My estimate:Those that eat sugar or drink alcohol, and exercise, get the plaque, while remaining slim. Those who are stationary experience their plaque rupture at rest, when their heart can't break the clot up. But if they exercise, their plaque will likely break off during strenuous exercise, at their highest. That is a totally different story. Those that exercise and don't eat sugar are plaque free. Those men that don't eat sugar or drink alcohol and don't exercise are so rare that the study didn't catch a single one. Easy.
I also predict that the plaque dissolves whenever you put your body into a starvation mode. Mine let go after 5 days fast, and yes, I did get the clots into my heart during my morning pull up sessions. And they broke into many and lodged themselves all over, including my brain and lungs. From there, they dissolved in about a week. It didn't require single visit to a doctor, nor a single pill.
This is a very interesting article, however I am left with a question after reading it: 1) What impact, if any, did diet play in the build up of arterial plaque and elevated calcium levels found some of the runners studied? I was surprised that there was no mention of diet in the article.
2
As someone with persistent idiosyncratic asymptomatic A-Fib diagnosed at 40 years old and who probably got it from too much strenuous exercise, I'd say, YES one can get too much exercise.
My cardiologist said he had two other young (30-45) patients with my same condition; one was a triathlete and the other an Ironman devotee. In my teens a typical day included a few hours of singles tennis in a 120 degree tennis bubble, a couple hours of ultimate frisbee, 7 mile bike ride to and from the beach to ride the waves, and whatever else I could fit before dark.
1
Sadly, “most people” are women, but women are missing from this study.
1
@Anna, that half the population was ignored was my first thought.
1
(They didn’t include women in the study, but plan to sometime later.)
That about sums it up.
1
This article and accompanying comments failed to answer the underlying biochemistry of extreme exercise. It is well established since the seventies by Freidovich and McCord that moderate exercise will benefit cardiovascular health, but extreme exercise may damage health. I addressed this subject in detail at the Age Management Group medical meeting in Tucson, Arizona, November 2018. In brief, people engaged In very heavy aerobic exercise generate enormous cascades of free radicals that escape the the body's lines of defense, especially the superoxide dismutase (SOD) line of defense. Unfortunately, very heavy aerobic exercise generates free radicals EIGHT TIMES, I say again 8 times, in excess of what the SOD first line of defense can deactivate and render harmless. An 8-times excess escapes the SOD enzyme and causes damages to living tissue and DNA. In my slides at this meeting I showed a free-radical pathology experiment performed at UpJohn-Pharmacia in Sweden by my dear friend, professor Karl Arforrs. Superoxide was injected into the bloodstream of hamsters, and ischemic arterial damage resulted. This induced ischemia was totally reversed when strong antioxidants such as glutathione were subsequently injected into damaged arteries. During aging, we develop increasing and ongoing deficiencies of these two vital hormones and the primary antioxidant, glutathione. Glutathione and hormone replacement therapy can remedy this situation. This is only part of my 8,000 word lecture.
9
I am now in my mid-80's. for around 10 years till age 25 I swam 6 miles a day at high intensity, the same kind of regimen as today's Olympians comprised of wind-sprints, et al.
I recently had a calcium count done, and am clean as a whistle.
Dr. Barry Sears did the research concerning the use of the "activated essential fatty acids" (EPA and GLA) by elite athletes (tri-athletes, marathoners, NFL stars) in the late 1980's. We were able to improve the cardiovascular efficiency of these participants by around 18%.
What was achieved was vastly improved delivery of oxygen into the muscles as a result of modulation of the prostaglandins the body converts these fatty-acids into.
Marathoners and Tri-Athletes as a result did not go into anaerobic metabolism, hence no lactic acid burn.
In actuality, it is far more beneficial for the body to burn fats for energy than to burn carbos and sugars (carbo loading is misguided). It's just that fats require oxygen for their metabolism, whereas sugars can be fermented without oxygen.
I credit my extremely clean "calcium count" to having modulated my prostaglandins by use of the correct ratio of EPA to GLA since 1986 and use of flaxseed oil since the 1950's.
10
One thing that all extreme exercisers need is a lot of sugar, or very simple carbs. And just much more food overall than the average person or moderate exerciser.
I've done a few multi-day marathon-type cycling races and in addition to consuming simple carbs during events, whenever I wasn't on the bike I had to be eating to replenish energy. The body can't handle complex foods during or right after extreme exercise, and you have to eat simple carb and simple fat foods until you feel better. Even just during training, I need simple carbs like energy gels or energy bars or, at best, bananas or honey to power me through the long workouts and into recovery.
Maybe these simple sugars can be investigated as a contributing factor, along with big recovery diets when the volume gets high.
A few years ago my GP suggested a calcium test. The results were scary high (1800). But followup tests indicated no occlusion or cause for concern. I am 67 years old and have run (years ago) a 2:47 marathon, two 100-mile races, and several ultramarathons. Currently I nordic ski race at a high level. So very athletic over 40+ years. So it was extremely interesting to see this study. Numbers as high as mine can (according to standard tables for the general public) indicate a high probability of death within a few years, but it feels like those high probabilities were wrong for athletically caused high scores.
5
Great. And what about for us middle-aged women???
8
Just curious, but did the researchers note the diets of the participants to see who was a vegetarian or vegan, who ate the traditional American S.A.D. diet or combinations thereof? Everything is interlinked, so 'exercise' cannot or should not be a 'stand alone' factor in people's health.
6
@kladinvt, Exactly!
Is anyone familiar with a condition called ‘Runner’s Dystonia’?
What else is being controlled for here? Some people who run a lot view that as a license to eat whatever they like (“I’ve earned it”). Could it then be that poor food choices are causing the plaque rather than the exercise itself?
12
obviously this study suffers from its retrospective design. The real question is whether prospectively people with a comparable cardiac calcium load to begin with, and who excercise vigourously, develop more plaque than people who exercise moderately.
2
There is no basis for drawing any meaningful conclusions from this study. The data is limited, the definitions and categories are drawn based on weak distinctions, the meaning and applicability of the calcium score is questionable...
This is not useful information for the layperson.
7
I jogged casually for many years, but when I was approaching age 60, I agreed to participate in what for me was a longer race. I trained hard to get into shape. Within a year after the race, I developed left-ventricle hypertrophy. I have no doubt that there's a connection.
3
This was not a manipulative experiment where individual subjects are randomly assigned to each treatment group; in this case there were the heavy, moderate, and light exercise groups.
Instead, this was a survey of existing patients self-reporting exercise level with extensive heart related measures of cardiac health.
Ignoring the veracity of reported exercise level, were these exercise groups representative of the overall population of men in the United States and were the differences in cardiac health only due to the level of exercise and not some other hidden treatment effect among the three groups?
The answer is no. This survey tells researchers some useful, but limited, information, but it does not definitively answer the question of exercise level on cardiac and circulatory health. Only a long prospective experiment with random assignment of subjects, drawn from the overall population, to the three exercise treatments will answer that question.
4
Just a thought to share, knowing how tricky it is to study these things effectively.
There is no mention of the role of mental / emotional stress. We know stress can increase arterial plaque all by itself. Many folks, myself included, who get engaged in high-level exercise are often drawn in by the anxiety-relieving qualities of hard workouts.
It may be that the two factors are countering each other, but not always with 100% effectiveness.
Just an idea...
14
They don't talk much about family history in this study.
It will be 10 years in July since my cardiac arrest. I had a 90% blockage in my widow-maker artery.
If a nurse had not been playing golf at 6:00 a.m., I would not be here today. She did CPR on me until emergency personnel arrived. I was 10 min from a hospital and they put a stent in and I have been fine since.
