Does extreme distance running go too far?

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Daily Herald Newspaper Published 07/23/2012

Does extreme distance running go too far?
By Erin Allday

In most every part of modern life — in how much we eat, sleep, work and play — moderation is the mantra.

And in recent years, that mantra has extended to exercise. Science is increasingly telling us that we need to work out only a few hours a week to fight heart disease and cancer and aging in general. For instance, researchers say, just 10 or 15 miles of easy running could add years to our lives.

But don't try to tell Joanna Reuland that running 10 miles a week is all she needs.
“I've always got my shoes with me in case there's time for a short run,” said Reuland, 25. “It's not something that I have to do — it's something that I love to do.”

Lately, she's been loving it a lot — as in, 100 miles a week. She runs a couple of hours on the way from her home in San Francisco to her office, and often another few miles later in the day. It's not unusual for her to take phone calls for work while out on a run.

On Sunday, July 29, Reuland will be running the San Francisco Marathon — twice. As in, back to back. She's starting at midnight to run the course in reverse, then joining the rest of the roughly 6,000 regular marathoners at the official start line to run the full course again.

Ultra-runners like Reuland are unusual, but these days, they're hardly rare. For all the news and science reports about Americans getting fatter and lazier, long-distance running, and endurance sports in general, are getting more popular every year. More than half a million people ran marathons in the United States last year — double the number of runners two decades ago.

And this increase is despite the growing clamor of doubters — both scientific and not — who suggest there may not be a lot of health benefits to so-called extreme levels of running. Sure, for years the couch potatoes and others who like to pooh-pooh exercise have insisted that long-distance running can't be healthy — it's not good for the knees, they say, and people can drop dead from that kind of physical abuse.

Their doubts may sound more like excuses than scientific reasoning, but some of their points are backed by fact. People do die while running, after all, although such incidents are rare. And it's true that many recreational runners suffer injuries, often because they push themselves too hard, too soon, sports doctors say.

“Injuries can ultimately undo the whole exercise process. You get injured and it sets you back and next thing you know, you're back at ground zero,” said Dr. Matt DeVane, a prominent Walnut Creek, Calif., cardiologist. DeVane said he doesn't discourage people from marathon-distance levels of training, but he doesn't promote that much running either.
“You don't need to do that much to be heart healthy,” he said. “I'm usually just trying to get people to move at all.”

Dr. Todd Weitzenberg, chief of sports medicine with Kaiser Permanente in Santa Rosa, Calif., notes that there's a vast field of research proving that running of any kind is healthful. Running has been associated with lower rates of heart disease, diabetes, cancer and aging-associated disability. Runners live longer than their non-running friends and family.
“You can argue that endurance sports put undue stress on our bodies,” he said. “But we're almost genetically hard-wired to push ourselves to the limits.”

Certainly no one is seriously arguing, he added, that the average marathoner is less healthy than the average couch potato.

What's sparked new debate is recent evidence that a lot of running — a lifetime of running marathons, for example, or the 50-plus miles a week demanded by ultramarathon training — may start to undo some of the benefits of exercise.
Two studies published this year got widespread attention for citing potential negative health effects from exercise — one of them, from long-distance running specifically. One study found that a small percentage of people may have an adverse reaction to exercise that actually increases their risk of heart disease and diabetes. A second study analyzed some of the changes to athletes' hearts that could put them at risk.

Yet another study found that, over the course of a year, there were fewer deaths among people who ran up to 20 miles a week, and at a fairly leisurely 10-minute-per-mile pace, than among people who didn't run at all. That wasn't a shock, of course. What was surprising was that there were fewer deaths among those runners than among people who ran more than 25 miles a week or at a faster pace.

In fact, the longer, or faster, that people ran, the fewer health benefits they seemed to get, until, the study authors joked, a runner could potentially run himself back to couch potato.

