Training Hard (Probably) Won’t Kill You
I recently re-read the Wall Street Journal article, “One Running Shoe in the Grave”. If you haven’t read it, I encourage you to read it, and then I strongly urge you to read Alex Hutchinson’s response to the article on RunnersWorld.com. The gist of the WSJ article is that some scientists believe that too much exercise – particularly higher-intensity exercise – can diminish or eliminate the expected health benefits of aerobic exercise by damaging the heart and increasing your risk for premature death. Their advice, therefore, is for athletes past the age of 50 to cut their mileage to 20 miles a week or less, and/or run at a pace slower than 8mph (7:30 min/mile pace).
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The research cited in the articles above used running as the method of stressing the body, but the scientists and doctors from the WSJ article seem to infer that it’s not running, per se, but rather high-intensity training (high heart rates, high level of metabolic stress) that can damage the heart and potentially lead to cardiac abnormalities, including coronary artery calcification and atrial fibrillation (a type of arrhythmia). That would mean that cyclists and triathletes who utilize high-intensity interval training would also be at increased risk.
Both articles also talk about “agendas” and point out that both sides of this argument – the cardiologists warning against the dangers of too much exercise, and the scientists and endurance athletic community questioning their conclusions – have agendas. I would agree, and I think Alex Hutchinson did a good job of promoting the endurance sports community’s agenda. In the endurance sports community we promote the idea that aerobic conditioning improves health and reduces a person’s risk factors for cardiovascular disease, Type II diabetes, metabolic syndrome, and a host of other chronic illnesses. We also believe that the negative impact of inactivity puts people at a far greater risk of premature death than moderate or even extremely high levels of activity.
Can high-intensity exercise sometimes lead to cardiac events? Both research and anecdotal evidence indicates that it can. In face, over the past 15 years CTS has coached more than 12,000 thousand athletes and a handful of those athletes have developed atrial fibrillation. Was it directly caused by training? I don’t know. The athletes I know of were successfully treated using electrical cardioversion or catheter ablation, and they returned to training and competition. A few other athletes discovered and were treated for cardiac abnormalities that were deemed to be congenital defects. In those cases, the increased workload of training brought their conditions to the attention of their cardiologists, and one could argue that those conditions – if left undiscovered and untreated – could have otherwise led to premature death.
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What does all of this mean for you, especially if you’re my age (54) or older? Well, I’m not a doctor and I’m certainly not going to tell you to just ignore the possibility that high-intensity exercise could lead to a cardiac event. But as an athlete and coach who has been involved in endurance sports for more than 40 years and worked with competitive athletes ranging from teenagers to septuagenarians, I’d urge you to keep articles like the one in the WSJ in perspective. For the vast majority of our increasingly-obese population, more exercise and more intense exercise is a good choice. Even for the majority of athletes, the realistic chance of suffering a cardiac abnormality from high-intensity training is remote. But, if you have a history of heart disease in your family or you had relatives who died from sudden cardiac events (heart attack, stroke) at relatively young ages, then a conversation with your cardiologist about your personal risk factors would be prudent.
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I realize I’m biased because I believe in the power of fitness, but neither the evidence cited in the WSJ article nor anything else I’ve read has convinced me that intense training puts healthy athletes at a substantially greater health risk than moderate-intensity training. On the other hand, there’s overwhelming evidence that being inactive (lower training workload, lower caloric expenditure) leads to weight gain, increased risk of Type II diabetes, increased risk of heart attack and stroke, hell – even increased risk of erectile dysfunction!
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But let’s be honest, we can achieve the health benefits of aerobic exercise without training for criteriums, mountain bike stage races, marathons or Ironman triathlons. Athletes set goals and work to achieve them because it’s fun, it makes us feel good, and being an athlete is an important part of our social network and our identity. For many athletes the health benefits are an added bonus, not the primary reason for being active. For me, the bottom line is quality of life, and being an athlete has and will continue to enhance the life I have in the (hopefully many) years I have left.
