Athlete’s Heart Risks: Fact or Fiction

Brad Cooper

Welcome to the latest episode of the Catalyst Health and Wellness Coaching Podcast. My name is Brad Cooper, and I’ll be your host. Today’s episode features a discussion about a subject that has received quite a bit of attention in recent years, the heart health of endurance athletes. Most likely you’ve seen the headlines about the potential dangers of endurance exercise, like fit marathon runners, dropping dead, or experienced masters athletes, having heart attacks. Clearly, those are real things. They happened. I’m in my mid fifties and I have a few friends who are incredible endurance athletes yet they’ve experienced heart issues of their own lately. It’s scary. And it’s resulted in some, in quotes, experts, advising people to stop these activities, but is that good advice? Should we all artificially cap our endurance pursuits at some predetermined level due to some of these reports? To answer that question, we were fortunate enough to have Dr. Barry Braun and soon to be Dr. Nate Bachman join us for today’s episode. They are part of a team of people at the esteemed Colorado State University that recently conducted an extensive study to see what the data, not the headlines say about the cardiac risks for long-term and serious masters endurance athletes. Their findings are fascinating, and they did a great job of explaining everything without going too overboard on all the PhD speak. Now, let me tell you a little bit about these two. Dr. Barry Braun is a professor and the head of the department of health and exercise science at Colorado State University. He earned his PhD at the university of California Berkeley, and did his postdoctoral work at Stanford university medical school prior to his role at Colorado State. He spent 14 years as a professor and director of the energy metabolism laboratory at U Mass Amherst. He’s published more than 100 peer reviewed research articles and is a fellow of the American college of sports medicine and the national Academy of kinesiology. Nate Bachman is currently pursuing his PhD at Colorado state, where he focuses on mechanisms that contribute to impaired blood flow in aging and disease. He was one of the lead researchers in this study that investigated the relationship between decades of high volume endurance training and markers of cardiovascular dysfunction that we’ll be discussing today. Before we jump in a couple of upcoming events, if you’re listening to this on the release date, it’s probably too late, but the Rocky Mountain Coaching Retreat and Symposium is this coming weekend in Estes park, Colorado. It is technically possible for you to join us, but you may want to just ponder it for next year at this point for 2020. However, for those of you looking to pursue your wellness coach certification, we have our last fast track of 2019 coming up November 9th and 10th in Colorado. If you’re looking to pursue the national board certification, the timing of this one is absolutely perfect. You can find all the details about those and a variety of other tools and resources on our new website CatalystCoachingInstitute.com that’s CatalystCoachingInstitute.com or feel free to reach out to us anytime with questions at Results@CatalystCoachingInstitute.com. We’re always happy to discuss questions about your career certification, national board process or anything else coaching related. Now on with the latest episode of the Catalyst Health and Wellness Coaching podcast.

Brad Cooper

All right, Barry and Nate, just a huge privilege to have you on here. I’ve been following this study basically since the beginning, had a chance to be a part of it in some small way. And we’ll jump into those details in a minute, but could you start us off by setting up the reason for the study, some of the background about what the popular press is saying? What’s the research confusion involves what, just, what led up to saying, this is a topic that we’re going to devote frankly, a few years to.

Dr. Braun

Let me start with that one, because Nate’s going to know a lot more than I do about, uh, about the specifics of the study since he ran that, big picture, you know, this has sort of been kind of in the wind for a while. This idea that, you know, people who have spent a long time, meaning decades, um, as endurance athletes are having, you know, greater incidences of heart problems, whether it’s atrial fibrillation or other things. Um, I have, you know, a whole panoply of, you know, folks I’ve been running with for years and years and years. And it just seems odd that so many of them have had an ablation or have had some kind of cardiac issue. And, uh, and that’s not unusual, but it’s all hearsay, you know, just because half of my running buddies seem like they’re having problems, doesn’t mean it’s real. Uh, I went to a talk, Paul Thompson, uh, gave it an ACSM I’m guessing three or four years ago. And he’s probably really started in a lot of ways the scientific part of, you know, can you do too much exercise, um, in terms of it being bad for your heart over time. And he tried to make the point over and over that look, you know, yes, these things are happening, but on the whole it’s very rare and exercise is good. You know, he kept saying, exercise is good, don’t come away from this thing saying exercise is not good. It’s not in very many people, but I looked around at the 200 people in the room and thought, yeah, but it’s all of us. It’s also something that is a much bigger issue here in the front range of Colorado, where people do a lot of exercise. You know, people doing 10, 15 plus hours of exercise a week is not unusual here. It might be unusual in Alabama, but it’s not unusual here. Uh, I came and talked to the cardiology group that we work with here at medical center of the Rockies. It was something they’re really interested in as well clinically because they see it on the ground. They actually see people who by most definitions shouldn’t have heart problems who do so, um, it really grew out of that partnership between this department, um, the cardiologist here in Fort Collins and then having, you know, a phenomenal grad student who was able to sort of do the heavy lifting in terms of actually get it done.

