Endurance exercise and coronary artery disease

[PeteD01]

This study is probably going to pop up in the lay press because of the surprising finding that highly trained (11 hrs per week) lifelong endurance athletes had worse coronary plaque/calcification than moderately fit subjects with a healthy lifestyle.

There is one problem with this study: there was no adjustment for diet.
Unfortunately, high level endurance athletes often eat a rather crappy diet, be it all the sugar gels/drinks/candy bars, or simply large amounts of processed foods to meet their caloric needs more easily.

I have known quite a few highly trained athletes over the years and the stuff that is marketed to them and what they consume is pretty terrible in many cases.
I turned myself into a fat burner about 15 yrs ago because I started to become concerned about the massive amounts of starch I tended to eat and on top of that I used to fuel myself with diluted (1:2) Mountain Dew on long bike rides.
I couldnīt even ride for more than an hour or two without this stuff. It was not easy in the beginning but after a year or so it got better and I also lost 2 inches waist circumference (I wasnīt overweight, it went from 34 to 31/32").
And I didnīt even go for all the protein shakes/gels/bars etc., all that ultraprocessed stuff that others consumed all the time.
 
So I believe there is a potential confounder here by not controlling for dietary factors. And what makes it even worse is that there is most likely a positive correlation of the amount of exercise with the amount of junk consumed, which would mean that the most intense exercisers have the highest junk intake. So if the diet had an effect, it would show up in the otherwise fittest athletes the most - which is exactly what the study shows.

I consider this study inconclusive as it might simply illustrate the old saying: you canīt out-exercise a bad diet.

Endurance Exercise Tied to More Coronary Atherosclerosis
Sue Hughes

March 10, 2023

The suggestion that long-term endurance exercise may lead to a paradoxical increase in coronary atherosclerosis has been raised again by a new study.

In the Master@Heart study, lifelong endurance athletes had more coronary plaques, including more noncalcified plaques, than fit and healthy individuals with a similarly low cardiovascular risk profile.

The study was presented at the recent American College of Cardiology (ACC) Scientific Session/World Congress of Cardiology (WCC) 2023 on March 6.

It was also simultaneously published online in the European Heart Journal.

"We consistently see higher plaque burden in lifelong endurance athletes. This is regardless of the plaque type, whether it is calcified, mixed, noncalcified, in the proximal segment or causing more than 50% stenosis," concluded Ruben De Bosscher, MD, Catholic University of Leuven, Belgium, during his presentation.



https://www.medscape.com/viewarticle/989475?ecd=WNL_trdalrt_pos1_230314&uac=172418FT&impID=5246376#vp_1

[Philociraptor]

PTF, I've recently started running a couple times a week at the age of 33. Not going very far, about 2 miles each session so far, but if I ever increase the distance diet might need to be taken into consideration.

[TreeLeaf]

Based on this study, you seem pretty positive diet is the causal mechanism at play that is showing the observed effect.

How do you know the increased coronary plaque isn't the result of exercise induced inflammation, or increased exposure to air pollution, or some other unknown factor?

Why are you so sure the causal mechanism is one's diet?

[brandon1827]

Also PTF

I've been running half marathons for around 12 years. I've done well with dietary issues at some points during those years and done poorly with dietary at other points. I've always undertaken exercise to offset my family history for heart problems...so this news is troubling to say the least

[PeteD01]

Based on this study, you seem pretty positive diet is the causal mechanism at play that is showing the observed effect.

How do you know the increased coronary plaque isn't the result of exercise induced inflammation, or increased exposure to air pollution, or some other unknown factor?

Why are you so sure the causal mechanism is one's diet?

I did not say anything to that effect.
There is a big difference in saying that a variable that is unaccounted for could cause the results to look like they do vs proposing that the unaccounted variable is what cause the results to look like they do.
Iīm saying that there is a potential major confounder that unfortunately would be able to provide a rationale for the results if strong enough.
The problem is that the confounder (diet) would cause an error in the direction of the findings and that is a problem if the impact of that variable is not quantifiable.
That is very different from saying that diet is a causal factor - but it might be.
The impact is simply unquantifiable and that makes the study results inconclusive.

[GuitarStv]

I thought it was pretty well established at this point that the more extreme end of endurance stuff is pretty bad for your heart?  Doing something like running a marathon at a decent pace is very hard and damaging to the body - full stop.  At one point I was cycling 140 km each Saturday morning.  Personally, I feel radically better when limiting my rides to 100 km and under.


With extremely long distance cycling I find that I tend to eat crappier foods than when I'm training in boxing or BJJ.  The latter has strict weight limits, and (while very intense) doesn't seem to burn as many calories as being on the bike for 6 hours.  For fighting sports I end up eating very, very clean.  On a long ride, I usually need to eat around 6000+ calories to maintain my body weight . . . and that's very hard to actually fit in my stomach without lots of carb heavy calorie dense foods.  But even with the occasional whole pizza, big bowl of pasta when I get back and some cliff bars / gatorade on a ride I tend to lose significant weight over a summer when cycling heavily.

