Discussion: WSJ Running Polemic

Article

"A fast-emerging body of scientific evidence points to a conclusion that’s unsettling, to say the least, for a lot of older athletes: Running can take a toll on the heart that essentially eliminates the benefits of exercise."

Thoughts? Clark?

[making popcorn]

[Junior Mints acquired]

Really.... referencing WSJ for science issues???

Some very 'scientific' quotes:

"Meanwhile, according to the Heart editorial, another large study found no mortality benefit for those who ran faster than 8 miles per hour, while those who ran slower reaped significant mortality benefits."

"said Dr. Cooper, adding that he suspects—without hard evidence—that extreme exercise can render a body more susceptible to cancer."

"chronic exercise addicts"

Where's the data?

Presumably in the 'cited' papers. I look forward to the meta analysis.

Here's some actual work by these scientists. I will let other people go to the effort of interpretation.

Mayo
MSMA
PCD

I hope the are right:) When my time comes to clock out I'd rather do it True Micah way then stuck in some nursing home. Let's go bowling!

One of those links took me to a paper that is retracted while they figure out how to convert from kJ to kcal.

Knowing the accuracy of the "science" reported by the WSJ in my own field of climate, I don't exactly place a lot of confidence in these reports either.

A thoughtful rebuttal is here.

Micah True hadn't seen a doctor in decades. I hope Gil is wiser.

Here's some actual work by these scientists

I didn't see any data. Where's the data?

I'm not sure I should get into this but its too tempting. On the mayo article on the graph on the third page the say that for vigorous exercise the mortality benefits peak at 50 to 60 minutes... But the graph doesn't show an data beyond that amount of time. How can we really say if that's a peak or not?

@T/D - my comment is not about going or not going to doc but more about doing what you enjoy, maybe having shorter lifespan, instead of living 100 years of boring life. We can only speculate what Micah True would have done after going to doctors and doctor would have advised to scale down on his activities. Some how I think he'd still continue to live his life the way he was living.

No, he'd have a pacemaker installed and the pacemaker would have not bothered him for 360 days a year, letting him run all the ultras he would want but not die. The sadness of that particular situation is that his issues apparently didn't require scaling down on anything, and that he was otherwise perfectly healthy. He also apparently had plenty of warnings but chose to ignore them. But this is going in another direction.

Here is a summary of Norwegian and Swedish studies on the same subject, for cross-country skiers:
http://www.medpagetoday.com/MeetingCoverage/ESC/28...

This article (as are many others in this vein) is a rationale that people can use to justify their lack of exercise. "See that dude running? He will die of a heart attack before me." It's scare tactic that sells newspapers.

If this study proved correct, very similar recommendations would hold true for other sports. Would any British journal dare to publish an editorial suggesting readers limit soccer practice to 3 hrs/wk?

Going to the doctor for your regular checkups and running more than 1 hour a day are not exclusive activities.
Just because Caballo Blanco did not check in with his cardiologist does not prove the point the article suggests.
And +1 @Geoman.

@Geoman
I agree, but I think more thorough studies like the Swedish and Norwegian ones are worthwhile. If intensive training involves risks, athletes deserve to know if they are significant.

>>> It's scare tactic that sells newspapers

The rebutall linked above is from Runner's World, which I believe is attempting to be profitable magazine promiting running, no? The sales tactics work both ways.

And I wonder, all those doctor visits by runners to deal with aches and pains and knee surgeries, etc. Does that really cost less than the smokers lung cancer treatment, for example?

It's interesting the work that Nathan posts the link to that the increase in treatment for AF (used as a proxy measure) in intensive exercisers was only significant in men, not women. You hear relatively frequent stories of these sudden cardiac events in men, but I hear few in women.

Also, that review has a pretty high definition of intense exercise.

http://www.medpagetoday.com/MeetingCoverage/ESC/28...

..."Basically, this study shows that even though physical activity is generally healthy, athletes committed to endurance sports at elite level have higher risk of suffering from a heart rhythm disorder," he said.

Tomaselli told MedPage Today that while there are some dangers to strenuous activity "exercise by far has more benefits to health than risks....

I can't provide the specific reference at this point, but Norwegian studies have found that 'serious athletes' may overdo training while having a cold, which can lead to inflammation (and permanent scar tissue formation) in the heart muscle. So if you absolutely have to train with a cold, maybe avoid the high-intensity stuff.

