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Healthy Older People Can and Should Compete in Endurance Events

An editorial in the January 2013 British medical journal, Heart, states that "Running too fast, too far, and for too many years may speed one's progress toward the finish line of life." The author bases his opinion on two recent reports presented at medical meetings:

• DISTANCE: One study of 52,600 people followed for 30 years showed that runners had a 19 percent lower death rate than non runners, but those who ran more than 25 miles a week did not live longer than non-runners.

• SPEED: Another study showed that runners who ran slower than eight miles per hour lived longer than non-runners, but those who ran faster than 8 MPH did not live longer.

These two studies are far too limited to make you think that older people should limit how much and how intensely they exercise. THEY APPEAR TO SHOW THAT INTENSE OLDER RUNNERS DO NOT GAIN AN ADVANTAGE OVER NON-RUNNERS. THEY DO NOT SHOW THAT RUNNING IS HARMING THEM. No reasonable physician should use just this data to recommend limiting exercise in older people. Overwhelming evidence shows that exercise helps prevent and treat obesity, high blood pressure, diabetes, heart attacks, strokes, and certain cancers, and helps to prolong life.

I am 77 years old and ride a bicycle more than 200 miles per week, race three times a week at 20 MPH, do interval training once a week, and lift weights seven days a week. I have no plans to change my training.

The author of the Heart editorial, James H. O'Keefe, a cardiologist in Kansas City who was an elite triathlon athlete, reported his concerns about older people exercising far and fast in the Mayo Clinic Proceedings (June 2012;87(6):587-595). He believes that too much exercise damages the heart and arteries by:

1) causing heart muscle to release enzymes (troponin and B-type natriuretic peptide) into the bloodstream, a sign of heart damage.
2) scarring the heart muscle

3) increasing calcium plaques in the large arteries
4) causing irregular heartbeats, in particular atrial fibrillation.

He is concerned about these findings in spite of the fact that he has no data to show that older exercisers are harmed by these changes. Overwhelming data show that exercisers have lower rates of disability and death (Arch Intern Med, 2008;168(15):1638-1646), and are healthier and live more than seven years longer than non-exercisers (Med Sci Sports Exerc., 1993;25(2):237-244).

REFUTING HIS ARGUMENTS COLLECTIVELY:
The apparent heart damage is the same type of muscle damage that is seen in the skeletal muscles of trained athletes. Here is why these changes are as beneficial to the heart muscle as they are to the skeletal muscles.

Every serious athlete learns that all training is done by "stressing and recovering". IF YOU WANT TO MAKE A MUSCLE STRONGER, YOU HAVE TO EXERCISE SO INTENSELY THAT YOU DAMAGE THAT MUSCLE. Then when the muscle heals, it is stronger than before it was damaged. So, knowledgeable athletes:
• Take a hard workout that damages their skeletal muscles. They know this because they feel burning during exercise, and soreness in their muscles eight to 24 hours after this intense workout.
• Then they take less intense workouts for as many days as it takes for the muscles to heal and the soreness to go away. If they do not take easier workouts on the days when their muscles are sore, they often injure themselves.
So workouts for knowledgeable athletes in all sports typically alternate one or more days of intense workouts with as many easy workouts as needed to allow recovery.

REFUTING EACH POINT INDIVIDUALLY:

1) HEART MUSCLE RELEASES ENZYMES (TROPONIN AND B-TYPE NATRIURETIC PEPTIDE) INTO THE BLOODSTREAM, A SIGN OF HEART DAMAGE: This is the training effect that you expect from proper exercise training. If you don't "damage" a skeletal muscle, it will not become stronger. If you don't "damage" the heart muscle, it will not become stronger. These enzymes that leak from the heart muscle into the bloodstream return to normal in less than a week, in the same manner that enzymes from damaged skeletal muscles return to normal in the same amount of time.