[TreeLeaf]

Also PTF

I've been running half marathons for around 12 years. I've done well with dietary issues at some points during those years and done poorly with dietary at other points. I've always undertaken exercise to offset my family history for heart problems...so this news is troubling to say the least

I wouldn't worry too much about it if you are a submarathon runner. There are other studies showing a reverse j shaped curve for endurance exercise and heart disease, where the risk of too much exercise only starts with the marathon runners.

Source:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543495

[PeteD01]

I thought it was pretty well established at this point that the more extreme end of endurance stuff is pretty bad for your heart?  Doing something like running a marathon at a decent pace is very hard and damaging to the body - full stop.  At one point I was cycling 140 km each Saturday morning.  Personally, I feel radically better when limiting my rides to 100 km and under.
...

Thatīs true but the problem with this paper is that the highly trained endurance athletes were not all crazy triahletes or other ultra-endurance athletes.
They were training on average 11 hours/week which isnīt that much actually.
I did that easily at some points just running around in the mountains with my dogs every day.
Hill centuries (biking 100 miles) was the most Iīve ever done.
So this is much more concerning than the known negative effects of excessive exercising on extreme endurance athletes.

[TreeLeaf]

Based on this study, you seem pretty positive diet is the causal mechanism at play that is showing the observed effect.

How do you know the increased coronary plaque isn't the result of exercise induced inflammation, or increased exposure to air pollution, or some other unknown factor?

Why are you so sure the causal mechanism is one's diet?

I did not say anything to that effect.
There is a big difference in saying that a variable that is unaccounted for could cause the results to look like they do vs proposing that the unaccounted variable is what cause the results to look like they do.
Iīm saying that there is a potential major confounder that unfortunately would be able to provide a rationale for the results if strong enough.
The problem is that the confounder (diet) would cause an error in the direction of the findings and that is a problem if the impact of that variable is not quantifiable.
That is very different from saying that diet is a causal factor - but it might be.
The impact is simply unquantifiable and that makes the study results inconclusive.

There are actually a lot of studies showing these sorts of effects from long duration endurance exercise.

You can throw them all out if you want to because they don't account for diet.

Or you can look at what the studies are saying is the statistically optimal amount of exercise and act accordingly, while acknowledging we don't really know what the causal mechanism is yet for increased plaque in ultra endurance athletes.

Your choice.

[PeteD01]

Based on this study, you seem pretty positive diet is the causal mechanism at play that is showing the observed effect.

How do you know the increased coronary plaque isn't the result of exercise induced inflammation, or increased exposure to air pollution, or some other unknown factor?

Why are you so sure the causal mechanism is one's diet?

I did not say anything to that effect.
There is a big difference in saying that a variable that is unaccounted for could cause the results to look like they do vs proposing that the unaccounted variable is what cause the results to look like they do.
Iīm saying that there is a potential major confounder that unfortunately would be able to provide a rationale for the results if strong enough.
The problem is that the confounder (diet) would cause an error in the direction of the findings and that is a problem if the impact of that variable is not quantifiable.
That is very different from saying that diet is a causal factor - but it might be.
The impact is simply unquantifiable and that makes the study results inconclusive.

There are actually a lot of studies showing these sorts of effects from long duration endurance exercise.

You can throw them all out if you want to because they don't account for diet.

Or you can look at what the studies are saying is the statistically optimal amount of exercise and act accordingly, while acknowledging we don't really know what the causal mechanism is yet for increased plaque in ultra endurance athletes.

Your choice.

Did you read what I wrote?

The issue is that the study subjects were not ultra-endurance athletes.
We of course know that those have increased risks.

Iīm in no way an ultra-endurance athlete and I have regularly met or exceeded the criteria that were used to categorize the athletes as "highly trained".

That is what is concerning about the findings - they apply to a larger population than ultra-endurance athletes who definititely have negative effects from excessive exercise.

And that is the issue, the study seems to suggest that negative effect of exercise happen at lower exposure levels - we are talking about 660 minutes/week.

In other words, the research showing cardiac issues with extreme levels of training has never applied to me, or so I thought, but this study appears to show that it did apply to me and would, by extension, apply to a lot more people.

[chevy1956]

And that is the issue, the study seems to suggest that negative effect of exercise happen at lower exposure levels - we are talking about 660 minutes/week.

In other words, the research showing cardiac issues with extreme levels of training has never applied to me, or so I thought, but this study appears to show that it did apply to me and would, by extension, apply to a lot more people.

I assume that this only applies when doing longer endurance type activities. So running or biking. So I assume exercise like for instance playing basketball or wrestling or soccer for instance wouldn't have the same negative effect.

I think your comment on diet is also relevant. It's such a huge part of your physical health. My FIL has always calorie counted to stay below a certain weight and he is pretty active. He has had several issues with his arteries being clogged. He doesn't care if he eats 10 brownies all day for instance if that keeps his calorie requirements below his targeted calories per day. He had an incident a couple of years ago and ended up in hospital. His doctor pushed for him to eat much more plant based.

[PeteD01]

And that is the issue, the study seems to suggest that negative effect of exercise happen at lower exposure levels - we are talking about 660 minutes/week.

In other words, the research showing cardiac issues with extreme levels of training has never applied to me, or so I thought, but this study appears to show that it did apply to me and would, by extension, apply to a lot more people.

