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Excessive endurance exercise

PETE GLADDEN
Pete’s World

Published: November 28, 2022

The expression, “too much of a good thing,” can probably apply to just about any of life’s endeavors––even to exercise.
Indeed, and according to the Cleveland Clinic’s Healthessentials webpage (https://health.clevelandclinic.org/can-too-much-extreme-exercise-damage-your-heart/), “Chronic extreme exercise training and competing in endurance events can lead to heart damage and rhythm disorders.”
Now as you might remember, I detailed my fateful run-in with cardiovascular disease in a two-column piece back in November 2017, where I revealed that one leading hypothesis for my arteriosclerotic ailment was my decades long involvement in extreme endurance activities.
Thus, with this confounding malady literally so close to my heart, I’d wanted to educate you further on the topic via a question I’ve been attempting to get an answer to ever since I was diagnosed with cardiovascular disease some six years ago.
But before I divulge my question, let me first give you a brief review of this curious exercise-related malady by returning to that Cleveland Clinic Healthessentials webpage where there’s a citation from my current sports cardiologist, Dr. Tamanna Singh.
There Singh states, “Extreme, long-term endurance exercise puts equally extreme demands on the cardiovascular system.” And this assertion by Dr. Singh rests on over a decade’s worth of research studies that indicate when the heart is repeatedly subject to extreme demands, year after year, maybe even over the course of decades, it can sometimes undergo a negative remodeling in such a way that its walls experience scarring and/or fibrosis (thickening).
Not only that, but those chronic extreme demands can also lead to accelerated coronary artery calcification - which so happens to be my particular affliction - in addition to a higher risk of arrhythmias like atrial fibrillation.
This exercise-related malady is known in the sports science world as excessive endurance exercise syndrome.
And despite researchers now entering a second decade of trying to understand it, I’m still searching for an answer to one of the most obvious questions surrounding it: Just how much exercise does it take to increase one’s risk of developing these heart related ailments?
But regrettably, the dilemma for exercise scientists with respect to this how much/how often question centers on two critical yet undefinable factors.
The first is the “what’s extreme exercising for one athlete may not be so extreme for another athlete” factor.
The second factor appears to be far more critical, and that’s the element of underlying genetic issues (family history of cardiovascular disease), where an extreme exerciser with a family history of cardiovascular disease - like me - might be much more prone to the aforementioned cardiac maladies than an extreme exerciser who has no genetic predispositions for heart disease.
Those two critical factors currently have researchers conducting studies aimed at trying to precisely establish the exercise thresholds that elicit toxic results - a very important parameter which could then assist in the screening of at risk individuals like myself.
But alas, there are currently no proven screening methods or parameters for detecting/determining the potential for the negative cardiac changes associated with excessive endurance exercise.
Now according to a Mayo Clinic publication, Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise, one strategy might be to “deploy post-competition cardiac biomarkers, echocardiography and/or advanced imaging such as cardiac MRI to identify individuals at risk for and/or with subclinical adverse structural remodeling and substrate for arrhythmias, but the cost would likely be prohibitive.”
Yet despite the lack of any quantifiable data at this juncture, there are still some very important warning signs to look for if you’re excessive and/or extreme with respect to your exercising, signs I wished I’d have known about prior to a fateful day in May 2016.
Some of these telltale signs include sudden and unexpected rapid or irregular heartbeat, tightness or pressure in the chest (in my case it was a tightness between the shoulder blades), shortness of breath, lightheadedness, blacking out or an unexplained deterioration in performance.
Such signs signal one’s need to immediately seek evaluation by a health care provider.
Now I have to say that I’m indeed a lucky guy, because despite my waiting longer than I should have in seeking medical consultation, I didn’t wait so long as to let my symptoms get the better of me.
So although there’s still no concrete answer to my year’s long question, we at least have those telltale warning signs to heed.
And with that, my advice to you extreme exercisers is simple: Listen to your body.





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