am sure not all of these articles are perfect studies they do make an attempt to look at a relevant clinical outcome ( heart disease, death) as opposed to a physiologic change (changes on MRI) that may not even affect long term morbidity/mortality.
- Teramoto M, Bungum TJ, Mortality and Longevity of Elite Athletes. J Sci Med Sport. 2010 July;13(4):410-6. They did a literature review of articles related to elite athletes and found that lo “long term vigorous exercise training is associated with increased survival rates of specific groups of athletes”. (data found inconsistent results in elite power athletes)
- Sarna S, et al, Health status of former elite athletes. The Finnish experience. Aging. 1997 Feb-April;9(1-2):35-41. They looked at athletes that participated in elite sports between 1920-1965 including skiing, hockey, soccer, basketball, boxing, wrestling, cross country skiing, track and field, wight lifting and compared to healthy controls. “We found that former aerobic sports athletes in particular have a high total and active life expectancy and low risk for ischemic heart disease and diabetes in later years.” Follow up data was obtained in 1985 and only 65.9% of original cohort was still alive.
- Chakravart EF et al, Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Intern MEd. 2008 Aug 11;168(15):1683-46. They compared 538 runners to healthy control group with an average age of 50. After adjusting for other risk factors they concluded that "Vigorous exercise (running) at middle and older ages is associated with reduced disability in later life and a notable survival advantage.
- Kujala UM et al. Heart attacks and lower limb function in master endurance athletes. Med Sci Sports Exerc, 199 July;31(7):1041-6. They followed 269 male orienteering runners (who were nationally ranked) for 11 years and compared them to 188 non-smoking male controls. The age adjusted odds ration was 0.15 (95% confidence interval of 0.03-0.67), P value 0.0059. They concluded that “In top level master endurance athletes having a long term training background and participating in competitive endurance sports, the risk both of heart attack and of lower limb disability is low.”
Not sure why the press latches on to articles that tout the negative effects of vigorous exercise. I have my thoughts but that is probably for another thread.
There is a group in Pittsburgh working on detecting potentially dangerous heart remodeling, versus adaptative remodeling. I have
started working with them, and we are looking specifically at identifying the potentially dangerous atrial fibrillations (that are initially
identified as lone) versus those that are innocuous.
Anyhow, there is a lot to do in this field, but my gut feeling is that it is going to be very difficult to establish a causal link. Of course, I’m a bit biased.
I don’t want a causal link between long endurance events and heart damage 
This just in, new report says that no exercise will damage heart, make you fat and lead to numerous other disesases
Take your pick!
this here being the key:
"The cardiac MRI findings agree with those reported earlier this year for a group of long-time marathoners. It may well be that there is some subgroup of endurance athletes who are susceptible to heart damage over the long term that manifests as fibrosis of the heart muscle itself. "
This could well be the case even assuming the accuracy of the studies cited further down in this thread. Even if the impact on the overall population studied is positive, there may be some subgroup for which it is negative, so the important thing is determining if that is in fact the case and if so figuring out how to identify the subgroup.
Another point that should not be overlooked is that one could have an impact that does not reduce the quantity of life (longevity) but does impact quality of life. In other words, longevity studies are not the only thing that matters in the analysis.