Middle-aged male racers also seem to be the most vulnerable. Dr. Thompson was a co-author of a 2012 study that found that, between 2000 and 2010, 59 people racing a full- or half-marathon in the United States experienced cardiac arrest. Of those, 51 were middle-aged men, almost all competing in the marathon.

Another 2012 study, using survey data from marathon medical directors, concluded that the overwhelming majority of cases of cardiac arrest during races involve middle-aged men, most of whom collapse in the final four miles of the course.

Still, while middle-aged male runners’ relative risk of cardiac arrest rises while they are completing 26.2 miles compared to when they are not, their absolute risk of cardiac arrest, even then, remains reassuringly low, Dr. Thompson says.

And over all, running lowers people’s chances of ever developing or dying from heart problems. A 2014 study published in the Journal of the American College of Cardiology found that, no matter how often or infrequently runners trained and raced, they were about 45 percent less likely than nonrunners to die from heart disease.

Obviously, however, talk to your doctor if you are concerned about your heart health, Dr. Thompson says, especially if you notice symptoms such as chest pain, shortness of breath, numbness in your left shoulder or jaw, or unusual fatigue before, during or after a run or race.

A Heart-Smart Approach to Marathons and Vigorous Exercise

As an avid marathon runner, Johns Hopkins cardiologist Erin Michos, M.D., M.H.S. , has closely followed the research on this trending fitness activity and its effects on the heart. Thus far, she says, there is far more compelling evidence in favor of endurance exercise than against it. Favorable effects on blood pressure, blood lipids, and body mass index have been reported with endurance training, and large studies show that people at higher levels of fitness are the least likely to die.

“I think it’s important not to scare people,” Michos says. “Exercise is good for people in general, and we don’t want to discourage athletes who are inclined to do endurance sports. More isn’t necessarily better, but it’s not necessarily harmful either.”

Here’s a plan to help you participate safely.

Choose Endurance Events for the Right Reasons

There’s no need to attempt a marathon or triathlon if your main goal is heart health, says Michos. The American Heart Association recommends just 150 minutes of moderate exercise or 75 minutes of vigorous activity each week. The good news for endurance athletes who enjoy extra activity: A large population study found that people engaging in three to five times the recommended minimum of physical activity had the best survival rates. Importantly, the researchers found no harm for those choosing to do 10 or more times the minimum amount.

Get a Heart-Health Checkup Before You Lace Up

A sudden death during or shortly after a marathon is very rare, but Johns Hopkins researchers found that most of these events occurred in people who had preexisting heart disease or a congenital heart problem. Bottom line: Before you ramp up your mileage, get clearance from your doctor, as Michos did. Discuss your health, heart disease risks, and training goals. Your doctor should ask about any symptoms such as chest pain or shortness of breath, ask about a family history of heart disease, measure your blood pressure, and listen to your heart with a stethoscope. He or she can perform the tests needed to determine how to proceed in the safest way possible for you.

Running marathon cuts years off ‘artery age’

Image copyright Getty Images

Training for and completing a marathon improves the health of a new runner’s arteries, cutting about four years off their “vascular age”, a study suggests.

Researchers from Barts and University College London tested 138 novice runners attempting the London Marathon.

Over six months of training, their arteries regained some youthful elasticity, which should reduce the risk of heart attacks and strokes.

And their blood pressure fell as much as if they had been prescribed pills.

Those who were the least fit beforehand appeared to benefit the most.

And smaller amounts of aerobic exercise are likely to have a similar effect, according to the British Heart Foundation (BHF), which funded the study, in the Journal of the American College of Cardiology.

How fast did they run?

It took them between four and a half and five and a half hours, on average, to run the 26.2 miles.

Is it dangerous?

Runners with a pre-existing but undiagnosed heart condition have died attempting marathons – but this is very rare.

Image copyright Getty Images

Lead researcher Dr Charlotte Manisty said: “People with known heart disease or other medical conditions should speak to their doctor first.

“But for most people, the benefits of taking up exercise far outweigh any risk.”

  • Is marathon running bad for you?
  • Ipswich runner ‘died for three minutes’ after finishing race

What is the best way to train?

Start months before a marathon, begin each session with a warm-up and gradually increase the distance run.

Having rest days between runs allows joints and muscles to recover and strengthen.

Ask a doctor about any health concerns.

How much exercise is needed to keep fit and healthy?

Over the course of every week, adults should do a minimum of either:

  • 150 minutes moderate-intensity exercise, such as brisk walking, doubles tennis or cycling
  • 75 minutes vigorous exercise, such as running, football or rugby

People should also do strengthening activities – such as push-ups, sit-ups or lifting and carrying – at least two times a week to give muscles a good workout.

  • Get running with couch to 5k
  • Running tips for beginners

BHF’s Prof Metin Avkiran said: “The benefits of exercise are undeniable.

“Keeping active reduces your risk of having a heart attack or stroke and cuts your chances of an early death.

“As the old mantra goes, ‘If exercise were a pill, it would be hailed as a wonder drug.'”