My cholesterol was low, way under 200. I was a pretty good runner from the time I was in junior high up until a couple of years prior to my cardiac arrest. There were weeks where I put over a 100 miles in training. My knee started giving me issues (swelling), prior to the cardiac arrest. So I did exercise equipment instead.
Just prior to my cardiac arrest I noticed my time exercising was a struggle. I never go to the point where my body settled in.
I thought it was just because I was in bad shape and I would eventually work through it and get back to normal. That was the only symptom I noticed.
One of the reasons I ran was my family history. My dad died of a heart attack at 73. Several of my uncles had heart attacks. My mom died of an aneurysm.
So I knew that my family history was not good and that I needed to exercise to try and not fall into the same family health issues.
I don't know what caused the blockage in my artery.
Maybe in my case, you can't outrun your genes.
There is no mention of any of that being considered in the study.
16
@mnfinn
I had a similar experience eight years ago. But I had my heart looked at because I noticed that things were not quite right when I ran at age 58. My "widow maker" (aka LAD) was 95% blocked. I'm running again after getting a stent, often winning my age group from miles to half marathons. The questionable heart genes are on the maternal side in my family. Heart attacks occurred on that side of the family beginning before age 50. I think running has helped me avoid heart attacks so far. I suspect a strong heart from running also helped keep you alive until you received your stent. Perhaps yo did "outrun your genes." Good luck and long may you run! -paul
I hope you are also able to continue to exercise to keep your heart in shape.
6
@Paul
I feel like I am doing well. I have found that a rowing machine and stair stepper give me workouts like when I was running.
I can do a 10k in rowing in around 50 min. Not great, but I feel like I'm pushing.
There always is that uncertainty in the back of your mind after having a cardiac arrest.
How hard can I push and not end up in the hospital again.
Thanks for your comments.
3
The following sentence suggests to me that there is a statistical problem with the study
"The extreme exercisers turned out to have less risk of dying prematurely than men with the same — or higher — calcium scores who rarely worked out."
If I understand correctly, the study lumps together all extreme exercisers with a particular calcium score -- say 200 -- and compares them to all the low exercisers with scores equal to or greater than 200. Shouldn't we compare high exercisers with a score of 200 to low exercisers with a score of 200? (And of course, 300 calcium scores to 300 calcium scores, etc.)
10
A fog that recently descended over my life was just lifted by this article!
I'm 71, was a competitive distance runner into my mid 30s, averaging 60-80 miles per week including intervals. After retiring from competition, I reduced my workouts to 5 miles a day, six days a week. For me, digestive issues were always front and center, celiac disease and ulcerative colitis. Never thought about my heart. Recently, my internist suggested an EKG and scan of my coronary arteries, just as a baseline. I thought it was a waste of time, but indulged him. My plaque was 200 and the EKG was festooned with red flags, including a heart rate of 54 and signs of an enlarged left ventricle. The cardiologist made it clear that there was trouble ahead unless I lowered that plaque score. He put me on Crestor and scheduled more tests. The statin made my muscles feel tight and twitchy. I pulled my right calf after three days, took weeks to recover, then puled my left calf the first day back. As a result of the treatment I'm now not working out at all. I'm emailing this article to my soon-to-be-ex cardiologist.
16
@peterquince
"My plaque was 200 and the EKG was festooned with red flags, including a heart rate of 54 and signs of an enlarged left ventricle."
Doctors don't know what the calcium score even means, a HR of 54 is great, and an enlarged left ventricle is expected in an athlete. Doctors learn about disease as it manifests itself in the average person. Most don't know squat about fitness, but they do love to write prescriptions.
9
@peterquince
Why is a heart rate of 54 a red flag? I thought a low heart rate was normal and good if you are a regular exerciser?
3
"The good news... is that even if that scan should reveal a high calcium score, that most people...'can and should continue to exercise.'”
And maybe darn well better?
6
I just have to add -
I strongly suspect the vast majority of folks here who are worried about 'exercising too much' have a gross misconception of what 'too much' actually is. It's a LOT more than you probably ever imagined. Exercising a ton won't necessarily make you live a lot longer, so if longetivty is your only goal, sure, you can do a lot less, but the unmentioned part is the tons of quality-of-life benefits that a lot of exercise yields that constantly go unmeasured in these studies.
The vast bulk of studies have shown that exercising a lot is overall helpful. Even the heart scarring studies in marathoners was debunked in that that scarring did not lead to greater mortality or morbidity over long term marathon runners.
13
@agarose2000
I agree with you. Unfortunately, researchers did define what extreme means- in this case, it was running 6 miles a day. That's only an hour a day. I don't think it's overdoing it. But it does further confuse people about what too much is.
6
There has to be some relationship between what these heavy exercisers eat to keep fueled and the arterial plaque buildup. Perhaps a study of some plant based ultra endurance athletes vs. omnivorous athletes may indicate that arterial plaque buildup is simply related to the overconsumption of saturated fat and cholesterol-containing food to satiate a ravenous appetite in the omnivorous athletes.
10
@Leonardo Garcia
Why does there 'have to be' some relationship? There may be, but as this study itself is far from being definitive, and its findings are hypothesis generating rather than conclusive, there are no 'has to be' results here.
6
@MCK451
Good point. There *could* be a relationship. I'm really interested in nutrition and endurance. Would love to see studies exploring this.
5
@Leonardo Garcia
Maybe it is the over consumption of sugar, grains and processed foods? It is becoming obvious the excessive availability of low density foods are causing many problems in all people. Athletes simply filter more and seem more invulnerable. Plant based diets are not better, science and evolution has discounted that illusion rather soundly.
4
I know a few endurance athletes (bicyclists and runners) with heart issues. Among other physical problems.
At least a few of them I believe could have avoided their issues if their training had been better managed over the years. By that I mean, non-pro, weekday warriors who train a lot often don't know how to program their training to better suit their needs and health. Which is a problem for most non-Pro, everyday "athletes" - who are their own trainers and motivators. (which I know really well)
Proper programming is not something a lot of everyday "athletes" in the local gyms, on the high school tracks, or on the roads - ever have access. We learn as much as we can from various sources, but in the end, we're our own coaches, physical therapist, nutritionist, motivational coach - and simply want to keep making progress. We push too hard when we should lay back. And who knows what sort of damages that might do...that wont show up till years later.
How can the long term effects of so many self-trained, "athletes" truly be known, when studies are typically done on pro, semi-pro, collegiate athletes with support systems?
Do we know these plaque buildups are due to the endurance discipline alone? Or could they be the results of several factors common to an endurance athletes lifestyle? Dieting? Typically low body fat, for long stretches of their careers?
What about training in often extreme conditions?
There's just not enough research involving these "other" factors.
7
@Boregard
I know a LOT of endurance athletes without heart issues or other physical problems, and I know a LOT of non-athletes with heart issues and other physical problems. Whom you know, and whom I know, do not prove that we know anything.
13
It’s 2019, and we’re still not studying women?
37
@Ann P. As the article said, they are extending the study to women. In doing a study like this, you do the easy part first - which in this case means studying men. There are many more men who undertake extreme cardiovascular stress via exercise than there are women.
2
@Rob-Chemist
The easy part first? That is a very weak argument. There is simply so much disregard for women in these studies. The correct approach would have been to conduct both studies simultaneously. It isn't rocket science...
3
@Rob-Chemist - that is not correct - more women run and enter competitive races than men. So yes, here we are in 2019 and they are still not studying women.
6
Yet again, women are left out. Did you know women die most often from heart attacks at a younger age because a) less education and publicly available knowledge on the matter b) when they do go to ER with symptoms they are sent home with "anxiety attack" diagnosis.
