Will Endurance Training Kill You? Perspectives on Velonews’ “Cycling to Extremes” Article

 

Last weekend I rode the 78-mile Copper Triangle event with my 11-year-old son, Connor. It was his longest ride ever, in mileage, elevation gain, and time on the bike. He did great and I loved sharing the experience and the day with him. As we both climbed Vail Pass with our hearts pounding away, I thought about the recent “Cycling to Extremes” article in Velonews and the questions people have been asking me about it. So, after consulting with cardiologists, cardiac surgeons, and electrophysiologists, here are some initial thoughts on the matter.

If you haven’t read the article, the quick summary goes like this: Some endurance athletes develop cardiac problems, including myocardial fibrosis (stiffening and thickening of the heart muscle), atrial fibrillation (an electrical problem that causes atria to quiver instead of pumping blood properly), or other types of tachycardia (an abnormally high heart rate that may feel like your heart is pounding or “skipping a beat”). The question is whether long-term participation in endurance sports increases an athlete’s risk for developing these conditions, and the article leans heavily in the direction that it does.

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This is obviously a cause for concern for many athletes. I’m almost 55 years old and I’ve been training and competing since I was 9. What did I do after reading the article? I went for a bike ride, complete with intervals, and I was far more worried about getting run over by a distracted driver than about potentially damaging my heart.

The physicians I’ve consulted since then generally agree with me. On balance, they believe the health benefits of exercise – including strenuous exercise – outweigh the risks of developing electrical or structural problems within the heart by a large margin. That’s not to say the risk isn’t there, but rather that exercise is only one of many factors that contribute – positively and negatively – to the health of your heart.

But that’s not really news. Everyone knows that some exercise is better for you than none, and for the people who read this blog and send me emails, the choice is not between their current training workload and nothing at all. You’re not going to hang up your wheels and just sit on the couch. What athletes are struggling with now, in light of this recent article, is the choice is between strenuous exercise and a more leisurely level of activity.

Here are a few things to consider:

Cardiac problems are extremely rare for CTS Athletes

In the past 15 years CTS Coaches have worked with more than 15,000 athletes. We are neither physicians nor medical researchers, but in that time we know of only a handful of athletes who have developed heart rhythm issues (AF, etc.), structural heart issues (fibrosis), or suffered a heart attack or stroke while exercising. How do we know? During an athlete’s coaching program, they have the opportunity to put a medical hold on their membership, and we ask them about their medical condition. When athletes stop working with CTS we ask why they are leaving. As part of our quality assurance program we also ask the coaches for information about athletes who cancel. The few athletes who have developed AF were open and eager to telling us, which leads me to believe other athletes would be similarly honest and forthcoming. Yet we are not seeing any increase in the number of athletes reporting arrhythmias or other cardiac problems.

CTS is probably one of the largest endurance coaching companies in the US. The vast majority of the athletes we coach are men between the ages of 40-65. Some have been training consistently for 30+ years and others are relatively new to endurance sports. All of them do interval training. If years of cumulative endurance training – including high-intensity training – were leading to a significant increase in arrhythmias in athletes over 40, I would expect we would be one of the first organizations to see it happening. It would be troubling and noticeable if more and more athletes were requesting medical holds or cancelling or dying because of cardiac health problems. But we are not seeing that at all.

You know what we do see a lot of? Cancer. At any given time of the year there are a significant number of athletes on medical holds because of cancer. I know of one athlete who has been on hold for an entire year; he’s not cancelling because the idea of coming off hold and returning to training provides him with motivation and hope.

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Atrial Fibrillation diagnoses are increasing in the overall population

The incidence of AF naturally increases with age and there are an estimated 75 million Baby Boomers (age 51-69 in 2015) like me who have reached an age when genetics and decades of lifestyle choices start expressing themselves. Things start going wrong, like your heart’s electrical system. So, if there is an increase in the number of AF diagnoses in athletes over the age of 50, perhaps it is because we are representative of a growing population of people over 50. The physicians I consulted also commented that technology has improved their ability to detect arrhythmias earlier, so more people of all ages are finding out they have them. Indeed, this study of 50-year trends of atrial fibrillation indicates the increases in incidence and prevalence are at least partly due to increased effort and efficacy of looking for them.

