The Right Diet for a Runner Is the One That Works for You

The Right Diet for a Runner Is the One That Works for You

Earlier this week, I read an article about what runners should eat while training for a 10-mile race. One piece of advice it offered: Take a banana and bagel to eat before the start of the race.

I don’t mind bananas. I have a bunch of them in my kitchen. But the few times I’ve eaten one before running, I tasted leftover banana for the entire run. Gross. I’d much rather drink a glass of whole milk before a run (which I’m sure has some of you thinking “gross!” too).

That’s because there is no one runner diet. There are no absolutes except that you’ll probably want to eat something if you’re going to run for a long time. That was the big challenge of writing our How to Feed a Runner Guide, which is why it’s more about setting up guidelines to help you figure out what works for you than dictating absolutes. I didn’t want to declare that one way is the right way when there are as many right ways as there are runners.

It’s not a finite process, either. I’ve been running for more than a decade and I’m still experimenting. While writing the guide, one expert suggested eating dates for pre-run fuel, so I tried it. That worked, but then I tried dried apricots, which I liked better. When my nephews did not finish all of the Wegmans animal cookies I had gotten for them to eat on a vacation, I tried a few before a five-mile run, and now they’re a pre-run staple. And there’s nothing I love more than nonalcoholic peach cider after a long, hot summer run.

But that’s me. That may not be you. The only way to figure out what works for you is to try things out — and long before race day, so you know whether a banana before a race is a good idea for you, or makes you say “gross!” like it does for me.



This article was originally published in The New York Times. Read the original article.

The Heart of a Swimmer vs. the Heart of a Runner

The Heart of a Swimmer vs. the Heart of a Runner

Do world-class swimmers’ hearts function differently than the hearts of elite runners?

A new study finds that the answer may be yes, and the differences, although slight, could be telling and consequential, even for those of us who swim or run at a much less lofty level.

Cardiologists and exercise scientists already know that regular exercise changes the look and workings of the human heart. The left ventricle, in particular, alters with exercise. This chamber of the heart receives oxygen-rich blood from the lungs and pumps it out to the rest of the body, using a rather strenuous twisting and unspooling motion, as if the ventricle were a sponge being wrung out before springing back into shape.

Exercise, especially aerobic exercise, requires that considerable oxygen be delivered to working muscles, placing high demands on the left ventricle. In response, this part of the heart in athletes typically becomes larger and stronger than in sedentary people and functions more efficiently, filling with blood a little earlier and more fully and untwisting with each heartbeat a bit more rapidly, allowing the heart to pump more blood more quickly.

While almost any exercise can prompt remodeling of the left ventricle over time, different types of exercise often produce subtly different effects. A 2015 study found, for instance, that competitive rowers, whose sport combines endurance and power, had greater muscle mass in their left ventricles than runners, making their hearts strong but potentially less nimble during the twisting that pumps blood to muscles.

These past studies compared the cardiac effects of land-based activities, though, with an emphasis on running. Few have examined swimming, even though it is not only a popular exercise but unique. Swimmers, unlike runners, lie prone, in buoyant water and hold their breaths, all of which could affect cardiac demands and how the heart responds and remakes itself.

So, for the new study, which was published in November in Frontiers in Physiology, researchers at the University of Guelph in Canada and other institutions set out to map the structure and function of elite swimmers’ and runners’ hearts.

The researchers focused on world-class performers because those athletes would have been running or swimming strenuously for years, presumably exaggerating any differential effects of their training, the researchers reasoned.

Eventually they recruited 16 national-team runners and another 16 comparable swimmers, male and female, some of them sprinters and others distance specialists.

They asked the athletes to visit the exercise lab after not exercising for 12 hours and then, when on site, to lie quietly. They checked heart rates and blood pressures and finally examined the athletes’ hearts with echocardiograms, which show both the structure and functioning of the organ.

It turned out, to no one’s surprise, that the athletes, whether runners or swimmers, enjoyed enviable heart health. Their heart rates hovered around 50 beats per minute, with the runners’ rates slightly lower than the swimmers’. But all of the athletes’ heart rates were much lower than is typical for sedentary people, signifying that their hearts were robust.

The athletes also had relatively large, efficient left ventricles, their echocardiograms showed.

But there were interesting if small differences between the swimmers and runners, the researchers found. While all of the athletes’ left ventricles filled with blood earlier than average and untwisted more quickly during each heartbeat, those desirable changes were amplified in the runners. Their ventricles filled even earlier and untwisted more emphatically than the swimmers’ hearts did.

In theory, those differences should allow blood to move from and back to the runners’ hearts more rapidly than would happen inside the swimmers’.