sarcomere2) SCARRING OF THE HEART MUSCLE: The "scarring" of heart muscle is the same as the scarring in skeletal muscles. It disappears after the muscle heals and is necessary for muscles to become stronger. (Diagram from http://www.ucl.ac.uk/~sjjgsca/MuscleSarcomere.gif). Skeletal muscles are composed of thousands of muscle fibers. Each fiber is a long rope made up of a series of thousands of similar blocks called sarcomeres, lined end to end to form a long chain. Each block attaches to the next sarcomere at the "Z line". Muscles function by shortening a little bit at each of the thousands of "Z lines". The "Z lines" all shorten simultaneously and the entire muscle then can contract. The "Z lines" are where muscles are damaged. It is damage to these "Z lines that causes muscle growth after healing, which makes muscles stronger.

3) INCREASED CALCIUM PLAQUES IN THE LARGE ARTERIES: Plaques in arteries may have more to do with the diet of endurance athletes than their exercise programs. High mileage athletes burn far more calories each day than do casual exercisers. Therefore, they have to eat far more food in order to have the energy to power their muscles during training. The extra food that athletes eat is likely to contain far more saturated fat, sugar, high glycemic-load foods, red meat, sugared drinks, and calories. All of these food components can increase the formation of plaques in arteries. Therefore, it is probably the increased intake of plaque- forming foods, and not the extra mileage, that may negate some of the benefits of long and hard exercise. Athletes who eat huge amounts of food and restrict these unhealthful components should have almost no plaques at all. I think that future studies will demonstrate that the increased deposition of plaques has nothing to do with running more miles or faster miles.

4) IRREGULAR HEART BEATS, IN PARTICULAR ATRIAL FIBRILLATION: At this time, we do not know if there really is an increased risk for irregular heartbeats in endurance athletes. All we know is that older competitive athletes suffer from irregular heartbeats just as younger athletes and non-athletes do. Furthermore, we have no evidence that older athletes are at increased risk for the harmful side effects of irregular heartbeats: fainting, accidents or sudden death.

The main concern about atrial fibrillation is that the patients are at increased risk for clotting in general and strokes in particular. However, nobody has shown that older endurance athletes with atrial fibrillation are at increased risk for clotting or strokes.

Dr. O'Keefe himself writes: "Sudden cardiac death among marathoners is very rare, with one event per 100,000 participants." Here are two of his references: Med Sci Sports Exerc., 2012;44(6):990-994; N Engl J Med, 2012;366(2):130-140.

BENEFITS OF ENDURANCE EXERCISE IN ALL AGE GROUPS: Dr O'Keefe is completely honest and reasonable in listing the following ways exercise helps to prevent and treat heart attacks:

• Increases the good HDL cholesterol
• lowers triglycerides
• treats obesity
• lowers high blood pressure
• Improves insulin sensitivity
• lowers blood sugar
• strengthens arteries
• helps with smoking cessation
• reduces psychological stress
• lowers hematocrit and blood viscosity
• expands blood volume
• prevents clotting
• increases blood flow to the heart
• increases collateral circulation to the heart
• increases tolerance of decreased blood flow to the heart
• reduces atherosclerosis
• enlarges arteries leading to the heart
• reduces major sickness and death

MY LAST WORD ON THE SUBJECT: I am 77 years old and plan to continue riding my bicycle 200 miles a week.
Note: I have sent this to the Wall Street Journal in response to their article, "One Running Shoe in the Grave", November 27, 2012.

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Healthful Diet Saves Lives of People with Heart Disease or Diabetes

31,546 patients, average age of 66.5, with known heart disease or diabetes were followed for almost 5 years (Circulation, published online December 4, 2012). Those who followed a healthful diet were significantly less likely to die of heart disease, or have heart attacks or strokes.

A healthful diet is loaded with fruits and vegetables and restricts sugared drinks, foods with added sugar, red meat and fried foods.

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This week's medical history:
Micheline Ostermeyer, Olympian and Concert Pianist

For a complete list of my medical history biographies go to Histories and Mysteries

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Recipe of the Week:

Firehouse Chili

You'll find lots of recipes and helpful tips in The Good Food Book
- it's FREE

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December 9th, 2012
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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