There’s been a ton of attention in the news lately about long distance running and heart health, including our post looking at whether your VO2 max is high enough to prevent heart disease. As we stated in the post, there are still some limitations in the research, which can be very frustrating.
One study will find that running is detrimental to heart health, while the next will say it’s just fine. Conflicting, confusing information for any runner, but for aging masters runners, even more so.
The heart is, after all, a muscle. As any aging runner can attest, our muscles just aren’t the same as they used to be. They tire more easily, recover more slowly, and damage far faster than in our 20s and 30s. Apply this to the heart, and well, it can be a bit disconcerting.
At the other end of the spectrum, it’s easy to assume that since we’re fit, lean runners with low blood pressure and resting heart rates, we have nothing to fear when it comes to heart health.
I know I’m one of my doctor’s favorite patients because he loves my vitals! But it’s never safe to get cocky or feel 100 percent comfortable with your health when you’re knocking on 50’s, 60’s, or 70’s door, right?
That’s the lesson that Dave McGillivray, director of the Boston Marathon, had to face. McGillivray famously runs the Boston Marathon course backwards each year at the end of race day. He also logs an annual run in miles that matched his years on his birthday.
He had completed a 59-mile run, in fact, around the time he began feeling shortness of breath at the start of his runs. The diagnosis? Coronary artery disease.
McGillivray changed his diet and dropped 27 pounds and 80 points from his overall cholesterol. You can’t outrun an unhealthy diet. We discussed this further in our interview with Dr. Mark Cucuzella about what every runner needs to know about how to lose weight.
So what’s the bottom line for those of us who have been running distance for years and do take care of our diets?
Let’s take a look at the information that’s available:
The evidence against long distance running
Perhaps the seminal study on heart health and long-distance running comes from cardiologist James O’Keefe in 2012. O’Keefe, himself a huge proponent of exercise, found that, while “a routine of regular exercise is highly effective for prevention and treatment of many common chronic diseases and improves cardiovascular (CV) health and longevity, long-term excessive endurance exercise may induce pathologic structural remodeling of the heart and large arteries.”
O’Keefe’s data found that chronic training for and competing in long distance events like marathons, Ironmans, and ultras can overload the cardiac valves. Done over time and this can lead to myocardial fibrosis, or a hardening of the valves. This means the tissue is stiffer and less flexible and is commonly seen in the progression to heart disease.
As Dr Mark Cucuzella also discussed, our bodies were not meant to run marathons, and running multiple long distances races within short time periods is not healthy.
Another study, this one out of Europe, found increased levels of coronary artery calcification (CAC) in a group of male marathoners over the age of 50. Increased CAC has been linked to increased mortality resulting from major cardiac arrest.
But Wait! There’s more:
Yet another, from the Journal of the American College of Cardiology, found that marathon runners have increased troponin levels at the conclusion of their races, a potential marker for future heart attacks in those presenting with chest pain in the ER. This level remains raised for several days, and then tends to disappear, suggesting that it may not have any long-term impact.
It is not looking good, right?
The evidence in favor of long distance running
If all that information has you scrambling to get a stress test, take heart (pun fully intended): It seems that for every negative report about cardiac health and long-term distance running, there’s an equally positive report. Aaron Braggish, MD, conducted this study, as presented in the New England Journal of Medicine, looking at cardiac arrest in marathons and half marathons.
His study reported 59 cases of cardiac arrest in the 10.9 million marathon and half-marathon runners over a 10-yr. period. According to Braggish, exercise may indeed lead to increased likelihood of a cardiac incident if a pre-existing condition is present.
However, he points out that distance running still trumps a sedentary lifestyle when it comes to heart health. Braggish, it should be pointed out, is a marathoner himself and trains up to six days per week.
Likely the most encouraging study to date on the topic is this one from the University of Hartford which set out to prove that years of distance running do not in fact lead to increased incidence of cardiac disease.
While the study showed that marathon training did not cancel out the effects of age, past poor lifestyle habits or a family history, it found no relationship between the number of hours the runners trained or how fast they ran and the levels of plaque in their arteries.
The researchers concluded that marathon training had not directly damaged the hearts of any of the subjects—Boston Marathoners and their spouses, for the record.
Phew!
Where does this leave us?
One issue with all of the studies conducted thus far is that they can’t nail down the chicken or the egg theory. In many cases, subjects were former smokers, or at the very least led sedentary lives prior to becoming runners.
Some had very low-quality diets prior to becoming runners, or even continued with these diets after starting. This was the admitted case with McGillivray, who has since cleaned up what he eats. Jim Fixx wasn’t able to outrun his past habits and we all know how that ended.
Clearly the evidence on long-term heart health and running is conflicting and confusing, and more studies need to delve into the subject.
If you’re a masters runner who has years of high mileage under your belt, the best bet is to stay on top of your routine tests and never ignore any symptoms that may indicate a heart issue is present.
As to the direction of future studies, perhaps South African physician and researcher Timothy Noakes, MD, has the best handle on all of it, as he states in this article: “What common factor, which cannot be prevented by regular exercise but which might even be triggered by physical activity, leads to both sub-clinical coronary artery disease and the triggering of a cardiac event? What indeed might we be missing?”
How can I change my diet to keep my heart healthy?
As Boston Marathon RD Dave McGillivray will tell you, you can’t outrun an unhealthy diet, especially when it comes to heart health. Whether your diet history is a clean slate or it’s one that included a few too many junk calories, now is the time to ensure you’re getting it right for heart health.
Rebecca Ramsing, MPH, RD, LDN, a nutrition consultant with Tambua Consulting, LLC/Health Promotion on Call, recommends that masters runners optimize activity with these heart healthy foods. The bonus, she says, is that a diet like this “may help boost performance and prevent injury as well.”
- Choose healthy fats, such as olive and canola oils, avocados and nuts, which provide monounsaturated fatty acids
- Eat fish or seafood twice a week, preferably fatty fishes such as salmon, albacore tuna and lake trout.
- Fill your plate with leafy greens – spinach, kale, chard, Asian greens…
- Add in cruciferous vegetables – broccoli, cabbage, Brussels sprouts, cauliflower
- Go for colorful fruits and vegetables that are rich in phytochemicals that neutralize free radical damage and maintain heart health. Great choices include all types of berries, plums, watermelon, tomatoes, and orange sweet potatoes.
- Coffee, tea, dark chocolate, grapes and apples are good sources of flavanols for healthy circulation that benefits your heart and your exercise performance
- Choose whole grains most often. Look for “100% Whole” on the label. Whole grains also include quinoa, oats, farro, bulgur, corn, and brown rice. Whole grains are rich in antioxidants, B vitamins and fiber
- Include beans and legumes for protein choices – lentils, black beans, chick peas
- Try various nut butters – peanuts, almonds, hazelnuts
The best thing is that, not only are these foods heart healthy, but they taste great, too. Take this list with you the next time you hit the grocery store and stock up—your heart will thank you.
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