I assume that this only applies when doing longer endurance type activities. So running or biking. So I assume exercise like for instance playing basketball or wrestling or soccer for instance wouldn't have the same negative effect.

I think your comment on diet is also relevant. It's such a huge part of your physical health. My FIL has always calorie counted to stay below a certain weight and he is pretty active. He has had several issues with his arteries being clogged. He doesn't care if he eats 10 brownies all day for instance if that keeps his calorie requirements below his targeted calories per day. He had an incident a couple of years ago and ended up in hospital. His doctor pushed for him to eat much more plant based.

I donīt think that we are at the point to be able to differentiate the effects of different forms of exercise - there is just no data. It seems that we are locked into accounting for all forms of exercise by simply adding up the minutes.

The issue is that the study results suggest that the known negative effects start at much lower levels of training than expected.

Now I do know for sure that when one exercises at a decent pace for more than ten hours per week, one starts to think about nutrition.
So, we are talking about a level of exercise that is far below of the triathlete/ironman level but which leads many to start using ultraprocessed sports nutritional products and/or other junk food.
Iīve seen that and experienced it myself and extracted myself from it with some difficulty. 

It all may come to that it is important WHAT one eats with the calories a secondary concern (or none at all; my crazy cravings went away after switching to fat burning).

The key is that the study does not take into account that athletes exercising for around 11 hours/week, and who are trying to meet their needs with easily digested carbs, often end up with eating a lot of crap.
I canīt quantify any of it but I have experienced it. I would never have touched Mountain Dew or any other soft drinks until I figured out that it kept me fueled during long mountain bike rides.

The bottom line is that we know that at levels of exercise the highly trained group is engaged in, nutrition is not something one cannot pay attention to.
And there it is where poor decisions can be made and the industry is marketing heavily towards that exercise enthusiast crowd with mostly cheap ultraprocessed junk.

Given all this, the conclusion to discourage endurance exercise at 11 hours/week is not warranted based on this study.
That does not mean that one cannot draw any conclusion from the study.
I would say that there are reasons to doubt that the volume of exercise is the driving factor of the higher coronary scores and that thsi conclusion requires more and better evidence.
But there is a conclusion based on common sense: we have ample evidence that certain foods are detrimental to our health; we also know that exercise ameliorates some of the deleterious effects of poor quality nutrition; we do not have reason to believe that exercise completely eliminates all the negative effects of poor quality food - in fact, common sense says that this would likely be a foolish notion.

In conclusion, continue to exercise for 11 hours/week and eat well - the study does not support cutting back on exercise, not at all.

[chevy1956]

But there is a conclusion based on common sense: we have ample evidence that certain foods are detrimental to our health; we also know that exercise ameliorates some of the deleterious effects of poor quality nutrition; we do not have reason to believe that exercise completely eliminates all the negative effects of poor quality food - in fact, common sense says that this would be likely a foolish notion.

In conlusion, continue to exercise for 11 hours/week and eat well - the study does not support cutting back on exercise, not at all.

Good feedback. Thanks.

[PeteD01]

Youīre welcome.

[TreeLeaf]

Based on this study, you seem pretty positive diet is the causal mechanism at play that is showing the observed effect.

How do you know the increased coronary plaque isn't the result of exercise induced inflammation, or increased exposure to air pollution, or some other unknown factor?

Why are you so sure the causal mechanism is one's diet?

I did not say anything to that effect.
There is a big difference in saying that a variable that is unaccounted for could cause the results to look like they do vs proposing that the unaccounted variable is what cause the results to look like they do.
Iīm saying that there is a potential major confounder that unfortunately would be able to provide a rationale for the results if strong enough.
The problem is that the confounder (diet) would cause an error in the direction of the findings and that is a problem if the impact of that variable is not quantifiable.
That is very different from saying that diet is a causal factor - but it might be.
The impact is simply unquantifiable and that makes the study results inconclusive.

There are actually a lot of studies showing these sorts of effects from long duration endurance exercise.

You can throw them all out if you want to because they don't account for diet.

Or you can look at what the studies are saying is the statistically optimal amount of exercise and act accordingly, while acknowledging we don't really know what the causal mechanism is yet for increased plaque in ultra endurance athletes.

Your choice.

Did you read what I wrote?

The issue is that the study subjects were not ultra-endurance athletes.
We of course know that those have increased risks.

Iīm in no way an ultra-endurance athlete and I have regularly met or exceeded the criteria that were used to categorize the athletes as "highly trained".

That is what is concerning about the findings - they apply to a larger population than ultra-endurance athletes who definititely have negative effects from excessive exercise.

And that is the issue, the study seems to suggest that negative effect of exercise happen at lower exposure levels - we are talking about 660 minutes/week.

In other words, the research showing cardiac issues with extreme levels of training has never applied to me, or so I thought, but this study appears to show that it did apply to me and would, by extension, apply to a lot more people.

I mean - your theory is fairly sound. Endurance athletes have to get the extra calories they are burning from somewhere, and they often do this by eating carbs for fuel.

My point is that this is a correlation study. You said yourself that the study does not take diet into account. I know there are plenty of studies linking specific diets with heart disease risk.

Implying that diet "would cause an error in the direction of the findings" as you state above also implies that you know that diet is...partially causing the effects. Does it not? You even used the word "cause" in your statement.

