Why Ultra-Exercise Should Be Combined With Ultra-Nutrition, Ultra-Sleep and Ultra-Testing

In the year 490 BC, the fittest runner in Greece, Phiddipides, ran 26 miles from Marathon to Athens, to announce a great victory over the Persians. After declaring the news, he dropped dead. Now, 2,500 years later, what have we learned about the risks and benefits of ultra-exercise?

Clearly we know that an active lifestyle is better than sitting on the couch watching TV (particularly if you are polishing off a bag of potato chips). In fact, the data is overwhelming that the more fit you are, the greater your longevity. But does exercise act like a medicine, in that what may help you at a moderate dose can hurt you at a higher dose? In the 1970s the concept that if you could finish a marathon in under four hours it was like an insurance policy against a heart attack. The times are changing forcing us to rethink that paradigm.

Scientific data from around the world indicates that competing in marathons strains the heart for hours to days after the event. Using blood tests designed for diagnosing heart attacks, scientists found that runners frequently have elevated levels of enzymes in their blood after a marathon, and these levels are not present after lesser degrees of exertion. Using MRI scans of the heart before and after a marathon, chambers of the heart dilate and show decreased function and may take up to a week to recover.

Furthermore, in as many as 10% of regular marathon runners, MRI results shows late abnormalities, such as fibrosis, or scars in the heart that persist and seem to increase the chance of heart events in the coming years. Heart rhythm abnormalities (particularly atrial fibrillation), may be five times more common among runners who regularly complete marathons. In one study so far, long distance runners actually had more silent coronary artery disease than healthy people who did not run marathons.

Researchers from the Copenhagen City Heart Study, which tracked runners of different abilities over 27 years, found that the people who participated in the fastest, longest, and most frequent running had a higher mortality rate than the moderate group and were no different from the couch potatoes!

Based on this data, researchers concluded that the “sweet spot” of running was a medium pace, no more than three times a week, and less than 2.5 hours total per week.

Recent data has used CT imaging of heart arteries in endurance athletes anticipating that those that exercise the most would have the least evidence of calcified coronary arteries. In a sophisticated analysis of 152 Master’s athletes studied with both CT angiography of the heart arteries and MRI, there were actually more with a calcium score >300, irregular plaques and plaques >50% narrowed in the athletes compared to sedentary controls. Of additional concerns, signs of scarring of the myocardium on MRI were found only in these ultra-athletes.

Another recent study of 284 active men used heart CT angiography to determine the amount and type of plaque related to the level of exercise. Participants with the most weekly physical activity had a higher frequency of coronary artery calcification and plaque than those less active! A positive and hopeful finding however was that the most active group had more benign plaque characteristics with fewer plaques mixed with soft and hart components. Most were mainly hard calcified plaques. The authors proposed that longevity in regular exercisers may be because of more stable, even if more advanced, coronary lesions.

The most recent headline grabbing scientific inquiry was published in the Mayo Clinic Proceedings. Over 3,000 subjects of young age and apparent health were evaluated periodically over 25 years including at least one heart CT scan to provide a calcium score. The participants were separated into those exercising less than optimal, those at guideline recommendations, and a super group exercising >3 times the recommended suggestions for physical activity. The surprise to the researchers and most others was that subjects who participated in 3 times the recommend activity guidelines had a higher risk of developing silent heart artery calcification by middle age. White males in the study who were in the 3X activity group had a whopping 86% higher chance of having calcified (aged) heart arteries!

What do we make of all of this data? Certainly none of these studies permit us to skip the gym, and we still must try as hard as we can to stand, walk and sweat during workouts on a regular basis. If you have a burn to do ultra-endurance events, I would suggest you know your coronary artery calcium score and have a stress test if it is very high (over 300–400 range). Although we do not know for sure, it may be best to participate in marathons at a young age and after training properly.

For most of us, planning some cross training activities, limiting the pace and distance of high intensity exercise, may be wise mixing running with some moderate activities including yoga and stretching. While slow and steady may not win the longevity race, ultra-exercise should be combined with ultra-healthy diets, ultra-healthy sleep, ultra-healthy stress management, and advanced laboratory and cardiac testing.