The rebuttal is from Alex Hutchinson who ran his sweat science blog well before it was linked to runner 's world. He is very well read and has an incredible ability to synthesize the science. (He also has run a few Salomon Dontgetlost Adventure Running Series races and wrote the excellent article about orienteering for men's journal mag earlier this year.

The character reference is from Salomon Dontgetlost, which I believe is attempting to be a profitable organisation promoting running, no?

Totally OT but no absolutely not! GHO is a not for profit organization but we are in the growing orienteering participation business. My point is that I would trust Alex's ability to synthesize and write about science. He is well read and is also an accomplished runner and the character reference is my personal opinion.

;) did I just get a rise out of you? I'd better go now...

I'm don't actually try to troll people in real life (much), but I do always find the "but you can't believe them because the are trying to profit/have an agenda" dismissal a bit weak, one that people typically use to unthinkingly avoid uncomforable arguments that oppose their pre-held beliefs. EVERYBODY has an agenda/is trying to profit, if you look deeply enough.

This Hutchinson looks pretty reasonable, seems his agenda really is finding the truth. He is trying to sell a book, though, which I didn't know about before, and which he's now successfully sold to me since it looks pretty interesting.

Is this really a thread suggesting that there's worry about "exercising too much"?

Clearly we'd all probably agree that there's a threshold of "too little", right? Some exercise is better than no exercise.

Why is too much such an issue as a concept?

Replace exercise with water and it's the same sort of situation, isn't it? Too much water is bad for you - even though we all recognize that water is a wonderful and essential thing...

I'm becoming more and more convinced that the mainline medical profession has gone astray and that there's too much carbohydrate and sugars in the typical diet - we can do just fine with fat thank you very much. Some carbs - certainly tolerable; all carbs - maybe not so good... ( Blog article here: http://www.timelyinsights.net/archives/re-thinking... )

It shouldn't be a surprise to find both upper and lower limits to anything.

Now - what are those limits for any individual - I doubt you'll get to them with averages. Everybody needs to figure out what works well for their own situation.

Labeling the WSJ article as a polemic is pre-judging it. Just as climate deniers resist curbing their fossil fuel consumption and close their minds to the science, fitness buffs are attacking the message, not the science. The British study on which the article was based and the Norwegian ones referenced in the comments both point out some serious consequences . I'd like to see more info on just how to determine how to determine my point of diminishing returns from aerobic exercise.

Well, I think I read through the science.

The science says:

(1) The more exercise you do, the greater your risk of atrial fibrillation, which in a vast majority of cases is non-life-threatening and conveniently limits the exercise. This is proven in multiple studies and fairly well accepted.

(2) The more exercise you do, the greater your risk of ventricular arrhythmias, which are life-threatening. Unlike the atrial fibrillation studies, sample sizes for these are small and error bars are large. Sustained ventricular arrhythmias are quite uncommon in both athletes and sedentary population unless there was a prior heart attack.

(3) However, all studies that measured overall mortality point to decreased overall risk of death with increasing exercise. I was unable to see a study that would inequivocally say, your overall risk of death increases past a certain amount of exercise.

Please refute my third point and then perhaps the discussion can continue.

The reason people are upset is that the likes of O'Keeffe assert something other than this third point, or seem to do so, or journalists employed by the likes of WSJ do—in the absence of data proving their assertions. They seem to say that since there is an increase in cardiac issues in athletes, exercise beyond a certain amount/intensity is necessarily bad.

But what really matters is the overall mortality; next, the overall quality of life.

Yes you will get more arrhythmia with exercise (I personally am an example), but I'm yet to see anything that would prove that the benefits I reap are outweighed by the risks.

The major cardiovascular benefit seems to be exercise-induced development of collateral arteries, which provide redundant support to the heart muscle when the main coronary arteries become occluded. For several Attackpointers, these secondary arteries seemed to have prevented a heart attack in their late 30s to early 50s. For one APer, the collaterals were the difference between commenting on this thread and being permanently unable to do so.

So the heart-related choice is between a certain percent risk of having arrhythmias vs. a certain percent risk of having an early heart attack, with the decrease in serious risks always winning over to decrease overall mortality. Perhaps there is a happy medium, dependent on the amount and intensity of exercise, but I have not seen studies with appropriate data.