My point is you don't KNOW this is true, based on this study, precisely because diet is not accounted for in this study.

You have a theory. You could be right. You could be wrong. You could be partially right and diet is partially causing the effects.

I also have a theory - that the results are driven by several things. Part of this is diet, but part of this is also exercise induced inflammation. A very small part is also simply inhaling more air pollution. There are various studies linking all of these things to heart disease risk.

Are you correct? Or am I correct?

You can decide. Either way this study doesn't support either of our theories.

My conclusion from reading these sorts of studies is to limit intense cardio exercise (heart rate zone 3-5) to around 60-90 minutes per day and to eat a healthy diet if longevity is your goal.

Coincidentally this is the same advice my triathlete coach told me as well...which to me says this is fairly common knowledge.

Too much exercise is not good for you but so few people have this sort of problem it almost doesn't make sense to point this out to the general population.

Also - the dose dependent effect of exercise is a reverse J shaped curve. Too much exercise might be mildly bad for your calcium score but not getting any exercise at all is horrible for your risk of developing heart disease, hypertension, cancer, strokes, diabetes, etc, etc.

Honestly I normally don't even tell people to limit their exercise. Odds are if someone is doing cardio exercise over 90 minutes per day on average they are some sort of competitive athlete, and are likely receiving professional advice about heart rate levels, exercise duration, recovery time for a given exercise or event, diet, etc, and might even be aware of the risks of their given sport.

This just isn't something most people need to worry about.

[NaN]

I did that easily at some points just running around in the mountains with my dogs every day.

That's being an ultra distance trail runner if you are easily doing 11 hr/ week of running at a 8-10 min/mile clip through mountains. That's like how most of those ultra distances races are - just a fast jaunt through mountains. :) There is a difference between training and being active. If you were just walking fast I don't call that training.

[NaN]

I did that easily at some points just running around in the mountains with my dogs every day.

That's being an ultra distance trail runner if you are easily doing 11 hr/ week of running at a 8-10 min/mile clip through mountains. That's like how most of those ultra distances races are - just a fast jaunt through mountains. :) There is a difference between training and being active. If you were just walking fast I don't call that training.

Yeah but the races are usually 50 to 100 miles ;-). But training and competing are different so while I think training can be healthy (if you count running 50 or 60 miles a week in often hilly terrain as healthy) I don't always think competing those long distances in one shot is. But of course I love them and I get to eat all the cake I want afterwards!

I would call anyone running 50 to 60 miles in the mountains every week to be a endurance sport participant, as labeled by the study and correlating with ultra runners in the previous study. Maybe it is an identity issue on the athlete and less so that the paper result are more serious this time around. ;)

[PeteD01]

I did that easily at some points just running around in the mountains with my dogs every day.

That's being an ultra distance trail runner if you are easily doing 11 hr/ week of running at a 8-10 min/mile clip through mountains. That's like how most of those ultra distances races are - just a fast jaunt through mountains. :) There is a difference between training and being active. If you were just walking fast I don't call that training.

Yeah but the races are usually 50 to 100 miles ;-). But training and competing are different so while I think training can be healthy (if you count running 50 or 60 miles a week in often hilly terrain as healthy) I don't always think competing those long distances in one shot is. But of course I love them and I get to eat all the cake I want afterwards!

I would call anyone running 50 to 60 miles in the mountains every week to be a endurance sport participant, as labeled by the study and correlating with ultra runners in the previous study. Maybe it is an identity issue on the athlete and less so that the paper result are more serious this time around. ;)

I shouldn't have written "running" but brisk walking in steep to very steep hills and about 35-40 miles per week with three short submaximal/maximal efforts/day.
There were trail runners on the trails and I can assure you I was not one of them.

[PeteD01]

I canīt write a book about this so let me just point out why I even posted this and Iīve mentioned that in the OP.

The problem with this study is that it will likely appear in the lay press as more evidence that too much exercise is bad for you, and every couch potato will nod their head in agreement not noticing that too much of anything is bad for you - thatīs why we call it "too much".

Then some will say: well 11 hrs/week is too much, not taking into account that the subjects were lifelong endurance athletes. This translates into a decades long increased exposure to a western diet and likely high easily digestible carbs unless the athlete consciously altered the diet.

We know that diet and physical activity are the main factors by far when it comes to metabolic syndrome, obesity and diabetes type 2; and we also know that the typical western diet is producing these outcomes, which could be interpreted as the particular toxicity of this diet.

Lay people who are not into these subtleties will simply extract the message that exercising for 11 hrs/week can give you a coronary and if they hear that the subjects were not just exercising but training for endurance events, the message that exercise can be bad for you will get even stronger.
This is terrible because the increased coronary artery pathology associated with endurance athletes is likely due to the intensity and duration of their training as well as increased exposure to a known toxic diet and possibly other factors.

These are really problematic conclusions someone who is not familiar with the subject could draw from this
.

The real message is actually this:
 
1) Donīt train like a maniac for some competition if health and well-being is the goal. (or to put it more positively, you do not have to train like a maniac to reap the benefits)

2) Address dietary issues, especially if your physical activity starts increasing your caloric needs. The last thing you want is an increased exposure to a bad diet triggered by exercise.