I know this because I researched this after I had a heart attack at 49! No, I was not obese, I was working out regularly. Felt great. A strange stomache ache, annoying back pain between shoulder blades all morning then, within hours a pulsating throb from shoulder to wrist, followed by vomiting and diarrhea and a feeling that an elephant was sitting on my chest. Went to ER, they said anxiety. Ex-husband physician persuaded ER resident (a female too) to do a cath. I was in pain all night, they gave me morphine for pain until morning when cath done, RDA 100% blocked! LDA 70% blocked. Doc was shocked. I have two stents. After that I researched and find women die very often of heart attacks that are preventable or treatable! Shame on medical profession.
51
It sounds like this biomarker, calcium in vessels, is not a good predictor of disease. At least not in the highest exercise group. The next article could highlight the marketing of these useless screening tests.
11
@Dave - Actually, coronary artery calcium, CAC, is an excellent predictor of cardiovascular disease risk and such screening is far from useless, but rather a major advance to determine, e.g., who will, and will not, benefit from statins.
Take, for example, the cardiovascular event results of over 13,000 Americans, avg. age 50, followed for an average of about 10 years after CAC scoring in: “Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring,” PMID 30409567, J Am Coll Cardiol. 2018 Dec 25;72(25):3233-3242.
When these people had CAC scores of zero, or less than 100, only 4% had Major Adverse Cardiovascular Events (MACE, fatal or non-fatal heart attacks and strokes) over the next 12 years. And, importantly, taking statins did NOT lower that 4% frequency at all. There was no need for the possible side effects and expense of statins.
However, of those who had CAC scores of over 100, and over 400, those who did not take statins had a MACE about 18% of the time, or at about 400% of the less-than-100 rate.
And—importantly—of these, those who took statins cut their MACE rate in about HALF to about 8%. For those with high calcium, statins proved highly beneficial.
See the study’s central illustration at: https://ars.els-cdn.com/content/image/1-s2.0-S0735109718386960-fx1_lrg.jpg
There are now many datasets like this. Calcium scoring is particularly important for those at seemingly intermediate risk, to better sort out who needs treatment.
4
@SRP What's the number needed to treat for those with calcium scores over 400 for instance? When you talk about risk reduction are you talking about relative or absolute risk reduction?
“They did not include women but plan to in a follow-up study.”
Of course. When will research stop routinely shutting out 50% of the population?
25
Though one would expect an "inverted U" effect -- more exercise is good until it hits a plateau and then decline as you get "too much" exercise. Instead, exercise seems to be better up to around an hour a day (20 minutes vigorous) where it stays plateau. Oh, and team sports are better probably because of social factors: https://well.blogs.nytimes.com/2015/04/15/the-right-dose-of-exercise-for-a-longer-life/
2
An important but unanswered question is what happens to these high exercisers if in their 60's or early 70's they develop a debilitating injury or severe arthritis that precludes ultra vigorous exercise. If the exercise was protecting them from myocardial infarction does that heavy plaque deposition now increase their risk?
11
I’m sure there’s a point at which incremental exercise doesn’t add more health benefits, and even slightly detracts.
But that point is much farther away than suggested when non-cardiac health changes of vigorous sporting are taken into account: abdominal fat (cancer risk), muscle atrophy, brain function etc.
All these studies are flawed in one or more ways: sample size, uncontrolled correlation of doing sports with other healthy lifestyle choices like better eating habits, focus on only one health benefit like heart disease instead of overall longevity, ...
9
I wonder if/how the heavy exercisers' development of collateral arteries impacted this study?
6
If you exercise a lot you also can eat a lot. Men who exercise a lot and have arterial plaque also probably do not consider any dietary restrictions such as eating less saturated fat and cholesterol laden foods, because they remain thin and appear healthy. It's my understanding that it is diet that supplies the plaque.
I wonder too, why a study of a small percentage of people? I mean, most people don't exercise enough. Are we trying to provide an excuse for not exercising? What is the point? Are runners dying in droves? It seems to me that it is a study without a purpose.
10
It’s hard in these studies to control for eating habits. As a competitive marathoner myself, I see the healthiest eaters are often the moderate exercisers.
The competitive athletes, especially among men, have a lot of “if the furnace is hot enough...” folks who pretty much eat and drink all they like and burn it off on the roads and trails.
5
@Chris
There were several studies a few years ago which claimed that too much endurance exercise might be bad for you. The evidence was weak, but those studies got a lot of attention in the press and of course some people took a perverse pleasure in the idea. This latest study ( among others) casts doubt on that hypothesis.
4
We already have scientific confidence in the following contentions: (a) most people are not harmed (apart from joint damage which may result in severe arthritis, pain and debility) by intense exercise, but a few will have fatal heart failure; (b) inactivity is bad for both the pulmonary and circulatory systems, as well as blood sugar regulation; (c) moderate, regular activity and avoiding long periods of sitting, standing still, and lying down are key to maintaining fitness and health. The rest is pretty much speculative & not particularly relevant for ordinary folks. We're also confident there is no good reason to engage in intense or extended exercise from a health point of view; it may be fun or necessary because someone is a professional athlete, but it is not "healthy", at least defined in terms of length of life free from pain & cognitive and physical limitations. SBR, in a separate comment, also correctly points out the research has been over-interpreted and actually tells us nothing that is interesting. It most certainly does not tell us that endurance athletics are good for us.
9
@Cephalus
It's better when listing a set of facts that the first one is indeed a fact. Intense exercise per se does not cause joint damage as far as the available studies reveal. If you think running causes degenerative joint disease (commonly mislabelled osteoarthritis), you need to look again at the available data. In fact, most of what you list as fact is unproven, disproven or unprovable (because the definitive studies cannot be done) so remains speculation with more or less (un)certainty.
9
It would be nice if they would connect the dots between the calcium score and heart attacks. It's not really clear what the connection is.
3
@Michigan Girl It's not really clear because that's not what the study is designed to answer. Looking at the abstract of the study, the question is listed in the first line. The study's aim is to answer whether intense and regular exercise affects mortality when controlling for plaque and calcium levels.
3
@Michigan Girl Arteries plaque is caused by a defective distribution of calcium in the body: https://www.healthandscience.eu/index.php?option=com_content&view=article&id=1196%3Avitamin-k2-counteracts-atherosclerosis-and-benefits-the-heart-us&catid=20&lang=us&Itemid=374&fbclid=IwAR2Rp7xBEMN07tPvuoHQ6PYzNLpYTkG_jQoqH89A4O97I1610KQ9GbxzQMo
1
When looking at the conclusions of studies like this it's important to be aware of what exactly is being compared and not over-conclude based on the data. What example, in this JAMA Cardiology study, the actual question posited in the abstract was "Is the presence of high levels of coronary artery calcification in the setting of very high levels of physical activity, for example, as typically practiced by masters marathon runners, associated with increased mortality?" What the study is NOT asking is whether high levels of physical activity is actually good for you or even whether high plaque levels are bad for you. The correct conclusion to draw is that given the same level of calcium and plaque formation, those who exercised intensely and regularly are less likely to die. That's not a very profound result and certainly, that's not very comforting because it doesn't address the more important question of "is plaque formation and high calcium levels bad in and of itself". If it is, then looking at study groups where you control for plaque and calcium levels risks could be merely analyzing the the differences between the cherries on two very unhealthy cakes. Rather than looking at the effects of plaque formation, this study merely treats it as a confounding factor that needs to be removed from the analysis. So I would say this article grossly oversells the study and its conclusions.
15
@SBR
At least there is one comment here that reflects understanding! Thank you
3
@SBR
But why do you say the results are not very profound or comforting? I thought it was very reassuring to know my mortality risk did not increase despite an increased calcium score possibly due to extreme exercise.
