Does endurance sport harm your heart?

[Jdsk]

...
The NHS, I believe, tends to work in terms of benefits in the immediate and near future. Stuff that’s many years away is likely not on its radar as that is more something relating to public and population health.
...

Each country's NHS advice contains much that will only help in several decades' time: exercise, diet, prevention of cardiovascular disease, prevention of lung cancer, prevention of osteoporosis...

Jonathan

[Jdsk]

, the sweetspot for maximum benefit from exercise is a sharper peak, equivalent to about 120 minutes of moderate exercise per week

Hopefully an actual expert will come along shortly (JDSK? Is he ok?), because my understanding is that the “120 minutes moderate” thing is not a peak, but the turning point onto the near-plateau of diminished returns. In other words that there’s not much point doing more, from a physical benefits perspective, rather than that doing more reduces the benefits.

Anecdotally, if it was a peak, most cyclists, and all touring cyclists, would be very unwell/unfit people, because I should think we all exceed it by quite some margin, if not in intensity then in duration.

Thanks for the vote of confidence! All well here. : - )

I am not an expert and I have not got any links to studies to hand, but:

My understanding is that rather than a plateau as shown on your graph, the sweetspot for maximum benefit from exercise is a sharper peak, equivalent to about 120 minutes of moderate exercise per week. Moderate exercise meaning that it raises your heart rate but you can still speak normally. With higher intensities and in particular durations of exercise regimes there is a lot of scatter in the data and therefore uncertainty about what exercise level benefit to health/longevity changes into detriment.

There have been several reports recently of young, very fit, endurance athletes suffering heart problems and some having to retire early, whether or not there is a causal link is another matter. Are there any cardiologists on this forum?

There's lots of evidence on most of the individual questions asked on the thread. But it seems as if many posters would rather discuss anecdotes and their own experiences of exercise. Or generalisations with little content.

Thanks to those who have actually cited stuff about what is known.

Jonathan

[Jdsk]

I'm an 88 year old nerd who has recorded every mile since riding to school age 12, Have covered 371,000 miles including 43 years commuting over 10-32 miles a day, 500+ time trials between ages 19 to 63 with a 24 hour at 59 and 151 audax rides up to 600k between
ages 56 and 83.

Developed atrial fibrillation when 65, 2 ablations were only temporary cures and for the last 19 years the advice has been "live with it"

Bought an e-bike 3 years ago and left the clubruns a year later. Became increasingly breathless 6 months ago and stopped riding. Diagnosed as fluid on the lungs "cured" by medication so am doing very short (12-15 mile) rides whilst waiting to see if a pacemaker is needed.

Have these miles caused the heart problems or are they the reason that I am still riding and otherwise in good health?

Yes, endurance exercise is associated with atrial fibrillation being more common. It's probably causative.

But to the best of my knowledge it just isn't possible to see if this is the case for any individual.

And exercise clearly brings many other benefits to both physical and mental health.

Please could you tell us a bit more about "fluid on the lungs". Is it congestive heart disease? And is the medication helping with the breathlessness?

I suggest making sure that the specialist knows how important the cycling is to you. And if you have any specific questions do write them down so that you don't forget any when you next discuss them, either in a consultation or remotely. That should include questions about the pacemaker.

Jonathan

[Carlton green]

...
The NHS, I believe, tends to work in terms of benefits in the immediate and near future. Stuff that’s many years away is likely not on its radar as that is more something relating to public and population health.
...

Each country's NHS advice contains much that will only help in several decades' time: exercise, diet, prevention of cardiovascular disease, prevention of lung cancer, prevention of osteoporosis...

Jonathan

Fair comment, my thoughts were that it rightly prioritises and focuses on the more immediate. The worried well and those looking for sound health advice customised to them are going to find their GP has difficulty coping with the immediate.

[ossie]

Don’t bank on it. Locally a lifelong and very fit older guy died of heart issues whilst out cycling. You can’t cater for every case but in general I avoid placing bets that I wouldn’t be comfortable about loosing.

I'd wager (and in my experience) more people die of a heart attack straining on a toilet than on a bicycle. There are some bets you have no choice about taking. Your cyclist would probably have met his maker doing one of many activities.

[Jon in Sweden]

I'd wager (and in my experience) more people die of a heart attack straining on a toilet than on a bicycle. There are some bets you have no choice about taking. Your cyclist would probably have met his maker doing one of many activities.

Agreed. A well trained cyclist is in the lowest risk category for cardiovascular issues.

I believe that VO2 max work is an important part of any cyclists training schedule. It's necessary for day to day cycling (a higher VO2 max just makes hills much easier) and it's necessary to maximise your VO2 in earlier life so that you maintain it as high as possible in later life.

For men, a VO2 max of 18-19 is the threshold at which independent living becomes very difficult. So climbing stairs, walking short distances and such like. It's a sort of threshold of disability. Everyone's VO2 max declines with age and the higher you start at, the longer it takes for you to reach that threshhold. For someone who trains consistently through life, it's quite possible to never get close to that line. That's what I hope to achieve.