But these differences do not necessarily show that the runners’ hearts worked better than the swimmers’, says Jamie Burr, a professor at the University of Guelph and director of its human performance lab, who conducted the new study with the lead author, Katharine Currie, and others.

Since swimmers exercise in a horizontal position, he says, their hearts do not have to fight gravity to get blood back to the heart, unlike in upright runners. Posture does some of the work for swimmers, and so their hearts reshape themselves only as much as needed for the demands of their sport.

The findings underscore how exquisitely sensitive our bodies are to different types of exercise, Dr. Burr says.

They also might provide a reason for swimmers sometimes to consider logging miles on the road, he says, to intensify the remodeling of their hearts.

Of course, the athletes here were tested while resting, not competing, he says, and it is not clear whether any variations in their ventricles would be meaningful during races.

The study also was cross-sectional, meaning it looked at the athletes only once. They might have been born with unusual cardiac structures that somehow allowed them to excel at their sports, instead of the sports changing their hearts.

Dr. Burr, however, doubts that. Exercise almost certainly remakes our hearts, he says, and he hopes future experiments can tell us more about how each activity affects us and which might be best for different people.

But even now, he says, “an important message is that all of the athletes showed better function than a normal person off the street, which supports the message that exercise is good for hearts.”


This article was originally published in The New York Times. Read the original article.

Why Lifting Weights Can Be So Potent for Aging Well

Why Lifting Weights Can Be So Potent for Aging Well

Weight training by older people may build not only strength and muscle mass but also motivation and confidence, potentially spurring them to continue exercising, according to an interesting new study of the emotional impacts of lifting weights.

The findings intimate that people worried that they might be too old or inept to start resistance training should perhaps try it, to see how their bodies and minds respond.

We already have plenty of evidence, of course, that weight training can help us to age well. By our early 40s, most of us are losing muscle mass, at a rate of about 5 percent a decade, with the decline often precipitating a long slide toward frailty and dependence.

But older people who lift weights can slow or reverse that descent, studies show. In multiple experiments, older people who start to lift weights typically gain muscle mass and strength, as well as better mobilitymental sharpness and metabolic health.

But lifting helps only those who try it, and statistics indicate that barely 17 percent of older Americans regularly lift weights.

So, as part of a larger study of weight training and the elderly, scientists at the University of Jyvaskyla in Finland recently decided to see if they could discover how weight training changes the minds as well as the musculature of people who had not done it before.

To start, they turned to 81 older men and women who were part of their health database and who had agreed to begin resistance training. These volunteers were all between the ages of 65 and 75 and, like many Finns, healthy and physically active. But they did not lift weights.

For the full study, they began a twice-weekly program of supervised, full-body resistance training at the university to familiarize participants with proper technique and build a base of strength.

After three months, the group was randomly assigned to continue training once, twice or three times a week, while a separate, untrained group served as controls. Periodically, the researchers checked the volunteers’ strength, fitness and metabolic health, and also their attitudes about the workouts, including whether they found them daunting or inviting and how difficult it was for the volunteers to find the time and resolve to show up.

This routine lasted for six months, by which time the people lifting weights had almost all gained strength and improved various markers of their health, even if they had lifted only once a week.

But then, after the months of supervised lifting, the exercisers abruptly were on their own. The researchers explained that they could no longer have access to the university facilities and provided them with information about low-cost, suitable gyms in the area. But any subsequent training would be at their own volition.

The researchers waited six months and then contacted the volunteers to see who was still lifting and how often. They repeated those interviews after an additional six months.

They found, to their surprise, that a year after the formal study had ended, almost half of the volunteers still were lifting weights at least once a week.

“We had estimated a rate of 30 percent,” says Tiia Kekalainen, a project researcher at the University of Jyvaskyla who led the psychological study with the senior author, Simon Walker, and others.

Also surprising, the researchers discovered little direct correlation between muscle and motivation. The people who had gained the most strength or muscle mass during the study were not necessarily those most likely to stick to the training.

Instead, it was those who had come to feel most competent in the gym. If someone’s self-efficacy, which is a measure of confidence, had risen substantially during the study, he or she usually kept lifting.

In effect, Ms. Kekalainen says, people who discovered that they enjoyed and felt capable of completing a weight-training session subsequently sought out and joined a new gym and showed up for workouts, despite no longer receiving nudges from the researchers or encouragement and companionship from their fellow volunteers.

“They found out that resistance training is their cup of tea,” Ms. Kekalainen says.

Most of them also told the researchers that weight training had provided them with renewed confidence in their physical abilities beyond the gym.

“They could do things that they thought they could not do before,” she says.