3) Contrary to what the study seems to suggest, 11 hrs of physical activity/week, or in that ballpark, might actually be the optimal volume of variable intensity physical activity, unless you use the time to training for the next ironman.


In summary:
On the individual level, physical activity of varying intensity for 60-90 minutes/day combined with a decent diet will most likely help avoiding to become a victim of the ongoing metabolic epidemic.
On a population level, this level of activity combined with a decent diet would likely make diabetes type 2 once again a rare disease.

(Yes, I looked into this a few years ago. It looks like that populations that are nearly free of metabolic syndrome and its consequences have two characteristics: they donīt follow a western diet and physical activity is often an average of 1-2 hours a day. Yes, I was very surprised at these relatively low times spent being physically active. But mind you, this is still 3-6 times the official recommendation of 75-150 minutes/week depending on intensity)

[TreeLeaf]

I did that easily at some points just running around in the mountains with my dogs every day.

That's being an ultra distance trail runner if you are easily doing 11 hr/ week of running at a 8-10 min/mile clip through mountains. That's like how most of those ultra distances races are - just a fast jaunt through mountains. :) There is a difference between training and being active. If you were just walking fast I don't call that training.

Yeah but the races are usually 50 to 100 miles ;-). But training and competing are different so while I think training can be healthy (if you count running 50 or 60 miles a week in often hilly terrain as healthy) I don't always think competing those long distances in one shot is. But of course I love them and I get to eat all the cake I want afterwards!

I would call anyone running 50 to 60 miles in the mountains every week to be a endurance sport participant, as labeled by the study and correlating with ultra runners in the previous study. Maybe it is an identity issue on the athlete and less so that the paper result are more serious this time around. ;)

I shouldn't have written "running" but brisk walking in steep to very steep hills and about 35-40 miles per week with three short submaximal/maximal efforts/day.
There were trail runners on the trails and I can assure you I was not one of them.

I don't think this is something you need to worry about then, honestly.

Most of the literature I have read seems to indicate this only applies to endurance athletes (mostly runners) in higher rate rate zones for extended periods of time, like 11+ hours per week, especially when there is not enough recovery time. Brisk walking just isn't going to get the heart rate high enough to do any damage, imo.

I doubt what you were doing had any sort of negative impact on your cardiovascular health.

[TreeLeaf]

I canīt write a book about this so let me just point out why I even posted this and Iīve mentioned that in the OP.

The problem with this study is that it will likely appear in the lay press as more evidence that too much exercise is bad for you, and every couch potato will nod their head in agreement not noticing that too much of anything is bad for you - thatīs why we call it "too much".

Then some will say: well 11 hrs/week is too much, not taking into account that the subjects were lifelong endurance athletes. This translates into a decades long increased exposure to a western diet and likely high easily digestible carbs unless the athlete consciously altered the diet.

We know that diet and physical activity are the main factors by far when it comes to metabolic syndrome, obesity and diabetes type 2; and we also know that the typical western diet is producing these outcomes, which could be interpreted as the particular toxicity of this diet.

Lay people who are not into these subtleties will simply extract the message that exercising for 11 hrs/week can give you a coronary and if they hear that the subjects were not just exercising but training for endurance events, the message that exercise can be bad for you will get even stronger.
This is terrible because the increased coronary artery pathology associated with endurance athletes is likely due to the intensity and duration of their training as well as increased exposure to a known toxic diet and possibly other factors.

These are really problematic conclusions someone who is not familiar with the subject could draw from this
.

The real message is actually this:
 
1) Donīt train like a maniac for some competition if health and well-being is the goal. (or to put it more positively, you do not have to train like a maniac to reap the benefits)

2) Address dietary issues, especially if your physical activity starts increasing your caloric needs. The last thing you want is an increased exposure to a bad diet triggered by exercise.

3) Contrary to what the study seems to suggest, 11 hrs of physical activity/week, or in that ballpark, might actually be the optimal volume of variable intensity physical activity, unless you use the time to training for the next ironman.


In summary:
On the individual level, physical activity of varying intensity for 60-90 minutes/day combined with a decent diet will most likely help avoiding to become a victim of the ongoing metabolic epidemic.
On a population level, this level of activity combined with a decent diet would likely make diabetes type 2 once again a rare disease.

(Yes, I looked into this a few years ago. It looks like that populations that are nearly free of metabolic syndrome and its consequences have two characteristics: they donīt follow a western diet and physical activity is often an average of 1-2 hours a day. Yes, I was very surprised at these relatively low times spent being physically active. But mind you, this is still 3-6 times the official recommendation of 75-150 minutes/week depending on intensity)

Agreed.

These sorts of studies are probably not good for the lay person to read, honestly, because they might get some false idea that exercise is bad for them.

Exercise is so absurdly healthy for people, in so many ways, we really should not be discouraging it at all.

Even in these sorts of studies everything has to be viewed in context. It is ONLY heart disease risk that increases, and ONLY a mild increase, and ONLY in lifelong high intensity endurance athletes exercising 11+ hours a week (emphasis on +)

Even in this group all their other risk factors - cancer, diabetes, hypertension, strokes, etc are all lower. So overall I would argue they will still have better overall health outcomes than your average sedantary person.