A lifetime of factors contribute to cardiac health and disease risk

The decisions you have made in the past 4-6 decades have made you what you are, for better and worse. High-stress careers can be rewarding and lucrative, but being a hard-charging Type-A person means dealing with a lot of stress. Maybe you thrive on it, but your body can still be negatively affected by it. And not all 50+ athletes have been athletes for their entire lives. Many athletes we coach spent decades gorging on cardiac risk factors: excess body weight, high cholesterol, high blood pressure, poor eating habits, little to no exercise, high-stress environments, heavy drinking and/or recreational drug use, and smoking. Dropping bad habits and becoming an athlete have done these people a ton of good and probably saved some of their lives, but good habits in the past decade may not completely negate or reverse the damage you did decades ago.

Even before your good and bad habits started building your profile for cardiac risk factors, your genetics dealt you a hand to play. Those cards may predispose you to high cholesterol, or blood clots, or arrhythmias. Could high-intensity exercise help to reveal an underlying problem? The physicians I consulted said yes. But they also said it’s likely not just the exertion, but a combination of acute factors like lifestyle stress, fatigue, dehydration, prescription drug interactions, heat stress… and exertion. A physician who specialized in electrophysiology pointed out that experiencing an arrhythmia isn’t a sure sign of a life-threatening or long-term problem. Even a perfectly healthy heart can skip a beat or race briefly and return to normal rhythm. Athletes are also more attuned to their bodies and sometimes notice arrhythmias before a sedentary person would. Further more, he pointed out that this could be a good thing if concern about these symptoms prompt the athlete to seek medical evaluation, making it more likely to discover an underlying cardiac issue, if there is one, sooner.

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We’ve seen this before

An article like the recent one in Velonews pops up at least once a year, although it’s typically been in running and triathlon publications or a large newspaper like the NY Times. The headlines warn that exercise can kill you, and the story cites a new study or some piece of evidence that may indicate those who exercise more have an increased risk of dying compared to those who perform more moderate levels of exercise. Alex Hutchinson, Ph.D., author of the “Sweat Science” blog on Runnersworld and the book “Which Comes First, Cardio or Weights”, has covered this topic extensively: “Will Too Much Running Kill You?”, “Heart Health and ‘Lifetime Exercise Dose’”, “The Too-Much-Running-Myth Rises Again”, and “The (Supposed) Dangers of Running Too Much”. There’s a lot of great reading in that list, as well as links to studies and subsequent commentary. Time and again, these articles and the subsequent discussions come back to the central premise that exercise is good for you, that more exercise is also good for you, and that there is a small percentage of the population that will push themselves too far and do damage to their bodies.

Where do we go from here?

The only thing I know for absolute certain is that we’re all going to die. The best we can do to prolong our lives is to continue doing things that reduce our risk factors for a wide range of diseases. Exercise – including strenuous exercise – is one of those things. But so is taking a more serious approach to rest and recovery.

The heart is a muscle, and like any muscle it adapts to stress. As an athlete you have a higher stroke volume (your heart pumps more blood per stroke) and a lower resting heart rate. These are positive adaptations from exercise. Just like any other muscle, recovery is key to maximizing positive adaptation and reducing injury risk. As such, it isn’t a huge leap to consider that overtraining or under-recovery may negatively impact the heart muscle in similar ways that under-recovery negatively impacts skeletal muscle, joints, connective tissue (ligaments and tendons), and the immune system. It is my belief that structured training that incorporates appropriate amounts of rest and recovery is instrumental in avoiding overtraining or under-recovery. Going back to the large population of CTS Athletes, the majority are what we call “time-crunched athletes” who train 3-5 days per week and have 3-6 weeks per year of either planned or unanticipated time (typically family or work related) away from training. In our population we’re not observing an increased incidence of cardiac disease or injury. So perhaps, if there is increased risk for athletes, it isn’t the workload or the intensity of the training that’s the problem, but rather the lack of recovery in poorly designed programs.

I guess there is one more thing I know for sure. I’m an athlete and there is no other lifestyle I would choose over this one. To this point in my life I believe being an athlete has kept me healthy, kept me from needing prescription drugs, provided me with a great and supportive community, allowed me to see the world from the saddle of a bicycle, and provided me with opportunities to spend my days riding shoulder to shoulder with my kids. Far from damaged, my heart is full of joy, and being an athlete is a big reason why.