Brad Cooper

Very interesting. Nate, do you want to add anything to that in terms of the, the background aspect? I think that’s a really good summary.

Nate Bachman

Sure. I think Barry really hit all of the big points as a pretty new graduate student coming to this project. I basically walked into a project that, um, all these other individuals, including Barry, our clinicians, as well as my lab director had basically already set up the big idea of this is what we’re going to do. So my role was trying to understand why do people think exercise is bad? And one of the measurements that’s really been of interest in this topic is coronary calcium scoring, which is essentially using a CT scan to get at if an individual has hardening in their coronary arteries. And basically what the literature has shown in some of these studies is a bit equivocal where there’s lots of studies or a handful, at least that have shown that some of these middle age athletes do have these coronary calcium scores, which you would expect these individuals should be at low risk for. What’s considered to be a measure of coronary artery disease. However, if you look at the literature carefully, some of these individuals tend to have history of disease and lifestyle factors like smoking, high blood pressure, diabetes, other things that contribute to this condition. So the question is, do they have this hardening in their arteries because they’re an athlete or because they were someone that was already at risk and later on adopted a healthy lifestyle. Additionally, there tended to be a lot less information about how this issue affects women. And the studies that have been done on women tend to not be really careful. So once again, recruiting people that have had, um, a little bit more of an unhealthy lifestyle, and what we really wanted to isolate was what is the effect of exercise training? Now we can’t get, we can’t truly get a cause and effect, but if we look at individuals that have been doing this kind of training of heavy endurance training, ultra endurance is how we termed it for at least a decade that don’t have high blood pressure that don’t have high cholesterol, that haven’t been cigarette smokers to really live the healthy lifestyle, including exercise. And hopefully we can isolate that a little bit more.

Brad Cooper

Hmm. Really good. I mean, it reminds me of Jim, all the discussion around, Oh yeah. This guy wrote a book on running. He was the big runner and he dies of a heart attack. Well, yeah, but he’d been a lifelong smoker leading up to that. So I think that connection that you’re making cause and effect or potential cause and effect is, is very, very valuable. So let’s get into the details of the study a little bit. And, and this is generally we, we do have some scientists that are listening in, but generally this is a wellness interest group. This is coaches. This is people that health and wellness is important to them. So don’t, don’t take us too deep into the science. But in terms of the details, could you set the stage in terms of methodology, procedures, participant selection, all those kinds of things?

Nate Bachman

Absolutely. So we, once again wanted healthy middle-aged adults. So this was the population we’re interested in middle age adults are a group of individuals that commonly do events, such as Ironman triathlons, lots of people doing ultra running, which are races that are longer than 26.2 miles. A lot of them don’t even get into this sport till they’re 40 years old. So we wanted middle-aged adults. So 40 to 65 healthy. So no history of diabetes, no history of cardiovascular disease, high blood pressure cancer, so on and so forth, none of that, no smoking. And we wanted men and women. Um, so we had two groups that we studied. We had our ultra athletes and how we defined that was individuals that were training for these ultra events, which are endurance events that are greater than six hours in duration. So there can be a mix of events. Those could be ultra marathon. So often 50 or a hundred mile foot races, an iron man triathlon, which involves a very long bike ride is as you know, some swimming as well as doing a marathon at the end, if the swimming and the bicycling wasn’t enough, as well as the long distance cycling races. So those could have been road or mountain bike. We have a subset of our athlete group, probably at least four or five that had been doing the leadville 100 mountain bike race. And some of these individuals have been doing this every year for a number of years. So really, really tough event at high altitude as well. Then our control group, we didn’t want to know if this amount of exercise was better or worse than people that were doing no exercise at all. Well, we wanted to know is how does this compare to individuals that are meeting the current guidelines for exercise, which is considered 150 minutes of moderate exercise a week, and specifically that refers to aerobic exercise. So what that can turn into, um, or equate to is light jogging, cycling, other aerobic activity that that’s getting your heart rate up, um, and your breathing a little harder, but it’s not really structured training for endurance events. It’s just generally being active and being healthy. So those were our two groups. And if one, I can quickly jump into the measurements, that would be great. Okay. So we had a whole host of measurements that we did both in our research lab here at Colorado State University. So the human performance clinical research laboratory, we brought participants in and had them do a maximal exercise test on a bicycle. So we could get at where their aerobic capacity was. So this is the gold standard for measuring aerobic fitness. At the same time, we had a 12 lead electrocardiogram on these participants. So this is very similar to what you would be called a stress test in a hospital. So did you have, do you have normal heart and blood pressure responses to exercise? So we made sure that no one had abnormal responses or they would have been excluded from the study. We also did a whole host of measures of vascular function, and we won’t get into the, to the fine details of those tests. The important thing to note is a number of the measurements we took in our research laboratory of vascular function relate to the future risk of having a cardiovascular event such as a heart attack or stroke. So really important measures. And typically the measures that we take have taken have been shown to be able to be modifiable by aerobic exercise. So presumably in just generally healthy, active people, these measurements should be better than someone that doesn’t exercise. So those were the measurements we did here at a research laboratory.

