WSJ article on exercise intensity, aging and cardiac health

[teleguy57]

My wife placed the print version of yesterday's WSJ article in front of me with the comment: "You should read this -- really." She's been supportive and/or at least tolerant of my cycling (depending on how obsessive I become at times) since we were married 32 years ago, but will take the occasional opportunity to question whether at age 58 I'm moving into my Walter Mitty years and should back off from trying to be in the lead group on the Wed night world championships or hammer out solo centuries from time to time.

There are many health professionals on the Salon; I'm interested in your thoughts on the questions of intense exercise, aging, and cardiac health raised in the article.

[professerr]

These sorts of studies have been coming out for the past year or so, but generally involved very elite level athletes training and racing at very high levels. What caugth my eye in the WSJ article was the study that said that runners who run more that 25 miles a week lost all the benefit that exercise would otherwise confer. That's not a lot of exercise, relatively speaking. Cyclists, even non-racing Joe Blows, tax their hearts for vastly longer that the 3 hrs a week it takes to run 25 miles. For me, 3hrs is a one day, moderate weekend ride, not to mentionthe fact that I bump up my heart rate to maximum all the time (not literally all the time, of course)

I don't know what to make of all this. I don't feel like I'm killing myself.

[brucew]

I'm not sure it's wise to take medical advice from the WSJ, just as I don't think it would be wise to take financial advice from the NEJM.

Bear in mind too, that up until 48 years ago, smoking was still good for you--even in the peloton.



The devil is in the details in these things too. The WSJ article cites an editorial, not a peer-reviewed study. So while it's a good conversation starter, it's probably not good science, despite the reputation of the cited journal.

[Philster]

I was also surprised at the moderate level of running where benefit stops. I think the study sites a max speed of 8 minute miles. I'm wonering who this relates to cycling. My guess is that effort level in running is much more constant but i really know nothing.

[ldamelio]

I think the jury is out on this and the evidence is way too preliminary to worry. Most heart disease in this country is lifestyle-related. However, even among athletes, there's a subset of folks with intrinsic cardiac disease. High intensity activity may not be ideal for them and may bring out underlying arrythmias or other latent problems in those already prone. The rest of us are probably fine. In general, the weight of medical evidence heavily favors exercise as increasing longevity. That, however, is not want people want to hear and does not sell newspapers. The NEJM articles that get picked up by the lay press every Thursday are the ones that grab the most attention and not necessarily the ones that change the way we practice medicine. Also, the write-ups in the press generally simplify a lot of complex data into a stronger conclusion than in the actual research paper. My professional take: as cyclists, we're all familiar with the effects of overtraining. My simplistic perspective - ride as much and as hard as you want, as long as it makes you feel better. Supported by appropriate rest and nutrition I really can't see any problem. Probably the lack of these that gets folks into trouble. Recovery becomes more important with age. Any concerns, find a local good primary care doc or cardiologist who understands athletes (rare as hen's teeth). There's lots of good technology for non-invasive evaluation to catch any problems early. How many times have you heard of someone dropping dead randomly on a ride or race from a cardiac condition ? Me - zero. Most people who croak during marathons and triathlons do so from fluid and electrolyte problems.

Now for my personal take regarding longevity and riding - I don't give a shit even if it's true. Tens of millions of jackasses in this country sit on their asses watching reality TV cramming McDonald's down their throat in between Marlboros while waiting for their gastric bypass to fix everything. They take decades off their life and tax the health care system. There is societal normalization of deviance here. Emphasizing this single article in the lay press caters to this. Cycling is my cigarette, my heroin, my weed. Makes everything better. The sport itself and the people and places it's brought into my life have enriched it immensely. I'll gladly give up a few months of my 80-90 (or hopefully more) years for that.

[darkmother]

Interesting. For me, even if I knew there were no long term health benefits to cycling I would still continue to ride as much and as intensely as I do now. To take it one step further-I suspect there is a fair chance I will be killed while riding, and it does not deter me in the least. Cycling might as well be a heroin addiction for me.

[monadnocky]

Although I haven't looked at the study itself, it appears that there are a few logical leaps being made from correlational data (as the WSJ article itself points out.) I would take the "conclusions" of the study - as well as the opinions of the authors - with a very large grain of salt.

Wait and see what subsequent studies suggest. This one study offers some (weak, it would appear) evidence, and not much more. It's good newspaper fodder, though.