Comments 65

  1. I had the heart attack, 40 miles into a 55 mile ride. Finished the ride thinking it was exercise induced heartburn [is there even such a thing? My PCP seemed to think so prior to this event]. Drove myself to the hospital – 100% blocked in the RCA. No good explanation ever given.

    Have dialed back endurance sports since, not because there isn’t a level that is good for me, but because it isn’t fun anymore. Medications limit my ability to enjoy a good, hard sprint or climb, the fear of another occurrence always in the back of my mind, and an exponential increase in the prevalence of distracted drivers.

    It’s very disheartening as I used to define the quality of my week by the finish of the big town line sprint towards the end of the Sunday group ride. I always relished dishing out pain on a long pull, slipping out on the break, or the tunnel vision of riding yourself blind trying to hang on.

    I find other things to make me happy now, but I miss the simple companionship of an epic group ride with the gang.

  2. I am a 65 year old male. I have had atrial fibrillation for 10 years. I have done 8 Marathons (1st one at age 50) and too many 100 mile bike rides to count. The AF was getting worse each year but this last year I started keeping my average heart rate down to 130 instead of the 150 I used to do (Max heart rate around 180). My AF is doing much better and I feel that short spans of heart rates in the upper ranges are ok but sustaining that high a heart rate for 4 to 6 hours is very stressful on the heart and was a major contributor to my AF.

  3. Nice article, as you indicate in the last paragraph it’s as much about the joy of life over the length of life. Athletes get the benefit of not only may be living longer but certainly living fuller more active lives. thank you for sharing this post.

  4. You can definitely see your skills within the article you
    write. The sector hopes for even more passionate writers like you who
    aren’t afraid to say how they believe. Always go after your heart.

  5. Just dropped in to check out your blog, I’ve been following it for a
    little while now. I run a blog as well and its important to support
    eachother. Theinfo you have posted is both accurate and to the point.
    I appreciate its difficult and time consuming to come up with and I applaud your
    effort. Cheers

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  8. But in America, and probably increasingly in Europe, middle aged men get into biking, not to ride to the grocery store, but to ride competitively with others right up to sanctioned races. Will Endurance Training Kill You?

  9. The article in VeloNews and elsewhere indicating that excessive training (duration, intensity, or both) leads to atrial fibrillation (AFib) is absolutely unscientific; consisting of association between age and amount of exercise and anecdotal evidence. These kinds of so called evidence are the primary cause of misinformation disseminated to the public.

    To my knowledge there is no experimental scientific research showing cause and effect in humans. Experimental evidence is the only valid way to determine cause and effect. In addition, to completely explain cause and effect, the physiology needs to be elucidated.

    Rick Simpson correctly raised the question of diet. For those who don’t know, the body’s ability to function is the result of metabolism (all the chemical reactions in the body). Some metabolism produces energy (energy metabolism) from the food we ingest (carbs, fats, protein). Bacteria (microbiota) in the body (mostly in the GI tract) are also involved in metabolizing substrates that are beneficial or detrimental to health. Commensal (beneficial) microbes metabolize indigestible carbohydrates (prebiotics) into health promoting substances. Some metabolism results in growth and maintenance of the body. As with chemistry, reactions produce correct products only when the correct substrates and catalysts (primarily enzymes in organisms) are available in the correct amounts and at the correct time.

    Most athletes are aware of electrolytes (commonly referred to as minerals). Electrolytes are molecules that dissociate into ions. Sodium chloride (commonly referred to as salt) dissociates into sodium and chloride. These two ions are the primary regulators of fluid volume in the body. Dehydration, especially long-term, from any cause is damaging to organs. Chloride is additionally involved in carbon dioxide transport in the blood. Sodium and potassium are the primary ions involved in creating concentration gradients needed for nerves to transmit signals. Sodium is required for absorption of monosaccharides. Calcium is needed for muscle contraction; magnesium for muscle relaxation.

    Most athletes are also aware of the need for protein. Some protein sources are more healthful than others; beef, pork and deli meats being the least healthful. These can promote cardiovascular disease and cancers.