Nate Bachman

And then a medical center of the Rockies. that was where they got into some of the more clinical tests. So they did a blood draw to get some typical measurements like cholesterol and some sex hormones and some other things, um, just to get a general profile of what these individuals blood look like. But the important measurements, the really big ones were, uh, cardiac CT looking at those coronary artery calcium scores. So was there hardening in the coronary arteries? They also, did an echocardiogram. So that uses ultrasound. And ultimately the goal of that test is imaging the heart. So both we can get size of the heart and the chambers, but also just make sure the heart is contracting and relaxing normally. So it just verifies that the heart is functioning. normally the valves are functioning normally, and there’s not any other disease that might influence the measurements that we’re taking. And lastly, there was a cardiac MRI. So if you’ve ever had an MRI for a shoulder injury, a knee injury, something like that, I’m sure a lot of the listeners probably have had an MRI before. Well, this one was a little different because we used a contrast dye. And ultimately with that contrast dye could show us was, was there any scarring in the heart? And this scarring in the heart on measurement is not as common in, in typical clinical practice, but it’s really important. Um, emerging in some research studies, not only because it can be related to a risk of having a cardiac event, but also this measurement has shown up in a number of these athletes studies. So we really weren’t interested in this measurement.

Brad Cooper

So interesting. So everyone’s sitting on their edge of the seats. Talk to us about the outcome. What’d you find? What, what, what came to the forefront through this?

Nate Bachman

So I don’t mean to bore you with our research and minutia, but there’s a few things that the listeners will need to understand about this study. First of all, there is no difference between our athlete group or ultra endurance athletes and our controls in blood pressure. So both groups had a normal blood pressure right around 120 over 75. So it’s important to note that because we wanted to make sure that any differences we were seeing weren’t because there was just major group differences in the overall measurements, such as blood pressure, which can contribute to other cardiovascular diseases. Right? So in the age of our participants, it was about 50 years old in both of our groups, as you would expect. We did, we did some measurements of body fat using an x-ray scan here at CSU our athletes were leaner than our controls, but both of our groups of both athletes and our controls were overall, um, healthy in terms of body mass index, the athletes had been training just slightly below 20 years. So 19 years was our average amount of years training. Um, and when we look at the physical activity per week, as a whole, our athletes were training about 11 and a half hours a week. And that’s specific just to their training. We were really interested in their training. So they might’ve been doing extra physical activity on top of that. But in terms of being on the bike, being in the pool or running, it was 11 and a half hours. On average for the control was about five hours of physical activity a week. But this was a little more loose in terms of they could have been walking the dog. They could have been doing some lightweight exercise, they could have been playing a sport. So this was just general exercise. So it’s really important when you think about they weren’t out there at 5:00 AM on their bike riding for five hours or doing interval training out on the track. Um, that was just general activity. So when we looked at those measurements of heart structure and function, and that was our echocardiography data. So this was just to confirm that everybody just look like they had a normal heart in terms of basic functioning. The athlete’s heart sizes were larger than our control group. And this is what you would typically see. Uh, if you look into the literature. So generally long-term endurance training, it promotes this condition called athlete’s heart, and it’s well established. Now that a bigger heart means you can pump more blood to your body when you’re doing a ton of exercise. So that that’s not of concern. However, when you see that you need to verify that the heart still works normally. So when we looked at measures of how well the heart contracts and relaxes, there was no differences between our athletes and our controls.