Of course, about half of the volunteers had told her and the other researchers that “they preferred other types of exercise,” Ms. Kekalainen says, and those men and women, for the most part, no longer lifted weights.

Ms. Kekalainen and her colleagues hope in future studies to explore the issues of what drew some people to the lifting and left others uninspired, and how weight-training routines might be structured to appeal to the skeptical.

For now, people interested in starting to lift weights should look for classes or trainers specializing in beginners and learn to lift safely.

But the overarching lesson of the study, she says, is that to discover how you feel about weight training, you need to weight train.

This article was originally published in The New York Times. Read the original article.

No Gym Can Match Her Hula Hoop

No Gym Can Match Her Hula Hoop

Marah Kabaservice jokes that she’s a closet exerciser. You won’t find the 50-year-old nurse practitioner at the gym or in spin class. She finds more motivation hula hooping and doing jumping jacks in the privacy of her home in Rutledge, Tenn., a town near Knoxville.

As an unathletic teen, Ms. Kabaservice was turned off from fitness by the forced activities of high school gym class. She flailed through dodgeball, softball, even warm-ups. “I nearly flunked P.E. because I couldn’t run four laps around the track,” she says. “By my 20s, I was a complete slug, smoking a pack of cloves a day.”

Knowing she had to make a change, she tried running again. Away from the judgment of peers, she found she actually enjoyed exercise. “When I was by myself, I could focus on myself,” she says. “My workouts became my time to zone out and think through my problems.”

Ms. Kabaservice says her home exercise routine has helped her cope with the stress of caring for her aging father.
Ms. Kabaservice says her home exercise routine has helped her cope with the stress of caring for her aging father. PHOTO: JESSICA TEZAK FOR THE WALL STREET JOURNAL

As she logged more miles, Ms. Kabaservice quit smoking and took up new workouts, like jump roping and her current passion, hula hooping. She’s gone from an exercise-hater to a never-miss-a-day obsessive. Exercise, she says, has been her saving grace the past six years as she’s cared for her aging father, who suffers from a debilitating neurological disease. At least one week a month, she flies to her parents’ home in Melbourne, Fla., to give her mother some relief from caregiving duties. Last year alone, she says she flew 64,000 miles back and forth.

“As I worry more about my parents, I’ve gradually upped the intensity and duration of my workouts at home, because it helps with my anxiety,” she says. “The exercise also helps to keep me in good physical shape so that I can help my bedridden dad with basic activities such as sitting up on the edge of the bed.”

Whenever she’s feeling stressed, she picks up her hula hoop. “It’s a healthy way for me to work out my emotions,” she says.

The Workout

Ms. Kabaservice works out six days a week at 5:30 a.m. Her home routine takes around 85 minutes. She spends about 50 minutes of that time hula hooping. She doesn’t just use the hoop around her waist—she also circles it around her glutes and upper thighs and mixes up the speed.

“I try to make it a whole-body workout and move my arms in a circular motion at the same time,” she says. Between bouts of hula hooping, she will do 10 minutes of jumping jacks and 10 minutes of elbow-to-knee touches with 2-pound dumbbells.

She stopped running the country roads near her home due to stray dogs. She now walks the perimeter of her 12-acre property for an hour, about six laps, once a week. She recently took up hiking in nearby Panther Creek State Park.

When in Florida, she uses an old exercise bike in her parents’ home, walks around their neighborhood and spends 30 minutes a day helping her father do a series of range-of-motion exercises. “Moving my dad into his recliner is a workout in itself,” she says. “I find I burn more calories in Florida and I’m not even hooping.”

Ms. Kabaservice says caring for her father is both physically and emotionally taxing. Simple acts, like helping get him in and out of bed, require her to keep up her strength.
Ms. Kabaservice says caring for her father is both physically and emotionally taxing. Simple acts, like helping get him in and out of bed, require her to keep up her strength.PHOTO: JESSICA TEZAK FOR THE WALL STREET JOURNAL
The Diet

Ms. Kabaservice says the stress of caring for her father, combined with the physical strength required to help him around the house, often leaves her ravenous. She spent all of December at her parents’ home and says she ate an entire box of Cheerios each day on top of her usual meals just to be able to maintain her weight.

Normally, she averages 2,800 calories a day. “I’m a vegan in a land of carnivores,” she jokes. She starts the day with oatmeal topped with pecans and almond milk. When working, she rarely has time for lunch. She instead snacks throughout the day on olives, nuts and blueberries. Dinner is often a large salad topped with avocado, legumes and nuts. Her vices are, depending on the time of day, Hawaiian Punch or bourbon.

The Gear & Cost

“The beauty of working out at home is that I don’t have to invest in trendy exercise garb,” she says. “I wear threadbare shirts and ratty shorts.” She bought her weighted hula hoop for $43. She buys Saucony sneakers.