I think that my V02 max is currently around 60. I will have it tested in summer (I'll be turning 40). I'm only 21 months back to training, so I'm hoping that I still have some newbie gains to eek out. I'd love to see 65 by the time I'm 45 and I'd like to think I won't have dropped below 60 by the time I'm 50.

To return to the original point, I feel that by pushing my CV systems maximal ability that I am insuring myself in the future against preventable health issues. I'm not an idiot when it comes to training, and rest regularly. I don't believe that pushing your VO2 max is damaging.

[Grandad]

Please could you tell us a bit more about "fluid on the lungs". Is it congestive heart disease? And is the medication helping with the breathlessness?

I suggest making sure that the specialist knows how important the cycling is to you. And if you have any specific questions do write them down so that you don't forget any when you next discuss them, either in a consultation or remotely. That should include questions about the pacemaker.

The breathlessness started earlier last year When riding. I noticed that I was making more use of the motor. Had an exercise ECG, 24 hour monitor and an x-ray with no mention of any specific problem. Appointment made for a face to face consultation in July with a view to fitting a pacemaker.

Appointment was cancelled, heard nothing further and in November the breathlessness became a lot worse. Raided the piggy bank to go private, Ecg and X-ray revealed fluid on the lungs. Nearly completed a 3 month course of medication then decision time for pacemaker.

Cardiologist knows my cycling history and his aim is to get me back on the bike. The medication quickly cured the breathlessness so I have restarted gentle rides with no problems.

[Psamathe]

Don’t bank on it. Locally a lifelong and very fit older guy died of heart issues whilst out cycling. You can’t cater for every case but in general I avoid placing bets that I wouldn’t be comfortable about loosing.

I'd wager (and in my experience) more people die of a heart attack straining on a toilet than on a bicycle. ...

Eat more fibre, less straining ...

Ian

[Chris Jeggo]

My thoughts on the risk of arrhythmia.

Thanks for that.

The metric that's the most powerful predictor of developing AF is lifetime hours of exercise, 2000 hours being the magic number.

From my mileage records I reckon I've clocked up roughly 20000 cycling hours since 1977. So maybe that really is to blame for my AF. No regrets, though; I wouldn't have wanted to miss all those lovely bike rides.

[Audax67]

The metric that's the most powerful predictor of developing AF is lifetime hours of exercise, 2000 hours being the magic number.

From my mileage records I reckon I've clocked up roughly 20000 cycling hours since 1977. So maybe that really is to blame for my AF. No regrets, though; I wouldn't have wanted to miss all those lovely bike rides.

Does that include cake stops? Looking at my log I've done >2500 since 2015, and since that includes the pandemic years and years where injury & other medical issues clobbered my fitness just as the season was getting under way, it would be a lot more in normal conditions. I've only had one official salvo of Afib, and that lasted for a whole 6 beats. I have an implant to detect it, too, my latest cardiologist believing that old git = Afib (= extra fees? I'm a nasty cynical old git into the bargain.)

Anyway, I'd humbly submit that the 2000-hour threshhold is a blivvet, which a Transpondian chum once defined as 10 gallons of chickenshit in a 5 gallon bucket.

[Carlton green]

I'd wager (and in my experience) more people die of a heart attack straining on a toilet than on a bicycle. There are some bets you have no choice about taking. Your cyclist would probably have met his maker doing one of many activities.

Agreed. A well trained cyclist is in the lowest risk category for cardiovascular issues.

I believe that VO2 max work is an important part of any cyclists training schedule. It's necessary for day to day cycling (a higher VO2 max just makes hills much easier) and it's necessary to maximise your VO2 in earlier life so that you maintain it as high as possible in later life.

For men, a VO2 max of 18-19 is the threshold at which independent living becomes very difficult. So climbing stairs, walking short distances and such like. It's a sort of threshold of disability. Everyone's VO2 max declines with age and the higher you start at, the longer it takes for you to reach that threshhold. For someone who trains consistently through life, it's quite possible to never get close to that line. That's what I hope to achieve.

I think that my V02 max is currently around 60. I will have it tested in summer (I'll be turning 40). I'm only 21 months back to training, so I'm hoping that I still have some newbie gains to eek out. I'd love to see 65 by the time I'm 45 and I'd like to think I won't have dropped below 60 by the time I'm 50.

To return to the original point, I feel that by pushing my CV systems maximal ability that I am insuring myself in the future against preventable health issues. I'm not an idiot when it comes to training, and rest regularly. I don't believe that pushing your VO2 max is damaging.

H’mm, I’ve been thinking about both those posts.

I won’t dispute Ossie’s professional experience but would observe that of the many people I know and meet only a very small percentage, could be around or less than 1%, are what you might call athletic cyclists who push themselves. On the other hand 100% of the people I know do use a toilet.

If someone is pushing themselves and focuses on VO2 max then perhaps their thoughts have become overly focused. I am reminded of the time when a pulled tendon stopped me running and I’m also reminded of a friend who died of a sudden aneurism - a hidden bodily weakness that was probably aggravated by his manual job. The death of a friend and neighbour also comes to mind, as a young man he worked so physically hard that he damaged his heart, he struggled with his heart in midlife and didn’t last long in old age - I’m not sure whether he got to draw a pension or not.