Nate Bachman

So what that tells us is that although these individuals have larger hearts, they function normally. So that would suggest that those increased heart sizes are probably related to train because in some clinical populations, you can have a larger heart, but it doesn’t actually work better. So we could confirm that it didn’t seem like there was any impairment in just general heart function. So one of the next things we looked at were those coronary artery calcium scores. So do we detect any hardening in the coronary arteries? And in fact, we did, um, in our control group, we saw two individuals that had coronary artery calcium scores. And in our athlete group athlete group, we saw eight individuals. So it’s important to point out to the listeners. There’s a little bit of a difference between what might be clinically important. What’s considered significant in terms of research and doing statistics. And when we compare these scores, a challenge is that these scores can range from having zero. So you’re not detecting any calcium to well into the thousands. So often in research, when we’re comparing, um, numbers between two different groups, we take an average from one group and we take an average from the other group and we compare those two averages. Now, as you imagine, when there’s lots of zeros and then some numbers that could range into the hundreds and thousands, it’s really difficult to compare an average from group a and an average from group B. So when we do our statistics, what we, what we essentially ask is, were there more athletes that had any calcium compared to controls? And when we ran those statistics, the answer was no. Um, and there’s, there’s a number of reasons that we could get into that could be potentially driving that.

Nate Bachman

But in terms of number of participants, statistically, we didn’t see that there is a difference, but when we look at the individual scores of those eight athletes that had calcium, a number of them had what would be considered reflective of a minimal to mild plaque burdens. So these scores, these numbers that you get are reflective of a plaque burden, so minimal to mild. However, there were a couple individuals that were in moderate to severe range. So on a clinical level, those are individuals that needed to be seen by their, their doctors immediately. When we look at the control group, the two individuals that had calcium were both in the minimal range. Uh, in fact, both of them had a calcium score below two, so quite low compared to the athletes that range from the lowest athlete has a six and the highest was in the mid five hundreds. Um, so we thought that was interesting and our statistics weren’t showing a difference, but we were still curious because when we look at these, we look at these graphs that we have, there is eight athletes and only two controls that had these calcium scores, um, out of 43 total people. So we were curious about that. So what we did is we, we took another step and wanted to see, is there a relationship between the volume of physical activity, someone does each week having any calcium score? So any calcium score that was above zero and what we found was, yes. So this is actually reflective of what some other studies have shown and perhaps, uh, some bigger studies, which you study, more people, you have more power to detect differences. So certainly a limitation of this study, which only studied 43 people, but we still found that relationship, which was surprising to us. So what we were curious about once we found this relationship, we were wondering, is there anything else contributing to this? We knew a number of things can lead to the development of calcium and things like age, gender, blood pressure, and body fat can all be contributors to the development of calcium. So we were wondering, well, is there just something else there that we’re missing and is one of these other factors, um, driving this relationship? So we could add all of those to our statistical tests, along with his exercise volume. And even when we added these other things that contribute, um, or could potentially contribute exercise was still a predictor of having an increased odds of having any calcium score compared to having none. So once again, in this population that we were pretty careful in screening for any other risk factors that potentially would contribute to disease, as well as having some of these measurements towards statistical testing, to try to account for that. It seemed like exercise volume is still playing a role, which is pretty curious.

Brad Cooper

If I remember the study and I don’t have it in front of me, but if I remember the overview, it identified that. But then in context of all risk factors, I think your conclusion was, yes, there’s this one marker, but overall, no difference between the control and the group study.

Nate Bachman

So I am so glad you brought that point up because that is a very important sticking point in this study that I think individuals should be aware of. So a lot of the studies that have looked into this, they say, you know, generally calcium is not something that we want and a higher calcium score for any individual tends to be worse than having no calcium at all. We’ll see this, what does it mean? So that’s one of the things we were really interested in. What does this mean? What does this mean for health? And I know, unfortunately there’s still some questions about that. However, one of the things that we were able to do is put it into a risk calculator. So we could take these calcium scores and individuals age their gender, along with some of their other information like their blood cholesterol and say, what is their ten-year risk of developing coronary heart disease based on this information we’ve collected? So we did that. We looked at both the athletes and the controls, and what we found is both groups are at a very low risk. In fact, there is no difference between groups with both of our groups, ten-year risk being close to about 2%.

Brad Cooper

So for the average person that’s out there doing 10, 12, 20, 25 hours a week of whatever they’re pursuing, how do they interpret that? I know you’re not in the clinical business, we’re not giving medical advice here, but what does this mean in general, for people that are participating in endurance sports, they’re not having issues now, but it’s in the back of their mind based on friends or peers?