Chris Carmichael
CEO/Head Coach of CTS
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Comments 21
I see by the date stamps I’m late in the conversation but I want to add my experience. I was a competitive swimmer in High School and college. I then transitioned to triathlons and 10k’s. Once kids entered the picture transitioned to running, 30-45 miles/week. At the age of 52 I was diagnosed with a-fib. Three different cardiologist said that it was most likely due to the decades of intense endurance training. There were no there structural issues with my heart. I was not able to tolerate the meds and so two years and two ablations later I am back in great shape and I exercise daily in moderation. I run very little and I am quite content. The exercise did not kill me but I do believe that it caused my a-fib. The operative phrase was decades of intense endurance training. When I went in for my second ablation the nurse told my wife that they see a steady flow of men in their late 40’s and early 50’s that are in great shape coming in for heart ablations.
Two doctors with great credentials are basically polar opposites on this.
Mercola and Maffetone.
And both have the studies and examples to prove their positions.
I can find article after article taking both sides of the interval or steady state
debate.
So who’s right?
Read the article in the Thirsday, 10/30 New York Times on runners over 80 years old who are competing in the New York City Marathon. Amazing. But, training “hard” all the time will just leave you overtrained and stale. There is a difference between being consistent about training and being overly “compulsive”. Go hard when there is a good reason to go hard, and enjoy the majority of your training time at moderate levels, focusing on form, technique and skills. Give your mind something else to think about other than how high you can get your heart rate, or how many watts you can push. You might just end up going faster with less effort.
I believe I have always had a heart abnormality that was finally captured during my increase in physical activity at age 50. As I started cycling and increased intensity my heart rate monitor picked up these abnormalities and was diagnosed with Afib. Underwent Cryo ablation which partially worked then did a second radio frequency ablation six month later to burn a few errant electrical signals.
I have now never felt better and can work at a higher intensity. The best news is that if I foun this at 60 I may not have been a candidate for ablation and would have to use drugs to control and avoid stroke.
Slower than a 7:30 pace? I was hoping to build up to an 11min pace by the end-of-this-year, and I’m years away from 50. I think the article would be better talking about what % of your max heart rate you should be pushing at what age. Also, I’m less worried about having a cardiac episode from high intensity training than I am about hurting my knees or feet as I age.
As someone who experienced SCA (Sudden Cardiac Arrest) and who also trained and rode more than 13,000 miles per year (did that for about 15 years in my 40’s and 50’s; in my teens, 20’s and 30’s I was a competitive swimmer, training daily), my view is that the subject of overtraining and damage to the heart is certainly a highly individualized topic, and one that requires actual testing to know whether or not a person is at a low or enhanced risk. While Mr. Carmichael’s experience has been that most of those he’s trained have not been adversely affected by HIT, that sort of observational data may not be relevant for the next person.
The day I experienced Sudden Cardiac Arrest (SCA) in July 2012, I was in what I thought was the best shape of my life: Riding faster than I had in prior years, my weight was down, and I was feeling strong and fit. I had just finished an uneventful quick 30 mile training ride. I was sitting at my desk when (I am now told) my heart went into Ventricular Fibrillation (VFib). Within seconds, I lost consciousness and my heart literally stopped. Four employees in my office gave me CPR for 14 minutes until the paramedics arrived. The EMT’s shocked me three times, got me in an ambulance and took me to the nearest hospital where, three days later, I had an ICD implanted in my left upper chest.
The doctors concluded that as a result of years of HIT and endurance riding that over time scar tissues had developed on parts of the mitochondrial tissues in my heart, which eventually led to an irregular interruption of the electrical circuits in my heart (it’s called “reentry circuits, and essentially what happens is that the electrical signal from the heart’s natural pacemaker hits the scar tissue and instead of traveling downward to stimulate the heart muscles’ regular rhythmic pumping action, the circuit gets interrupted by the scar tissue, traveling around and around in a sort of “rentry loop”).
This is far more common than one might think, and many of the published studies which are referenced in the WSJ article to which Mr. Carmichael alludes demonstrate that point.
