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core power yoga st paul
hello, great to be here. i'm a cardiologist, but before that,i was an exercise enthusiast. i've exercised, i bet,pretty much everyday of my life. i had two grandfatherswho were alcoholics. but for me, my wayof copping with life is exercise.
core power yoga st paul, when i'm nervous, anxious, tired,happy, sad, or whatever, i exercise, if i have the time,and sometimes even when i don't. you might have seen mein an airport, waiting for a flight, running up the down escalatorwith my backpack on, to kill 20 minutes.
but i always thought that exercise wasthe best thing for my heart, and i think that's how i decided,at age 15, i wanted to be a cardiologist. but now that i am 56 years old,and a lot of decades have gone by, i've started to have a few warning singsfrom my heart; a couple years ago i noticed this, and i got on a mission. i'm a research cardiologist,and i have a research fellow. we have been working on thisfor a couple years, with the help of some of the brightestcardiologists from around the country, we came to some startling new insightsthat seem to emerging about exercise.
this made me think twiceabout my lifestyle, and i'm worried that i may havemade a lethal mistake. i hope it's not too late,but let me tell you the story. so, as i said, i have beenexercising for a long time. but if we go back 2,500 years,there is a guy named pheidippides who ran the 26 miles from a battle field near marathon, greece, into athens to proclaim the news abouta momentous victory over the persians. when he arrived at the emperor's throneand said, "victory is ours,"
he abruptly collapsed and died. now, you may have heard that story before, but what you probably didn't know is thatpheidippides was an accomplished runner. he'd been a greek heraldmessenger his whole life. he ran a lot of miles everyday, i bet he was the fittest guy in athensthe day he died. that's strange. but now let's go forwardtwo millennia or more. when the baby boomers came of age,another boom happened: the running boom.
if exercise was good for youas anybody could know, then more had to be better, and the ultimate test of runningand endurance was a marathon. there was a physician who became famousback in the mid-70s by boldly proclaiming that if you could complete a marathon,you were immune to heart attack. this urban myth actually stillholds sway with a lot of physicians. one of my patients and friends is john. he is 68 now, but he's beenrunning for 45 years. as he puts it, if he hasn't runtwelve miles in a day,
he felt like he was wimping out. when i saw him, he cameinto see me, and i said, "john, let's do a cardiac scan,a ct scan, simple, little, non-invasive, quick, high tech scan of your heart. your arteries, i'm sure, will besoft and supple, clean and healthy. so that's what a normalcardiac scan should look like: no calcium whatsoeverin these arteries. his is over here; his score was 1,800. anything above zero is abnormal,
anything over 400 is severe; at 1,800,his arteries are harder than his bones! that can't be good, and he didn't haveany other risk factors to speak of. so in fact, people do dieduring marathons, but let's be realistic. if you look at the latest data,the risk is minuscule: 1 in 100,000 participants. i've gotten to be friendswith a guy named amdy burfoot. amdy won the boston marathon in 1968. he is currently editor-in-chief and has been a long time editor at largeat runner's world magazine.
in conversations we've hadin recent months, he has challenged me. "if endurance extreme exercisesare so bad, show me the bodies." he's got a good point;1 in 100,000 is a pretty low risk. but i'm not so worried about that; running is supposed to add years to your life,and even life to your years. so, could it be shorteningyour life expectancy? i'm not worried aboutdropping into a risk, i am just trying to dothe right thing, i'm a cardiologist,
i'm the business of finding outthe ideal diet and lifestyle. i'm coming to the conclusionthat running marathons and extreme endurance athleticsdo not fit into that recipe. so, that being said,let me be clear about this: there is no single stepyou can take in your life to ensure robust healthand remarkable longevity than a habit of daily exercise. this is a study of over 400,000 chinesethat was just published last year. we published an editorialalong with this afterwards,
but they found vigorous exercise,this is all cause mortality reduction, the more reduction the better,and this is minutes of daily exercise, so 10, 20, 30 minutes of daily exercise. at 45 or 50, you get a pointof further plateau, so further efforts and time do not appear to convey further improvementsin life expectancy. down here is light to moderate exercise:walking, housework, day to day moving around; just get offyour seat and move around. more is better there; it's not quiteas beneficial as vigorous exercise,
but more is better. you can exercise all day it seems, without getting yourself in troubleif you keep it down. so, one of my heroes, i love evolutionary medicine, i think if you look in the worldof nature and into our deep past, you can find the template forideal health, even in our modern world. charles darwin was wrongabout one thing though: it's not the survival of the fittest.