    Less well-known is the effect of the various types of fatty acids (derived from dietary fat). Many are aware that saturated fats, such as butter and meat fat, may be less healthful (debatable). Monounsaturated fats may or may promote health (also debatable). Polyunsaturated fats are the most bioactive of all fatty acids. Omega-6 fatty acid metabolism results in the production of eicosanoids that can cause inflammation. Omega-3 fatty acids compete with enzymes involved in omega-6 metabolism and reduce inflammation. These are only the macro-effects; there are many other metabolic effects. Inflammation is involved in many diseases, such as cardiovascular, diabetes, etc.

    The composition of the diet affects nutrient absorption. For example, fat soluble vitamins (A, D, E, K) are not absorbed unless accompanied by dietary fat.

    Cooking methods affect the healthiness of foods. For example, cooking red meat over a fire results in carcinogen production. Cooking make some nutrients (energy nutrients in particular) more readily available, but destroys others; especially water soluble vitamins).

    Food processing affects the healthfulness of foods. Partial hydrogenation of mono- or poly-unsaturated fatty acids adversely affects energy metabolism of fats and eicosanoid metabolism. Food additives are also frequent causes of health problems.

    Farming methods cause adverse health; especially foods grown with pesticides.

    Genetics are always a consideration; however, genetics generally are not a factor unless some environmental factor, for example dietary, smoking, chemical exposure, causes an epigenetic change.

    Metabolism produces products that can have positive or negative consequences. Carbon dioxide and free radical are two negative examples that are eliminated by the body. Carbon dioxide is eliminated through the lungs when exhaling; free radicals are eliminated by endogenously produced antioxidants.

    Since this is not a course on nutrition or physiology, consider these simplified examples. To summarize, the foods we eat can be health-promoting or disease-promoting. Most likely, diet is the enabling cause of the heart problems associated with excessive exercise, just as with cardiovascular disease in the sedentary population. As several commenters have pointed out, rest and recovery are important. Muscle and other tissue is repaired during sleep, provided the necessary nutrients are available.

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  11. A major point of the article is to show possible consequences of chronic overtraining over a period of years in combination with other stressors and likely a personality and genetic factor. With CTS, assuming you are following a systematic program to monitor and gauge performance I believe the signs of overtraining would become evident and adjustments made might help to prevent serious issues like mine, maybe, maybe not! I agree that these type of cases are still somewhat rare with athletes and every one is unique to the individual. Pay attention and enjoy with some moderation and good quality rest is my message. I still participate and enjoy cycling, XC skiing and much more and would not think of stopping. The benefits still far outweigh the risks, just pay attention to your body!

  12. Garbage in garbage out. With a non plant based diet you will clog up your arteries with animal fat. This will cause you heart to stop. It doesn’t matter your age or fitness level. This destruction of blood vessels is reversible with a change to a plant based diet.

  13. I did the same Copper Triangle this year. At 69 I felt it was a major achievement. My first high altitude ride. My heart rate maxed at 162 but that was at the beginning when I had not warmed up. Most of the ride was much lower. I did find myself gasping for air couple times on the 2 12% climbs. All in all I felt good as an intermediate non-racer rider. I plan on riding until I can’t stay up right. 🙂

  14. I believe the greatest benefit of both the Velo News article and the CTS discussions is to bring this subject to the forefront. I am a former CTS coached athlete and I’ve had AFib and AFlutter which my doctors diagnosed as being a likely result of my endurance training and racing. I had a temporarily successful cardioversion and then, so far, a successful ablation which has held over the past few years. I continue to train and occasionally race. I’m 62. I completely agree with the idea that continuing endurance training is beneficial. What changed for me has been that my attitude and awareness towards how my body is affected is different. Listening to my body and tailoring workouts to try and achieve more whole body balance take precedence over achieving goal swim bike run times or even specific training programs. I sometimes wonder if a training program could be written that centered on strength and flexibility training and rest and let the swim bike run workouts come in where time allowed. The advice I’ve gotten from my doctors was to both not change my activity levels and to minimize or eliminate over exertion or worse, trauma ( ie Ironman, marathons, hard triathlon racing, racing in the heat, etc.). I am continuing to learn the lessons of living with an endurance sport lifestyle and I take some of the lessons learned from dealing with my heart as part of that process.