Increasing levels of arterial plaques in middle age folks that exercise "intensely" should be taken as a warning for what it is, that even exercise can be overdone. Okay, the thickened plaques may be more stable in those folks than in the sedentary but what happens as they age? Any evidence that folks that engage in intensive exercise live longer or better than those on more modest exercise regimes?
2
It’s not the same plaque as cholesterol causes.
This is not settled science.
6
This result reminds me of the study that showed that while riding a bike at night is more dangerous than during the day , the cyclists who do ride at night are less likely to be injured on a per mile basis than the ones who strictly ride in daylight hours.
I do hope to see the women’s study done soon. I have backed off very intense exercise because I get rare episodes of a very elevated rate that wakes me up at night during peak fitness and a complete cardio work up (although no holter monitor ) has uncovered no abnormality.
2
@Dani Weber if I had to take a guess, it may not be the heart that's the problem. A racing heart could indicate poor blood pressure control (low BP excursions) when resting and possibly a kidney issue. It could also be a neurological issue with control of peripheral circulation or vagal control of heart rate at rest. But if it does happen again, you should ask your doctor to consider other systemic factors rather than focusing on the cardiac system.
2
I see many comments skeptical of running as a healthy sport for aging bodies. My mom is nearly 80 and has been running about daily for 40 years. She was super competitive runner for many years and still competes. She runs a 5k at 12-13 min mile pace. Has no arthritis or pain. Her diet isn’t great. I realize it’s not valid to make population estimates on one person but just want to provide a counter to all the skeptics of running
7
@Wendy Interesting anecdote. I think what many small scale studies are showing is that there is a great unknown — possibly interplay of genetics, diet, exercise, etc — that determines overall health and what causes some runners as in this study to have arterial plaque problems.
1
@Wendy
Thanks for your post and the support for running and exercise as we age. I wish you would post more often. Maybe, your mom, too.
This past Thanksgiving I was diagnosed with coronary heart/artery disease. I was 52 at the time and was a pretty vigorous exerciser for the past 35 years. I have 40-50% non-obstructive blockage in one of my arteries. Needless to say I was shocked, and disheartened (no pun intended). I did a nuclear stress test and passed fine but I stopped lifting heavy and did light, short, ballistic workouts, emphasis on the light and short (20 - 30 minutes) - I kind of gave up. All these months, I’ve wondered what I did wrong. Too much fast food (2-3X a month)? Too many Doritos? My primary care physician seemed stunned also because all my blood tests previously showed I was in the least likely category for heart attack. I am on lipitor now and my primary physician recommended I eat 4 tablespoons of olive oil (studies show the Mediterranean Diet work as well as statins), and I have decreased my salt intake due to blood pressure issues (genetic and muscular causes) - though my cardiologist may put me on a pill for bp if I can’t bring it down naturally. I just wanted to say that this article gives me hope. I had been toying with going back to harder and heavier workouts because I hate where I am at - I planned to go into my seventies pushing myself as hard as I could but I got scared. Seeing that I am not alone in this has given me the possibility that I am not an unlucky fluke or a fool. Thanks!
6
@Kno Yeh
I developed a SV tachycardia after running marathons for 20+ years and went to Mayo for an ablation. While there, I met in the surgery prep room a French cyclist(39) that was a domestique for a Tour de France team that had developed a similar rhythm issue. My ablation failed, his was successful. I chose not to go back for a second try. The cardiologist recommended I quit running and extreme exercise. I continued with lighter running, maybe 25 miles/week down from 50-70 and started medical Qi Gong exercises along with daily magnesium supplements. Twenty years later, I'm still on same exercise regime and doing fine. Don't be afraid of NOT being in peak fitness. Like running your car engine up to the redline, there is fine line between being super healthy and throwing a rod.
10
Gretchen Reynolds loves intense exercise and welcomes any news that justifies it. A dear family member regularly rode his bike for four hours or more, up mountains, several times a week. He may not have had plaques but he DID develop ventricular tachycardia, known to develop from overexercise. He died on his mountain, his feet still in his toe clips, from his v-tach, a sudden cardiac death. Plaques are not the only cause of cardiac difficulties. Overexercise can be dangerous, and this knowledge is not disseminated. We would so enjoy having our dear one still alive, exercising less vigorously.
8
@Sassafras =
I too lost a friend to his heavy exercise. He was a marathoner who spent hours and hours outside running. He had fair skin and developed melanoma. Tragically, he left behind two adorable elementary-school-aged daughters.
3
@Sassafras
I lost a friend who sat on a couch all day eating - gee, is nothing safe?
5
So, Here I sit, cat on the mat, at an Independent Living facility having breakfast with my 96 year old mother. When I go for dinner in the dining hall, I will see many more Nona-octo/genarians. I can tell you without diving deep into the data: none of these people ran or jogged a day in their respective lives. My mother has been a life-long asthmatic. They all probably met the 30 minute moderate exercise point on a day to day basis.
My mother and father (died at 91 years) followed a healthy diet, had good medical and health care. My mother's mother who defininately did not run or jog, but did walk a lot, lived until 94.
Hmmmm. Genetics, the luck of the draw. Diet, our choice.
I see a lot very elderly people enjoying their lives. I bet that's not a new thing for them.
19
@Moses Khaet A lot of people find exercise enjoyable. I know I do.
1
My late grandmother(98) always told us, "everything in moderation" as she drank her daily beer/s(4), smoked her Kent cigarettes(half pack/day), and ate her bacon,eggs, and half stick of butter every day. As a forty-year runner that has trained at times at a rate that is simply abhorrent, I'm shooting for 78.
3
The message is that the non invasive calcium score is not valid in people who exercise a lot. Which makes curious the advice at the end which is to go get testing. The confounding factor that I would like to see investigated is use of non steroidal anti-inflammatories. These are likely cardio-toxic and have high use in older athletes.
6
Men in the Dallas, TX area (including those who exercise) have more plaque than normal? Not surprising, considering the dietary habits of the region!
12
@PA Blue I do not live in Dallas area. I was a participant in this study. I am a moderate exerciser in my estimation....10-12 hours per week. My calcification results have been zero for the last 18 years. In my case its in the genes.
2
"They did not include women but plan to in a follow-up study." Oh thank you, thank you. We women always treasure our follow-up study status. So grateful we're considered worthy of being an afterthought.
128
@MLChadwick Lighten-up Ms. Chadwick. Perhaps the study justifiably focused initially on the group most likely to suffer cardiac disease.
3
Exactly.
@Max Cardiovascular disease is the no.1 killer for both sexes.
7
Endurance running has actually been linked to poor heart health. Some studies have found that the hearts of lifelong male endurance athletes may contain more plaque or other signs of heart problems, such as scarring and inflammation, than the hearts of less active men of the same age.
For example, "Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119133/
10
I’m an old marathon runner(77+) with 30 marathons mostly barefoot last 8 years. My n=1 experience is not running beyond threshold, preferably 10 miles or 2 hrs daily. Simply to built my mitochondria and capillaries,building the brown muscles. HIIT is not for me. I’m running 2019 Boston marathon barefoot, my 7th consecutive bf marathon. I was 8th in age group 2018. It was cold and tough. Please listen to your body, the only, yet the best coach!
23
I wonder what I’d find in my feet after running for 2 hours in the Bronx.
5
“A second group completed somewhat less exercise, and a third group finished less than half as much exercise each week as the most avid exercisers.“
Along with the other problems mentioned in the comments (observational nature of the study, multiple uncontrolled confounders such as diet, sleep, medical & exercise history, and medications for underlying disorders) I’m not sure what relevance this has. Especially because these control groups are not well described here. It implies that there is some diminishment in premature mortality from running 6 miles a day instead of 5K, as in the second group. And if you only run 10 miles in a week, that is less protective? Nobody In any of these groups appears to be sedentary. The point seems to be that there isn’t an increased risk of running 40+ miles a week, but it implies more than that: there is actually a protective effect. What were the P values between each group? A fun little weekend read, but not something to change behavior one eay or the other.