That study and others all build evidence for the U-shaped curve of exercise benefits: that greater effort begets greater benefits, but only to a certain point. Then the benefits drop off, suggesting that there's probably a maximum amount of exercise before it starts to become unhealthy.

In another way to look at the U-curve, someone running 10 miles a week may actually be healthier than someone running 60 miles a week.

While the U-curve is pretty widely accepted, there's disagreement over how much exercise may be too much. Many scientists say, assuming there exists a maximum safe amount of running, it's probably so high that very few runners will ever get there.

“There are probably levels of exercise that are excessive for the average individual,” said Dr. Anthony Luke, medical director of the San Francisco Marathon who heads the RunSafe clinic at the University of California, San Francisco. “But we can't arbitrarily say too much is 50 miles a week, or 100 miles. I don't think everyone has the same limits.”

The concern, according to Luke and other sports-medicine experts, is that there does seem to be some small percentage of runners who are at risk for fatal heart attacks when they run at a certain distance or intensity. It's a rare thing — for every 100,000 runners who compete in marathons every year, only one dies — but “no one should be dying at a marathon,” Luke said.

Those runners may have heart conditions that haven't yet been detected, or they could simply be at increased risk of heart attack anyway, and they just happen to drop dead during a run. Earlier this year, distance-running legend Micah True, 58 — better known among his fans by the name Caballo Blanco — died while out on a trail run from cardiomyopathy, which is the result of an enlarged heart. And many endurance athletes develop enlarged hearts over time.

Whether that means that athletes are at increased risk for dying from a heart condition isn't obvious. True was just one example, and multiple studies haven't proved one way or the other that endurance athletes have a higher rate of sudden death.

But rather than setting safe limits for running, the better approach, many running advocates and sports doctors say, is finding out why those people die, and how their deaths could be prevented.

A middle-aged or older person who's taking up running for the first time should get checked out by a doctor and screened for possible heart conditions. But it doesn't make financial sense to screen every runner in the United States —and screening tests can't catch every potential heart problem.

Plus, doctors and scientists don't yet fully understand exactly what happens to athletes' hearts when they run long distances or at a sustained hard pace. A recent study by the Mayo Clinic, where researchers took care to note the various and many positive health effects from exercise, analyzed changes to the heart and blood vessels that are sometimes found in endurance athletes.

The Mayo Clinic scientists found occurrences of irregular heartbeats, enlarged hearts and thickened artery walls, but it was unclear how many, if any, of those effects were potentially harmful or whether they were pre-existing conditions. And it was also not known how many endurance athletes actually experience those effects.

“Any blanket statement about these runners is sure to have exceptions to it,” said Dr. James Fries, a professor of immunology and rheumatology at Stanford who has studied runners for decades. “We study the mean, and we report what happens to this group or that group. But nobody's actually the average.”
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Replies

  • BenderFitness
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    Very interesting article, thanks for sharing. I agree with the Dr who said every individual has their own limits. You can't arbitrarily place a number on those limits. I also think that some runners experience difficulties with health issues simply because they train their bodies for one specific activity, which can create muscular imbalances, and significant limitations in flexibility.

    It will be interesting to read future research in this area. :)
  • xoyasminxo
    xoyasminxo Posts: 132
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    I would like to run a marathon just once. After that, no thanks. I know a guy who has really bad knee problems from running marathons for 20+ years. No thanks. I can stay in shape without that!
  • katapple
    katapple Posts: 1,108 Member
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    interesting! I love to run, but I usually don't get in more than 25 miles in a week. I do other things too. I ran my one marathon, and now it's crossed off the bucket list ;)
  • staceyseeger
    staceyseeger Posts: 783 Member
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    Thanks for the article! Very interesting...