  15. Chris,

    Thanks for providing perspective to a very disturbing article in VeloNews. Disturbing, IMO, b/c, as you said, it points to what would be a disturbing conclusion without anything close to an adequate factual basis, I expect better from VeloNews.

    1. I also rode the Copper Triangle and have dicided not to ride it again. Not because of a threat of any heart problems, but the danger from other inconsiderate riders. These rides are not a race. They are tours open to all level of riders. I want the recers to put on a different hat and then they can maybe tell some riders about how much fun it would be to race in race oriented field. They could use this ride to RECOVER.

  16. A bit late to the comments section, but I am a competitive athlete, age 62, who this past spring overdid the anaerobic efforts. I depleted my muscles of iron and developed atrial flutter, related to atrial fib but not quite the same. Have read two articles this week, the other by Dr. Gabe Mirkin on atrial fibrillation but neither mentioned the atrial flutter. Heart rate at rest went from high 30’s-low 40’s to mid 60’s and went to 120-130 as soon as I rose. You have to be on blood thinners for a month before they will perform cardiac ablation. Got that done June 17 and pulse immediately went to 51. Have done 4 and 5 plus hour rides since wearing a heart monitor. Recovery rides are very easy, not exceeding 105 heart rate. Can not yet do hard intensity weekend rides but will attempt a 106 mile Gran Fondo in Vermont on Saturday.
    Atrial flutter of atrial fibrillation are not uncommon among long term competitive runners. Running elevates the heart rate much more than cycling and a number of members of my running club have experienced these issues in their 60’s or 70’s. For 23 years I ran 50-70 miles a week, much of it high quality and would race 20-30 times a year. Have trained with top coaches, see Dr. Phil Maffetone, so have had expert guidance. In my opinion training with CTS does not guarantee that these issues will not impact you.

    1. Post
      Author

      We absolutely agree that training with CTS is no guarantee that you won’t have cardiac issues. We have worked with athletes who have developed atrial fibrillation and other cardiac issues. There have not been many, and not a dramatically increasing number, that we know of. But we would never make the claim that working with CTS or using our training methods eliminates the risk for cardiac problems. There are too many factors involved. – CTS

  17. I am 64 now, and I trained for 2 years with CTS (about 5 years ago) and attained my goal of being able to race in my age group competitively. However I began to develop supraventicular tachycardia, with rates of up to 220 – this seemed to occur after a particularly intense interval or effort. I managed to document it as not being AF (which means little or no stroke risk). My cardiologist asked me to slow down (I laughed). The tachycardia will stop only after I stop exercise – I have ridden 50 miles once with rates about 190 and no issues.
    Now I take a beta blocker (metoprolol) before cycling. It has, unfortunately, dropped my power output by 10%; however the tachycardia is now much rarer and resolves quickly even if I am still riding.
    My cardiologist thinks it is probably the lactic acid that is triggering the rapid rate, but does not feel it is dangerous. I am still riding hard, but no longer racing. I am not an ultramarathoner and rarely ride over 120 miles.

  18. Thanks for the article. I did see the VeloNews article and it caught my attention. I don’t compete but I do try to keep up my conditioning and try to improve my performance. I use a HR monitor and wattage meter. I do intervals on almost all of my rides.

    Last August I did long ride for me – 4 hours – although I had done rides like this in the past. I was with a group of stronger riders for about 1/ 1/2 hours during the middle part of the ride. Toward the end of the ride on some short hills my HR started shooting up from 165 to to over 210, I experienced a very strange sensation I could not really describe. Scared the you-know-what out of me. I visited the emergency room – had and EKG – they found no problems and was diagnosed with dehydration. A couple of weeks ago I again experienced what I now come to believe is an arrhythmia episode.

    I suspect that my issues relate to:

    1. A gain in weight
    2. Age – I just turned 60
    3. Not keeping a consistent training schedule.
    4. Not eating/hydrating correctly on the rides I experienced the episodes on.
    5. Mentally remembering that in the past I was in much better condition and enough of a competitive attitude that makes me attempt longer/harder rides/efforts than my conditioning indicates.
    6. Stress at home and at work

    This spring I had a stress test and echo-cardiogram – no issues were found. My understanding is that those tests will not necessarily identify arrhythmia problems.