13
Physicians treat patients and not X Ray pictures or lab reports.
Regular exercisers pass the equivalent of a treadmill tolerance test every time they go out.
2
I always wondered about caloric restriction, animal studies relate that to health and longevity, some skinny scientists are restricting calories for longevity.
How can a marathoner restrict calories? Or is diet a factor? Plaques are cholesterol (and calcium,) the liver turns carbs into cholesterol, but not if you burn them up quickly?
I know a healthy 60ish athlete who avoids all carbs, says he's a " don't know if that's prudent.
2
@Oreamnos, it is not prudent but just a fad. Study after study by legitimate sources have prove fruit, vegetables, etc are necessary.
5
@Oreamnos
Cholesterol is fat derived from animal sources
Triglycerides are fats derived from plant sources
Excess protein in the diet is chopped up and turned into carbs in the liver so you can’t get away from ingesting carbs ; your body won’t let you - all the excess amino acids that are the waste product from that protein to carb conversion are excreted in your kidneys and can damage the kidneys .
Carbs cannot turn into fats that would violate the laws of entropy
Even when we are eating meat only part of that is protein and part of it is carb and part is fat - the same way when we are eating vegetables and grains again part is protein part is carb and part is fat and part is fiber
3
From the article: "No one doubts, of course, that our hearts benefit from exercise. Study after study shows that people who meet the standard exercise guidelines, which call for about 30 minutes a day of moderate exercise, have a reduced risk of developing heart disease."
It doesn't matter how many of these Observational Studies appear to say that—if ALL of them suffer from the same two fatal flaws:
(1) "Selection" bias—i.e. that healthier people are more able and willing to exercise, and so are automatically disproportionally represented in the more-physically-active cohorts (and visa versa), and
(2) "Health-consciousness" confounding—i.e. those with the health discipline to sacrifice the time to exercise regularly will, on average, also be health-conscious enough to eat better, seek and take their medications and preventive screenings more, etc., etc, and these hundred of other-healthy-behaviors are not controlled for.
And each of these effects can be huge.
As frequently noted, association is not causation.
Please, please, please, point to the large, long-term, hard-outcome RANDOMIZED controlled trials on exercise.
Thanks so much!
26
@SRP: If articles like these convince more people to live healthier lifestyles, they would have done their job (Item 2 in your list). With a population as diverse as humans, there are always going to be variables that do not get counted.
As for Item 1, the study seems designed to examine the effects on people who are healthy enough to exercise. People who are already unhealthy have a different set of problems to work with.
Association approaches causation as the sample sizes increase.
6
@SRP
Agree wholeheartedly. There is much more at play for MI risks and occurrences besides calcium scores and presence of plaque. The article piques interest but should in no way be considered an answer to quantity,quality, or duration of exercise.
2
@mlbex -
"Association approaches causation as the sample sizes increase." [!]
Ummm, no.
this proves what has been said for years....You cant out exercise a bad diet. Reading the studies, coronary health is unrelated to exercise. there has been a great correlation with ingesting of animal saturated fats and plaque formation. Even marathoners who eat the Standard American Diet(S.A.D.) will develop plaques.....A study comparing diets of runners and plaque formation will be really helpful
19
@lola4md
Have you read any research on animal saturated fats in the last ten years? More specifically - animals that are pastured, grass fed, free range. Processed foods, too many simple carbs (like pasta and bread), vegetable oils,
and the white death (SUGAR) are the likely culprits.
6
"Scientists also aren’t sure how, at a molecular level, strenuous exercise might prompt the buildup of plaques..."
Some recent studies conclude that excess calcium is related to plaque development, possibly because the calcium portion of plaques has been found to be higher than the cholesterol portion.
That raises an interesting question as to whether excessive calcium intake itself is a risk hazard.
5
@Sequel Which is exactly why excluding woman was foolish...because women typically consume much higher levels of calcium.
3
As a 21 year old division 1 collegiate lightweight rower, this article speaks to me in ways that probably differ greatly from the majority of people. Our training includes hours upon hours of high-intensity training combined with with long-duration, low intensity workouts. In no way do I think being a serious athlete is harmful to my health, and I do not think the majority of people think this either. However, what struck me immediately about the article is how misleading the title is to the general public. Yes, Reynolds does explain later on that the study was conducted in males over 50 and that the exact physiological mechanisms of developing more plaques is somewhat unknown, so many confounding variables are left out. For example, what are the diets of the participants? The sleep habits? History of exercise during childhood, adolescence, college-age years? By making the title so misleading, people might start to develop negative perceptions of exercise before they even read the article. Or, maybe they do not read the entire article, but only the title. Maybe, they do not think of the wealth of confounding variables in the one study, or that this one study does not have others to back it up. I think there needs to be a little more care in misleading the public. As a young person, I think there needs to be an environment that more effectively supports a culture that allows for greater exercise and healthier patterns of daily life overall.
58
@Gabby
Good comment. Most people are pretty inactive, and many people have the idea that exercising "a lot" (however they may interpret that) is likely to be harmful in some way. Running 6 miles a day (the highest level of exercise in this study) is definitely not an extreme amount of exercise, particularly if one is inactive the remainder of the time. A lot of people are likely to read /skim this and get their negative ideas about exercise reinforced. Certainly there needs to be more nuance to the discussion when considering what is "too much" exercise. Active people have a higher need for sleep and nutrients compared with sedentary people, so exercise may end up having harmful physical effects on someone if they're not getting those things. And of course, you can definitely do "too much" if you are unaccustomed to it. But this type of article is not helpful to any discussion about exercise.
11
@Gabby Possibly, as a young person, you might learn one day that complex questions and problems do not have simple solutions and that many, especially NYTimes readers often do, in fact, read more than just the headline. What you find 'misleading' I actually found informative possibly because I have come to learn over time that this kind of information is better understood in a broader narrative. Actually I would be more apt to distrust an article which did not elaborate how the conclusions came to be.
7
@Dan Howell
I agree completely that most NYT readers do read more than the headline and can fully comprehend the information in a larger context. However, I can attest to the fact that other students my age simply do not have enough time in their busy days to read every article they lay their eyes on. The title may be ‘misleading’ when the reader does not have adequate supporting information to understand the complex issue or enough education to understand how to be critical of scholarly journal studies presented in articles.
As a student in health science, one of the most important things I have learned is that so often studies are represented in media that may not have full systematic reviews including meta-analyses. Clearly, there is no simple answer to why the higher exercise group acquired more plaque, and, contrary to your belief, I do not believe there ever could be a straightforward solution to the issue because of the differences in physiology, psychology, and behavior of each participant.
Though you may have found the title informative, I think it is important to note that there are inherent structures in society that provide privilege which enables understanding of the article with a broader lens, which many viewers might not have.
5
And that's why I am not exercising today!
2
people can exercise too much, especially if the exercise is intense...but another recent study in JAMA stated that: Cardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit.
3
As a 66 year old runner training for the Boston Marathon, and having received a stent 8 years ago, I found this article and the comments of readers interesting. I hope the researchers figure out why the extreme runners do not show the effects of the plaque in their arteries because I do wonder what happens when I retire from running. I have extensive collateral circulation from my running, and I wonder if that might be part of the explanation for the reduced problems in the extreme exercisers.