On point 3 from Tundra above, The WSJ article appears to be quoting from a pre publication version of an article by O'Keefe and Lavie soon to be published in the British journal , Heart. They say "the runners in the group had a 19% lower death rate than nonrunners, according to the Heart editorial. But among the running cohort, those who ran a lot—more than 20 to 25 miles a week—lost that mortality advantage."
My interpretation of this:
The extreme runners (more than 25 miles per week) lose that mortality advantage, i.e are back to the average rate of the non runners.
So the death rate of moderate runners, say 8 to 15 miles per week , must be way more (i.e. less deaths) than 19% less than average, to make the average for all runners 19% less than non runners.
The paper hasn't been published yet, so the actual data isn't available, but it must have gone through peer review by now.
We'll have to wait and see, but I doubt if the WSJ reporter would distort it that much. They have seen the paper and interviewed the authors. We haven't.

In what world is 25 miles a week extreme running? That's about 30 minutes a day.

In what world is arguing points in the absence of data anything but polemic and not science? Publish first, discuss later.

The paper has been published. Note that it was published as an editorial, not a research paper. My institution is not a subscriber, but the first page is freely available:

http://heart.bmj.com/content/early/2012/11/21/hear...

Also, here is a response from Amby Burfoot:

http://www.runnersworld.com/health/what-latest-exc...

Are BMJ editorials peer-reviewed?

It appears not. From the journal web site:

"Heart has an active commissioning strategy of editorial, educational and review articles to augment to the original research content of the journal...Editorials are shorter, up to 1500 words and 16 references, and give the judgment of the writer based on published data."

So upon what published data is the judgment of the editorial based?

Well, it appears I am in error about the O'Keefe Heart editorial. The WSJ article mentions a study involving 52,600 people followed for three decades.... But among the running cohort ....more than 20 to 25 miles a week—lost that mortality advantage.
But this study with actual data is apparently somewhere else, just the conclusions are quoted in the Heart editorial. And it does apparently refer to older runners, since it follows them for 30 yrs, long enough to get significant mortality data.

So I forked out the fee to view the article. I can't paste it here, but the relevant references are, for the 13000 runners and 42000 non runners:

Lee, Pate and Lavie, Running and all cause mortality risk: is more better?
Medicine and Science in Sports and Exercise, San Francisco CA

Also similar data from the Copenhagen Heart study:
Schnohr, P , Assessing prognosis: a glimpse of the future. Jogging health or hazard? In : Cardiology ESO ed. EuroPRevent Dublin Ireland European Heart Journal 2012

Schnohr equates running to use of alcohol: moderate usage brings benefits, excessive use has drawbacks.

I wonder what proportion of "extreme runners" actually run for the purpose of living longer? I can't imagine it is a major motivating factor. Quality of life, yes, but a few extra years?

So the first article (Lee, Pate and Lavie, Running and all cause mortality risk: is more better?), is unpublished according to its lead author (tried searching on the journal's website, and confirmed). What is the view of scientists, of which we have plenty on AP, of the ethics of publishing an editorial largely based on an unpublished article by the same authors, with underlying data unavailable for public review?

And here's to the other reference, the Copenhagen "data":

"This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal."

So...

I'm back to the original question...

WHERE IS THE DATA?

and a follow-up question, just what are these academic standards for BMJ journals? I'll skip the polemics about the likes of WSJ, for which standards are an oxymoron. I'm really surprised, given this, that anyone would take O'Keeffe and Lavine seriously; Burfoot and Thompson are wasting their time fighting trolls (who have surprising access to print media).

And I hope y'all have fun reading the MedPage summary of Schnohr's presentation... Enlightening how we've gone from "Joggers Live Longer, Possibly Happier, Lives" to "One Running Shoe in the Grave".

During 35 years of follow-up there were 122 deaths among joggers versus 10,158 deaths among non-joggers.

P.S. Don, I would ask for your $30 back from BMJ. So much for "the judgment of the writer based on published data".

This is certainly not gold plated data. But it is data. There are a lot of "inconvenient truths" out there. Boxers found out a long time ago. Football, ice hockey seem to be finding out more every season. I hope this preliminary data gets thrashed out as the review process goes on, and stimulates more studies.

I just want to find out what helps me develop my body and what harms it.