I say this not as someone with any agenda, but as someone who has been on both sides of this issue, as an athlete and as someone who has experienced first-hand the potential downsides and risks of HIT and being an endurance athlete. In my view, it makes no sense to generalize about whether “most’ athletes are or are not at risk. This is a highly individualized thing, and the only way to know or to evaluate the risk, even if you’ve never experienced any symptoms, is to undergo at least the bare minimum of testing, which includes getting an EKG if you’re going to embark on a training program. A coronary calcium screening is also a good place to begin.
From my perspective, it makes no sense to minimize the risks that HIT presents to some people. Lifestyle and “quality of life” are vitally important, but so is remaining alive. If anyone has experienced arrhythmias (usually AFib, but sometimes SVT or other dangerous heart rhythms), I would urge you to get tested– and to see a cardiologist regularly– before just dismissing your symptoms and saying that “quality of life” is more important. You may continue to be lucky and never experience any adverse event or condition…..or you may not. Get screened, see a cardiologist regularly, and by all means, learn CPR because it could just save your training partner’s life if they have an unforeseen cardiac event.
BTW, I still ride, just slower and less often, take beta blockers (which has reduced my speed and endurance), but my quality of life is just fine, and I am thankful for every day I’m here.
I am a 68 yr old life long endurance athlete. First as a competitive runner and then as an avid cyclist I have done hard intervals for over 50 years.
I developed a pretty severe heart arrhythmia three years ago. After consulting with my cardiologist (an a whole battery of tests including a heart MRI) nothing serious was found and I never lost any training time. By restricting the amount of caffeine and paying particular attention to hydration I have the arrhythmia under control.
I found this article very interesting, Not sure, nor was my cardiologist, that the training had anything to do with the condition other than triggering an on-set. Bottom line is I continue to do intervals and do not feel restricted by the condition.
60 and going strong. For those of us who like to push ourselves we know the benefits. Here’s an apt quote I came across recently:
“When there is no peril in the fight there is no glory in the triumph.”
Pierre Corneille
Here’s to triumph.
Great responses here! Compartmentalizing is easy, but knowing takes time. After all, it is your body and you, better than anyone, know how you feel. However, as a 60 year old woman, still trying to challenge myself and improve, it is a bit disappointing that there isn’t more data/research on older women and their abilities/potential.
About 3 years ago while training with CTS and at age 60 I began to develop episodes of SVT (tachycardia) to rates up to 220. This only happened when I was at aerobic threshold but was very intermittent. I wore an EKG monitor for a month while riding before bringing the strip to my cardiologist. Although not a candidate for ablation, I now take a beta blocker before riding which has cut my threshold and power by about 10%. However I still ride with the hammerheads but do not race anymore. Apparently the SVT was like a mutant stress test; the fact that I had no symptoms or EKG changes showed my heart is in great shape.
Perhaps had I ignored it, or let it run for very long periods, or had underlying heart disease this would have been an issue. Maybe some of us type A athletes who ignore warnings or did not have a healthy lifestyle when younger and do have pre-existing conditions are skewing the studies. In my case I do not intend to stop cycling hard!
Ben,
I’m curious how your SVT’s resolved when you had them? The normal way for people who know about the issue is to “bear down” really hard or make themselves cough and in the back of the ambulance medics can use Adenosine but it’s a bit uncomfortable for the patient.
I have been a recreational road cyclist for the past 18-20 years. Formerly I was a (not very fast) endurance runner. Took up cycling when I realized that I could recover faster from hard cycling efforts vs. running. In 2010, I developed chest pains while cycling on a 30 mile training route. Family genetics was against me regarding heart disease (I was 56 then 60 now). All my labs were good but I soon learned and actually observed that I had three completely blocked coronary arteries. I underwent bypass surgery and am now cycling faster and more enjoyably than I have in years!