    Planning on my first 50 or 100 mile UltraMarathon next year!
  • marycmeadows
    marycmeadows Posts: 1,691 Member
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    Wow. i know people like this.... I'm currently training for a half marathon - which is nothing compared to what some people run.... but anything more than that seems excessive to me.
  • newhabit
    newhabit Posts: 426 Member
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    I think some people just love to run. And it's hard to put limits on it for them and they probably wont' do that to themselves. they'd rather run than worry about this. but i do see how injuries can put a limit on what you do.
  • chivalryder
    chivalryder Posts: 4,391 Member
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    Why do people climb Mt. Everest?

    Because they can.

    Would it kill them?

    High probability.

    Should we stop them?

    Heck no.

    I would personally love to become an ultra marathon runner. With my previous passion of mountain biking, I wanted to start competing in 24 hour solo races. I then had a knee injury which was not caused by my cycling, and kicked me out of the sport. Now, I'm looking for the same challenge, just in running (for now).
  • Fannyannefeisty
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    Does extreme distance running go too far?
    snip

    ... not if you turn around half way through your run!!
  • athensguy
    athensguy Posts: 550
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    OMG. My hobby isn't continually improving my health? I guess I better quit.
  • bacamacho
    bacamacho Posts: 306 Member
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    Running more than 20 miles a week is more than health benefits for me. In this age of instant gratification and interaction being more through the computer than irl, for me often anyway, getting outside and running as long and hard as I can is a reminder of humanness, my mortality. I'm nowhere near fit enough for anything beyond a healthy 30 miles, but I find such a distance amazing. I think of the amount of time I'd have enjoying the great outdoors and getting to know my body. Not how long I'll have left in this world or how many calories I'm burning, although I imagine it'd be plenty. ;)
  • naculp
    naculp Posts: 225 Member
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    Running more than 20 miles a week is more than health benefits for me. In this age of instant gratification and interaction being more through the computer than irl, for me often anyway, getting outside and running as long and hard as I can is a reminder of humanness, my mortality. I'm nowhere near fit enough for anything beyond a healthy 30 miles, but I find such a distance amazing. I think of the amount of time I'd have enjoying the great outdoors and getting to know my body. Not how long I'll have left in this world or how many calories I'm burning, although I imagine it'd be plenty. ;)
    I'm running my 2nd marathon in November, 1 year after my first. I completely agree on the satisfaction and gratification of running pointed out here. I don't feel the need to brag or fish for compliments; it's more of a personal achievement and saying to myself "Way to go body, you just carried me through 26.2 miles in a single run!" And that rush from crossing the finish line... it's just awesome! Nothing can compare
  • rybo
    rybo Posts: 5,424 Member
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    I've ran 2 marathons. Not planning a third anytime soon, but I have never felt better than the last few weeks leading in to my marathons. Healthy & energetic.
  • ebaymommy
    ebaymommy Posts: 1,067 Member
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    Running more than 20 miles a week is more than health benefits for me. In this age of instant gratification and interaction being more through the computer than irl, for me often anyway, getting outside and running as long and hard as I can is a reminder of humanness, my mortality. I'm nowhere near fit enough for anything beyond a healthy 30 miles, but I find such a distance amazing. I think of the amount of time I'd have enjoying the great outdoors and getting to know my body. Not how long I'll have left in this world or how many calories I'm burning, although I imagine it'd be plenty. ;)
    I'm running my 2nd marathon in November, 1 year after my first. I completely agree on the satisfaction and gratification of running pointed out here. I don't feel the need to brag or fish for compliments; it's more of a personal achievement and saying to myself "Way to go body, you just carried me through 26.2 miles in a single run!" And that rush from crossing the finish line... it's just awesome! Nothing can compare

    Agreed on both accounts.

