Extreme Exercise and the Heart

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I got a link to this New Yorker article from my friend Stacie, from Louisville. It addresses the exact same concerns I had when I did this post on extreme exercise and heart conditions. The New Yorker Article has quotes from both Dr. James O’Keefe and Dr. John Mandrola, both who I now know personally. These guys are avid athletes and have both personally experienced the results of their beliefs. Both have heart issues and are heart doctors, plus very good athletes. So, they are really the messengers of bad news, even if we don’t want to hear it.

If you read the New Yorker article, it says that every doctor that the author, who also is a cardiologist, interviewed for her article, said “every cardiologist I spoke to who studies this issue is a current or former endurance athlete.” I found that interesting. So, these guys are just like us. They would like exercise to be the fountain of youth that its been touted to be, but for a small minority of us, it is a poison.

And small minority is the key, I hope. It says that doing extreme exercise will up your chances of atrial fibrillation 5 fold, from .3% chance to 1.5%. That is still pretty low. But it’s enough that if you think you have any issues, you should get checked out.

I did. I actually called Dr. O’Keefe and went over to Kansas City and he did a scan of my heart. That was nearly two years ago. I don’t have any plan to change my lifestyle, but am cognizant of the potential issues that could arise.

I think all the doctors that are involved in this controversial topic are trying to do the best they can for their patients. It seems like many of the studies have been done on runners, not so much on cyclists. Eventually, this heart issue vs. extreme exercise is going to be a very hot topic for general health. There are a lot of us that would be perfect test subjects for the studies. Athletes that have been exercising continually since they were teenagers.

Anyway, this wasn’t meant to be a scare post. It is just a heads up for something that we all need to be aware of. There is no downside for looking out for the symptoms of something, no matter how small the percentage is, that could be a life threatening issue.

Here is a video that Dr. O’Keefe did a couple years ago. It explains some of his ideas.

7 thoughts on “Extreme Exercise and the Heart

  1. Mike L

    Steve, I have been very healthy through my adult life. And cycling has enhanced that. And even though heart issues run on one side of my family, the other has none. Other than an unusually high max HR, and some rapid heartbeats when I was young, I’ve hadn’t had any problems. Then in December, I had a 4 hr atrial fibrilation (a-fib) event. I got all checked out, and wore a monitor, and I didn’t have any continuing issues or lingering effects. But since clotting can be an issue with a-fib, and I won’t always be conscious of it happening, I end up taking a baby aspirin a day. And in case it happens again ( I can actually feel it happening), I carry Flecainide to take on the spot. If I had it often or continuously, I’d probably have to take it daily. It’s only happened one more time since December. So I agree that while we don’t want to think our sport may have a negative effect on our health, anyone that thinks they have experienced an unusual or irregular heartbeat needs to get it checked out. It is better to have to take a small aspirin a day than it is to throw a clot that could lead to stroke. Thanks for the blog.

  2. joriverdog

    He often states the exact prescription of duration and effort put out is not known…what is known that ”over doing it” without sufficient recovery..Especially over 45 yrs is probably bad. So doing the TDF after 40 yrs. is probably very bad for longevity….let’s see how long Horner lives…kidding. Really though this is common sense stuff. I know many who read this have had the experience of being in a break say for 3 hours and feel like shit…body is telling them to ”pull over” and have some nice shade in a barcolounger…so we overdrive our bodies with our minds and that is probably not healthy…but that is sport. Doing it too often when you are past 50 is probably not healthy. But in the final analysis….are we really meant to arrive at old age with a perfect body? OR…slide in sideways, bent, broken and dusty ..yelling “Man that was a Hell’ve a Ride”!! I kprefer the latter. Peace Out

  3. Seis Pendejos


    don’t be a douchebag and a crackerjack box certified doc. think of all the over 50 marathoners.

    I guarantee that Steve’s mailbox has been flooded with riders who have had afib and are still riding the hell out of their bikes.

  4. joriverdog

    Funny…but I don’t think you even listened to the Cardiologist…hence your comment…it was the Cardiologist that was saying this..not me doucebag.

  5. Darrell Davis

    People who have/had Afib are not “riding the hell out of their bikes”. Maybe if you have a couple of AF episodes a year, but not if you go into AF after every hard ride, or every time you try to ride hard, or weekly for no reason at all. When you go into Afib, your race is over, and just getting home from an easy ride is a struggle. This is from personal experience over at least 10 years. At the moment, I’m somewhat in AF remission, even though this is not supposed to ever happen. Probably temporary.