[GuitarStv]

I don't think this is something you need to worry about then, honestly.

Most of the literature I have read seems to indicate this only applies to endurance athletes (mostly runners) in higher rate rate zones for extended periods of time, like 11+ hours per week, especially when there is not enough recovery time. Brisk walking just isn't going to get the heart rate high enough to do any damage, imo.

I doubt what you were doing had any sort of negative impact on your cardiovascular health.

There are tons of studies of the impact of endurance sports on heart health.  I haven't been able to find very many for extremely intense bursts of activity . . . like in a BJJ or boxing match you're going balls out for a 3-6 minutes - easily hitting max heart rate, then taking a short break and doing it again.  And again.  And again.  For probably 8 - 10 hrs a week on average.

I know that cycling long distance at hard tempo isn't all that great for me, but I can't imagine that the shorter/more intense workouts are really any better.  It wouldn't surprise me to find out that any sort of exercise where you are regularly pushing yourself is suboptimal.  My problem is that doing what's most likely the optimal exercise tends to be boring enough that I end up not continuing.  :P

[TreeLeaf]

I don't think this is something you need to worry about then, honestly.

Most of the literature I have read seems to indicate this only applies to endurance athletes (mostly runners) in higher rate rate zones for extended periods of time, like 11+ hours per week, especially when there is not enough recovery time. Brisk walking just isn't going to get the heart rate high enough to do any damage, imo.

I doubt what you were doing had any sort of negative impact on your cardiovascular health.

There are tons of studies of the impact of endurance sports on heart health.  I haven't been able to find very many for extremely intense bursts of activity . . . like in a BJJ or boxing match you're going balls out for a 3-6 minutes - easily hitting max heart rate, then taking a short break and doing it again.  And again.  And again.  For probably 8 - 10 hrs a week on average.

I know that cycling long distance at hard tempo isn't all that great for me, but I can't imagine that the shorter/more intense workouts are really any better.  It wouldn't surprise me to find out that any sort of exercise where you are regularly pushing yourself is suboptimal.  My problem is that doing what's most likely the optimal exercise tends to be boring enough that I end up not continuing.  :P

Well - to be fair I have mostly just read the runner studies because I am a runner. I just never got into cycling much because running shoes are cheap and the local trails are all for hiking/running and don't allow bikes.

If someone can point me to a study showing that brisk walking is bad for your heart health I would love to read it, because I do far more brisk walking than running. I have just never come across such a study.

ETA: In fact I do a lot of brisk walking just like the OP describes - miles and miles of walking through hilly trails in the woods. I seriously doubt this is bad for my heart health because my heart rate doesn't stay in elevated levels the whole time.

I am open to the idea I could be completely wrong though.

[jeninco]

I don't think this is something you need to worry about then, honestly.

Most of the literature I have read seems to indicate this only applies to endurance athletes (mostly runners) in higher rate rate zones for extended periods of time, like 11+ hours per week, especially when there is not enough recovery time. Brisk walking just isn't going to get the heart rate high enough to do any damage, imo.

I doubt what you were doing had any sort of negative impact on your cardiovascular health.

There are tons of studies of the impact of endurance sports on heart health.  I haven't been able to find very many for extremely intense bursts of activity . . . like in a BJJ or boxing match you're going balls out for a 3-6 minutes - easily hitting max heart rate, then taking a short break and doing it again.  And again.  And again.  For probably 8 - 10 hrs a week on average.

I know that cycling long distance at hard tempo isn't all that great for me, but I can't imagine that the shorter/more intense workouts are really any better.  It wouldn't surprise me to find out that any sort of exercise where you are regularly pushing yourself is suboptimal.  My problem is that doing what's most likely the optimal exercise tends to be boring enough that I end up not continuing.  :P

I'm not going to copy'n'paste for you, but if you do a search on "advantages of HIIT training", you'll get pages and pages of results from reliable sources.  I think as long as you're not injuring yourself (and, as I recall from your other postings, you're pretty good about stretching and working up to the higher-intensity stuff -- if it were me doing that much boxing, my calves would be screaming, for instance!) it's probably someplace on the "not bad for you" to "actually, quite good for you" end of the spectrum.

Thanks for the topic, @PeteD01 ! This was a cool read! Also, I concur -- 11 hours/week isn't all that much exercise (although I'm not yet fully retired enough to get there, I don't think... hang on, 4 hours of skiing + 2 hours of running, plus 1 hour HIIT class, plus 2 hours of lifting, ... hang on a sec...nope, I mostly walk otherwise. Phew!/sarcasm) especially if it's moderate intensity.

[wenchsenior]

I suspect one possible hypothetical cause of elevated heart risk associated with hard core aerobic exercise is that it could excessively raise cortisol for long periods, thus potentially increasing generalized inflammation, which in turn is associated with heart disease.

I recently did an admittedly brief trawl through PubMed looking for research on exercise types as relates to PCOS management. I did so b/c there's a recent inundation of 'influencers' online going on and on about how aerobic exercise is bad for PCOS.  This seems like hot nonsense on the surface, and I'm skeptical that it's true, but I try to remain open-minded.  The idea behind this is that excess cortisol can influence inflammation and reproductive hormone cycles, which logically likely is true. And, therefore, anything that increases cortisol must therefore be bad for PCOS.