    My final comment is that there are a number of factors that may not be true for the dedicated competitive athlete who manages to keep a very good structured training schedule and a lot of the regular Joe’s (like myself) who don’t.

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  20. Excellents thougts. The absolute sure thing in the world is that the whole of the people who have read the article are died in 100 years. Exercise is a great thing, including very hard exercise. The only aspect that i can be concerned is that many athletes over 40 don’y pay attention on a good cardiologic examination every year. Thanks

  21. I am living the Velonews article since crashing 30 months ago. The reading I’ve done carefully cites *more likely than those not participating in endurance sports. My cardiologist is flummoxed by contradictory symptoms and lack of risk factors. He’s perplexed by a resting heart rate of 28-32, no hardening arteries, low cholesterol, and superb blood pressure. I’ve had several episodes that came short of passing out at 28 mph, as I did 30 months ago. But I know many long term riders who have developed cardiac issues over the past few years. Maybe it’s the “recovery” magic, but I believe a disproportionate portion of older riders will develop these kinds of health issues

  22. My HR occasionally goes up 20 – 30 BPM above what it would normally be, usually no more than a minute or 2. Doesn’t seem to correlate to intensity — it has happened at recovery pace — but often happens after a sudden movement (ie., after sitting up to ride no-handed, or right after taking a drink). This has happened for 20+years. (I’m 47.) Is this considered A-Fib. or something else? Is it the dangerous type?

    1. Post
      Author

      If you haven’t already, a visit to your cardiologist would be the best bet. As several cardiologists told us, the earlier you go in to see them the better the chances you’ll detect something before it becomes a problem. – CTS

  23. The article was talking about Ultra Endurance athletes. I don’t think doing the Time Crunched programs constitutes Ultra Endurance.

    1. Post
      Author

      The article talked about athletes with a long history of endurance training, as in decades of structured training with high-intensity intervals and races. Based on the way they lay out the information, ultra-endurance athletes could be at lower risk because the intensity level is generally lower. The Velonews article is somewhat different than the articles we’ve seen in running and triathlon publications, in that they focused on frequency or overall volume of training as the cause for increased danger. The Velonews article makes the case that increased intensity, and particularly long-term exposure to high-intensity training over a period of decades, is the problem. – CTS

  24. Hi Chris, great article. I have had cardiac issues from endurance events only due to competing in an Ironman with a virus.
    Basically it took me 7 months to recover and I still have some erythema from time to time. Now 50 years and some 4 years after the event It hasn’t stopped me from training and still regularly complete your interval session. Plus I have completed both Full and half ironman races since.
    I suppose the moral to story look after yourselves don’t be stupid ( Iike me) and you can you train until the end of your time.
    Chris thanks for the great sessions you have put out and fantastic guide ness you offer through these blogs.
    Cheers
    Andrew

  25. I am a 66 yr old very successful competitive racing cyclist and have been for at least 30 plus years of my life. I have been living with and managing AF for at about 7/8 years. Based on pure personal experience I am convinced my AF occurs either when I have done too much intense interval training or I am about to sicken with a cold but it has not yet come out in body so that I can tell. Rest invariably is the answer and not necessarily that much. Also I believe gym strength training is key allowing me to press the pedals harder but with less strain on my heart.

  26. After reading this article. I see no reason to stop biking. I am 65 and in excellent health. Biking is my Prozac. It keeps me from being depressed. It is what i love to do. If I die doing it then so be it, I will have died doing something that I enjoy. I believe there are many questions that need to be answered before anyone can say stop bicycling because it is not good for your health. This could be due to overtraining and not enough recovery between rides. It is to simple to say don’t ride because it is bad for your health.

  27. It is interesting to see that this article has generated more discussion than virtually any I have seen or can remember. As a practicing cardiac surgeon I congratulate Chris on a well presented, balanced, and thoughtful discussion. From my perspective there is nothing we do that is without risk – life is about balancing and mitigating them. Certainly the more thoughtful and informed the individual the more “optimal” the result. Personally I strongly believe that the positive effects, both physical and psychological, of fitness and exercise so far outweigh the potential negatives that in my life articles such as that in Velonews go into the interesting but not particularly helpful bucket.
    As an addendum, it sure would be interesting to see some health outcomes data out of that enormous database.