[al_yrpal]

Perhaps the question should be "does endurance sport harm your body?"

In many cases of course it does. Just think about folk you know who have participated in endurance stuff and how they suffered all sorts of physical problems, particularly with joints and quite possibly with hard working organs like the heart. The body is just like any machine, work it hard and it suffers and wears out as its abilty to put itself right is overtaken by wear and tear.

A couple of years ago after a scan I was given 8 stents in the arteries serving my heart after a bit of chest pain. Had I not got these my heart muscles would surely have been damaged. Thinking back to my childhood my father was retired from his job driving steam trains because of the same thing. He lived to 84 and died of emphasima and lung problems. Take care of your body, dont overdo things and enjoy a long life.

Al

[Jdsk]

Perhaps the question should be "does endurance sport harm your body?"

In many cases of course it does. Just think about folk you know who have participated in endurance stuff and how they suffered all sorts of physical problems, particularly with joints and quite possibly with hard working organs like the heart. The body is just like any machine, work it hard and it suffers and wears out as its abilty to put itself right is overtaken by wear and tear.
...

That's another good question.

We now know quite a lot about effects on joints, and the findings aren't particularly surprising, although quantitation always helps.

With the exception of atrial fibrillation I wouldn't expect many of us to know people whose hearts have suffered from exercise. And it's very hard to identify causes in individuals rather than associations in cohorts.

Jonathan

[Jon in Sweden]

H’mm, I’ve been thinking about both those posts.

I won’t dispute Ossie’s professional experience but would observe that of the many people I know and meet only a very small percentage, could be around or less than 1%, are what you might call athletic cyclists who push themselves. On the other hand 100% of the people I know do use a toilet.

If someone is pushing themselves and focuses on VO2 max then perhaps their thoughts have become overly focused. I am reminded of the time when a pulled tendon stopped me running and I’m also reminded of a friend who died of a sudden aneurism - a hidden bodily weakness that was probably aggravated by his manual job. The death of a friend and neighbour also comes to mind, as a young man he worked so physically hard that he damaged his heart, he struggled with his heart in midlife and didn’t last long in old age - I’m not sure whether he got to draw a pension or not.

I just like numbers and metrics. Call it an aspect of my ASD or a perculiar character trait, but it's part of my enjoyment around sports.

One thing to consider is that manual labour and cardiovascularly demanding sport don't have a great deal of overlap when it comes to CV training.

For example, I wear one of those watches overnight to track my sleep and RHR. When I train hard on the bike, my RHR goes up (from a normal 50-51 to about 55-56), indicating CV system stress and informing my choices about training the following day.

I did two gruelling days at work Thursday and Friday lunking 15 tonnes of timber around (in 30-40kg bearer form) which left my grip and posterior chain fatigued. But it had zero effect on my CV system. My overnight HRH data suggested that I had not trained.

Manual labour is tough, and developing work capacity is important, but sensible CV training is a different kettle of fish.

I am however fully open to the notion that I'm overdoing it. I try to listen to my body as much as possible and I have plenty of historic niggles. But I am somewhat obsessive, and perhaps researching the benefits of VO2 max training is simply me engaging in confirmation bias to justify what I enjoy doing!

For the record, I'm about to head out for 75 minutes of hill rep training

[Cowsham]

H’mm, I’ve been thinking about both those posts.

I won’t dispute Ossie’s professional experience but would observe that of the many people I know and meet only a very small percentage, could be around or less than 1%, are what you might call athletic cyclists who push themselves. On the other hand 100% of the people I know do use a toilet.

If someone is pushing themselves and focuses on VO2 max then perhaps their thoughts have become overly focused. I am reminded of the time when a pulled tendon stopped me running and I’m also reminded of a friend who died of a sudden aneurism - a hidden bodily weakness that was probably aggravated by his manual job. The death of a friend and neighbour also comes to mind, as a young man he worked so physically hard that he damaged his heart, he struggled with his heart in midlife and didn’t last long in old age - I’m not sure whether he got to draw a pension or not.

I just like numbers and metrics. Call it an aspect of my ASD or a perculiar character trait, but it's part of my enjoyment around sports.

One thing to consider is that manual labour and cardiovascularly demanding sport don't have a great deal of overlap when it comes to CV training.

For example, I wear one of those watches overnight to track my sleep and RHR. When I train hard on the bike, my RHR goes up (from a normal 50-51 to about 55-56), indicating CV system stress and informing my choices about training the following day.

I did two gruelling days at work Thursday and Friday lunking 15 tonnes of timber around (in 30-40kg bearer form) which left my grip and posterior chain fatigued. But it had zero effect on my CV system. My overnight HRH data suggested that I had not trained.

Manual labour is tough, and developing work capacity is important, but sensible CV training is a different kettle of fish.

I am however fully open to the notion that I'm overdoing it. I try to listen to my body as much as possible and I have plenty of historic niggles. But I am somewhat obsessive, and perhaps researching the benefits of VO2 max training is simply me engaging in confirmation bias to justify what I enjoy doing!

For the record, I'm about to head out for 75 minutes of hill rep training

How did you fair in that 152km race the other day?