[Too Tall]

First wrt Idamelio's comment "How many times have you heard of someone dropping dead randomly on a ride or race from a cardiac condition ? Me - zero."
Saddly I know of a number including a teammate, a well known local bro racer and numerous close calls. My best pal Jimmy, who taught me everything worth knowing, used to be the studliest of all at our tue/thur worlds...total class act too. He now wears a pacemaker and chews beta blockers. Bobby "the bullet" Phillips...same deal...I could go on. It is anecdotal in our small world of elite masters athletes that guys are having heart pace issues, nobody knows what it is all about and there will likely never be a useful study. What I personally know and a bunch of us agree on is that the elite guys who stick with the sport seem to have these issues at or around the age of 50+ FWIIW Bobby is back and racing again.
I don't know what to tell you other than at your age (ouch) you'd better not hide from things like high blood pressure, coronary artery disease etc. because the stress of pushing your body to the limit is going to express these weaknesses more than it would if your main form of exercise is a brisk walk.
Thoughts?

[ldamelio]

Sorry to hear of those riders. I don't ride at the elite levels of the sport (50+ cat 4 packfill). One of our local legends, Joe Saling, has coronary disease and stents and still races well at 72 or 73. Agree wholeheartedly with you about not ignoring the possibilities of cardiac disease with aging - I may have overstated my point. Important to monitor one's health more closely as a masters athlete and get adequate rest and nutrition. I do this myself and so far no acute problems (lifelong asthma much better than in childhood). Work aging me much faster than training.

[chancerider]

Even more sad then the middle-aged warriors who drop dead from intense exercise are the cases of high school-aged kids who die during sporting events from undiagnosed cardiac irregularities. However, most of us can benefit from exercise and won't have to worry about such things. All I know is at my "advanced" age of 57, I have no plans to stop what I'm doing as far as physical activity. I only wish I had time to do more. I don't worry much about this because I am not an elite-level guy who spends a lot of time at or above max heart rate, etc... or obsessively training my ass off. But, as my old man always said, (an old-school guy who nonetheless made it to 91 and passed on peacefully in his sleep) "You gotta keep moving".

[Velo Wilco]

How many times have you heard of someone dropping dead randomly on a ride or race from a cardiac condition ? Me - zero.

One for me. Group ride and nothing spectacular. He was in his 50's and a great rider. Extremely well known in my area for starting up a large group and trail advocacy. He was feeling "off" and peeled off back towards the car. He passed away shortly after leaving the group on the trailside due to a heart attack.

Definitely makes you re-think things.

[Jonathan]

I wouldn't take financial advice from the Journal either.

Jokingly my uncle tells me that we are given so many heart beats in life and he wonders why I'm in a race to use them all up. I'd not doubt that elite level intensity is harmful vs something less stressful, it actually seems like common sense, but taken in the totality I doubt that few here have to worry and the positive effects may out weigh the negative for us recreational or weekend warrior types.

[Too Tall]

That's a big 10-4 Chance. I'm doing the same and if you look at the demographic of riders who sign up for my Spring Training Camps they all look like us! There are gobs of healthy masters athletes riding at very high levels, doing great and no reason to quit.

FWIIW I had borderline to high blood pressure for years, it caught up to me in the form of abnormally thickened heart walls. T.K. saw it during Ballers two years ago when I was dragging a$$ up the parkway. This mostly resolved with medication, weight loss, diet and lots of prayer but I'll probably never be the same and it could have been a WHOLE LOT WORSE.

[WayneJ]

Jokingly my uncle tells me that we are given so many heart beats in life and he wonders why I'm in a race to use them all up. <snip>

Someone sent this to me a while back. It made me laugh:

A Wise Chinese Doctor. (Weekend Joke) | Magsx2's Blog

[allezdude]

[QUOTE=ldamelio;455579 How many times have you heard of someone dropping dead randomly on a ride or race from a cardiac condition ? Me:- zero. [/QUOTE]

Me: two this year, and we're not talking about Elite riders. 1st guy, died 3 days after he turned 50. Had previous heart attack, stent, but kept riding, had heart attack in bed. 2nd guy, 52, died very much the same as Jim Fixx- near the end of a training ride, tails off the back of the group, collapses to his knees, has massive heart attack and dies even though CPR performed immediately. No electrical activity in his heart when the paramedics arrived.

I think this video which was mentioned in the comments to the WSJ Article is pretty good: Run for Your Life! At a comfortable pace, and not too far: James O&#39;Keefe at TEDxUMKC - YouTube

There is a psychological aspect to endurance riding that I think links to the cardio issue; riding helps with depression and the endorphins make us feel better. So, can we get these same psychological benefits with more moderate physical activity? As a long-time rider/racer, I don;t know, but this article and the deaths of the 2 local riders has me re-thinking my approach to riding.