  28. I believe that this research is pointing to the consequences of over-training. I see this in my care of patients almost daily. I am forever grateful to Chris and his knowledgeable staff for bringing me to a clear understanding of active recovery after experiencing over-training myself.
    CTS is not seeing what the research is suggesting because they provide a comprehensive and balanced training program, bringing their athletes to consistent performance (read excellence), the platform for healthy, extraordinary achievement.
    I always recommend CTS for my endurance athletes, and educate them why. I have seen atrial fibrillation and its consequences in young athletes, among other medical problems I think were associated with over-training combined with poor lifestyle choices. Instead of having this research be a worry for athletes, I see it as a call to action to include experienced coaching as an essential part of any serious endurance training program. And for them to share this awareness with those they care about who put the hammer down regularly.

  29. I exercise about 6 days a week. James O’Keefe, MD ( cardiologist with a bent on nutrition & exercise ) has been the lead author on a few of the papers that gave the seminal call on extreme endurance and fibrosis of the heart muscle. In essence can there be two much of a good thing? When the heart muscle is worked so hard that it begins laying down thick collagen or fibrous tissue then per these articles it is a negative. Dr O’KEEFE did triathlons for years. I believe he has scaled back aerobic exercise to an hour or less. I don’t believe he does super long runs say 10 miles or more or longer bike rides at high pace as in the past ( 40 or more miles). In my mind to each his own. At 51 I still like to cycle 3k miles a year, play full court bball, tennis, snow ski, yoga, some hiking, flyfishing and cross training. In my mind it is essential to keep moving or your dieing.

  30. I read the Velo news article last week, and Chris mentions here what I took from the article. Lack of rest and/or recovery from the athletes, over training and not properly refueling with hydration.

  31. I can chime in with my own personal experience that is totally inline with the article. I have been a CTS athlete for 6 years now and am 11 years removed from sextuple heart bypass surgery. I have zero restrictions on how much and often I output. If you doctor does not give you any limitations, just go out there and have fun and work as hard as you wish (or can!). My fitness level has constantly improved every single year I have been with CTS and I now just turned 60. After riding over 10,000 miles last year, I was diagnosed with cancer in January and was totally shut down by aggressive radiation and chemotheraphy until the end of March. Two weeks after treatment, I began yet another rehab stint and am getting close to my pre-cancer level of fitness. So yes cancer is out there and unfortunately hits randomly and hard. I was declared cancer free on June 18th and keeping my fingers crossed it stays that way. Live and enjoy every day to the very fullest!

  32. I have been an athlete my entire life. A soccer player in my youth but then moved into the endurance sports (Triathlons Sprint-Ironman, marathons, and now cycling). I have maintained a healthy lifestyle and diet. This year I started having issues with my heart and noticed that my heart rate was dropping during hard efforts (NOTE: it is vital and I mean vital, to watch and know your numbers. I was never a data junkie but now I am so glad I was since I noticed the change before it was too late).
    I was diagnosed with Atrioventricular block and required a pacemaker.
    Never saw this coming…Was it the constant training and racing? No clue and I wouldn’t have changed a thing but it is important to pay attention. At the “young” age of 48, I am now a proud member of the pacemaker club.

  33. There are a lot of unanswered questions on this topic:
    —IF exercise can cause heart problems how much?
    —IF exercise can cause heart problems how intense?
    —why do some have these problems and the VAST majority do not?
    —what is the influence of diet? We all know the Standard American Diet (aka SAD) is less than optimal. Is this the cause?
    —are there genetic susceptibilities?
    —does chronic lack of sleep have an influence?
    These are just some of the questions that need to be answered. I believe this subject has been sensationalized and the rare occurrence of this problem confirms this. This is a wake-up call to check your habits (diet, sleep, over-training, etc.) but not a cause to stop training. the incidence is too rare for that. More/better study needs to be made.

  34. All endurance athletes over the age of 40 or 45 should see and develop a relationship with their local cardiologist (one that will listen and understand the endurance athlete). Check ups, stress tests, ehco(s) and bloodwork can help an athlete stay in the know.