Ms. Kabaservice walks the perimeter of her 12-acre property for an hour, or about six laps, three days a week.
Ms. Kabaservice walks the perimeter of her 12-acre property for an hour, or about six laps, three days a week. PHOTO: JESSICA TEZAK FOR THE WALL STREET JOURNAL

The Scoop on Hoops

If you want a full-body workout, a hula hoop might not be the first piece of equipment you grab. But 30 minutes of hooping is comparable with power yoga, boot camp, cardio kickboxing and other group fitness classes, a 2010 study from the Exercise and Health Program at the University of Wisconsin, La Crosse showed. It burns a similar number of calories and gets people to similarly elevated heart rates.

On average, participants burned 210 calories. The study used a weighted hoop and participants had some experience hooping.

A sampling of feats by hula hoop fitness instructor Getti Kehayova.

Rocking your hips from side to side to keep the hoop circling around your waist at a constant speed activates core muscles. Get creative, and it can become a full-body workout, says Getti Kehayova, a hula hoop fitness instructor in Las Vegas.

“I have everyone do squats while hula hooping,” she says. “It helps engage the quads and also helps with balance and posture.” She has students hold a 5-pound dumbbell in each hand and do arm raises to the side and front while hooping to work their shoulders. “To engage your core to the fullest, get your speed going for 30 seconds, then spin at normal speed, then spin fast again,” she says.

If you’re still a beginner, Rebecca Burton, a hula hoop fitness instructor in Gainesville, Fla., suggests alternating regular hooping with arm exercises. For example, to work your shoulders and triceps, reach your arms above your head, hands together, and spin the hoop around both hands while keeping your arm muscles engaged, Ms. Burton says.


This article was originally published in The Wall Street Journal. Read the original article.

Exercise vs. Drugs to Treat High Blood Pressure and Reduce Fat

Exercise vs. Drugs to Treat High Blood Pressure and Reduce Fat

Exercise can lower blood pressure and reduce visceral body fat at least as effectively as many common prescription drugs, according to two important new reviews of relevant research about the effects of exercise on maladies.

Together, the new studies support the idea that exercise can be considered medicine, and potent medicine at that. But they also raise questions about whether we know enough yet about the types and amounts of exercise that might best treat different health problems and whether we really want to start thinking of our workouts as remedies.

The possibility of formally prescribing exercise as a treatment for various health conditions, including high blood pressure, insulin resistance, obesity, osteoarthritis and others, has been gaining traction among scientists and physicians. The American College of Sports Medicine already leads a global initiative called Exercise Is Medicine, which aims to encourage doctors to include exercise prescriptions as part of disease treatments.

But while drugs face extensive testing before they can be approved and prescribed, exercise studies, even those examining exercise as a treatment for illness, have tended to be relatively small and short-term. They also rarely compare exercise, head-to-head, with drugs to treat the same condition.

So, the authors of the two new reviews independently decided to stage their own exercise-versus-drugs scientific rumbles and, for each, use the same, slightly indirect approach. They would, the researchers decided, collect the best recent studies looking at the effectiveness of drugs for a condition and the best comparable studies using exercise to treat the same illness and collate, analyze and compare the various results.

For the first of the new reviews, which was published in December in the British Journal of Sports Medicine, researchers at the London School of Economics, Stanford University and other institutions decided to focus on systolic blood pressure (the top number), in large part because high blood pressure can be so physically devastating, increasing risks for heart disease, Alzheimer’s and early death. Hypertension also is treatable, with drugs that include beta blockers, diuretics and many others, or exercise.

The researchers now gathered 391 randomized, controlled trials — the accepted gold standard for testing treatments — that looked at either a drug or some form of exercise to lower blood pressure. Together, the experiments included almost 50,000 volunteers, with more than 10,000 of them in the exercise studies.

The researchers then summed the data from the drug or exercise tests and found that, in aggregate, all of the drugs and any type of exercise lowered blood pressure, although drugs generally achieved slightly greater reductions. That extra bump downward from drugs may have been a result in part, the researchers believe, to a reliance on relatively healthy volunteers in the exercise studies; their starting blood pressures tended to be lower than in the drug trials, so the drop by the end was slighter.

The methods in the exercise studies also often were less tidy and precise than in the drug tests, the researchers point out. Volunteers in the exercise studies rarely were blinded, for instance, since it’s hard to prevent people from knowing whether or not they are working out. There also was little long-term follow-up of exercisers.

