Are we Jacking our Hearts???

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I got an email a few days ago from John Mandrola, MD. He’s a cardiac electrophysiologist from Louisville, Kentucky. He also races cyclocross passionately. He has a blog at

Anyway, he has a video, at the blog above, from a very prominent sport cardiologist, Dr. James O’Keefe, that presents some data on the effects of chronic endurance exercise on the heart. Much of the data pertains to runners and triathletes, but cyclists are What are you doing for Thanksgiving? involved too. Here’s a link to a WallStreet Journal article on the subject from last Tuesday.

I watched the full video, which is 18 minutes, and it is a presentation for the layman. It has a bunch of charts and tells you a lot of information. Below is a video of Dr. O’keefe that he made for the Mayo Clinic, that generalizes his premise.

What Dr. O’Keefe says is that the amount of exercise that we’re all doing is a pretty bad thing for our hearts. He has lots of statistics and studies that he uses. Essentially, when we exercise for long durations, our hearts, which are already very enlarged, get micro tears in them. He cited a study when took blood samples after the Boston Marathon and virtually all of the samples had troponin, the protein that they test for to measure certain heart disorders. Also, he presented information on atrial fibrillation and calcification of the heart due to excessive endurance exercise. The good news is that the conditions can be reversed.

Anyway, after spending some time Friday, researching the validity of the whole issue, I decided to call Dr. O’Keefe and see if I could talk to him personally. It turns out he is local, over in Kansas City. I spent a long while trying to get past the levels of interference that all doctors seem to have. Eventually I got the voice mail of Joan, his assistant and left a message. So far, after two business days, no return call. I’d say I have about a 20% chance of getting a hold of him this way. I’ll have to be more creative, I guess.

I think I’d be about the perfect guy for him to study. I’ve been doing endurance athletics nearly since I’ve been able to walk. Plus, I’ve hardly ever taken more than a couple weeks off since I was a teenager.

The reason this is important to me is because when I feel shitty riding, I seem to have the same symptoms. And one of those symptoms is kind of a weird feeling in my chest, like my heart is just a bit achy. I’ve had it lots of times, and have always attributed it to allergies, because it eventually just goes away and I get going good. I’ve never had this flatness or weird feelings in the winter, November and December, when there aren’t any real allergies.

I’ve had a few emails exchanges with another heart guy from OKC. He has been good for my mindset. I understand that these studies on long term exercise are in their infancies and there needs to be a lot more done.

I’ve never been under the illusion that what I’ve done virtually my whole life is very good for my general overall health. Especially my heart. I personally know a lot of riders that have had major heart issues that pretty much ended their careers. I think when people do things that are very extreme, especially physically, that usually doesn’t work out that well for their longevity. I’m kind of a quality of life over quantity of life type guy. But, that being said, I’m not really to a point that I feel like throwing in my chip.

Hopefully, I’ll start riding good and get out of this funk thing pretty soon. And maybe I’ll get a hold of Dr. O’Keefe and he can answer some of my questions. After watching him talk, I doubt he’ll put my mind at ease, but at least I’ll have a little more knowledge to mull over.

31 thoughts on “Are we Jacking our Hearts???

  1. Bernd Faust

    rule of thumb: 1 hour running max for training, 1 hour lifting, 30 min swimming, 3 hours riding..less is always better. I did a few half ironman and ran 1 26.2 mi in my life , but never trained to long. the 26.2 took 2;59,59, 1990 in Munich on the course Frank Shorter won in 1972. I lost 8 pounds and said never again….”Moderation” is key….

  2. jim sully

    Easy way to corner him…You mention he’s a cross devotee, Hell ST, just enter a race he happens to be contesting, then chat w him as the race plays out.
    Something akin to this, he suffers like a dog+you glide along fairly effortlessly in uninterrupted chatty flow.
    Guarantee he’ll wanna discuss your concerns after the event too, as he will be gobsmacked that some geezer(you) breathlessly stayed on point as he wobbled+cobbled all 55min+ 1.

  3. scott

    If this study happens to be valid, we’re pretty well screwed. but the reality is, i suppose, that there’s really not much to be done except to exercise way more moderately – and i’m with you in that quality trumps quantity.

  4. jp

    interesting you bring this up,I have been thinking the same thing lately that I would like to speak with a doctor about my heart. I have noticed a tightness and discomfort while laying flat under the breast area on my left side when taking a deep breath, its weird,concerning, when you feel weird like that it gets you wondering what might be going on. And its hard finding a good doctor and one that understands that you are an athlete, and not somebody that just goes out jogging for 10 minutes a few times a week.

  5. MR

    “I think I’d be about the perfect guy for him to study. I’ve been doing endurance athletes nearly since I’ve been able to walk. Plus, I’ve hardly ever taken more than a couple weeks off since I was a teenager.”

    Quality of life, especially night life, has been the cause of more than a few Freudian slips in men. You can’t be feeling too bad this morning.