no, in fact it's the survivalof the moderately fit, ok? if the best you can dois walk one flight of stairs before you have to rest,things are not looking good. it could be a bumpy ridein the next few years. on the other hand, if you can dance, lightly swim, or even jog six milesan hour, that's a ten minute mile, that's a pretty comfortable pace, right? your mortality plummets, and if you,after warming up on a treadmill, can achieve a speed of sevento seven and a half miles an hour,
you are pretty much bulletproof,when you look at outcomes. in fact, further attainmentsof peak fitness do not translate into further increases in life expectancy. it plateaus out. in fact there's even a little trendthat it might even go up a little bit. so, the important concept isthat dose makes the poison. it's true with a lot of things,and if we could come up with a pill that gave all the benefitsthat we get from exercise, i'd be looking for work.
in fact, exercise not only cutsyour chance of premature death in half, but it reduces risk of heart disease,alzheimer, osteoporosis, depression. it is an amazing drug, but just likeany drug, there is an ideal dose range. if you don't take enough of it,you don't get the benefit. if you take too much of it,it could be harmful, maybe even fatal. when you're sitting here, listening,sitting around like most americans do, doing nothing, your hearts pumping,just idling along about a gallon a minute, about four, five liters a minute. if you went out, went for a runright now, and you ran hard,
that would go upfour, five or even sixfold. five, or six gallons a minute! that is a workout,your heart is working hard, but that's what it's meantto do, intermittently. you know maybe 5,10, 30 minutes,and maybe up to 60 minutes but by 60 minutessomething starts happening: the stretch in the chambersstarts overwhelming, the muscle's ability to adapt, the catecholamineand adrenaline levels rise,
the free radicals blossom,and it starts burning the heart. it starts searing and inflamingthe inside of your coronary arteries. we're not really meant forthese sustained levels of exercise, for hours at a time. if you go to a marathon,and this has been done several times, you take a troponin levelat the end of the marathon, over half of them will haveelevated troponins. what's a troponin? troponin is a sacred chemicalto us cardiologists.
when we see that a troponingoes up it means one thing: heart muscle has died. normally, we hop into actionbecause that generally means there's a heart attack going on,we need to get a vessel open! in this case, these are little micro tearsfrom the stretching and the searing, and it's not a big deal if you do it once. these are little micro tears, they heal; a few days later it's gone,the heart's back down to normal size. but if you do this over and over again,the chambers start dialing up,
they get scarred, they get stiff,they thicken. if you look closely you can seethese little white patches in these veteranextreme endurance athletes accumulate and for people who have been doing thisfor years and decades, their heart becomes older before its time. we're asking too much of it,it's overwhelming the heart's capacities. this is a fascinating studydone by a cardiologist that i know, and whose son is also a cardiologist. these two were both avid runnersup in minnesota.
they did a study looking at the ct scans,like i've shown you of john's, looked at a group of marathoners whohave been doing this for at least 25 years at least 25 marathons in that timecompared to secondary controls. you can see here that they had 62%more plaque despite fewer risk factors. people say, "that can't be true." in fact, a german cardiologistjust replicated this study showing a 108 marathonerswith similar findings. hard to dismiss. veteran endurance athletesalso have a five fold increase risk
of atrial fibrillation,a dangerous irregular heart rhythm. there is sort of an epidemicof this going on among runners because we've only been doing thisfor a few decades and it takes a while for this to develop. even more worse, when we see this,as cardiologists, our pupils dilate, our heart rate goes up;this is ventricular tachycardia, which is a potentiallylife threatening rhythm, and we can see this from the scarring in the ventriclein some endurance athletes.
so "born to run" is a bookthat was published, a non fiction book, published just in 2009. the hero of this storyis a guy named micah true. he dropped out of american culture, went down to livewith the tarahumara indians in the northern part of mexicoin the copper canyons. he was an epic runner, legendary for his ability to runlong distances, hundred mile races. the indians down there nicknamed him"caballo blanco", the white horse,
for his abilityand his remarkable endurance. so micah true died, sadly,at 58 years of age, on a routine 12-mile run, in the wilderness of new mexico,in march of this year. when they did the autopsy, they found an enlarged, thickenedheart with scar tissues. the coroner said,"idiopathic cadiomyopathy." but i've looked at that path report,and it reads like a description of the pathology we might expect to seein some extreme endurance athletes.
my colleague who wrotesome of these papers with me, peter mccullough, has coined the term"pheidippides cardiomyopathy." that's what he had. there are a couple papers that arecoming out in the next two months, and we're publishinga couple papers as well. they are going to changethe thinking about exercise. this is one of them by chip lavie,one of my colleagues, and maybe my best friend. he down in oshner clinic in new orleans,and this is a look at 50,000 runners.