I have engaged in a high intensity, short duration exercise routine on a trainer when I cannot ride outside. This has resulted in a way to improve fitness and is not boring. My cardiologist told me that as long as I am not in discomfort, I can go as hard as I want (or am able) to manage. I think the key as noted above is to truly LISTEN to your body and not ignore signals that your body sends. It also helps to have a persistent spouse/partner to assist you in seeking proper attention.
Discomfort? Im not sure what this means in the context of high intensity, these intervals hurt, almost by definition they cause discomfort, OTH, if theres discomfort even before getting to the high intensity point, then I usually stop and this is what I consider (maybe incorrectly) listening to my body and hearing the “not today” message. Under these circumstances high intensity is self limiting anyway, the ability to hit the target (power levels) is simply not there, yet the sensation of ‘going hard’ remains.
While I have limited experience it appears in my casual observation that many coached endurance athletes work out very differently from the uncoached endurance athletes. I see a lot of “self coached” Type A people who just pound it hard most days doing similar routines.
It would be interesting to see if this creates different results for each population.
CTS has a very valuable dataset for Older / Coached / Endurance athletes.
Does CTS have any grad students looking for a great thesis?
Could article Chris on an interesting debate. My view on this is that perhaps like with most “studies” on human behavior, they never seem to address the underlying reason/s for a person pushing themselves to achieve that may in fact be the real underlying cause of the problem. Reasons for example like: fear of failure and not being good enough; the need to prove themselves; to be a winner; to be successful; to be the best; to satisfy the adrenalin need; etc … I’m sure you get what I mean. Driven by these needs the person will more than likely refuse to listen to what their body is telling them – a situation further compounded by advocating beliefs such as, “your body is stronger than your mind; your mind will give up before your body …etc.”
The reasons I mention above are elements which I find missing from most research results like this case in point, or other like smoking, drinking, sex and relationships or whatever. Research and/or researchers don’t ever seem to explore and identify a subject’s (tested) underlying emotional needs that are driving them.
Perhaps therefore it could well be that the damage caused to the heart and body as reported/referred to in the WSJ article is the accumulation of repetitive “pushes” by a person when the body was instead saying “not today; or, not so long today; or, not so hard; or, I am not feeling well today, don’t train.. etc.” I have yet to see research results where these factors are considered and taken into account about the subjects being tested.
As a 60+ recreational road cyclist putting in an average of 8-10hrs a week training including high intensity, there are days when I am quite happy to listen to my body and flop on the couch instead of getting on my bike or in the gym. And if that results in my finishing a 100K race 20 min slower .. what the hell, who else really cares other than me. This however may be what makes my training that more enjoyable and perhaps extend my longevity all other things being equal – but may never be able to be proven scientifically or through research analysis.
From South Africa – happy training and riding fellow roadies … stay healthy and LISTEN to your body :-))
“finishing a 100K race ” In my opinion, this is where the fallacy begins. It is NOT a race; it is not about being first, but being last.
Mental toughness and listening to your body are difficult to reconcile for me. I just turned 63 and plan to continue my multisport lifestyle including doing intervals is all 3 sports. The greater danger is in sitting at home.
I am 50 and have been an endurance athlete most of my life. When I was 44 I was diagnosed with AFib (mucb younger than the average age for Afib). They tried catheter ablation, but without success. I still go into Afib occasionally, but I can get myself out of it. I was ok’d to train again by my doc and I’m back racing masters. My father was a Marathon runnER and developed Afib as well. They don’t really understand the endurance training or genetic components of Afib or SVT. All I know is I feel that I’m a much healthier person overall than if I lived my life as a sedentary person
http://www.multibriefs.com/briefs/acsm/active10-28.htm
CVD – cardiovascular disease
You nailed it in the last sentence…quality of life. I think most of us who are truly active would rather die at 75 fit, healthy, and still on our bikes than 80 and couch potatoes! 🙂 Hopefully neither of those things happen though! 😉
Over 70 and still training hard and have been for a number of years. What is hard? I was doing hill repeats yesterday reaching >95% Max HR. I have been more worried about my joints than my heart, though no major problems there either. Touch wood.