Question for you: When you use the word “extreme” is it more in the context of the length of the event (i.e. ultra marathons etc) or are you talking about “extreme” in the sense of elevated heart rate as in HIIT etc?
I had a-fib but haven’t had it since an ablation last February. I have chosen not to do any HIIT since then because I had read for someone of my age (69) the risk of a-fib reoccurrence increases and it’s just not worth it. On the other hand, I don’t do marathons, let alone ultras, but I’ve been trying to do a couple of hours of Z1/Z2 daily and I’m curious if there is any data on that and the potential for reoccurrence of a-fib.
Have to think the pros (physically, mentally, emotionally) greatly outweigh any cons (return of a-fib) but just curious to get a sense of your context on “extreme exercise.”
very interesting, and timely! (just found your Stack, based on the story below)
I'm 70 yo male, lotta running miles over last 30 years (+40 marathons). Been prediabetic for all these years (a1C 5.9 - 6.5).
Earlier this year, based on CGM use, determined/eliminated grains and processed carbs, etc). Latest lipid results much improved (i.e., triglycerides go from 150 to 60, HDL go from 40's to 62, 35d...). LDL still a little high (149) and a1C now 6.1. All other stats are good to excellent.
New Dr suggested CAC. Results come back:
Agatston score: The total (aggregate) calcium score utilizing the AJ–130 method is 977. Total volume score is 810.
This means that 10% of similar patients will have a higher calcium score.
Individual major vessel AJ–130 scores are:
LMA: 57, volume score 47
LAD: 835, volume score 678
LCx: 0
RCA: 85, volume score 85
Other: 0
Other findings: Heart and great vessels are normal in size. No pericardial or pleural effusion. Visualized lung fields are clear.
To my uneducated, curious nerd runner's assessment, this don't look so good!!!
Doc appointment is in 2 weeks. Assume if this were imminent death, he'd call me and tell me to go straight to OR!!!
But the running addict that I am, I've kept up my 20 mile/week and feel great!! Next marathon planned for May 2026!
Looking forward to my Dr's assessment and recommendations!
My beef with these studies is the definition of "extreme," or consistent lack thereof.
I've run more than 130,000 miles in the previous 46 years. Sounds extreme!
Or maybe not--it basically works out to averaging a little more than an hour a day during that time, with probably something like 85% of that at an easy to medium intensity. Sounds moderate!
Other would-be definers, such as number of marathons run, are also unhelpful. Is a marathon running 26.21 miles as fast as possible on the day? Covering that distance at a jog? There's no consistency in what people mean by that.
Agree Scott - the "extreme exercisers" in the cohort studies showing coronary calcification usually comprise masters athletes who've been competing at a high level for 20-30 years and logging several hours a day of exercise. We don't have much data in younger "extreme exercisers" (IronMan triathletes, etc.) and definitions + amounts of exercise across studies isn't consistent.
All of this is to say I agree. We don't have a definition of what "extreme" is.
I think about it a LOT, Joshua. I've had a few heart-related things in the last decade or so but any test I've done has come back negative (i.e., "no issues) regarding heart structure and function. I think lifestyle has a big role to play here and we don't know how the two interact. My speculation is that these extreme exercising cohorts we do have data on also have some other health factors that confound the findings - they drink, smoke, have diabetes, etc.
Tl;dr: I'm not yet convinced exercising a lot is in and of itself harmful.
Question for you: When you use the word “extreme” is it more in the context of the length of the event (i.e. ultra marathons etc) or are you talking about “extreme” in the sense of elevated heart rate as in HIIT etc?
I had a-fib but haven’t had it since an ablation last February. I have chosen not to do any HIIT since then because I had read for someone of my age (69) the risk of a-fib reoccurrence increases and it’s just not worth it. On the other hand, I don’t do marathons, let alone ultras, but I’ve been trying to do a couple of hours of Z1/Z2 daily and I’m curious if there is any data on that and the potential for reoccurrence of a-fib.
Have to think the pros (physically, mentally, emotionally) greatly outweigh any cons (return of a-fib) but just curious to get a sense of your context on “extreme exercise.”
Thx. Keep up the great work.
very interesting, and timely! (just found your Stack, based on the story below)
I'm 70 yo male, lotta running miles over last 30 years (+40 marathons). Been prediabetic for all these years (a1C 5.9 - 6.5).
Earlier this year, based on CGM use, determined/eliminated grains and processed carbs, etc). Latest lipid results much improved (i.e., triglycerides go from 150 to 60, HDL go from 40's to 62, 35d...). LDL still a little high (149) and a1C now 6.1. All other stats are good to excellent.
New Dr suggested CAC. Results come back:
Agatston score: The total (aggregate) calcium score utilizing the AJ–130 method is 977. Total volume score is 810.
This means that 10% of similar patients will have a higher calcium score.
Individual major vessel AJ–130 scores are:
LMA: 57, volume score 47
LAD: 835, volume score 678
LCx: 0
RCA: 85, volume score 85
Other: 0
Other findings: Heart and great vessels are normal in size. No pericardial or pleural effusion. Visualized lung fields are clear.
To my uneducated, curious nerd runner's assessment, this don't look so good!!!
Doc appointment is in 2 weeks. Assume if this were imminent death, he'd call me and tell me to go straight to OR!!!
But the running addict that I am, I've kept up my 20 mile/week and feel great!! Next marathon planned for May 2026!
Looking forward to my Dr's assessment and recommendations!
Thanks for sharing this John, and best wishes for the results of the follow-up with the Dr. Assuming you've been asymptomatic up until now?
Yes, absolutely no issues. VO2 + 43 (per Garmin), RHR 48 - 52.
My beef with these studies is the definition of "extreme," or consistent lack thereof.
I've run more than 130,000 miles in the previous 46 years. Sounds extreme!
Or maybe not--it basically works out to averaging a little more than an hour a day during that time, with probably something like 85% of that at an easy to medium intensity. Sounds moderate!
Other would-be definers, such as number of marathons run, are also unhelpful. Is a marathon running 26.21 miles as fast as possible on the day? Covering that distance at a jog? There's no consistency in what people mean by that.
Agree Scott - the "extreme exercisers" in the cohort studies showing coronary calcification usually comprise masters athletes who've been competing at a high level for 20-30 years and logging several hours a day of exercise. We don't have much data in younger "extreme exercisers" (IronMan triathletes, etc.) and definitions + amounts of exercise across studies isn't consistent.
All of this is to say I agree. We don't have a definition of what "extreme" is.
It’s been popping up more and more it seems. How do you think about this yourself, as a life long endurance athlete?
I think about it a LOT, Joshua. I've had a few heart-related things in the last decade or so but any test I've done has come back negative (i.e., "no issues) regarding heart structure and function. I think lifestyle has a big role to play here and we don't know how the two interact. My speculation is that these extreme exercising cohorts we do have data on also have some other health factors that confound the findings - they drink, smoke, have diabetes, etc.
Tl;dr: I'm not yet convinced exercising a lot is in and of itself harmful.