(Sportpoint74, Envato Elements)

As you can tell by all those 26.2-mile bumper stickers popping up around the country, the popularity of marathons and long-distance running continues to grow. But so has the number of studies examining whether consistent endurance racing is healthy.

Recent research has raised alarms about the potential for plaque buildup and scarring in the heart in some long-distance runners. Yet other studies have suggested that when marathoners get heart disease, they may be able to weather it better than non-runners.

What isn’t being debated, however, is the power of getting off the couch.

“Any type of aerobic exercise has a positive effect on the heart,” said Dr. Dan Meyer, chief of cardiac transplantation at Baylor Scott & White Health in Dallas. “Running is such an efficient mode of exercise. It can be relaxing and a stress reliever at times. I find it having as much emotional benefits as physical.”

The roots of today’s modern marathon reach back to the legendary Greek story of the messenger Pheidippides. He ran the distance from Marathon to Athens, about 25 miles, to announce “Nike!” (victory) over the Persian army.

Some accounts say Pheidippides already had covered 150 miles in two days. And most of the stories say he collapsed from exhaustion after his announcement.

Fast forward a few thousand years and, depending on good temperatures and local climate, running season always is in full swing somewhere. And from Myrtle Beach, South Carolina, to Los Angeles, the lineup of marathons grows each spring and fall.

In 1976, about 25,000 runners finished marathons in the U.S., according to Running USA, a nonprofit that promotes distance running. Forty years later, in 2016, more than 507,000 people had.

Dr. Peter McCullough, chief of cardiovascular research at Baylor Heart and Vascular Institute in Dallas, has completed 54 marathons, one in every state. But he stopped in 2012, after he said research showing the potential dangers made them not worth the risk.

“I thought there was enough evidence that I wasn’t willing to pay the ultimate price,” said McCullough, who still runs but for 5 or 6 miles at a time.

“I’m convinced that to go grind it out for hours on end at a steady pace is the wrong thing,” he said. “Some experts are divided about this, and the concern is that it could dissuade some people from exercising, but we just can’t bury our heads about it.”

He’d like to see more research, such as a widespread registry of athletes involved in endurance sports and eventually a clinical trial that includes MRI results.

McCullough was part of the 2012 study that used MRIs to identify the long-distance runners whose right atrium and ventricle dilated immediately after a marathon and up to 24 hours later. It also included blood tests that showed an elevation in biomarkers that are indicators of heart stress and injury.

“Our theory is that 25 percent of people are susceptible to this recurrent injury of the heart,” McCullough said. A smaller subset, he estimates about 1 percent, could be prone to scarring. Myocardial fibrosis, or scarring of the heart, can lead to heart failure.

A study published in 2017 on triathletes showed that 18 percent of the male participants, those who trained and competed the most, had more heart scarring than the other athletes.

Meyer, who has finished 16 marathons tries to keep a daily running streak going, even if it’s a few miles a day. He said federal guidelines of at least 150 minutes of moderate-intensity exercise a week or at least 75 minutes at a vigorous intensity “are reasonable and promote heart health for the long-term.”

He pointed to a Stanford University study published in 2008 that focused on runners and non-runners in their 50s. Researchers tracked them for more than two decades.

At the beginning of the study, the runners ran an average of about four hours a week. After 21 years, their running time declined to an average of 76 minutes a week, but they were still seeing health benefits. Nineteen years into the study, 34 percent of non-runners had died compared with 15 percent of runners.

Dr. David Sabgir, a cardiologist with Mount Carmel Health Systems in Columbus, Ohio, said he doesn’t want studies that apply to one segment of hardcore long-distance runners to dissuade others from getting into exercise.

“The sedentary rates in this country are shocking,” he said. In 2005, Sabgir founded Walk with a Doc, a health program that brings doctors and patients together to walk in their communities. It’s now at 473 sites in 25 countries.

Sabgir, who has run about 10 marathons, was on a 4-mile run with friends recently and they agreed about the many other benefits.

“That social connectedness is probably equally beneficial to the physical activity,” he said. “I’ve been so cardiovascular-focused, but there are reductions in mental health diseases, arthritis and cancers. … The power of exercise can be miraculous.”

If you have questions or comments about this story, please email [email protected]

New study cites link between marathon running and some heart-attack factors

BELMONT, Mass., Oct. 17 (AScribe News) Marathon running may trigger a cascade of potentially heart-damaging events, as reported by McLean Hospital researchers in back-to-back papers in the Oct. 17 American Journal of Cardiology.

Dr. Arthur Siegel, director of Internal Medicine at McLean, and his collaborators analyzed the blood of marathoners less than 24 hours after finishing a race and found abnormally high levels of inflammatory and clotting factors of the kind that are known to set the stage for heart attack.

“My concern is for people who exercise thinking ‘more is better,’ and that marathon running will provide ultimate protection against heart disease,” Siegel said. “In fact, it can set off a cascade of events that may transiently increase the risk for acute cardiac events.”

Does that mean you should hang up your running shoes?

“No, not at all,” said Dr. Charles Schulman, president of the American Running Association. “But it does mean we need to understand more about marathon training and how the human body reacts to stress. “I’m concerned that running a marathon has come to be viewed as a modern rite of passage,” Schulman said. “Dr. Siegel’s research may lead us to conclude that running a marathon is not a panacea. In fact, coupled with poor or improper training, it could lead to consequences much more serious than just the usual running injury.”

