Performance vs Longevity

The latest Attia Podcast features cardiologist James O’Keefe, they talk about the risks of too much exercise. It would be useful to have a thread to examine his case, analyze the evidence and maybe flesh out some best practices.

Key Issues:

  • Perhaps this is only relevant for athletes older than 45yr. Our younger self can get away with at lot of load and intensity.
  • Balance vs Specificity. Diversity of Training.
  • Proper measure of high intensity and % of total load.
  • Individuality, everybody has their own heart physiology, family history, etc.
  • The value of Z2

Cheers!

Just listened to this last night. I did start having freq PVC’s and some runs of SVT back in my mid 50’s when still training hard on top of a very demanding job. This hasn’t occurred with my restart in my 60’s, with the exception of sitting in the sauna. Sticking with lots of zone 2 and the low volume plans.

1 Like

(this post was moved to this thread, so that’s why it reads a little strange.) Anyone listen to Peter Attia’s interview with cardiologist James O’Keefe? O’Keefe’s description of the damage excessive exercise can cause a person’s heart was a bit unnerving. He refers to it as a “reverse J curve” where exercise improves health up to a point, but more than that causes harm. The surprising part was how low the amounts were that he recommended - 15 miles of running each week. I’m not a runner, but that seems like about 2-3 hours. He also says only a small chunk of this should be at high intensity. I’m guessing nearly everyone reading this would fall outside of his recommendations. Think this is legit or alarmist? If you think it’s legit, will you ignore it anyway? I’m curious about how people balance health vs. desire to be faster.

already being discussed here:

1 Like

I will definitely give the podcast a listen, but I feel like it is a bit alarmist while still being legit. It’s relatively widely accepted very high levels of aerobic exercise is not healthy (as in, more is not always better) but I think the actual likelihood/probability of suffering significant complications is low, especially when compared to the other end of the spectrum (no or not enough exercise).

Alex Hutchinson addresses this in his first book - “Which Comes First, Cardio or Weights?”, I believe…though it’s been some time. iirc he draws a comparison with regard to marathons and the risk of heart failure during. While you do run a higher risk of suffering heart failure while running a marathon (relative to a perfect control scenario), the risk of injury or death due to a traffic incident would you have been driving on those roads on a Sunday morning instead is higher, or something like that. I’ll see if I can pull the actual verbiage and update this post. I see it as balancing risk vs reward, the same as cycling. If we all wanted to exclusively maximize health and likelihood of never getting injured, we’d reduce training volume, only run/ride inside (where it’s safer), etc but at some point certain things are worth calculated risk (and in this case I see the level of risk as quite low).

4 Likes

I happened to listen to this after having entered the 2021 Marmotte GF (177km 5000m+) at 49 yo which I think we can all agree is probably not anyone’s idea of a healthy pursuit!

On the other hand I never raced a bike to be healthy, it was to be fit and fast. That said I estimate that the overall benefits (physical and mental) far outweigh the risks. When I look at most people my age I don’t want to live their lifestyle regardless of how many extra years I might get, I love doing what I do and how it makes me feel.

I have many friends still riding and in some cases racing in their 50s, 60s and 70s and the only one I can think of with heart issues basically stopped riding his bike 20 years ago. Otherwise I’m struggling to think of many, if any, who have any kind of major health issue related to too much exercise.

The only concession I might consider is ensure I have one two days off each week, have a complete break each year and of course monitor how I feel and get checked out if necessary.

4 Likes

Beyond your z2 and TR LV comment, what were your takeaways? I’ve made it thru 40 minutes and still listening, but I’m an engineer and you are far more qualified to follow the conversation.

I think we might need to go through the references in order to find some sort of quantitative rudder. Specifically,

  • what kind of intensity and volume is not healthy when you feel perfectly fine executing?
  • what about that study on older professional cyclists and health issues?
  • Can you measure that “enlarged” heart cavity issue?

Many more questions than answers in the podcast.

This podcast is new to me, can folks give a general count of grains of salt it should be taken with. My podcast app pointed out he was on the GOOP podcast in the spring so the red flag warning speaker let out a loud AH-WOOOO-GAH. Certainly that does not mean there cant be valid info here, I plan to give it a listen and see what there is to see, just asking if this guy is legit or is this a gateway drug into antivax MLM land?