    1. Totally agree, my husband has been cycling both Mtn. and road bike for the past 12 years. Before that, he has always been very active. He runs on days he can’t bike. On Saturday morning his group likes to do a 50 mile ride. They use strava to measure all the ups, downs, push, and recovery. One afternoon in May he had just rode a two hr Mtn Bike ride came home showered ate dinner, sat for a bit then went into a-flutter! He is 44, healthy eater, healthy lifestyle….. Dr’s say gotta slow down. Heart is now to big and thick. He has just had ablation. But Dr now says his chances for developing a fib just went up. So……..

  35. Interesting perspective – I’m 65 and have been riding, running, etc all my life. I’ve adapted to age by not going quite as far, not going quite as deep, and allowing more recovery time. if a ride of higher intensity (and I love chasing a PR on one of my routes) has left me fatigued, I’ll back way off or stay off the bike for a day, or three, if necessary and not fret over it. That means the quality of my rides is consistently higher and I avoid the long term fatigue that crept in off and on when I was younger and felt more compelled to get out every day – sometimes less is more.

  36. I have been riding a bike for exercise for over 45 years I am 71 and have been doing intervals recommended by Chris for many years. My health numbers are great and my Dr calls me his poster boy I took all 3 gold medals in the Delaware Senior Olympics and broke the state record by over 5 minutes I am going to have my story of good health and my training regimen and success published in our local Beach Life magazine in the October issue The writer asked me when I plan to stop cycling I told him when I can no longer swing my leg over my top tube which he will write in the article So LIVE strong and enjoy the ride

    1. Hi Ray..
      What are your thoughts on over training? I’m 72 and I’m watching my Strava segment times and my power decline. Last year I averaged 250 kms per week of hilly riding – which of course is a lot less than serious cyclists ride – and thought, um, maybe that’s too much for me, I’ll cut down and see what happens. I have done that this year without any brilliant result- though no further decline. I have read that as we get older we are more prone to overtraining, though the whole concept seems vague.

  37. I’m in my mid 40’s and my wife sent me that article a few weeks ago. Then I went out and rode a 200km 3400m ride and that article just kept coming back into my head. I am not a life long athlete, I’ve only been riding a couple years, did that article even apply? I don’t know. My brain just spun in circles with the information for hours and then I realized I loved being out there whether suffering up the climbs, rolling past the trees and dropping down into the valleys.

    I also realized, nobody knows what is going to happen tomorrow, I think statistically I have a higher chance of dying in a car crash or a slip in the shower. So in the end, I just decided that of my options, riding (hard) was the most conducive to being happy and healthy.

  38. The article seems to propose that strenuous exercise can damage the heart muscle. I have never heard that said about any other muscle in the body. Is the heart muscle supposed to be a different sort of muscle?

    My impression is that we are groping in the gloom at this point.

  39. To quote Jimmy Buffett: “I’d rather die while I’m living than live when I’m dead.” Thanks for your insights & inspiration!

    1. That’s one of the things that ocurred to me. The article cites Micah True’s death, but if you’ve read Born to Run, that’s how he wanted to go out.

  40. As you point out, everyone’s chance of dying is 100%. As for me, I would rather live to 80 than merely survive to 90.

  41. Thanks, having had a heart attack and stent placement at 47 I have since then been training and competing. I am now 61 and except for age related aches and pains I am still planning on continuing. As an aside, it is amazing to me how competitive the 60 plus groups are, especially in my area.

  42. Due to the healthy lifestyle from training and eating all the Doctors I consulted with when battling cancer not only gave me excellent odds for beating cancer (head & neck), they also wanted me in their experimental data base.

    Training, which I also throughly enjoy, is a great way for more to reduce stress, which is what unhealthy lifestyles excelerate.

  43. Nice article, as you indicate in the last paragraph it’s as much about the joy of life over the length of life. Athletes get the benefit of not only maybe living longer but certainly living fuller more active lives.

  44. Chris, It would be interesting for you to use all the names in your data base to do a questionnaire of health of your athletes. This would be much more helpful on a subject like this to see if any health problems came up even years after they stopped using you as their coach.

    1. As a 75 year old who rode the same Copper Triangle you did, but more slowly, the bottom line is always what’s the alternative? Something out there is going to get me—so I will do the bike till then. Did 2 hours tempo this AM and you are right the key is to rest and recover.

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