Exercising regularly is one of the best things you can do for your health. You already knew that, right? Staying physically active reduces the risk of heart disease, diabetes, obesity, depression, and other chronic diseases. You know you need it, and most people don’t move their body enough. But is it possible to get too much of a good thing when it comes to working out?
Emerging research suggests that extreme endurance exercise, like running marathons and ultra-marathons, participating in Ironman triathlons, and doing intense long-distance cycling, could damage the heart. This concept is known as the “extreme exercise hypothesis,” and there’s evidence to support it.
The U-Shaped Curve of Exercise and Health
The extreme exercise hypothesis says that there is a U-shaped curve that describes the health benefits and risks of exercise training. While being sedentary increases risk, and moderate exercise decreases risk, excessive high-intensity exercise may shift the benefit-risk ratio back towards increased risk and harm.
In other words, more is not always better when it comes to exercise. The health benefits seem to level off at a certain point, beyond which additional training may lead to diminishing returns or even potential harm to the cardiovascular system.
Cardiac Remodeling in Endurance Athletes
So, what happens to the heart during prolonged intense exercise? Studies show veteran endurance athletes can develop patchy myocardial fibrosis, especially in the atria, interventricular septum, and right ventricle. Myocardial fibrosis refers to scarring or thickening of the heart tissue.
This scarring seems to result from repetitive volume overload and stretching of the heart chambers during long bouts of exercise. Over time, this creates an environment that increases the risk of rhythm disorders like atrial fibrillation, an irregular heart rhythm that can increase the risk of stroke. Extreme exercise has also been linked to coronary artery calcification in some athletes.
Calcium build-up in the arteries is a marker of atherosclerosis. However, it’s unclear if the calcification that athletes get has the same prognostic significance that it does in sedentary individuals.
Longevity and Extreme Exercise
Despite these potential adverse cardiac adaptations, studies consistently show that elite endurance athletes live longer than the general population. This suggests that the benefits of regular exercise on longevity likely outweigh risks, even in people who do large volumes of exercise. Most people don’t have to worry about getting too much physical activity; they’re more at risk of not getting enough.
However, there is some evidence who consistently engage in ultra-endurance events, like extreme marathons and the training that goes with it, may not enjoy the same longevity advantage as those who exercise in moderation. One study found that running more than 4-5 hours per week at a pace of seven miles per hour did not confer any additional reduction in mortality risk compared to running less than 2.5 hours per week.
So, while elite athletes still have excellent long-term health outcomes overall, extreme exercise could diminish some of the protective effects seen with more moderate training regimens. Finding the “sweet spot” of maximal benefit and minimal risk is an area of ongoing research.
Weighing the Risks and Benefits
For most people, the benefits of regular exercise far exceed any potential downsides. Aiming for the recommended 150 minutes per week of moderate activity is a smart goal for most adults looking to optimize their health.
Individuals who want to train for endurance events can still do so but should be aware of the potential cardiovascular risks if they have a preexisting heart condition or genetic predisposition. It’s a good idea to check with a doctor and get screened before signing up for a marathon or taking part in an extreme exercise program. It’s important to talk to your doctor before exercising if you have medical problems or take medications too.
The Bottom Line
Exercise is a powerful medicine and one that we all need. For most casual exercisers, there’s no risk of incurring the downsides of exercise. Though endurance exercise is linked with cardiac changes in a small subset of athletes, the risk is low, and the health benefits are still there for casual exercise and athletes alike.
What the extreme exercise hypothesis shows is we need more research to determine optimal exercise doses and identify people who may be at higher risk from intense training regimens. In the meantime, the best approach is to stay active, gradually increase training loads, incorporate strength training and adequate recovery, and listen to your body’s cues. If something doesn’t feel right, slow down or stop, and talk to your physician.
When it comes to vigorous exercise, as with most things, moderation is the key to maximizing the incredible health benefits while minimizing the potential risks. Think about balance! And make sure you’re giving your body rest between more intense exercise sessions. Your body needs time to recuperate from strenuous exercise. So, get enough rest, manage stress, and ensure you’re eating a nutrient-rich diet to maximize the benefits of your efforts.
References:
- Eijsvogels TMH, Thompson PD, Franklin BA. The “Extreme Exercise Hypothesis”: Recent Findings and Cardiovascular Health Implications. Curr Treat Options Cardiovasc Med. 2018 Aug 28;20(10):84. doi: 10.1007/s11936-018-0674-3. PMID: 30155804; PMCID: PMC6132728.
- O’Keefe JH, Patil HR, Lavie CJ, Magalski A, Vogel RA, McCullough PA. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin Proc. 2012 Jun;87(6):587-95. doi: 10.1016/j.mayocp.2012.04.005. Erratum in: Mayo Clin Proc. 2012 Jul;87(7):704. PMID: 22677079; PMCID: PMC3538475.
- Medzikovic L, Aryan L, Ruffenach G, Li M, Savalli N, Sun W, Sarji S, Hong J, Sharma S, Olcese R, Fishbein G, Eghbali M. Myocardial fibrosis, and calcification are attenuated by microRNA-129-5p targeting Asporin and Sox9 in cardiac fibroblasts. JCI Insight. 2023 May 8;8(9):e168655. doi: 10.1172/jci.insight.168655. PMID: 37154157; PMCID: PMC10243800.
- Clinic C. Heart Risks Associated With Extreme Exercise. Cleveland Clinic. Published July 30, 2020. Accessed March 10, 2024. https://health.clevelandclinic.org/can-too-much-extreme-exercise-damage-your-heart
- “Signs of Overtraining: 13 Tip-Offs and What to Do – Healthline.” 17 Apr. 2020, https://www.healthline.com/health/signs-of-overtraining.
- Kreher JB, Schwartz JB. Overtraining syndrome: a practical guide. Sports Health. 2012 Mar;4(2):128-38. doi: 10.1177/1941738111434406. PMID: 23016079; PMCID: PMC3435910.
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