But the problem is that most cases of PCOS are driven by insulin resistance that disrupts normal reproductive hormones; and as far I could find, there's little concrete research indicating what types of exercise are best for managing IR (beyond the generalized finding that some exercise is better than none, and if one has IR one should be sure to get regular exercise, of course). There's a bit of evidence that strength training might be slightly better than pure aerobics, but I didn't see anything concrete...it seems not remotely studied enough to draw conclusions. There is also a small subgroup of people with PCOS symptoms and no insulin resistance/healthy glucose-processing function...it's unclear if this is even the same disorder as 'typical' PCOS; but regardless, it is possible that THIS form of PCOS is in fact primarily driven by some problem with the adrenal and cortisol function and/or sensitivity. In those cases, perhaps it's true that anything more than gentle aerobic exercise could be problematic.

But for a more generalized 'healthy' population, what is defined as 'excessive' cortisol?  Presumably if exercise briefly increases cortisol levels, then longer harder exercise spikes it more/longer. So it's possible that marathoning, or Olympic caliber training, in certain sports does in fact create some generalized inflammation above and beyond what is optimal for the body (even in healthy people, let alone people with issues like PCOS) that could lead to heart problems.

But does this risk outweigh the many health benefits of more moderate regular exercise? I agree with Pete. I strongly doubt it.

[GuitarStv]

Elevated cortisol levels are a real bitch, and health impacts are not something to be discounted.

I used to do boxing drills from 6:00 - 7:00, then an hour and a half of hard sparring until 8:30.  I'd relax afterwards, lower my body temperature, hydrate (but not too much so I'd be up all night peeing), eat clean, avoid screens, and then slip into bed at about 12:00.  And then I'd get maybe an hour of sleep even though I was unbelievably exhausted.  Just every time I'd close my eyes, by brain would shock me back awake.  Then I'd have an easier day the next day, go to bed early, and sleep 10+ hours.  This went on for months.

Doctor said that it was because of cortisol (and norepinephrine) from the workouts.  You naturally have high cortisol levels in the morning and this tapers off during the day.  This hormone cycle is used to develop good sleep patterns.  When you perform very intense exercise, your body produces huge quantities cortisol and it can elevate well beyond what you would have even first thing in the morning.  Once sufficiently elevated this can easily take more than six hours to clear from your blood back down to levels that allow you to sleep.  There's no real way to stop this other moving your intense exercise sessions to early in the morning, which doesn't work for most boxing/bjj gyms.

Norepinephrine is released during intense activity (especially pushing your limits) and acts as a heavy stimulant.  It also radically impacts your ability to sleep for the worse.  Turns out you can actually clear some of this one by consuming a couple teaspoons of baking soda after the exercise.



Sleep alone is massively important for whole body health and mental acuity, and it's not uncommon for people involved in intense training to have problems with it.

[chevy1956]

Sleep alone is massively important for whole body health and mental acuity, and it's not uncommon for people involved in intense training to have problems with it.

I tend to sleep every afternoon after intense exercise for an hour or two so this point is interesting.

[GuitarStv]

Sleep alone is massively important for whole body health and mental acuity, and it's not uncommon for people involved in intense training to have problems with it.

I tend to sleep every afternoon after intense exercise for an hour or two so this point is interesting.

There are different nervous systems, different definitions of 'intense', different metabolisms, different overall approaches to things that probably all play into your chemical load and how it impacts you.  For a while I thought that this was maybe unique to combat sports (there's a big shock of adrenaline when you feel pain after getting popped in the nose that isn't exactly calming), but I've since read a lot about triathletes, ultra endurance runners, and cross fitters all experiencing the same.  It seems to be exacerbated by shifting drills/exercises regularly . . . if you're often doing similar activities your body gets used to it and the cortisol build up is lessened.

[PeteD01]

Alright, here is the latest discussion of the study and it illustrates nicely what happens when something like that study gets churned through the news cycle.
The discussion isn't even happening in the lay press yet and the results are already reported in a very misleading fashion.

The summary simply refers to the group of "lifelong endurance athletes exercising 11 hrs/week" as "lifelong exercisers".
So within a few days there is already a statement out saying that the study supposedly shows that lifelong exercisers have no better or worse health outcomes than healthy controls and those that start exercising later in life.



European Heart Journal published the provocative results:

Lifelong exercisers had a significantly higher CAC burden than controls, which confirms previous work.

Lifelong exercisers had a higher percentage of multiple coronary plaques, plaques ≥ 50%, and proximal plaques.

There were no significant differences in the mixture of plaque types in the three groups. About two thirds of the plaques in each group were calcified and the remainder were deemed noncalcified or mixed.

When looking only at noncalcified plaques, lifelong exercisers tended to have a higher prevalence of multiple plaques, plaques ≥ 50%, and proximal plaques.

So named "vulnerable" plaques were extremely infrequent in all three groups.


https://www.medscape.com/viewarticle/989417?src=FYE#vp_2

[chevy1956]

Sleep alone is massively important for whole body health and mental acuity, and it's not uncommon for people involved in intense training to have problems with it.