Some of these same issues bedeviled the exercise science highlighted in the other new review, which was published in February in Mayo Clinic Proceedings. For this study, the researchers zeroed in on fat and, in particular, visceral fat, a particularly hazardous type of fat that accumulates around our middles and deep beneath the skin, smothering internal organs and heightening the risk of metabolic problems.

Several drugs currently are approved to trim visceral and other types of fat, including metformin and orlistat. Exercise also has been shown to reduce visceral fat. But there has been little science comparing those approaches.

So, the researchers, most of them from the University of Texas Southwestern Medical Center in Dallas, rounded up recent relevant drug experiments and similar randomized trials using exercise to fight visceral fat. All of the experiments had to have lasted for at least six months. Then they aggregated results.

Again, as in the other review, drugs and exercise both succeeded for most participants; using either approach, most people lost some visceral fat. But in this review, exercise was slightly superior in that for every pound someone dropped, more of it was visceral fat when they exercised than when they used drugs.

The upshot of the review is that “lifestyle changes such as exercise should be the first step” when people set out to reduce visceral fat, says Dr. Ian Neeland, an assistant professor of internal medicine at UT Southwestern Medical Center, who oversaw the new review.

He and his colleagues also found that aerobic exercise trimmed visceral fat more effectively than strength training, although most of the exercise trials were small-scale and had no placebo control.

Taken together, the new reviews indicate that exercise can equal or exceed the effects of drugs on high blood pressure and visceral fat. But they also underscore that clinical exercise science could stand to raise its game and develop greater rigor in testing exercise as medicine.

Long-lasting studies that directly compare different drugs and various types of workouts are needed, Dr. Neeland says, although they will be logistically difficult and expensive.


This article was originally published in The New York Times. Read the original article.

Exercise May Help to Fend Off Depression

Exercise May Help to Fend Off Depression

Jogging for 15 minutes a day, or walking or gardening for somewhat longer, could help protect people against developing depression, according to an innovative new study published last month in JAMA Psychiatry. The study involved hundreds of thousands of people and used a type of statistical analysis to establish, for the first time, that physical activity may help prevent depression, a finding with considerable relevance for any of us interested in maintaining or bolstering our mental health.

Plenty of past studies have examined the connections between exercise, moods and psychological well-being, of course. And most have concluded that physically active people tend to be happier and less prone to anxiety and severe depression than people who seldom move much.

But those past studies showed only that exercise and depression are linked, not that exercise actually causes a drop in depression risk. Most were longitudinal or cross-sectional, looking at people’s exercise habits over a certain period or at a single point of time and then determining whether there might be statistical relationships between the two. In other words, active people might be less likely to become depressed than inactive people. But it’s also possible that people who aren’t prone to depression may be more likely to exercise. Those types of studies may be tantalizing, but they can’t prove anything about cause and effect.

To show causation, scientists rely on randomized experiments, during which they assign people to, for instance, exercise or not and then monitor the outcomes. Researchers have been using randomized trials to look at whether exercise can treat depression after people already have developed the condition, and the results have been encouraging.

But it would be almost impossible to mount a randomized trial looking at whether exercise prevents depression, since you would need to recruit a large number of people, convince some to exercise, others not, follow them for years and hope that enough develop depression to make any statistical analysis meaningful. The logistics involved would be daunting, if not impossible, and the costs prohibitive.

Enter Mendelian randomization. This is a relatively new type of “data science hack” being used to analyze health risks, says Karmel Choi, a postdoctoral research fellow in psychiatric genetics at Massachusetts General Hospital and the Harvard T.H. Chan School of Public Health, who led the new study.

With Mendelian randomization, scientists zero in on small snippets of genes that vary from person to person. These variants are passed out before birth and do not change afterward; they are not altered by upbringing. Thanks to large-scale genetics studies, scientists have associated many of these snippets with specific health behaviors and risks. People with certain gene variants are, for example, more likely to overeat or be physically active than people without that variant.

More recently, scientists realized that these differences in people’s DNA offered, in effect, ready-made randomized trials designed by nature, since the variants occurred in mathematically random fashion.

Because of that inherent randomization, scientists could crosscheck the numbers of people with or without a snippet related to a health risk or behavior, such as, say, a strong likelihood to exercise, against another health outcome, such as severe depression. And if a large percentage of people with the variant did not develop the condition, scientists felt they could conclude that the behavior related to that variant caused the change in risk for the other condition.

And that result is what Dr. Choi and her colleagues found when they applied Mendelian randomization to exercise and depression. To reach that conclusion, they turned first to the UK Biobank, an enormous database of genetic and health information for almost 400,000 men and women. There they identified people who carried at least one of several gene variants believed to increase the likelihood someone will be active. Most of those people were active, and few of them had experienced depression.

People without the snippets, meanwhile, tended to move less, and they also showed greater risks for depression.