There are examples of endurance athletes that have had to have defibrillators implanted because of arrhythmias. I am unaware of any study that specifically looks at senior endurance athletes, or retired professional endurance athletes. To make sure I wasn’t doing any harm, and in anticipation of doing some VO2 work Kholie Moore style, I finagled a stress test out of my primary care provider. This was a nuclear stress test that looks at the heart perfusion before and after the exercise. I made sure to have the techs continue after their usual stopping point, which for me was a pulse of 135 (mid zone 2). I failed in the test because my legs gave out before I reached a pulse I’ve seen on the ramp test. My heart was completely normal on the scan. Other than testing like this, I don’t know how you would know you are OK to proceed. One thing to remember is that in the podcast, the emphasis was on the minimal effective dose of exercise to derive the benefits of heart health and longevity.

2 Likes

Attia’s a doctor who usually interviews other doctors, so much of it is over my head. My general opinion is that he seems legit and scientifically grounded. His approach is a bit obsessive/perfectionist, so he often loses me there as well. In this case, the person he was interviewing, O’Keefe, seemed more moderate (don’t overdo it, do activities with friends, have a sense of play to your activities, etc.) even if his message might ultimately seem radical to us.

1 Like

You can easily measure the heart cavity size with ultrasound non-invasively.

perhaps because I’ve only been cycling for 5 years, but I’m finding better results doing less intensity than is in the TR mid-volume sweet spot base plans. And listening to this podcast is leaving me thinking its also a (heart) healthier approach, even without conclusive evidence.

2 Likes

Yep, completely agree. I’ve jumped on the ISM train recently as this year has shown me I respond very well to an unstructured version of it, and this podcast just reinforced it to me from a health standpoint. IMHO I think there is way more of a push to do too much intensity in amateurs than there should be.

4 Likes

what’s the ISM train?

Iñigo San Millán :steam_locomotive::steam_locomotive::steam_locomotive:

1 Like

Sooo…I feel I’m about 8% qualified to input some info about this.

TL;DR – riding hard gave me a bad heart, riding easy gave me a healthy heart.

2019 I had a couple stress tests. First one was the usual treadmill ECG; stoppage due to high blood pressure. Second one was a nuclear test. Same deal, high BP stoppage.

The first stress test came right after I spent 10 months doing almost only hammerfest riding.
The second stress test came right after I did SusPB HV and SSB2 HV and two weeks into a VO2 block (1 rest week in 4 months).

Tests showed perhaps some scaring which indicates previous heart attack. Also showed possible ischemia. Doc sez NO intensity until we can figure this out. Plus take these drugs. Awesome.

For 12 months I was on an exclusive diet of low HR Z2. For 12 months I read all I could about the heart.

Then I had a CT angiogram (“gold standard” of cardio exams) which showed my heart is 99.99% awesome.
2020 raised my HRmax by 1bpm. Take that, genetics!

My learnings:

  • The athletic heart and the diseased heart share a lot of similar symptoms, but almost none of the same causes. The average medical professional does not know how to tell the difference. This can lead to misdiagnoses. Seek out a performance specialist.

  • Huge difference between health and performance. By definition, performance is not sustainable, thus not healthy. Health can be sustained for 100 years but will never achieve performance levels. There’s a balance.

  • Brisk walking might just be the best exercise ever. Do Z2/<LT1 like your l life depends on it.

  • The heart needs rest. Rest it. A lot. But it’s also a monstrous powerhouse. Use it.

Anecdotally, I tracked my HRV while I was doing all my Z2. I started with totally fired readings, like in the gutter of the muddiest Roubiax. After 4 months of low HR riding, my readings were drastically improved. Z2 is healthy for you, and you can do a ton of it.

Also, don’t be afraid of intensity. It’s what’s prescribed to recovering heart patients.

And mine was abnormal on the scan. As my final cardio doc said, “Lots of problems with those tests. Mainly with the test itself and with the people interpreting the test.” I read one study where a healthy patient was leaning too far forward during the treadmill test which altered his heart function enough that it was interpreted as diseased and by the week’s end he had an unnecessary heart operation. No thanks.

That’s the scary part because you usually don’t know until there’s catastrophic failure. I would say if you are ~50 and plan on doing any kind of HIIT, go get that yearly physical.

The grand takeaway: Masters athletes might just have to face the fact that they aren’t half their age. :wink:

6 Likes

So in a nutshell a polarised approach would be more sensible for us older guys?

1 Like

That’s exactly why I swapped over to using xert as it provides a more polarized approach.

Being over 50 and soon to retire/be made redundant this is a great and equally worrying thread.
I am on low volume sweet spot so from reading these comments so far it seems the best way for me to adjust my training is keep to LV do some Z2 long rides outside and plenty of walks with the dog.

:thinking: There were calls for an older person’s training plan a while back too.

But then no one lives forever but I’d like to have a healthy heart whilst I’m around. :grin:

And I’ll soon have time to ride way more than I do now… … :joy:

3 Likes