With respect to the comments of some readers: I do not think that my stent in my coronary artery is the result of plaque from running or diet; rather I suspect the main cause is family disposition on the maternal side. I am in the extreme exercise group because I enjoy running and I like to be competitive. I have no known injuries from running, despite having done so for more than 50 years, and doing so at a high intensity for a significant number of those years. I'll have to wait , hopefully for a long time, to see what my running has done to my life span! Until then, I'll just follow Neil Young's hope: "Long may you run".
13
I tend to agree with your thoughts! I received 2 stents 6 mnths ago and my emotional feeling was disappointment that in spite of working out and taking care of my diet , this happened to me. My cardiologist confirmed your thoughts, you cannot overcome bad genetic disposition with exercise or diet!
4
@Deon
I think you might not be able to eliminate totally the underlying genes, but I am certain that you can alleviate their effects. Exercise will make you heart stronger (my resting heart rate is in the mid 40's) and build collateral circulation in your heart. Those effects will decrease the damage done if an artery becomes clogged, increasing your chances of survival. I say this as a biologist/physiologist. Wishing you well Deon.
1
One obvious question that this study seems to beg: Instead of taking the chance of developing more cardio-vascular scarring and it's concurrent risks of free floating plaque from heavier and heavier work out's, wouldn't it be more prudent for the average person who is, after all, primarily interested in the benefits of regular exercise (rather than the development of a super hero enhanced body or metabolism)) to focus on engaging in a regular routine of moderate exercise?
And doesn't the underlying message of this latest study seem to prove out the long standing assumption that by focusing on a regular routine of moderate exercise, instead of on performing greater and greater physical stunts, the average person who engages in moderate exercise not only is less likely to damage their cardio-vascular system (to say nothing of harming their neuro-muscular and skeletal systems), but also stands to strengthen their hearts, jump start their immune system and even possibly enhance their cognitive faculties?
18
Yes, but what they happens to this plaque after the men age and stop running? Are they worse off, then had they never extreme run?
Of course, one doesn't have to stop. Think of the 105 year old man that was still bicycling competitively. But most people, as they age, they tire and slow down. They don't push themselves like that bicyclist was doing.
My belief is you do not exercise more than you are willing to sustain for the rest of your life.
4
@Don Wiss -
The problem is that the longer you stress your body, the sooner you will break it.
I think that every retired person I know who was once an avid exerciser has eventually had to stop because of an orthopedic injury CAUSED by the exercise. Every one; it is just a matter of time. It is self-harm, kind of like smoking.
Every sports- or exercise-related injury is really a health-system failure. (But it is a bug profit center for hospitals and keeps tens of thousands of orthopedic surgeon in their Mercedes...)
6
Thing is, any study from the Cooper Institute is going to be biased toward the unwell to begin with. Nobody is going to go all the way to Texas for treatment at a heart rehab center unless they were in pretty bad shape.
1
@Ron A
I am a member at Cooper. People do travel to be evaluated but I think most of their data comes from locals. Cooper has a special clientele who really care about their health. It is an amazing facility and I am thankful every day that we are so blessed to have it in our city. The staff at all the Cooper entities are caring professionals who are doing all they can to further our collective health. You can eat bad food and not exercise anywhere.
1
What were the men in group who exercised more strenuously eating? Plaques would indicate saturated fat caused by dairy and meat, and inflammation caused by sugar. The role that food plays in your health is huge! They needed to include that in the study.
14
@Paula Check out this recent article. What you're saying checks out.
https://medicalxpress.com/news/2019-01-plant-based-diets-benefit-athletes-heart.html
3
@Ben good article Ben, thank you for sharing!
Maybe the single gender study (only males) is because the 21,000+ men were first tested over a decade ago and the women cohort was not populous enough to include them?
Obviously multi-gender studies should be standard today.
I'm in the strenuous group and have passed a heart stress test and a sonogram. I have been taking a statin for 25 years which helped keep my cholesterol down below 240 and my HDL very high, because of exercise I guess.
Keep doing these studies and publishing them, even if flawed in some way.
1
@Liam Ryan Personally, I don't know many woman who have an hour or more a day to exercise because most woman work full time and also bear the almost full burden of child-rearing and home-maintaining to boot.
1
When my partner runs for 6 miles, he has burned over 600 calories, so yea, he wants to go to the pub for a burger and beer because he has earned it.
I think that is why people who exercise have more plaque and gunk.
7
Or maybe the study is further confirmation that we understand a bit, but far from all or even most of what really contributes to health. Maybe what we describe as "plaque" will turn out to be an array of things. Maybe there is some attribute to life style that goes along with extreme exercise that causes plaque. Who knows? These studies are intended to chip away at the margins of the unknowns. Journalists then try to spin the results into something readers can use to derive the optimal routine. This study, for example, only speaks about chance of dying after having a heart attack - it does not speak about overall health or even (if I understand the article) about having the heart attack to begin with. It's not meant to tell you if you should exercise more or less because that's not the purpose of the study. And then many of us critique the article as though the writer designed the study or twist the article into either criticism or confirmation for some opinion we have. Kind of silly in the end.
7
It is important to note that arteries are not a straight line. There are branches that are similar to tributaries from a free flowing river. There is a greater likelihood of plaque build up in those branches. That's Fred Kummerow's description from his book.
Never having run a marathon, I am content, at age 58, to continue running 10K races for the foreseeable future, then transition to 5k, then keep walking and hiking until the end.
10
The study deals with cardiovascular health, but there are other important elements of health to consider. This is purely anecdotal evidence, of course, but I used to work in offices with orthopedists, and I'm pretty sure I'd see their eyes light up with $ $ when they got new patients who ran more than moderately or did extreme training, especially the middle-aged-plus weekend warrior types. Joints and connective tissue can't always take the pounding over time. These docs had relatively few walkers or swimmers as patients. And even for the cardiovascular system, everything good for you is mainly good in moderation. So let's be careful out there.
9
Numbers please? How much less likely to die prematurely?
2
My interpretation of this study is that plaque buildup is irrespective of exercise but that exercise- the intenser the better- will help protect you from its deleterious effects. A CT scan showed I have mild calcification in the left anterior coronary artery. I wasn't sure what to make of it but, after seeing this study, I'm a little less concerned about it.
1
I used to run significant distances outdoors, but at one point developed a heel spur. I thought it somewhat odd, because at 5' 8" and about 135 pounds I could not imagine that the running I was doing would be putting much pressure on my feet. Wrong! Then later another foot problem developed in a large toe. For the past number of years, instead on running outdoors, I get a lot of aerobic exercise via ellipticals at the gym, in addition to weight training. Happily my heel spur has vanished and my toe has recovered.
But I always marvel at these accounts of people in their 60s, 70,s and 80s describing their running routines. But they often leave omit any impact on their knees, hips, lower back, and feet. Unless they're a bit bionic, It's hard to believe someone in their later years can engage in such strenuous running without damage to some part of their anatomy...and I must say that I'm also a bit skeptical of some of the accounts I read in the comments to articles on physical activities. Someone wrote recently that he's in his mid 80s, about my weight and lifts about 260 lbs. Then today a 67 year old man writes his resting blood pressure is 45. Maybe its true, but I gotta see these guys.
4
@Peter Lobel I’ve often had the same thought. I often think that some bodies were made to run, and some are not. Just like some are made to swim and some aren’t.
3
I think he said his resting pulse was 45. A BP 45 is pre-death.
1
Hope I'm still alive to read the study about exercise and women's heart health that is parenthetically alluded to, if and when it ever comes out. Maybe in 15 years, which is what this study took to finish?
13
@Kate
Though the article refers to “people” with regards to the results, it would be a sensible and easy question for the report authors to answer: “Do you believe this result applies to women equally?” Because it’s true that heart attacks have been shown lately to have differences for men and women, and that raises concerns. But that doesn’t mean we come from different species, and that the producers of the study were ignoring women. Why make the divisive conclusion so earnestly?