Dr. Braun

It’s a good question. And I think it, you know, begs another question, which is how many of the people in the ultra endurance group are doing this because of their health. And I would say, you know, interpretations of this study, um, if you flip it around and don’t say does doing too much exercise damage you is, does doing a lot more exercise, help you and the answer I think, and I think this is the power of you having a control group that was actually somewhat active, as opposed to inactive. Exercise is better than no exercise. Like that’s not really much of a novel finding, but to see that, you know, the people who are, you know, Nate said are kind of, you know, doinking around, you know, walking their dog and going for a jog and going for a walk or going for a hike that, that at least in terms of cardiovascular risk seems to be as good as spending 20 hours a week. Um, doing hard exercise, I guess that that’s one interpretation that if all you care about is minimizing your risk for cardiovascular disease, you don’t have to go out and spend 20 hours running, cycling, and swimming, but I’m going to say with some certainty that very few of the people doing that are doing it because they’re trying to minimize their cardiovascular risk. There’s a whole difference in the people are out there. So, you know, in some ways I, I, I take it as, uh, personally, um, a little bit of, uh, reducing some of the anxiety that I do have as each one of my friends, you know, reports, um, having had an ablation or having had some, something that has come up, you know, heart wise, but I admit, you know, every time I’m running intervals in, you know, 95 degree heat, or, you know, we’re trying to run Hill repeats up Horsetooth it’s, it does it’s in my mind, I can’t stop sort of, uh, the idea that is this really a good idea? Um, and if the answer is, or if the question is, is this a really good idea to, for my health? The answer is probably not really, I just don’t care.

Brad Cooper

Right. But for that audience, and probably most of the folks really dialed in on this right now, they’re the ones who say, but I love it. That’s, that’s who I am. Do they need to be, and I, again, I’m going to say this 17 more times while we’re talking here, this is not medical advice, folks. This is just their interpretation of some of the results they’re seeing, but for that person, should they be scheduling a rest day for their heart or there, is there any kind of advice that you think has come out of this study or is the result, you know, what we don’t know yet? And until we do, there’s not a reason to change what you’re doing on a daily basis.

Dr. Braun

I’ll let Nate take this, but I’ll just give one sentence that I would say, based on what we found, which, you know, Nate made a really good point. We have more questions than answers. There’s nothing that we saw that seems like it should give people real pause for, Oh my God, maybe I should really do something differently. I don’t think there’s enough. There, there for people to start making changes based on this study. What do you think about that Nate?

Nate Bachman

So just a few more things that I’d like to point out in some of the results that we saw. We looked at the MRI data that looks to detect scarring in the heart. We didn’t find that in anybody, no athletes, no controls, not a single person. So that’s a really good thing. That was great news for everybody. And, and for us, at least the individuals that we studied here in Colorado, what that says is perhaps that’s one less thing that we need to be worried about. Um, it still is a little confusing as to why some of the other studies have shown that. And some of that may be due to some of those other studies, just studying a lot more people when you cast bigger net, you’re more likely to catch something. The other thing that I wanted to point out is we did do all those measurements of vascular function here in our research lab. One of which being a measurement of how stiff the aorta is, which is the great big blood vessel that comes out of the heart and goes through your abdomen. And this measurement is important because it’s related to future cardiovascular disease events, including heart attack and stroke. So generally a less stiff aorta is a better, better thing. And what we found is both of our groups had very low aortic stiffness. So that was good. However, the athletes had an even lower value than the controls. So what that suggests to us is that they’re still receiving vascular benefits from their exercise training.

Brad Cooper

And when you say lower value, Nate, you mean better, uh, less stiff aorta.

Nate Bachman

Yep. It’s, so lower is better, less stiffness. Yep. That’s correct. And this is important when we think of a lot of these studies have focused on the heart and we wanted to know about the heart, but we also wanted to know what about the rest of the vasculature? When we think about cardiovascular health, it’s cardiovascular, it’s not just cardio, right? So we really wanted to take those other measurements and including that aortic stiffness measurement, we saw that the athletes still had those lower values. So when we do our risk calculations, our risk calculations are not set up to incorporate those measurements into the risks. So perhaps those measurements could even be lowering risk more than we can truly account for. But at this point in time, not seeing fibrosis, seeing those measures of vascular function that were improved or other measurements, like we took the thickness of the carotid artery, which is an artery in your, in your neck. And that relates to cardiovascular risk as well. And there was no difference between groups suggesting that there wasn’t an increased plaque buildup in that artery, in the neck. All of those things say to us that we just don’t have overwhelming evidence that it’s bad at this point in time, based on the people we studied and based on the screening techniques and standards we use. Now, the interesting thing for athletes to think about when we think about the coronary artery calcium scores, just about nobody in this study wouldn’t have had a cardiac CT normally, if they had not been recruited for a research study, they wouldn’t have fit the criteria because they’re healthy, they’re asymptomatic and they don’t have overwhelming risk ahead of time, which is one of the reasons if you have a higher risk an intermediate risk, specifically, your cardiologist says, we know you don’t have any symptoms right now, but we’re concerned maybe something’s going on. Let’s do this scan. That’s not the case with our, our athletes or our controls. Everybody not only felt great, but generally had low risk. So these are individuals that if we hadn’t had done this study, they would not have found those measurements in their hearts. So it creates a question that’s really more for the cardiologists and for the imaging professionals of, should we be screening these people that if they were not an athlete would not be having this imaging test on, is it worth a small amount of radiation exposure? Is it worth the potential stress over having to get another test? Is it worth the cost? Um, the time that it takes to do this imaging procedure, all of those things are generally pretty low, which is why we incorporated as a measurement for this study. However, those are all reasons why we don’t just give a calcium score to every single person. So it really is something that for individuals that are doing this volume of exercise, I think was really important for them to have a very Frank conversation with their doctor and just doing their normal checkups. If you’re generally at low risk and you talk to your cardiologists, they’re the one that should be making the decisions about your health. And certainly not me.