I tend to sleep every afternoon after intense exercise for an hour or two so this point is interesting.

There are different nervous systems, different definitions of 'intense', different metabolisms, different overall approaches to things that probably all play into your chemical load and how it impacts you.  For a while I thought that this was maybe unique to combat sports (there's a big shock of adrenaline when you feel pain after getting popped in the nose that isn't exactly calming), but I've since read a lot about triathletes, ultra endurance runners, and cross fitters all experiencing the same.  It seems to be exacerbated by shifting drills/exercises regularly . . . if you're often doing similar activities your body gets used to it and the cortisol build up is lessened.

Cool. I heard Khabib (superstar lightweight MMA fighter) talk the other day and he stated he typically had an afternoon nap as well. I wonder if the bolded part explains the need for sleep.

[poxpower]

Honestly this tracks pretty well with everything I know about health and longevity...
Watching Bryan Jonhson now. https://www.youtube.com/watch?v=j_AtQ6N4jQc&t=5089s

Health and longevity all seem about caloric restriction, intermittent fasting of some kind, high intensity resistance training and not being outside in the sun 15-20 hours a week like cat1/pro cyclists.

As someone who bikes 10-15 hours a week on average it's really making me question what the hell I'm doing at this point.

[wenchsenior]

Honestly this tracks pretty well with everything I know about health and longevity...
Watching Bryan Jonhson now. https://www.youtube.com/watch?v=j_AtQ6N4jQc&t=5089s

Health and longevity all seem about caloric restriction, intermittent fasting of some kind, high intensity resistance training and not being outside in the sun 15-20 hours a week like cat1/pro cyclists.

As someone who bikes 10-15 hours a week on average it's really making me question what the hell I'm doing at this point.

Didn't listen to the vid so I have no idea how sun plays in (skin cancer, presumably), but you will pry my sun exposure from my dead hands!  LOL.  In this case, I'm totally willing to give up a few extra years of life in exchange for optimal mental health (if I have no sun exposure for even 3 days, depression starts to flare severely and rapidly).   It's funny looking back at the 'eras' of my life in terms of mental health. The more sun, the better my mental state. It's not by any stretch the only thing that affects my emotional health, but it is unquestionably one of the biggest.

[jeninco]

Honestly this tracks pretty well with everything I know about health and longevity...
Watching Bryan Jonhson now. https://www.youtube.com/watch?v=j_AtQ6N4jQc&t=5089s

Health and longevity all seem about caloric restriction, intermittent fasting of some kind, high intensity resistance training and not being outside in the sun 15-20 hours a week like cat1/pro cyclists.

As someone who bikes 10-15 hours a week on average it's really making me question what the hell I'm doing at this point.

Didn't listen to the vid so I have no idea how sun plays in (skin cancer, presumably), but you will pry my sun exposure from my dead hands!  LOL.  In this case, I'm totally willing to give up a few extra years of life in exchange for optimal mental health (if I have no sun exposure for even 3 days, depression starts to flare severely and rapidly).   It's funny looking back at the 'eras' of my life in terms of mental health. The more sun, the better my mental state. It's not by any stretch the only thing that affects my emotional health, but it is unquestionably one of the biggest.

Sheesh, yeah. I grew up in a place where it's basically dark and gloomy from Nov - Feb or March, and it wasn't until I moved to a place that's sunny around 360 days/year that I realized I'm not naturally grumpy all danged winter.

[poxpower]

Didn't listen to the vid so I have no idea how sun plays in (skin cancer, presumably)

Yeah skin cancer and just general skin damage ( i.e. wrinkles/spots etc. ).
He's a super rich guy who's whole thing now is to spend as much time/effort/money as possible on stopping/reversing his aging and then sharing the results.

[wenchsenior]

Honestly this tracks pretty well with everything I know about health and longevity...
Watching Bryan Jonhson now. https://www.youtube.com/watch?v=j_AtQ6N4jQc&t=5089s

Health and longevity all seem about caloric restriction, intermittent fasting of some kind, high intensity resistance training and not being outside in the sun 15-20 hours a week like cat1/pro cyclists.

As someone who bikes 10-15 hours a week on average it's really making me question what the hell I'm doing at this point.

Didn't listen to the vid so I have no idea how sun plays in (skin cancer, presumably), but you will pry my sun exposure from my dead hands!  LOL.  In this case, I'm totally willing to give up a few extra years of life in exchange for optimal mental health (if I have no sun exposure for even 3 days, depression starts to flare severely and rapidly).   It's funny looking back at the 'eras' of my life in terms of mental health. The more sun, the better my mental state. It's not by any stretch the only thing that affects my emotional health, but it is unquestionably one of the biggest.

Sheesh, yeah. I grew up in a place where it's basically dark and gloomy from Nov - Feb or March, and it wasn't until I moved to a place that's sunny around 360 days/year that I realized I'm not naturally grumpy all danged winter.

I'm currently miserable at the trade-off of avoiding climate-related drought impacts in the Southwest, with having enough sun exposure to maintain good mental health in retirement. I mean, drought stresses me out a lot, but no sun ?probably? is going to stress me out more on a day to day basis. I honestly don't know what the best decision is.