Delving deeper, the scientists found that, statistically, the ideal amount of exercise to prevent depression started at about 15 minutes a day of running or other strenuous exercise. Less-taxing activities like fast walking, housework and so on also afforded protection against depression, but it took about an hour a day to have an effect.

Finally, to be sure that physical activity was affecting the risk for depression, and not the other way around, the scientists repeated the Mendelian style of analysis on a separate large genetic database. This time they looked for gene variants related to depression and whether people who carried those variants and a propensity for depression tended to be physically inactive. It turned out, they did not.

So, the researchers concluded, physical activity in this analysis lowered the risk for depression, but depression did not affect whether people exercised.

Mendelian randomization remains a mathematical exercise, of course, and in the real world, people’s lives and behaviors are shaped by more than genetics. Many factors no doubt play a role in who develops depression. The gene variants related to being active could, for instance, also and separately play some kind of antidepressant role, Dr. Choi says, adding that the intertwined genetic and behavioral linkages between exercise and mental health will require many more studies to disentangle.

But already these results do provide “strong evidence” that being physically active, whatever your genetic makeup, can help protect against depression, Dr. Choi says.

How Many Push-Ups Can You Do? It May Be a Good Predictor of Heart Health

How Many Push-Ups Can You Do? It May Be a Good Predictor of Heart Health

Could push-ups foretell the future and the state of a person’s heart?

A new study in JAMA Network Open hints that this might be the case. It finds that men who can breeze through 40 push-ups in a single exercise session are substantially less likely to experience a heart attack or other cardiovascular problem in subsequent years than men who can complete 10 or fewer. The results suggest that push-up ability might be a simple, reliable and D.I.Y.-in-your-living-room method of assessing heart health, while at the same time helpfully strengthening the triceps and pectorals.

As almost all of us know, cardiovascular disease is the most common cause of death globally. Heart attacks and strokes also lead to considerable disability, lost work time and otherwise circumscribed lives and abilities.

But avoiding or treating cardiovascular disease requires recognizing that it might have begun or is on the horizon. Many medical tests of heart health, however, such as treadmill exercise-stress testing or heart scans, are expensive and complicated and can be difficult to interpret.

Many of these tests also generally are designed to pick up heart disease after it has started, not to predict the likelihood that it might develop. Meanwhile, mathematical risk scores that evaluate information about a person’s weight, cholesterol profile, smoking history and other health data are predictive, but in a way that is broad, impersonal and abstract.

Physicians and the rest of us who rely on our hearts have had little ability to evaluate cardiovascular health and the risk for future problems in a simple, scientifically valid, personalized and visceral way.

That void prompted researchers at Harvard University, Indiana University and other institutions recently to consider the health and fitness of a group of more than 1,500 Indiana firefighters. The firefighters reported each year to a single clinic in Indiana for a medical checkup that included the standard assessments of each firefighter’s weight, cholesterol, blood sugar and other health data. They also completed a submaximal treadmill stress test that estimated their current endurance capacity.

The researchers originally were most interested in that last measurement. Plenty of past studies have linked high aerobic fitness with a reduced risk for later heart disease and vice versa. The researchers thought that they might be able to quantify how well the treadmill test predicted future heart problems by using the database of firefighters’ health information.

So, they gathered information about each man’s stress test results — few women were working as career firefighters in this group, so only men were included. They also recorded any cardiovascular problems reported to or uncovered by clinic physicians in the 10 years after each firefighter’s first appointment. The data about heart problems was fairly comprehensive, since the firefighters needed their physician’s approval to return to work after even minor heart concerns.

The researchers planned to compare stress test results to subsequent cardiovascular problems to get a sense of how prescient the treadmill testing might be.

Then, almost incidentally, the researchers noticed that more than 1,100 of the firefighters also had completed push-up tests during their yearly exams. That testing had been bracingly analog: a clinic staffer counted how many push-ups each man could complete before his arms gave out or he reached 80 and was told he could quit showing off and stop.

Since they had the push-up data, the researchers slipped it in as a second data set in their examination of current fitness and later heart problems, categorizing the men by how many push-ups they could complete: zero to 10; 11 to 20; 21 to 30; 31 to 40; and 40-plus.

They then ran numbers.

And to their surprise, push-up capability proved to be a better predictor, statistically, of future heart problems than the treadmill tests.

Men who could complete at least 11 push-ups had less risk of developing heart problems in the following decade than those who could complete fewer than 10, they found.

This risk reduction mounted impressively at the highest level of push-up ability. Those men who could get through 40 or more push-ups had 96 percent less risk of heart problems in the next 10 years than those who quit at 10 or fewer.