Brad Cooper

So you’re, you’re saying that’s a question to bring up with your family practice doc, or request a referral to say, Hey, I’d like to get a baseline, I’ve been doing this for 20 years, not having symptoms. Do you think that’s a conversation worth bringing up with your family practice or you’re not going to have a cardiologist if you don’t have risk factors, but is that what you’re suggesting is to potentially go down that path if you’ve been at this for 20 years?

Nate Bachman

I mean, that’s my, that’s my personal opinion. There certainly could be even differences of opinion within our research team, but we did a really comprehensive set of tests, looking at many measures of cardiovascular health and disease risk and generally didn’t detect a lot that was concerning. However, we did find a couple people that needed to be treated right away. One of which, who is in probably close to the peak of his competing, uh, career. So not having symptoms and competing really well doesn’t necessarily line up with whether there’s something underlying or not. However, that’s completely anecdotal. That’s my observation of a single person. But, but once again, what it tells us is there’s just some stuff there. We still don’t understand. And when we’re thinking about research versus the health of an individual, that’s where people need to be aware of their own health and have those conversations with their doctor. Yeah.

Dr. Braun

Just to piggyback on something you said, Brad, that I think is important. You know, the other reason to get this information out there and especially to try and publish in a, in a clinically oriented journal, it’s read by practitioners is, you know, if you were to go to your family physician and say, you know, there’s nothing really wrong with me, but I’ve been doing hard exercise for 20 years. And I just kind of like to know where I stand, because I read something in runner’s world or about, you know, doing a lot of endurance exercise and damage to your heart. You know, I think that many clinicians would look at you and say, what are you talking about? Your blood pressure is 110/70. Your cholesterol is 130. So, you know, in some ways educating the cardiology world or, and the general physician world, this is not crazy that, you know, there’s a reason for this. I think it’s going to be really useful. I think, you know, Fort Collins and the Denver area, um, you’re a lot less likely to get a look of, you know, you’re insane from your family physician, if you would report this. And if you were to try and do this, you know, in Fayetteville, Arkansas, not that I’m picking on Fayetteville, Arkansas.

Brad Cooper

But, but then by the same token on the, on the other end of the spectrum, the physicians need to know, Hey, the guidance is not automatically, you’re doing too much based on anecdotal evidence. Here’s a study that says we can’t find a difference in terms of this risk calculator.

Dr. Braun

Totally agreed. Right. That’s also important that you know, that the knee jerk response is, Oh, well, you’ve got to slow down, man.

Brad Cooper

Right, right. Cause I think that’s my concern I’m concerned on both ends. Cause I’ve got three buddies over 55 been doing this for 25 years and they’ve, they’ve all been struggling with some sort of heart irregularities. And yet does that mean we just stopped? Does that mean they just stop there? There’s there’s just so many of these anecdotal things that you hear again, the Jim Fix example is, is the classic historical one of all the non-runners go Oh yeah. But he died of a heart attack. Yeah. Have you read you read anything about Jim?

Dr. Braun

That’s a really great point. We were just talking about Jim the other day, which is interesting. Cause I feel like there’s probably a whole generation that actually has never heard of him. Yeah, absolutely. And that, you know, the, the non, uh, exercise world says, Oh, look, you know, he did all of these things and he still died of a heart attack at 55. But as you pointed out, he also had all of these risk factors he’s accumulated earlier, in addition, a terrible family history, right. His dad and his brother both died of heart attacks in their forties. So he probably bought himself 10 extra years at least by doing the exercise. So I think those examples are really instructive and also to counter the idea, um, from one, you know, misinterpreted, uh, example that somehow, um, the sweet spot for exercise is, you know, a much lower number. And if you’re doing more than that, you’re probably doing damage.