Exercise because you love it and it feels good to extend youth a bit further. Exercise because you want to be free of the slow accumulation of pain and limitations that accompany becoming fat and weak and stiff. Exercise because you want to participate in life in a physical manner.
Don’t exercise because you think you will live longer. Exercise because you want to live better in the time you have. We all die.
146
@D Priest
Part of the problem is that those lethal heart attacks begin in one's 50's.
If it were just about living to 95, I might not care.
1
@D Priest
Living better is what should be emphasized with respect to exercise. If you exercise regularly, you feel good. There are countless ways to exercise vigorously, not just marathon running. Exercise reduces many types of pain because a body will produce endorphins and when you push your self to the limits of what you think you can do, regularly, the endorphins remain active post work out. This has a cumulative effect and the efforts generated to complete the workout will spill out into other aspects of life. "Dieting" becomes easier and it becomes easier to complete physical chores, like vacuuming, carrying out the trash or chopping firewood. People who exercise vigorously are less sensitive to pain. Those who are physically fit and are more likely to find employment and command more respect naturally.
Exercise may or may not prolong your life, but without a doubt, vigorous exercise improves the quality of life.
13
I posted a comment to an article by Gretchen several years ago on this subject . There are studies that have shown an optimal level of calorie burning from exercise for adults (the maximum anabolic yield) which is around 2,500 calories per week. At that level of calorie burn, our bodies are most efficient at building new cells. Beyond this level of activity, we become more susceptible to the destructive effects of over activity which goes beyond cardiovascular problems.
6
The article should have mentioned the risk of heart rhythm problems.
4
The analysis proves next to nothing. People with very high arterial calcium levels, identified with scans, are advised (as I was at 70 seven years ago) that they are at higher risk of cardiac disease because of arterial plaque that could break off and block blood flow to brain or heart, resulting in stroke or myocardial infarction. But no amount of exercise (or diet or giving up smoking or alcohol) will reduce plaque. My blood pressure is controlled by medication and exercise, but that won't reduce plaque either. My dad, one of his brothers and his parents all died of cardiac disease. None of them exercised, and none of the medications available now existed while they were alive. Genetic factors may account at least as much as exercise and diet for cardiac risk. But less invasive cardiac surgery procedures have vastly reduced risk of death, especially angioplasty and trans-aortic heart valve replacement. Still, nothing reduces plaque.
The statement that nothing reduces plague may not be true. There are studies that show some plague regression from statins and the new drug repatha. I guess we shall see as times goes forward
1
There is also evidence that a low fat whole food, plant-based diet can reduce plaque in some cases. See separate studies by Drs. Ornish and Esselstyn. More research is needed in this area.
5
@Richard -
It is rare for plaque to "break off" and cause a problem.
What happens is the plaque ruptures, causing a thrombus, a clot to form. The thrombus, or parts, can then break free...
Also, regressing plaque is no cure—the key is to STABILIZE the plaque, to make it less "vulnerable," less prone to rupture, or wearing away. The key is to to keep the endothelium healthy. That is why any "regressing" of plaque through diet, even if it was possible, doesn't necessarily get you any hard-outcome improvements.
Because it is plaque stability that is important, given a constant calcium (and so plaque) volume, more calcium is actually BETTER. See PMID 24247483:
“Conclusions: CAC [coronary artery calcium] volume was positively and independently associated with CHD and CVD risk. [However,] At any level of CAC volume, CAC DENSITY was INVERSELY and significantly associated with CHD and CVD risk. “
See also: PMID 27903540, 2610688, 26449405, & 27903543.
3
Interesting comments about the extreme exercisers and was glad to see that some blanket statement of "why" was left up in the air. But why, oh why, didn't the author at least give a brief comment about the effects of the two control groups? More people would fit into those categories and would find those results intersting and important.
6
I’m 67 y/o and have been distance running/biking for 45 years. I pride myself as a climber and frequently find myself at altitudes of 12,000ft I also compete in skyscraper stairwell races. I’m very competitive for my age category.
My cardio score which was taken two years ago was 8. My resting pulse is 45 /-. My BP Runs about 120/80 but can sometimes be a bit erratic especially the day after a 3-4 hr workout in hot weather. My recovery time seems to be longer than I like.....sometimes some dizziness after sitting for a period of time.....my aorta is slightly enlarged and we’re monitoring this annually....so far the md says keep doing what I’m doing...
19
@Alan Lanctot Thank you for mentioning dizziness after sitting. I just had a spell of that, for 2 weeks, which came to me out of the blue. In retrospect, I had been pressing too hard and probably overtrained, getting ready for the swimming meets of the spring season. I am 85 and I compete in the endurance events (1000 yd FS). I cut down and my symptoms promptly disappeared.
8
My coronary calcium score is 5262.45 .White 68 yr old male placing me the 99 percentile for heavy calcium.
One stent in RCA at age 48.
Heavy exercise prior to age 48.
5
If a middle age athlete isn't having symptoms of ischemia, then a heart scan would be a really bad test. One should only do a medical test if it will change what you are going to do. According to this article, if an asymptomatic male middle aged athlete's heart scan reveals a high or low calcium score, no useful information is gained. I bring this up because some executive physicals include heart scans. Over testing is bad medicine.
26
@Diane Also a heart scan is a specialized X-ray test (according to the Mayo Clinic) . X-rays are ionizing radiation and cause cumulative cell damage and increase risk of cancers and other problems. One should not have X-rays done except when the information obtained justifies the risk.
4
The burgeoning popularity of half marathons indicates that a lot of people want to be fit but don't necessarily want the added risk of wear-and-tear or injury that seems to come with training for a full marathon. I'm 64 and am able to finish half marathons in under 2 hours training about 18-24 miles a week. While I'd love to qualify for Boston, I'm not sure that I want to risk worst-case consequences by doubling my mileage.
6
Running six miles a day is light training for 5000 meters and longer. If for sprints and shorter mid-distance and a good portion of it is interval work it is adequate or even a lot.
1
@Iplod I dunno -- 40 miles a week for a 50-year-old distance runner isn't a ton, but it's pretty solid for most who race 10K to marathon distances. Especially as the median or average for a large group. I qualified for Boston three times and seldom ran more than 50 mile weeks.
3
@Mark E when I was marathoning in my 30s 40 miles a week was great and 50 miles optimal. Now nearing 60 if I hit 40 miles a week regularly that would be off the charts. I agree entirely with you that in the 50-65 age group that's a lot of running.
1
I am a woman, so this article offers me no answer to the question posed in the title. But it does beg the questions, Why are women always relegated to "follow-up studies"? And what harm or strain does that reality cause my heart?
139
@RES
Maybe you can ask the author of the study. It was a woman. I'm sure she had a good reason for doing things the way she did.
9
@Ron A
It was actually three MDs - all women. As you say, they probably had good reasons.
Per the abstract "The present study included participants seen from January 13, 1998, through December 30, 2013, with mortality follow-up through December 31, 2014." Perhaps there was inadequate data for 1998 for women. Or not enough women died...
5
@RES
The summary in the last four paragraphs makes it clear that the study applies to all people.
3
I am a woman, so this article offers me no answer to the question posed in the title. But it does beg the questions, Why are women always relegated to "follow-up studies"? And why has that been perfectly okay with men? And what does that reality do to my heart?