The findings suggest that push-up capability might be an easy-to-use marker of cardiovascular disease risks, the researchers concluded, at least in men who resemble the firefighters.

Of course, this study was observational. It can show that more push-ups are linked with fewer heart problems, but not that arm strength directly improves heart health or whether becoming able to do more push-ups will drop the risk for heart problems over time. It also cannot tell us how the two might be linked.

But “muscular strength is one component of good fitness,” says Dr. Stefanos Kales, a professor of medicine at Harvard Medical School and senior author of the new study.

Push-up proficiency probably also indicates an interest in healthy eating, regular exercise and normal weight, he says, all of which could contribute to stronger hearts.

Best of all, push-up testing is simple, requiring only the ability to count. If that count should end before 10, however, you may want to talk to your doctor or a trainer about how to increase your fitness and strength and perhaps better protect your heart, Dr. Kales says.

Can You Get Too Much Exercise? What the Heart Tells Us

Can You Get Too Much Exercise? What the Heart Tells Us

Many middle-aged marathon runners and other endurance athletes are familiar with concerns from their loved ones — and occasionally their physicians — that they might be exercising too much and straining or harming their hearts.

For all of them, a large-scale study published recently in JAMA Cardiology should be mollifying. It finds that middle-aged men who work out often and vigorously do tend to develop worrisome plaques in their cardiac arteries. But those men also are less likely than more sedentary people to die prematurely from a heart attack or other cause.

The findings raise the interesting possibility, in other words, that strenuous exercise may protect the heart against the very problems to which it also contributes.

No one doubts, of course, that our hearts benefit from exercise. Study after study shows that people who meet the standard exercise guidelines, which call for about 30 minutes a day of moderate exercise, have a reduced risk of developing heart disease.

There have been some hints, however, that people can exercise too much, especially if the exercise is intense. In past studies, researchers scanning the hearts of longtime endurance athletes, such as marathon runners, have found scarring in those athletes’ heart muscles and also hefty deposits of coronary plaques, which can break free and block arteries, causing a heart attack. But most of those earlier studies were small and provided a single snapshot of the athletes’ hearts; they did not follow people for years to see whether their heavy exercise and any subsequent buildup of plaques was linked to heightened risks for heart attacks and shorter lives.

So, for the new study, scientists at the Cooper Institute in Dallas and other institutions decided to delve into just that issue.

They also happened to have a useful trove of data readily at hand, in the health records of tens of thousands of people who had undergone exams at the affiliated Cooper Clinic. Many of these exams included scans of people’s hearts, along with detailed questionnaires about their exercise habits.

The researchers focused on the records of 21,758 men, most of them in their 50s. (They did not include women but plan to in a follow-up study.) They categorized the men into groups, based on how much they exercised. Those in the sweating-the-most group worked out vigorously for at least five hours a week and often more. The researchers used a mathematical measure (known as metabolic equivalent of task) to characterize the men’s workouts. But in practical terms, these extreme exercisers were doing the equivalent of running about six miles a day.

A second group completed somewhat less exercise, and a third group finished less than half as much exercise each week as the most avid exercisers.

The researchers also looked at the scans of each man’s heart. The degree of plaque accumulation can generally be assessed using a coronary artery calcium score. Someone with a score higher than 100 is considered to have worrisome plaque buildup.

Comparing the groups, the researchers determined that the men in the highest-exercise group were prone to developing plaques. They were, in fact, about 11 percent more likely to have a calcium score higher than 100, compared to men who moved less. Some of the extreme exercisers had scores above 800.

Finally, the researchers checked death records for a decade or so after each man’s latest exam, to see if any had died. And some had, particularly from heart attacks among men with calcium scores higher than 100.

But few of those men came from the group that exercised the most. The extreme exercisers turned out to have less risk of dying prematurely than men with the same — or higher — calcium scores who rarely worked out.

In essence, these results suggest that large amounts of exercise can up someone’s risk of developing plaques, while also lessening the likelihood that he will die from a heart attack precipitated by those plaques, says Dr. Laura DeFina, the chief science officer for the Cooper Institute, who led the study.

This curious outcome probably occurs because extreme workouts create a unique type of plaque, she says. “There is some evidence that the plaques” in highly active people “are denser and more stable” than those in sedentary people, she says, making them less likely to break free and cause a heart attack.

But that idea is speculative, she says, and requires more study. Scientists also aren’t sure how, at a molecular level, strenuous exercise might prompt the buildup of plaques, and why some people’s arteries remain unaffected, no matter how much they exercise.

Dr. DeFina and her colleagues hope to look into those issues in future studies. In the meantime, she says, middle-aged runners and other endurance athletes should pay attention to any heart-related symptoms, such as chest pain or shortness of breath, and talk to their doctors about the desirability of a heart scan.