Brad Cooper

So let’s take the researcher hat off for, for Barry here for a second, you mentioned, you’ve got several friends, you talked about sitting in the ACSM meeting and looking around going. Yeah, I think it’s all of us. And I just mentioned my peer group, the folks that I train with, you know, several examples of folks that are dealing with this now, what if you put your friend hat on instead of your researcher hat, what advice would you give a buddy who says, I’m not having anything Barry, but you know, I’m reading this stuff. And I saw that thing out of Minnesota that that doctor recommends X, Y, Z. And do you think I should do something different? Do you think I should be tested? What, what would your general response be to that person as a friend? Not a researcher.

Dr. Braun

Yeah. So I think the biggest thing is to kind of pay attention and, you know, be a little more aware of things that seem a little off. So I’ll give you one example of a friend from Massachusetts who a phenomenal athlete and, uh, you know, all the way from junior high through, um, now he’s, uh, 55, 56 still running at a really high level. Uh, he was out doing a track workout. So this is the only symptom he had. Um, he was out doing a track workout. Um, knew what his effort level was instead of hitting 400 meter intervals in 75, 76 seconds, he’s hitting them at 80 and 81 seconds. I’m thinking this is weird. This is not right. After that he finishes the workout a little bit off and decides to go visit the doc. And it turns out he had a heart attack. Only symptom was his times were a little high.

Brad Cooper

Were faster than most people would die for.

Dr. Braun

So I guess the advice is, you know, pay attention. If there’s something that seems off, um, you know, don’t just chalk it up to, Oh, I’m having a bad day or I didn’t sleep as well as I thought last night that, you know, it might be worth, you know, getting things checked out even before they seem serious.

Brad Cooper

That’s good advice. I think that’s one of the advantages that serious athletes have as they, they know, wait, I should be running a 76 quarter. I just ran an 81 and yet everything else is the same. That’s too big of an anomaly or, you know, any kind of, my power rating on my bike is, is down 20 Watts and I haven’t had any hard sessions lately. So it’s like you have an extra tool to draw on to self reflect at a much deeper level than the general population might have.

Dr. Braun

Right. In some ways you could almost look at it as, you know, an early warning system. Right. My guess is that my friend, Chris, you know, by noticing the fact that he exercises at such a high intensity, you know, notice something or, you know, a symptom came out that may never not have come out for 10 more years, but may have resulted in a fatal heart attack as opposed to this kind of shot across the bow that he got, you know, just because he happened to be hitting intervals in a slower speed. So, you know, he was able to be diagnosed with a very mild heart issue, um, as opposed to what could have been a, you know, a life ending heart issue in 10 years.

Brad Cooper

Right, right. Excellent example. All right. Just a couple more guys. Really appreciate it. How do you see this research moving the dial on the way cardiologists family practice docs address, serious endurance, masters athletes going forward if they read it?

Nate Bachman

You know, one of the interesting things that I’ve had the experience of working with this project is depending on what doctor, uh, physician you speak with, you can get a very different response in terms of how they think about this issue. In fact, I was at a conference last week and I gave a talk about this topic. And afterwards, a guy came up to me and he said, you know, I have a friend and he’s an ultra runner and had a heart issue. And he went to his doctor and his doctor said, you need to stop, stop, stop doing the ultra running. That’s a problem. It’s going to make things worse. That’s why you’re in this boat to begin with something to that effect. And of course, what does he do as you and Barry both know you went to a new doctor because you need a better answer, one that fits your agenda. But so he went to this other doctor and this other doctor said, no, you’re fine. Keep doing what you’re doing. So there’s a little bit of discrepancy there between the research medical opinion and also someone’s experience if you’ve been a cardiologist for multiple decades, and you’ve only ever seen calcium scores in the context of disease. And in context of individuals that perhaps are sedentary, you know, that a higher score typically means a greater risk. So I think some of this is going to be a challenge because it counters the way people think about what some of this means. And it counters that perhaps you can have some markers that are suggestive of risk and disease, or even have disease, but exercise is still an important tool. And we’ve seen that with things like cardiac rehab. So cardiac rehab being the clinically supervised exercise programs that are for individuals that have had situations like a coronary artery bypass graft, where after having a heart attack, they are encouraged to exercise and incrementally do more and more exercise to help promote their health and try to reduce that event from happening again. Right. So I think there could be some challenges based on individuals’ experiences, their personal biases, and also where they work in this country. Cause like Barry pointed out, depending on what part of the country you live in, this type of exercise volume could be pretty familiar to you in terms of people, you know, and people you care about, or it could just be even like a lot of people in this study that were controlled is the kind of thing these volumes of exercise are crazy. We certainly don’t believe that because without, without all our wonderful participants, we wouldn’t have been able to run this study. But I think the challenge is really having more of these, more of this research that’s done that says, we see that there’s some markers that can be a little concerning, but what else can we measure to show that things in this individual’s health are still good?