[rec head]

I don't like that these studies never mention all the benefits you get during your life of being active. The story talks about mortality only. What about the self esteem you get from being fit? What about feeling good during the days you have instead of feeling sick all the time? To me this is the stuff that matters. Then again my only real long term goal for cycling has been to keep me healthy as I get old. I only do a few races a year.

[Tom]

I don't like that these studies never mention all the benefits you get during your life of being active. The story talks about mortality only. What about the self esteem you get from being fit? What about feeling good during the days you have instead of feeling sick all the time? To me this is the stuff that matters. Then again my only real long term goal for cycling has been to keep me healthy as I get old. I only do a few races a year.

Bingo. In my opinion, it's better to burn out than it is to rust.

[monadnocky]

I don't like that these studies never mention all the benefits you get during your life of being active. The story talks about mortality only. What about the self esteem you get from being fit? What about feeling good during the days you have instead of feeling sick all the time? To me this is the stuff that matters. Then again my only real long term goal for cycling has been to keep me healthy as I get old. I only do a few races a year.

Good point. One study, even is perofrmed properly and is replicated by other researchers, only contributes to a body of knowledge. One can't point to an isolated study and call it truth; unfortunately, newspapers tend to write about these things in such a way ("new study confirms xyz" or "new study shows that...")
I'm not implying that this particular article should be dismissed. But it hardly proves anything, and, I'm sure, the authors never intended to make any sort of definitive claim.
Disclaimer... Haven't read the original article.

[teleguy57]

As usual, great insights from fellow Salonistas. My gut is there could be something here, but I agree that a single research study leaves much to be desired. Even extrapolating from running to cycling is a leap. As TT pointed out though, there are anecdotes about health issues with cyclists. I do control my BP with meds, and do believe diet and exercise contribute to overall health. There are some serious riders/triathletes in my GP's practice group, althoug my doc is a more casual rider than racer-type. Next time I'm in to see him think I check in on their view of this topic.

I actually prefer to look at it this way... I have at least another 15-20 years to reach my potential.

[bigbill]

About an year ago, I had a scare when I had been experiencing chest pain for a few days and finally reached the point of going to the doctor at work. When I got there they did a EKG which was abnormal followed up by blood work which showed elevated troponin levels. I chewed up aspirin, was put on oxygen, and packed away in an ambulance to the local hospital. The local Naval Hospital didn't have a cardiac unit. At the time, I was 46, not in great shape, had been in an extremely stressful job for the last two years, and had just returned from a cross country trip. I was admitted to the cardiac unit where I stayed for the next 72 hours. For the first 24 hours my troponin levels rose and peaked around noon on the second day and then began to lower. During those 24 hours, I was on oxygen, taking nitroglycerin tablets, getting blood thinner shots in my abdomen, and small doses of morphine for my chest pain.

On the evening of the second day I was scheduled for a stress test. An earlier ECG had shown no abnormalities other than a large heart but that had been identified during a physical in my 20's. The stress test involved walking on an incline on a treadmill but I ended up running because walking wasn't getting my heartrate high enough. Again, no abnormalities, proper heart functions with no damage found, no blockages, or anything otherwise. I still felt like shit, my chest hurt, and thought I was going to die. During the second day, I had a CT scan of my chest to check for any other damage or hernias, all negative.

On the third day, I had a lower abdomen to pelvis CT scan which was also negative. The barium milkshakes were awful. I felt better, the chest pain was lessening so they discharged me with post heart attack medications including beta blockers. I took the medications as prescribed and was told to not work out or stress my heart for at least two weeks. At the end of that time, I started riding my trainer bike on my computrainer at low wattage for 30 minutes. My heartrate wouldn't go above 100 and my legs felt like they were on fire due to insufficient blood flow. After a month of this, I got an appointment with a cardiologist who reviewed my records and all the test results. His first remark was to stop the beta blockers since they were keeping my resting HR in the low 40's. He determined that my cardiac event wasn't likely a MI but nothing was conclusive. About three days off the beta blockers, I felt more normal and my heart started responding to exercise. I've been good since and although I was still in the stressful job until September, my current job (retired naval officer and process engineer) is low stress with decent hours. I'll have time through the winter and next year to regain the fitness of my 30's, it'll be interesting to see how my body responds.