  6. john adamson

    I’m at the point where I thought I was supposed to be doing more high intensity and less miles – I have base.

  7. JR

    ” I’ve been doing endurance athletes nearly since I’ve been able to walk.”

    Are you the Wilt Chamberlin of cycling?
    ha ha

  8. Bryan

    I’m in trouble then. I usually ride at least 2 hours/day during DST, and on the weekends routinely ride 4+ hours each day. During off season, I do at least 30 minutes on the exercise bike, 30 minutes on an elliptical, then close to an hour in the pool doing 2000 yards – pretty much every weekday. I’m guess I’m dooming myself?

  9. Rad Renner

    So maybe this is why we need an “off-season”? To let our hearts recover from all the “stress” we put on it with all the training we do for 9-10 months per year? And maybe the rest of our body, too?. It would makes sense that we should allow our body a long rest period to “get back to normal” for a little while each year. Anyway, probably most of us “amateur” cyclists do not train as long and as hard as you, Steve, so we might not be as much at risk as you (but then, everyone’s different). I think I average around 10-12 hours/week for most of the season, any more and I get too tired (I’m 47). Some weeks will be as much as 14-16 hours, but then I’ll need to cut it back for a while to recover. Even machines need repair, right?

  10. MR

    Could there possibly have been any better title for today’s blog given the braggadocio you dropped in there? Not sure how I missed that the first go round.

  11. sb

    While I agree the science needs more work, this idea makes sense to me from an evolutionary perspective. The only reason early men would run that hard for so long would be in life-threatening situations, and those would be rare (e.g. a big fire maybe?). Not even being chased by a lion would make you run that hard for hours; you’d either be caught and dead, or get away pretty quickly.

    I think this also ties nicely into the whole “Paleo” exercise / diet movement. It makes sense to me that our bodies adapted over thousands of generations to the challenges of living in the wild. Our diet and exercise should approximate that.

    Bicycle road racing is not even close to “paleo”.

  12. Robert Ellis

    I bet he would contact you if he knew you were trying to get ahold of him. Go get an echo, an ekg and I liked that ferritin idea from a few days ago.

  13. David J

    I watched the video and got a big laugh when he said “Darwin was wrong on one thing…”. Seriously??… JUST ONE THING???? If Dr. James O’Keefe Jr believes in Darwins thinking then I’ll take his views on running and physical activity as stated in the video as crap.

  14. Martin M

    Get that exercise ECG Steve if you’re worried. Can’t pretend to be anything like as fit as you, but I had an exercise ECG a couple of years back when I was getting unexplained chest pains. The tech and nurse were pretty bored by the time I finished the protocol and commented that most people they see are maxed out pretty quickly (lots of unfit people here in the UK), I know how I’d rather be. Big thing to avoid is going hard if you’re carrying a virus, but you know that already.

  15. Brady Schmiedeberg

    That study was 60 recreational runners sampled from the Boston Marathon. That is a pretty big jump to someone who has raced since they were born. They probably tested some people who did a couch to marathon program for one month prior to marathon. Of course their damage markers will be high. Check this analysis out .

  16. Mark Merritt

    I think its described as Hypertrophic Cardiomyopathy, or overenlarged left ventricle. Ryan Shay died in the olympic marathon trials 5 years ago, and recentely Micah True, legendary ultra runner was also found dead of a heart attact. Shay was actually diagnoised as a child but was cleared to exercise.

  17. Daniel Miller

    Just spent some time reading some of O’keife’s papers…

    It’s a shame that he seems to be overstating his findings in that video. What he’s saying may or may not be true…to quote one of his first author papers:
    “this concept is still hypothetical and there is some inconsistency in the reported findings. Furthermore, lifelong vigorous exercisers generally have low mortality rates and excellent functional capacity. Notwithstanding, the hypothesis that long-term excessive endurance exercise may induce adverse CV remodeling warrants further investigation to identify at-risk individuals and formulate physical fitness regimens for conferring optimal CV health and longevity.”

    Not everyone who smokes their whole lives get lung cancer. Just like not everyone who trains hard their whole lives will have any pathological alterations. Likewise, some people who ride their whole lives may never be able to push 300w for an hour/

    I say ride your bike and forget this guy. Life’s too short, and again, he seems to be overstating his own data…

    If you volunteer for one of his studies, it may just be a whole ton of tests and worry for you. Again, life’s too short.

  18. channel_zero

    I’m doing what Bernd Faust posted and haven’t looked back. Training times exceeding what Bernd posted is practically worthless for most cycling events.

    IMHO, the exception would be when you are guaranteed to be in the saddle at race pace (whatever that is for you) for more than 3 hours. Then and only then, do you need to simulate the length of the race to maybe 80-90% of the hours at a steady tempo, not even race pace. The end of the session tempo will be hard, the beginning, not so much.