I don't think anyone ever thought smashing your head at great speed against someone else's head/a side panel was a good idea.

T/D is right is saying it's strange that they should be writing an editorial as if the data had been accepted and published through peer review when it hasn't. How do we know they didn't take that approach because it was rejected previously due to fatal experimental flaws?

Yes, it is important to continue doing these studies, I completely agree with that. But something does sound a bit fishy about this one.

@Becks and @T/D - it's simple - article is published by journalist who's job is to sell paper or on-line adds by creating some controversy. Journalists are original trolls.

When I read more about Dr. O'Keefe views from links that other folks published on this thread he did not sound as extreme as I would have guessed just by reading original article published by j-man.

Any study that examines this phenomenon is going to have a lot of flaws. Every individual has a different pattern of exercise duration, intensity, consistency, and longevity. Very few people run 40 mpw with 30 min/wk at T pace and a 5-21k race once a month for 30 years.

How are you ever going to isolate the "hidden danger" when some people take the winter off and others race hard every weekend? Besides, unless you have heart-rate data for every participant's entire career, you'd be using self reported exertion levels. One person's "9" exertion level could be 85% of MHR while another calls that a "7." Maybe the hidden danger is hard running when there are high ozone or particulate counts. Unless you have the time of day of each workout recorded, you'd miss that factor.

If 7:30 pace is a level that "feels" too fast for the authors, then shouldn't that be adjusted for age, sex, and weight? 7:30 is pretty fast for a 60F.

This study uses "all-cause" mortality. But a 5 hr/wk athlete has 3120 hours more exposure to training accidents than a 3 hr/wk one over 30 years. 3120 hours is a lot of time where you can get hurt by a drunk or distracted driver, or slip on the ice, or get impaled by a log. Should training accidents count when you're discussing health benefits?

There are so many things about the work of Lavie et al. to challenge, it's hard to know where to begin. Though I'm glad bct brought up all-cause mortality, because it suggests an orienteering analogy: all-cause mortality is to epidemiology what a yellow course is to orienteering - a valid exercise, but only providing the roughest hint of the overall terrain. Cancer, in particular, tends to dominate all-cause mortality - my gut reaction to their findings (setting aside their lack of data) would be that "running under 7:30 pace must somehow contribute to cancer".

We can add self-plagiarism (not to mention evolutionary determinism!) to the list. Whenever you submit a paper, you attest that similar work is not currently being considered for publication elsewhere. Here are two paper abstracts from 2010/2011:

Progress in Cardiovascular Diseases
Volume 53, Issue 6, May 2011, Pages 471-479
Exercise Like a Hunter-Gatherer: A Prescription for Organic Physical Fitness

Abstract
A large proportion of the health woes beleaguering modern cultures are because of daily physical activity patterns that are profoundly different from those for which we are genetically adapted. The ancestral natural environment in which our current genome was forged via natural selection called for a large amount of daily energy expenditure on a variety of physical movements. Our genes that were selected for in this arduous and demanding natural milieu enabled our ancestors to survive and thrive, leading to a very vigorous lifestyle. This abrupt (by evolutionary time frames) change from a very physically demanding lifestyle in natural outdoor settings to an inactive indoor lifestyle is at the origin of many of the widespread chronic diseases that are endemic in our modern society. The logical answer is to replicate the native human activity pattern to the extent that this is achievable and practical. Recommendations for exercise mode, duration, intensity, and frequency are outlined with a focus on simulating the routine physical activities of our ancient hunter-gatherer ancestors whose genome we still largely share today. In a typical inactive person, this type of daily physical activity will optimize gene expression and help to confer the robust health that was enjoyed by hunter-gatherers in the wild. © 2011 Elsevier Inc.

American Journal of Medicine
Volume 123, Issue 12, December 2010, Pages 1082-1086
Achieving hunter-gatherer fitness in the 21 st century: Back to the future ( Review )
O'Keefe, J.H.a , Vogel, R.b, Lavie, C.J.c, Cordain, L.d


Abstract
The systematic displacement from a very physically active lifestyle in our natural outdoor environment to a sedentary, indoor lifestyle is at the root of many of the ubiquitous chronic diseases that are endemic in our culture. The intuitive solution is to simulate the indigenous human activity pattern to the extent that this is possible and practically achievable. Suggestions for exercise mode, duration, intensity, and frequency are outlined with a focus on realigning our daily physical activities with the archetype that is encoded within our genome. © 2010 Elsevier Inc. All rights reserved.

