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Friday, November 23, 2012

Can Endurance Sports Hurt Your Health?

Exercise is good for you.  But is there such a thing as too much exercise?

-At the end of marathons, runners have been shown to have elevated troponin levels, a markers of heart muscle damage.  They may also have elevated CPK levels, representing skeletal muscle damage.  The consequences of these abnormalities are not known.

-One study found that there was MRI evidence of dysfunction of the right ventricle of the heart.  This was a transient finding, and, again, the long-term consequences aren't known.

-Arrhythmias, such as atrial fibrillation, are more common in endurance athletes.

-Athletes have died during Ironman distance triathlons.  That said, athletes have died during marathons, half marathons, and shorter distance triathlons, and the incidence of sudden deaths during the Ironman is no greater than any other distance race.

-Long-term marathon running increases the amount of calcium in the coronary arteries, which is a marker of coronary plaque.

-Blood markers of inflammation are higher during intense training.
Me -- on my way to becoming an IronMan!

So what about me?

I'm a triathlete, who has completed 13 marathons, an Ironman triathlon (Ironman Lake Placid 2010), countless other road and trail races and triathlons of other distances, and next weekend I will be running my first ultramarathon, a 50-k (31 mile) race.

I've had an arrhythmia -- AV nodal re-entrant tachycardia, a form of SVT (supraventricular tachycardia).  I underwent a successful ablation procedure in April 2009, and have had minimal palpitations since.  To my knowledge, AV nodal re-entrant tachycardia is not an arrhythmia that is encountered any more frequently in athletes than in non-athletes.

During my Ironman Lake Placid training, I did some blood work.  My cholesterol numbers rocked, my hemoglobin was well within the normal range, and electrolytes were good, but my high-sensitivity c-reactive protein level, a marker of inflammation, was quite elevated at 7.4, with normal being levels less than 2.

As I trained for Ironman Lake Placid, I was tired all the time.  I didn't feel good.  My run times dropped, and I slogged along on my long 15 to 20 mile practice runs at an 11 to 12 minute per mile pace.  I couldn't wait for my 6+ hour long bike rides on Pacific Coast Highway to be done.  And the swimming... I've never been a fan of long swims, so the day I had to swim two miles, thankfully my friend Ray was there to entertain us with the occasional group hug or joke, as we then doused our faces in the water and stroked on to the finish.

I finished Ironman Lake Placid in 14 hours and 45 minutes.  I see my friends and teammates who have done multiple Ironman races.  I contemplate how on a flat course and the right training I could finish in under 13 hours.  Because I could achieve that.  I even thought about signing up for Ironman Arizona 2013.  Fortunately, when the race went on sale last Monday morning at 11 AM, I was busy with patients and wasn't bored at my computer to repeatedly hit the "refresh" button.

But, if I were honest with myself, I don't want to do another Ironman.  I will do an ultramarathon for the same reason I became an Ironman -- to say I've achieved that distance.

I'm not going to be an endurance athlete forever.  I'll always be physically active, and I hope that during the length of my "career" as an endurance athlete that I can take away the health benefits and not be left with the possible consequences.


Gail Janicola said...

Dear Dr. Shenkman, I am not a triathlete, but I am madly in love with one. (My husband:) Although a cyclist and fit from years of consistent gym workouts and then several rounds of P90X, he had never done a triathlon before. (He did not even own a pair of running sneakers.) Then, as we were entering 2011, wanting to model a "you can do anything you put your mind to" ethic, and feeling compelled to mark the 10 year anniversary of 9/11 in a personally significant way, he signed up for the Panama City FL Ironman, which would take place on 11/5/11. Very long story short, he did it... ironically, in the same time you completed yours (14:45:46). He has remained constant in his decision to savor that experience as "once and done", vowing never to train for or participate in another full Ironman. However... he had a busy race schedule this year, doing sprints and Olympic distances, and amongst other races he is scheduled to compete in 2012, he has gifted himself (with my full support of course) with a registration for the Kona half Ironman in June. At the end of August, he experienced an arrhythmia that was diagnosed as atrial fibrilation. Needless to say, this was upsetting to us both. Reading your blog, in addition to the discussions we had with his cardiologist, helps me to understand the connection (endurance athlete -> heart "issues"), and I'm somewhat comforted by the idea that it is typically benign. It still makes me a bit anxious, even though I see that, you, a cardiologist, is still continuing to train and race. I believe so deeply in balance, and always pray that he is achieving that. Thanks for sharing your story and allowing me to do the same. Your expertise is also greatly appreciated. I truly hope you achieve all your goals. I absolutely what it takes to get there!

glovemtb said...

Been a cardio athlete for many years with many friends who started to have heart issues.
(Came to suspect that most, but no all are related to diet. As everyone tried to out exercise their diet.) Of course when I over-do and don't allow adequate healing time I have issues. But....
My non-progressive cardiologist told me it was age related & genes. Started my research and reversed all of my symptoms.
Came to differentiate the inflammatory process (good) in exercise vs diet poisoning inflammation and subsequent endothelium damage.
Once I modified diet and my blood markers returned to normal as well as B/P. Heart issues resolved and I have output I had 20 years earlier.
How ? Thanks to a progressive cardiologist like Dr. Shenkman, I am now NO OIL vegan diet. (via Dr. Marc Katz with research by Dr. Caldwell Esselstyn)
To quote:
"Regular strenuous exercise protects against heart attacks but produces oxidative stress and inflammation as well. How could this be helpful? The reason is that inflammation caused by exercise is different from inflammation associated with disease states. Physical activity lowers the risk of a heart attack by increasing anti-inflammatory molecules(Kasapis and Th ompson 2005)."...
Easy to moderate aerobic exercise: lowering 1. of systolic blood pressure, improved lipids, improved body composition (e.g.,
less fat, more muscle). Example: walking, easy jogging,
easy bicycling, hiking, easy rowing, stair stepper, elliptical
machine, etc.
2. Moderate to vigorous exercise: lowering of systolic and
diastolic blood pressure, improved lipids, improved body
composition, improved blood sugar control, increased
cardio respiratory fitness, reductions of risk for all causes
of mortality (cancer, stroke, heart attack, etc.). Example:
hiking uphill, running, cross-country skiing, cycling,
rowing, and swimming.
-- Stephen Parsell "Dare To Live"

More references to heart remodeling studies.
Reference to improved bone mass from impact sports:

Thank you Doctor Shenkman for pioneering diet as well as athletics. You are a wonderful inspiration.
"The fault is not in our genes, but in ourselves...and the way we eat." We have the power to change it !

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