Brad Cooper

Right. Really well done. We’ve been talking a lot about the practical implications for the athletes throughout this conversation. A lot of our listeners are health and wellness coaches. They’re, they’re maybe not participating in this themselves at that level at that 10 to 20 hours, but their clients are. Any advice kind of wrap up advice on what you might suggest, or maybe I should say how you think they should approach it with their clients that are asking them about different things they see in magazines and newspaper headlines?

Dr. Braun

So let me take a first stab, which is, you know, I think, you know, reiterating that as far as we know, um, from the world of research and now it’s, you know, obviously a lot bigger than just what we’ve done, with other people who have done these larger studies. You know, there’s no tangible, verifiable, real risks to doing a lot of exercise. Uh, so again, I sort of see that as people advising their clients, you know, if you’re doing this and you’re loving it and it’s contributing to your quality of life and you’re not having any symptoms, then it’s hard to make a case for stopping or even backing off. You know, again, knowing that it’s worth paying a little more attention in case you do feel like something, that’s something that seems like a symptom. But I, at this point, don’t see anything that says, you know, you should advise your client that, you know, they could, that they should do less. I think it’s a reasonable thing to say that if all you care about is is general overall health and, uh, all you care about is trying to do something that’s going to lower your risk then you don’t need to do 10, 15, 20, 25 hours a week. But I don’t see anything that says that somebody who’s doing that and it’s part of their life and it’s part of their quality of life should stop or even back off.

Brad Cooper

Yeah, very well said very well said, Nate, any closing comments you want to throw out there?

Nate Bachman

I just want to point out when people were thinking about their concerns that we haven’t identified any cause and effect for us in research, that might seem fairly obvious, but even working with this data, it’s always important to remind ourselves we haven’t taken individuals that were sedentary and trained them for ultra endurance events and then monitored them carefully for a decade. And then taking some measurements, we’ve taken a cross section of people. So we’re really not sure what’s driving this and driving some of these markers, particularly the calcium is what is what a lot of people are interested in. Some people maybe they have some other unidentified risk or there’s some other mechanism going on that we don’t understand that interacts with exercise. And generally a lot of the studies don’t have measurements of outcome. So they have the calcium, but how does that actually relate to those individuals having a heart attack in the future? There was one really big study, quite large, about 20,000 men, men. So only men. So we don’t, we don’t know what this means for women, but what they did is they looked at a bunch of men that were regular exercisers. So maybe not exactly athletes, but regular exercisers and different levels or volumes of exercise and looked at their events. And what they found was that while having a higher calcium score gave you more risk than having lower or no calcium score than for giving calcium score, exercise decreased your risk compared to someone that wasn’t exercising. What it, what it tells us, it still gives us a pretty, pretty strong case that looks like exercise is good, whether you’re healthy or unhealthy, you probably should still exercise. And for the individuals that aren’t doing this for how they’re doing this because they want to compete. And of course you want to win, right? We don’t see anything overly terrifying at this point in time.

Brad Cooper

Excellent, gentlemen, appreciate it so much, Dr. Barry Braun and soon to be Dr. Nate Bachman. Excellent, excellent clarification identification laying out the details. Not obviously taking it too far, but allowing us to see through what does this mean for us on a daily basis. Thank you so much. We’ll look forward to updates as they come and really appreciate it.

Nate Bachman

Thank you.

Dr. Braun

Thank you, it was fun to do it.

Brad Cooper

How was that for interesting? Again, just to stress, this was not intended to be medical advice. They’re simply sharing the results of the research study and some of the discussion around the outcomes. Big, thank you again to Barry and Nate, some great insights, some fascinating research, and hopefully this will move the conversation forward based on the evidence instead of simply headlines and some sort of recency effect of those closest to us. I’m hoping this study and the conversation today, will do exactly that. Please feel free to share it, again feel free to reach out to us any time if you’ve got questions about health and wellness coaching, there are a lot of exciting things happening in the industry, and we are happy at any point to help you navigate the journey. You can find details about our final coach certification of 2019. It’s going to be this November in Colorado, along with all sorts of other tools and resources. We’ve got special reports. We’ve got recommended book lists, all kinds of things on the new website at CatalystCoachingInstitute.com or reach out to us anytime, Results@CatalystCoachingInstitute.com. We’re here for you when you’re ready to move forward. Thanks again for joining us. If you’re on Twitter, I post tips articles, updates about human performance and optimizing that performance. And my address is @Catalyst2Thrive at catalyst two thrive. And then you can follow Dr. Barry Braun @BraunBarry So at Braun Barry, make it a great rest of the week. Keep moving toward better. And I’ll speak with you soon on the next episode of the Catalyst Health and Wellness Coaching Podcast.