    I'm running marathon #6 in just over a month. This one is purely "for fun" and my first ever without a time goal. I'm pacing my mom in her first marathon the day before her 50th birthday. I anticipate this will be the most fun 26.2 I've ever run. Sometimes it's not about just exercise and burning calories....sometimes it's about pushing yourself to do more than you ever thought possible (my original goal was to just run one marathon the year I turned 30....never thought I'd do another one). And sometimes it's about being along for the ride and pushing someone else to do what they never thought possible. My mom lost over 80lbs over the course of the past 2 years. A couple years ago she couldn't run down the block let alone a full mile. And here she is with 2 half-marathons under her belt and going to tackle the full distance. I'm so proud of her!
  • ixap
    ixap Posts: 675 Member
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    As an ultrarunner, I've been eagerly awaiting publication of the study mentioned, the one that shows reduced lifespan for the extreme runners vs. moderate runners. So far the data was presented at a conference, and the researchers have done interviews / press releases, but the actual study isn't published anywhere. The little snippets you get from press releases don't offer near enough information to judge if there are problems with the study's conclusions.

    I will say that the joint issues that running supposedly causes have been TOTALLY debunked by scientific research. Sure some runners end up with arthritic knees, but so do many many non-runners. If anything, runners have a lower incidence of arthritis and other knee issues than the sedentary.

    I will also say that my ultrarunning group is made up largely of people 50-75 years old, and they are in simply amazing shape. They look great, have tons of energy, and have a wonderful quality of life with very few health problems. I've been with my group for 10+ years and so far no one I know has developed any health problems from their running, despite regularly doing 50-100 miles per week for decades.

    So I'm sticking with it unless there's some really convincing evidence forthcoming that shows it's dangerous. Thus far I'm FAR from convinced.
  • madmickie
    madmickie Posts: 221 Member
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    Moderation in all things?

    Doing anything to an extreme level is likely to have some negative side effects. Outside top distance athletes very few people run 100 miles a week ( I think I heard Mo Farah say he does 120 mpw - but it doesnt take him very long!).

    You will strengthen bones, muscles ligaments tendons cardiovasular systems - but you are also creating more wear and tear, exposing yourself to injury. It's a balancing act between health, performance, pleasure, satisfaction, effort and time. That balance point is different for everyone I guess. Each to their own.
  • ixap
    ixap Posts: 675 Member
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    OMG. My hobby isn't continually improving my health? I guess I better quit.
    guess so!
    also, it turns out that more than 5 hours per week of TV watching, internet surfing, cross-stitching, sudoko puzzling, or any other hobby doesn't continually improve health either. guess we might as well not do anything. oh wait, sitting around not doing anything is bad for you in excess too... what to do?
  • ronadams52
    ronadams52 Posts: 176 Member
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    Some health factors you may want to consider when chosing extreme sports from the Mayo Clinic.

    Potential adverse cardiovascular effects from excessive endurance exercise.

    O'Keefe JH, Patil HR, Lavie CJ, Magalski A, Vogel RA, McCullough PA.


    Source

    Mid America Heart Institute of Saint Luke's Hospital of Kansas City, MO, USA. jokeefe@saint-lukes.org


    Abstract

    A routine of regular exercise is highly effective for prevention and treatment of many common chronic diseases and improves cardiovascular (CV) health and longevity. However, long-term excessive endurance exercise may induce pathologic structural remodeling of the heart and large arteries. Emerging data suggest that chronic training for and competing in extreme endurance events such as marathons, ultramarathons, ironman distance triathlons, and very long distance bicycle races, can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which return to normal within 1 week. Over months to years of repetitive injury, this process, in some individuals, may lead to patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, creating a substrate for atrial and ventricular arrhythmias. Additionally, long-term excessive sustained exercise may be associated with coronary artery calcification, diastolic dysfunction, and large-artery wall stiffening. However, this concept is still hypothetical and there is some inconsistency in the reported findings. Furthermore, lifelong vigorous exercisers generally have low mortality rates and excellent functional capacity. Notwithstanding, the hypothesis that long-term excessive endurance exercise may induce adverse CV remodeling warrants further investigation to identify at-risk individuals and formulate physical fitness regimens for conferring optimal CV health and longevity.

    Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
  • ronadams52
    ronadams52 Posts: 176 Member
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    Kenyan and Ethiopian distance runners: what makes them so good?

    Wilber RL, Pitsiladis YP.


    Source

    Athlete Performance Laboratory, United States Olympic Committee, Colorado Springs, CO, USA.


    Abstract

    Since the 1968 Mexico City Olympics, Kenyan and Ethiopian runners have dominated the middle- and long-distance events in athletics and have exhibited comparable dominance in international cross-country and road-racing competition. Several factors have been proposed to explain the extraordinary success of the Kenyan and Ethiopian distance runners, including (1) genetic predisposition, (2) development of a high maximal oxygen uptake as a result of extensive walking and running at an early age, (3) relatively high hemoglobin and hematocrit, (4) development of good metabolic "economy/efficiency" based on somatotype and lower limb characteristics, (5) favorable skeletal-muscle-fiber composition and oxidative enzyme profile, (6) traditional Kenyan/Ethiopian diet, (7) living and training at altitude, and (8) motivation to achieve economic success. Some of these factors have been examined objectively in the laboratory and field, whereas others have been evaluated from an observational perspective. The purpose of this article is to present the current data relative to factors that potentially contribute to the unprecedented success of Kenyan and Ethiopian distance runners, including recent studies that examined potential links between Kenyan and Ethiopian genotype characteristics and elite running performance. In general, it appears that Kenyan and Ethiopian distance-running success is not based on a unique genetic or physiological characteristic. Rather, it appears to be the result of favorable somatotypical characteristics lending to exceptional biomechanical and metabolic economy/efficiency; chronic exposure to altitude in combination with moderate-volume, high-intensity training (live high + train high), and a strong psychological motivation to succeed athletically for the purpose of economic and social advancement.
  • ronadams52
    ronadams52 Posts: 176 Member
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    Prolonged depletion of antioxidant capacity after ultraendurance exercise.

    Turner JE, Hodges NJ, Bosch JA, Aldred S.


    Source

    School of Sport and Exercise Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.


    Abstract

    PURPOSE:

    The purpose of this study was to examine the short- and long-term (up to 1 month) effects of an ultraendurance running event on redox homeostasis.

    METHODS:

    Markers of oxidative stress and antioxidant capacity in peripheral blood were assessed after a single-stage 233-km (143 miles) running event. Samples were collected from nine men (mean±SD: age=46.1±5.3 yr, body mass index=24.9±2.3 kg·m⁻², maximal oxygen uptake=56.3±3.3 mL·kg⁻¹·min⁻¹). Peripheral blood mononuclear cells were assayed for nonspecific DNA damage (frank strand breaks) and damage to DNA caused specifically by oxidative stress (formamidopyrimidine DNA glycosylase-dependent damage). Protein carbonylation and lipid peroxidation were assessed in plasma. Reduced glutathione (GSH) was measured in whole blood.

    RESULTS:

    Peripheral blood mononuclear cell frank strand breaks were elevated above baseline at 24 h after the race (P<0.001). Formamidopyrimidine DNA glycosylase-dependent oxidative DNA damage was increased immediately after the race (P<0.05). Protein carbonylation remained elevated for 7 d after the race (P<0.04), whereas lipid peroxidation was increased for 24 h (P<0.05) and fell below baseline 28 d later (P<0.05). GSH, a measure of antioxidant capacity, also showed a biphasic response, increasing by one-third after the race (P<0.01) and falling to two-thirds of baseline levels 24 h later (P<0.001). GSH remained depleted to approximately one-third of prerace values 28 d after the race (P<0.01).

    CONCLUSIONS:

    Ultraendurance exercise causes oxidative stress, which persists for one calendar month depending on the specific biomarker examined. These results suggest that ultraendurance events are associated with a prolonged period of reduced protection against oxidative stress.
  • CarsonRuns
    CarsonRuns Posts: 3,039 Member
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    If you're scared, do something else.