    There is no question that some amount of cardiac hypertrophy is almost a given for a serious cyclist. The comment that O’Keefe makes about hypertrophy and scar tissue makes a lot of sense, but how your heart responds and how much scar tissue builds up will vary with each individual. Atrial scarring/fibrosis is a known risk factor for AF. Look up articles by N. Marrouche on PubMed if you want to know more about this. Why do fit cyclists have more AF than the age-matched population, no one really knows, but the atrial scarring could be a contributing factor. It is also possible that because of extreme swings in catecholamines, and the compensatory increase in vagal tone post exercise, some kind of autonomic imbalance triggers AF. I’ve been in both patterns, AF induced by hard efforts, and AF a couple of hours after a hard effort, essentially during the recovery phase. Two big ways to lose big.

    If you have serious cardiomyopathy, then it makes sense to take a big break and let your heart heal up. I’m able to race at a decent level with under 15 hours per week, hopefully for me that is somewhere at the bottom of O’Keefe’s U-shaped curve of exercise benefit as a function of hours trained. At 54 years old, racing at a fairly high level for my age is pretty rewarding and that amount of training doesn’t seem excessive. There is a reason the field sizes at Nationals get smaller for the older groups, we all have to decide what tradeoffs make sense.


  6. Shredder

    Bobby Julich has RSVT renetrant supraventricular tachychardia… I got this too after 3 seasons as a junior cyclist. I like to go hard and push myself and one day when I was going max at altitude my heart just raced and vibrated at 240bpm – but I describe this as superficial meaningless heart flutter, and I just stopped feeling any underlying major heartbeat. Once my heart started to go into tachychardia regularly during training and racing at age 18 it pretty much ended my hopes to be a great cyclist. But I can still race, it’s just the luck of the draw if my tachychardia kicks in…if it does I can go from hero to zero in one second on the bike, mid training ride, or mid pedal stroke in a race. The major trigger is going all out, then letting up completely (think criterium racing)… If I just do an all out continuous effort (think time trial) I can hold off the tachychardia… If I drink any alcohol the night before it increases the chance of an episode. Caffeine triggers it too. I can be sitting at the desk at work and it kicks in. It can last from a few seconds (rare) to over an hour (not as rare as you’d want…) Being a somewhat thin cyclist I can see the heartbeats looking down at my chest and count them. I can feel them of course. A HR monitor has tracked them of course… I also got a take home monitor to record it for my cardiologist to study. One time when more severe angina accompanied the tachychardia (it always hurts a little bit, feels like pulling on the heart muscle or a heavy ache) I went to the ER. Now that I am 46 the episodes can be even more frequent…like every other day…. At the ER they really went crazy and hooked up all the machines then gave me an injection and said it would stop the tachychardia but it would feel “like a horse kicked me in the chest,” I did feel a heaviness after they administered this drug that did stop that episode, but the doctor wanted it to hurt me more than it did and I had to fake the “kicked in the chest feeling,” because it is the same feeling I get each time my heart stops having tachychardia naturally and it doesn’t really bother me at all. It’s actually a great relief! The surgeon recommended the surgery where they fry that little node they find that triggers the unproductive electrical fibrillation. All arthroscopic and outpatient, but with too high a risk of death 3% and too high a risk that I would need a pacemaker at like 5% and a risk that I would not be able to go hard on rides! That’s no fun. This is the same reason I do not take a beta blocker for this. The proported downsides of my tachychardia I have had all my adult life are relatively none… just some discomfort- I guess they said I would “wear out my heart,” but they did not put too much data behind this claim. It does feel as if my heart might suddenly stop sometimes…. I can say that at the moment the tachychardia stops…it goes from 180-240 bpm down to 56-62 or so (my resting HR) immediately… So imagine your heart is racing, but you are not really tired or breathing hard… You are kind of pissed off at your stupid heart racing ineffectively and your body and brain can tingle and get a little light headed feeling. it can make you gasp for breath a bit too. But all of a sudden just a rapidly and as unexpectedly as it comes on, it goes back to the normal bpm and rhythm! So its like boomboomboomboomboomboomboom………pause…..BIG BABOOM (contraction in the heart that you can feel) then it kicks into the normal rhythm (and I experience pleasurable relief. If I am still riding I can immediately go hard again! I am at a higher risk that it will kick in again….but it might not. Sometimes I am stronger after this because a 190+ HR honestly just feels “OK” after the episodes (I tell myself it is free max HR training with no required efforts!!!! I can still ride hard and finish some of the group rides if I get it and it DOES NOT go away… I have figured out how to regulate my heart by increasing my respiratory rate and concentrating on my inspirations and suspirations, etc. but I can’t go over like 70% so you get dropped if it’s hard for sure. The real frustration is in races when this happens, but you know you have the fitness to do well it just really makes you look like a wimp!!! Not even my best cycling friends believe my tachychardia excuses… I don’t even mention it anymore and was forced to write this….:)


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