The good news from this study, Dr. DeFina says, is that even if that scan should reveal a high calcium score, it appears that most people “safely can and should continue to exercise.”



This article was originally published in The New York Times. Read the original article.

Can Low-Impact Sports Like Cycling Be Putting Your Bones at Risk?

Can Low-Impact Sports Like Cycling Be Putting Your Bones at Risk?

Could competitive cyclists be putting their bone health at risk?

A disquieting new study of bone density in elite cyclists and runners suggests that the answer might be yes. The study found that the cyclists, both male and female, had thinner bones than the runners, even though all of the athletes were young, healthy and enviably fit, and many of the cyclists lifted weights.

The results underscore the divergent effects of various sports on our skeletons and also stir a little unease about the long-term impacts of pursuing low-impact exercise at the expense of more high-impact activities.

By and large, the available scientific evidence shows that physical activity is desirable and even necessary for bone health. Children who run, hop and play develop thicker, stronger bones than those who remain sedentary, as do teenagers and young adults who participate in sports involving sprinting and leaping.

Most scientists agree that these kinds of activities build skeletal strength by generating sudden, sharp forces that minutely bow or deform the affected bones. Such activities jump-start processes within the body that increase the number of bone cells and help to prepare those parts of the skeleton to withstand similar forces in the future.

Even middle-aged and older people, who once were thought to face inevitable thinning of their bones with age, can maintain strong skeletons if they are sufficiently active, recent studies show.

But which types of exercise bend bones in a desirable way — and which are too gentle — remains uncertain. Some past studies suggest that running generates enough force to remodel bone, while other experiments with runners conclude the opposite. Ditto with weight training. And multiple studies have raised concerns about negligible or even adverse effects from non — weight-bearing exercises, such as cycling and swimming, which put little pressure on bones.

In hopes of gaining more clarity about sports and bones, researchers at the Norwegian School of Sport Sciences and the Norwegian Olympic Training Center, in Oslo, decided to look closely at the skeletons of world-class, competitive cyclists and runners.

They focused on elite, full-time athletes in large part because the athletes’ heavy training could be expected to amplify any impacts from and differences between the two sports.

They wound up recruiting 21 high-level runners and 19 road cyclists, men and women, most of them in their 20s and all of them lean, fit and with several years of intense competition behind them.

The athletes reported to a lab, where scientists measured their body composition, with particular focus on the density of their bones, both over all and in their lower spines and the tops of their femurs — portions of the skeleton that can indicate general bone health.

The researchers also asked the athletes about their training, health and calcium intake and whether they spent much time in the gym. The latter question was of particular interest to the researchers, since weight training often is recommended to athletes in sports like cycling to bulk up their bones, as well as their muscles.

The scientists then compared data. Some of the differences between athletes were substantial, if expected. The cyclists trained far more than the runners, for instance, averaging about 900 hours a year in the saddle, versus about 500 annual hours on the road or treadmills for the runners.

The cyclists also did more weight training, with most of them heading to the gym during their off-season for intense lifting. None of the runners did that.

The athletes in both sports consumed enough calcium to meet their expected daily requirements.

But they had noticeably different bones.

The cyclists, as a group, all had thinner bones than the runners, and more than half of them met medical criteria for low bone mineral density in some portion of their skeleton. One of the riders, a man, displayed clinical osteoporosis in his spine.

These results are potentially worrisome, says Oddbjorn Klomsten Andersen, a graduate student at the Norwegian School of Sport Sciences and a former national-team cyclist himself, who led the study, which was published in BMJ Open Sport & Exercise Medicine.

“There are limited studies following young cyclists through their careers,” he says. “But studies in master cyclists demonstrate that a larger proportion of them have low bone mineral density or osteoporosis” than people who do not cycle.

This study cannot tell us, though, why cyclists’ bones might be thin, he adds. They could have been eating too little or sweating too much for ideal bone health. Both low calorie intake and high rates of calcium loss through sweating have been tied to bone loss in other studies.

More surprising, the cyclists’ heavy weight training seems not to have built much bone.

But, as Mr. Andersen points out, this was a one-time snapshot of the athletes’ health. It’s possible, he says, that weight training prevented even greater bone thinning.

It is also encouraging, he says, that the runners harbored relatively healthy bones, since some past studies have hinted that running might not stimulate bone building.

Over all, the study’s findings suggest that serious cyclists might want to consider at least sometimes branching out, Mr. Andersen says.

“I would generally recommend combining cycling with weight-bearing exercise to promote good bone health,” he says.



This article was originally published in The New York Times. Read the original article.