    I think there’s a word for it now too, “reverse periodization.” Before when I tried to explain it, most considered me nuts. When it gets marketed by someone else, I’m sure I’ll hear about it again.

  19. channel_zero

    Just as an FYI, my longest, rarely done cycling time is 3 hours, shortest is 30 minutes including warm-up with an average of about 45-60 minutes.

    Consistently setting new PR’s at all distances while volume varies inversely to intensity, but only by an hour or two for each week. Picture a pretty high intensity, low volume workout schedule.

  20. Ted Lewandowski

    He is a professor of medicine at the University of Missouri – KC – you can send him a direct email via Linkedin or request that he join your network. You can also call the University and ask for a class schedule that Dr. O’Keefe teaches and show up either before or after class.

    I am sure he would be happy to have you participate in one of the lectures and his studies.

    Problem solved.

  21. Jef

    I’ll probably be banned for life for this but I recall there was a guy in the 90s that also had an ‘achy heart’.

  22. John Mandrola

    Hi Steve,

    First of all, thanks for posting on this important and quite curious topic. And I really appreciate the shout out.

    Second, I hope those weird sensations in your chest turn out to be nothing serious.

    Third, here is the comment I left on the WSJ article:

    “As a heart rhythm doctor and a bike racer, the steady stream of seemingly super-healthy endurance athletes that populate my practice piques my interest. Why is it that someone so fit and so strong could develop the same diseases that sedentary overweight smokers get? Why is that heart CT scans of marathon runners look like those of smokers? Why is that Born-to-Run types suffer sudden death unexpectedly early? How do we ignore the multitude of studies on long-term endurance exercisers that show (otherwise unexpected) cardiac scars? It’s well known that scar in the heart predisposes to electrical abnormalities.

    Here’s the problem for cardiologists: the overwhelming majority of the disease we see occurs in large part because of inadequate exercise. Most should exercise more. But like everything in life, too much of something is….well…too much.”

    Greetings to you and your readers from Louisville KY.

  23. ted

    I agree with others here, that if I”m going to endanger my health, I’d rather do so with a good brisk bike ride in the fresh air and warm sunshine than by cigarette smoke, vodka and Big Macs. Steve, I love the blog because you and your crew hit some good miles, and also do good food, good wine, good dogs, good cats, and good friendships. If you die from that, you’ve had a wonderful life!

  24. Bill K

    Looks like I’m safe doin’ 40 minute Crits and 45 mile road races…That’s all you get, when you’re old old old.

    I also get that “achy” heart feeling after I’ve been taking it easy, in the off season, and then starting up again.
    I’m glad that my heart doesn’t feel as bad as my legs do, after a hard workout.

  25. Brandon

    I’m gonna ride until I croke. I won’t stop unless I’m forced to by some unforeseen mobility issue. If my doctor told me to slow my riding or even quit I think I’d just ignore it and keep at it. A fifteen hour week sounds good about n

  26. Jeff Miskimins

    I agree with Daniel Miller. I watched and listened and wasn’t convinced either. When he said he ran up the escalators with a backpack for 20 min at the airport while waiting to board I thought ” this is a guy obsessed with getting fitter and will do just about anything to get faster”. Who the hell does that? Somehow I don’t think ST would whip his bike and warmup trainer out and do a 20 min interval to “get that edge” on his competitors. I think he knows he’s never going to “achieve” whatever he dreamt and now he wants justification for “slowing down”. He said he was 56 now and he jogs with his wife and back strokes in the pool and plays with his kids. Nice sales pitch buddy. What the hell does that got to do with your research? And then after a boatload of research he quotes the ancient Greeks saying “Everything in moderation”. Really? No shit Sherlock. Nothing new there. Lets face it. Most of us would love to be able to run sub 5min mile marathons but most of us will never be able to do that. Including the obsessed research cardiologist. Sorry buddy.

  27. Gary Epler

    I ran several marathons in the 1980s and trained for a half-marathon October 2012 running weekly 2.5 hour training runs. I also really enjoy a vigorous one-hour workout. Sometimes, these are so intense that I call them a “bucket” workout which means having the feeling of throwing up in a bucket from an intense workout – these are from working out with a weight guy who loves pushing 200-pound sleds with 20 push-ups and 20 kettle-bell lifts in between. The issue is that these are great workouts because they feel good and give you a phenomenal amount of energy for the day. I would like to do them for years. But, for seniors (for some or for all – I don’t know the answer), having a 160 to 170 maximal heart rate for too long is going to cause atrial flutter or atrial fibrillation requiring cardioversion and may require ablation, which means destroying the four aberrant firing sites at the end of the pulmonary artery leading into the left atrium. My cardiology friend has recently been seeing this situation among 45+ year-old elite cyclists and runners. Hopefully it’s reversible, until new research is available, for me my workouts are going to be limited to a heart rate of 125. This may have to be adjusted downward in the years to come. Gary R. Epler, M.D., Boston


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