It is worth noting that the authors of the second abstract, especially Cordain have a financial interest in the development of Cross Fit. I happen to enjoy both, but I'm still not sure of any of the science. As someone said above, these kind of studies are minefields to control for - I'll stick to my molecular biology, thanks!

I'm a little surprised that acjospe hasn't joined in the discussion yet, in view of the comment in her Nov 9 training log, shortly before this thread began--

Light exercise is good, sure, but what about excessive, obscenely intense exercise? Does that shorten one's life? I wouldn't be surprised.

My own feeling is that while studies I've been looking at since this discussion began may not be conclusive about too much exercise being worse for your life expectancy than modest exercise, there is plenty out there that is suggestive of potential concerns, with one or two gaps to be closed between the questions being addressed in different studies, gaps which might quite well turn out to be filled by subsequent surveys with a slightly different purpose.

It doesn't seem to be particularly contested in the postings earlier in this thread that there is a considerably higher incidence of atrial fibrillation found in populations engaging in intense physical activity. It would seem that it is a pretty strong effect, perhaps as much as a factor of 4 or 5 above the typical level in the more prevalent low exercise sector of the population. This may not be much of a problem in one's youth, since atrial fibrillation is usually not in itself life threatening. But over the longer term, it is to be noted that people with AF are about 5 times as likely as the population at large to suffer a stroke, and that on average the strokes are more major for a person with a history of AF. While stroke is not quite up there with heart disease and cancer as a major cause of death, it is number 4 in the US. One might be inclined to say right away that there is a direct causal link--more exercise implies more AF implies more strokes implies shorter life. However, it is a little less clear whether AF developed from exercise early in life persists when one gets older if the exercise intensity drops off after joints go bad or competitive interest wanes. And I don't know if it has been shown that in the population of extreme exercisers with AF (which is a very small subset of all people with AF) there is also a higher likelihood of stroke. Such studies are hard to do with statistically significant populations, just because there aren't a lot of people out there that do extreme amounts of exercise (if there were, we wouldn't be describing it as extreme!). Also, we don't know what causes the apparent saturation of the exercise benefits for mild exercise. Maybe we are just seeing a neat balancing off of a higher chance of stroke just neatly compensating for some continuing positive effects of more exercise. But if I were required to make a small wager on what 50 years of continued research is going to show, I would probably bet on some small reduction of life expectancy with really extreme exercise levels (where really extreme is defined by somewhat more than I personally have indulged in :) !)

My main other comment would be that it doesn't seem very sensible to do one's exercise simply to prolong life, but only if the exercising is providing some immediate pleasure. For example, in the rather nice study referred to in the article initially attracting Alex's attention, they followed 650,000 subjects for 10 years to discover that very modest levels of exercise extended life expectancy by up to as much as 5 years, with the effect saturating by about 9 hours a week of walking at 2 miles an hour. If one considers that 9 hours a week is about 8% of one's waking hours, and that life expectancy is nowadays something like 80 years, it is interesting to note that if you spend 60 years walking just to live 5 years longer even though you don't enjoy the walking, you have already used up 5 years of waking hours in the process, and those were waking hours when you were young, not ones getting added on at 80 when you have (likely) become old and decrepit! So I would say go ahead and exercise as much as you can and still enjoy it, just don't do it purely as a health enhancer as if it were a duty!

sorry eldersmith, hadn't been following this thread, I'm theoretically locked in a room writing my thesis =). I'd agree with what you're saying - don't bother exercising if you don't like it just for an extra few years of life, exercise because you want to do it, and appreciate the immediate health benefits. Assuming that the years I lose due to too much exercise are at the end of my life, well, I'm having a grand time now, and from what I have seen of people in the last few years of their life, not so much. So, I'll keep exercising what some may consider extreme amounts!

I don't put a ton of stock into what I see in non-peer-reviewed journals. Everybody just wants a reaction. I drive a car nearly every day, but there aren't too many folks telling me to stop that (other than chitownclark) (one). Funny, NYT didn't list "running >25mi/wk" on that table... CDC lists "accidents" as fifth highest cause of death in this country. oops, got sidetracked.

Damn, I read through this thread too fast to truly enjoy my popcorn.