LIFELONG ENDURANCE EXERCISE offers no advantages over a generic healthy lifestyle when looking at more favorable heart vessel plaque composition (coronary artery disease).
Today we explore a new Belgian study that reminds us of the paradox of exercise: Many observational studies find that exercisers have fewer cardiovascular events, but imaging studies also report higher rates of coronary artery calcium in endurance athletes, particularly those who have run several marathons.
“People sometimes sneer at those who run every day, claiming they’ll go to any length to live longer. But I don’t think that’s the reason most people run. Most runners run not because they want to live longer but because they want to live life to the fullest.
If you’re going to while away the years, it’s far better to live them with clear goals and fully alive than in a fog, and I believe running helps you do that. Exerting yourself to the fullest within your limits: that’s the essence of running and a metaphor for life — and for me, for writing as well. I believe many runners would agree.”
― Haruki Murakami, What I Talk About When I Talk About Running
The exercise paradox
The exercise paradox refers to the phenomenon that while regular physical activity is associated with numerous health benefits, including improved cardiovascular health, stronger bones and muscles, and a reduced risk of chronic diseases such as diabetes and certain cancers, engaging in too much exercise or pushing oneself too hard during exercise can have negative effects on the body.
(I parenthetically note that another form of exercise paradox refers to why physical activity does little to control weight.)Photo by Zac Ong on Unsplash
The paradox we address today arises from the fact that exercise is a stressor on the body, and too much stress can lead to negative outcomes. For example, excessive exercise can cause overuse injuries, impaired immune function, and hormonal imbalances.
In extreme cases, too much exercise can lead to a condition called exercise addiction, in which a person becomes obsessed with exercise to the point where it interferes with their daily life.
Therefore, the paradox is that while exercise is generally good for our health, it is possible to do too much of a good thing and for exercise to become harmful if not done in moderation.
Endurance exercise and heart vessel disease
Belgian researchers recently presented the results of the Masters@Heart study. They asked whether lifelong endurance exercise is linked to more coronary atherosclerosis than standard “normal” exercise levels.
The investigators aimed to better understand the exercise paradox by doing detailed heart vessel imaging. They studied three groups: lifelong athletes, late-onset athletes (beginning after age 30), and “super-healthy” controls.
Of the 1100 middle-after male volunteers, researchers selected 605 randomly (to drop the risk of enrolling people with health concerns responding to ads for the study).
A control group had good health. The members were without any risk factors, took virtually no medicines, exercised regularly (but not more than three hours weekly), and had excellent measured breathing capacity. Cycling was the most commonly done exercise.
All of the volunteers had an extensive evaluation, including coronary CT imaging.https://en.wikipedia.org/wiki/Coronary_arteries
Researchers published the provocative results in the European Heart Journal:
- Lifelong exercisers had a significantly higher coronary artery calcium burden than controls, confirming the findings of previous studies.
- Lifelong exercisers had a higher percentage of multiple coronary plaques, plaques of at least 50 percent, and proximal (closer to the artery origin) plaques.
- Plaque types did not differ between the three groups. Two-thirds of the plaques in each group appeared calcified, with the remainder non-calcified or mixed.
- For non-calcified plaques, lifelong exercisers tended to have a higher prevalence of multiple plaques associated with at least 50 percent blockage and proximal plaques.
- The good news? So-called vulnerable plaques were extremely infrequent in all three groups.
Bottom line – Exercise and heart disease
The bottom line? Lifelong endurance sport (compared with a generic healthy lifestyle) was not associated with more favorable coronary plaque composition. We need more follow-up to see if there are any negative health consequences of the endurance exercise of these subjects.
This study reminds us of a J-curve of exercise benefits: Too little is bad, but too much may increase risk. Are you in the Goldilocks zone for exercise volume?
The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.
Thank you for reading “Exercise and Heart Disease.”