26
The results of this study are consistent with my own experience. I have been an endurance runner and cyclist for many years. About 9 years ago, a calcium scoring heart scan found arterial calcium deposits. A follow-up scan last year indicated that the deposits increased. I continue to exercise but I am now following a vegan diet that excludes oil and most simple carbohydrates. When I look around and see overweight, unfit people in the majority, I feel fortunate to be able to exercise and I will continue. I also have a better understanding of the role of diet in maintaining good cardiovascular health. My advice is to seek out research about the role of diet. Many if not most endurance athletes eat big meals after long workouts. If these meals are typical of the standard American diet, an increased incidence of arterial plaques is not surprising.
33
@Dave You say you have calcium score. Almost everybody does. What is important is whether the score is above 100. It does the reader little good to know that you increased your score after exercise unless we know the original score and the increased score.
1
@Dave, I agree that a plant based whole foods diet, with low to no added oils, salt, and sugar, is perhaps the healthiest diet we can eat. There is evidence that it can also slow, stop, or even reverse atherosclerosis. Among many other health benefits.
I was recently surprised to learn that dogs can not only survive but also thrive on vegan diets. A study of sled dogs, who were as healthy and performed as well on a vegan diet compared with their normal diet, was an eye-opener. (Though the study lasted only 6 months.)
3
@Dave
So, have you been retested to see if the change of diet had its desired effect?
2
Why did this study only pertain to men? The focus is too narrow.
Why not do a study with both men and women and include all exercise groups?
I exercise a great deal. I'm healthy, active and show no signs of negative impact on my heart.
I'm getting a bit tired of the rampant exclusion of women in medical studies.
72
@Pamela L.
Agreed.
Women in health and medical clinical research are always, at best, the after thoughts.
10
@Pamela L.
When I see the ubiquitous campaign with the pink bows against women's breast cancer, I never feel jealous that men's prostate cancer is never as much a celebrated cause.
6
@derek
Probably because breast cancer kills proportionally more women of all ages, and during peak reproductive/childrearing and earning years, than prostate cancer, which tends to kill older men.
But women get and die of heart disease just as often as men, even though their symptoms often go ignored until it is too late.
12
The one thing I find interesting in all of the stories about exercise studies is that the word speculative is always near the end of the story.
Does anyone care to speculate about that?
9
@Bags Sure. All scientific hypothesis testing of general phenomena is based upon examining a subset of all relevant cases (such as all aging endurance athletes, or all aging male endurance athletes in this case), inferring implications for other cases (others not in the study), and then speculating about explanations for what has been observed - about the causes of any observed results. No study can study the causes of the causes of the causes of the observations, but it i logical to speculate about them because that leads to new questions and new understanding.
I would like to know what happens to an avid exerciser who develops significant plaque buildup over time and then stops exercising as hard, or stops all together.
Does that “safe plaque” suddenly become dangerous?
89
Good question. Something that should have been brought up during editing and referenced in the article.
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I have been a competitive endurance athlete for most of my adult life (running, cycling). Right around the age of 55 I significantly increased the duration and intensity of my workouts. I saw a dramatic improvement in my performance and had multiple top-3 placements in my age group. I thought all this hard work was good for my health. After 4 years I developed Atrial Fibrillation (AF). Research indicates that AF is highly correlated with aging athletes who participate in intense exercise and is due to scarring of the heart muscle.
So what has been my learning through all this?
1. Moderate exercise is healthy and promotes the maintenance of a strong body and mind.
2. Intense exercise of any type is meant to break the body down and by doing so can improve athletic performance. HOWEVER IMPROVED PERFORMANCE DOES NOT NECESSARILY MEAN IMPROVED HEALTH.
Competition is very rewarding. However, It would be great if everyone could enter into competitive endeavors with their eyes wide open.
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I'm a competitive swimmer who experienced similar cardiac issues at 56. While I didn't go into A Fib I did experience some arrhythmia that went away when I stopped being such a freak about my workouts. I took it as a sign that my heart wanted to dial down the intensity and at 62 I'm happy to comply with abbreviated but still intense workouts 3x a week.
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@Lamar Johnson
I think it is unwise to push to your limit beyond a certain age, with the possible exception of endurance. And I have trouble understanding cardiac stress tests at higher ages as well — I wouldn't do it to my car, even if a mechanic was standing by :o)
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@Lamar Johnson Yes, studies have shown that exercise can make AF more likely because it enlarges the atria.
But the connection you've made to your extra activity could be a coincidence. Did you get injured and use the diclofenac anti-inflammatory? Have you been using ibuprofen for pain? Both these NSAIDs have been shown to significantly increase AF risk.
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The runners with the most vigorous workout would eat significantly more. Plaque ultimately come from the food we eat.
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@George This is consistent with my observations of many other cyclists. After a long athletic ride, cyclists often feel free to eat unhealthy foods in abundance. I lost a friend to a heart attack while on a strenuous ride. He had a habit of binging on fatty, fried foods.
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To those who feel that running is good for the young, but the aged need to dial it back; do you think older people who run well and long need a lesson in moderation?
So many people who exercise are out of touch with the basics of what they do. Congenital problems aside, 6 easy miles of running to someone in tune with their body is no problem. And 3 miles of HIIT per week is just what the doctor ordered.
OTOH, just because a home run hitter hits the ball hard does not mean you will get the same results constantly swatting at the ball if you have no sense of timing, rhythm and balance. Likewise, not all running is equal. If you run with those 3, I doubt you would add arbitrary limits.
I am skeptical. Let's apply a little common sense. Dosage always matters. Too much salt, for instance, leads inevitably to death, as does too little. The same is true for any nutrient you can name, including water. (If you disagree, name one.) Why wouldn't the same be true for exercise? We are not evolved to run marathons, so there is just no reason to suppose that they are healthy.
Everything in moderation, people, as your Mother told you!
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@Finsq: Contrary to your assumption that we did not evolve to run marathons, there appears to be some consensus that we did evolve to run all day long. And possibly, moderate runners were weeded out in the evolutionary process.
Myself, I try to convince my body that I am still young, hoping it will agree.
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@Finsq
Exercise is not something you ingest so you're not going to OD on it, in that sense. For some people, running a single mile a day may be too much and for someone else they may like to do 10. I knew a man who ran 16 miles a day (8 miles each way to/from work). I don't think it even phased him.
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@Ron A
I should've mentioned that the guy I referred to who ran 16 miles a day was in his late 30s.
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Of course, one can exercise too much, but this article's focus is too narrow, assuming that heart disease as health is the only criteria. The first that is most obvious as when it's an extension of an eating disorder; I was very aware of the problem from back in the 1980s, and will occasionally wonder about younger women at my gym, seeing signs that might indicate excessive exercise. Also, larger amounts or higher intensity, of exercise are generally correlated with less frequent sex, but even that is not a simple result, as other aspects of a person's life make it meaningful in terms of long-term relationship viability, since I have seen at least one study showing that less sex correlated with lower rates of relationship breakup.
As for the study itself, there are different types of plaque that calcium scores can't discern, hard and soft, and the soft are more often implicated in heart disease. This study is not able to discern the difference. Even then, while calcium scoring has been sold to the medical world, it is of limited use, mostly as an adjunct to other types of testing, like cardiac stress tests, or along with other risk measures, like BP, BMI, etc.
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It's probably beyond the scope of this study, but it might be interesting to see what kind of diets these runners were consuming - - omnivore vs. vegetarian vs. vegan.
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@Jim-Yes, I agree! Our diet can greatly affect our heart health. Also, this article did not really discuss free radicals which studies have shown can occur after intense exercise (especially endurance training).
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These results do not surprise me. Those men who worked out the most likely had richer blood vessel networks supplying oxygen to heart tissue, and could survive blocks to arteries that others may not. But frankly I think six miles a day is too much. We may have evolved running that much to track down our food, but we likewise did not evolve to live into our eighties or nineties. Our parts can wear out. Exercisers should keep in mind that more can sometimes be less. This is common sense.
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