52,000 people followed for decades,on average 15 years but up to 30 years. they compared the non-runners,about 38,000, to the runners, about 14,000 and what they found was that runnersdid live longer, 19% longer, but if we look closer,you'll see that the runners, compared to the non-runners,for the risk of death, the reference is one. if you ran more 25 miles per week,your benefits went away. you only got 25-27% reductionin mortality rate.
if you ran between 5 and 20 milesa week, ideally 10-15 miles a week. when we looked at the running speed,sure enough if you ran too fast, over eight miles per hour,which is a 7:30 pace, the benefits went away. now they weren't worsethan the non-runners, but heck if you're running that much, you would think you'd getsome health benefits, but no, you have to back offto a six or seven miles per hour pace, which is about a ten miles per hour jog.
interestingly, how many days a week? seven days a week if you're running,the benefits go away. you need to run fewer days,two to five ideally. so another study that'll be published soonis this one from across the pond. the copenhagen city heart studycompared the non-runners to the runners and found the same thing; the relationship appears muchlike that of alcohol. mortality is lower in peoplereporting moderate jogging than in non-joggersor those undertaking extreme exercise.
the moderate joggers got a 44% reductionin mortality, they live six years longer, but it went away if you over did it. so the truth is that exercise does conferpowerful benefits, and the belief is "more is better". but we're learning that moreis not better in this case. one of my good friends meghan newcomeris a triathlete from new york city. she grew up next door,a dear family friend, she's one of the toptriathletes in the country.
she did ten races last year,and she is 30. she won half of them. the other half she collapsed from heat exhaustion, dangerousheat exhaustion near the end of the race. i told meghan, "meg, if you wantto be in the real olympics, which you very well could be,you just keep hammering away, maybe up your game a bit. but if you want to be alive and well for the 2052 olympics, 40 years from now, you need to back and way off.
back your pace off and findsome healthier exercise pattern." so there's one last studythat i want to tell you about. this is a study from last yearthat looked at mice. they hammered these mice,they ran them to exhaustion, every day, for four months,and you know what? this replicated those same findingsthat we saw in micah true, and the other findingsthat i told you about. but what provides hope to meis that when they took these guys off their iron mouse training regiments,their hearts came back down to normal.
the fibrosis even melted away,and their ventricular irritability and atrial fibrillationtendencies, all gone. well, i'm a man not a mouse, but here's hopingthat maybe that works in humans too. anyway, we're not meant to run.we're not born to run, i should say. we're born to walk; we needto be walking more today. we need to be strolling, we need to be movingour body rather than sitting. every chance you get, move,
and do some high intensityinterval training from time to time. but personally, i've found that what i donow is i've shorten my runs up. i go, when i run, i run a one and a halfto, at the most, three miles, but typically about two miles. i take the pace down, and i walkwith my wife, play with the kids, and stop in meadowsor parks, and do some yoga. when i'm swimming, ratherthan churning away, i go on my back, and i do some nice gentle backstroke. i watch the clouds sail overhead,and see the birds soaring in the sky,
and i can feel my heart relaxing,healing, and getting better. so all things in moderationis not a new concept. this was something that oneof phidippides' contemporaries, the father of medicine said,2,500 years ago, "the right amountof nourishment and exercise, not too much, not too little,is the safest way to health." so i've never presented in my 30 yearsas a cardiologist such controversial data. but the truth is,this is a u-shaped curve. the couch potatoes are using this
as an excuse to continuetheir sedentary behaviour. then there's the wholeextreme exercisers, people like me, who don't want to hear this mess; in fact,they kind of want to kill the messenger. i've been getting a lotof adverse comments about this research. but you know what i've decided? it is that you need to snuggle in to the safety of the middle ofthe "u" curve when it comes to exercise. or when it comes to anything else in life. to me, i've decidedthat running too fast and too hard
is only going to speed up my progress towards the finish line in my life. so i've decided to back it off, and hopefully, enjoymore sunrises and sunsets. thank you. (applause)
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