Few studies have defined the cardiovascular risks imposed by a 26-mile run on a person with a presumably healthy heart. However, it is known that there are diminishing returns from the benefits of exercise as intensity and duration are increased. What’s more, other studies indicate that overtraining leads to decreases in immune function and increases your risk of disease.

Also troubling, Siegel and his colleagues found that early stage markers used to detect heart attack in the emergency room (creatine kinase-MB, considered the gold standard) produced positive results on the runners, none of whom displayed any cardiac symptoms, suggesting that the test is misleading for this group. Runners and their doctors need to be aware of this discrepancy.

“On the basis of early stage markers, runners can be overdiagnosed with heart attack,” Siegel said. He believes the high levels of creatine kinase-MB and hence the false-positive result are released by injured skeletal muscle, rather than heart muscle in the runners. In contrast, cardiac troponins, as late-stage markers for heart attack, remained normal the day after the race.

To explore the cardiac risk of long-distance running, Siegel followed a group of 80 physicians who are members of the American Medical Athletic Association. The subjects, entrants in the 100th to 105th Boston Marathons, were on average 47 years old, had no reported history of smoking or coronary disease, and had run several prior marathons.

At each of the five races, researchers drew blood three times the day before the race, within a few hours of finishing and the morning after the marathon.

Normally, blood maintains a balance of blood-thickening factors inflammatory and clotting factors and blood-thinning, or fibrinolytic, activity. Exercise is known to raise the levels of both types of factors. Siegel found that while the balance between thinners and thickeners was maintained in the blood of the marathoners before and just after the race, it was disrupted the morning after: fibrinolytic activity returned to normal, but clotting and inflammatory factors were elevated.

Despite the high levels, none of the subjects in the study collapsed or experience an acute cardiac event during or after their races. Siegel believes that in addition to an increase in inflammatory and clotting factors, a second event such as a disrupted atherosclerotic plaque or a cardiac arrhythmia is needed to trigger a heart attack.

“The rise in inflammatory and clotting factors loads and cocks the gun, but another complication needs to occur to pull the trigger during a marathon,” he said.

“Sudden death during strenuous exercise is uncommon,” Schulman added. “Most of those who die during exercise had pre-existing conditions that were augmented by the strenuous exercise.”

“The benefits of an active lifestyle are tremendous,” said Susan Kalish, executive director of the American Medical Athletic Association. “But Dr. Siegel’s work shows that marathoning may have its risks. If your goal is to improve your health, go for a run … but perhaps don’t train for a marathon.”

Investigators from the Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital in Boston collaborated on this research.

McLean Hospital is the largest psychiatric teaching affiliate of Harvard Medical School, an affiliate of MGH and a member of Partners HealthCare System. The American Medical Athletic Association is an association of running doctors and sports medicine professionals dedicated to promoting public health through physical fitness.

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It was the death heard ’round the running world.

In July 1984, acclaimed author and running guru Jim Fixx died of a heart attack while trotting along a country road in Vermont. Overnight, a nascent global movement of asphalt athletes got a gut check: Just because you run marathons doesn’t mean you’re safe from heart problems.

Fast-forward 35 years, and Boston Marathon race director Dave McGillivray is amplifying that message for marathoners, especially those who have coronary artery disease or a family history of it.

“Being fit and being healthy aren’t the same things,” says McGillivray.

He should know. Six months ago, the lifelong competitor underwent open-heart triple bypass surgery after suffering chest pain and shortness of breath while running.

As marathons, ultramarathons, mega-mile trail races and swim-bike-run triathlons continue to explode in popularity, doctors are re-prescribing some longstanding advice: Get a checkup first and talk with your primary care physician or cardiologist about the risks and benefits before hitting the road.

For McGillivray, 64, the writing was on his artery walls. Both his grandfathers died of heart attacks; his father had multiple bypasses; his siblings have had heart surgery; and a brother recently suffered a stroke.

Neither McGillivray’s marathon personal best of 2 hours, 29 minutes, 58 seconds, nor his decades of involvement in the sport could protect him.

“I honestly thought that through exercise, cholesterol-lowering medicine, good sleep and the right diet, I’d be fine,” he says. “But you can’t run away from your genetics.”

Aerobic exercise such as running, brisk walking, cycling and swimming is known to reduce the risk of heart disease, high blood pressure, stroke and certain types of cancer, and it’s been a key way to fight obesity, Type 2 diabetes, osteoporosis and more. Studies have shown those who exercise regularly are more likely to survive a heart attack and recover more quickly than couch potatoes.

But new research is providing a more nuanced look at “extreme exercise” and the pros and cons of running long.

In a study published in December in Circulation, the journal of the American Heart Association, researchers in Spain found signs suggesting that full marathons like Boston may strain the heart. They measured substances that can signal stress and found higher levels in runners who covered the classic 26.2-mile (42.2-kilometer) marathon distance compared with those who raced shorter distances such as a half-marathon or 10K.

Only about one in 50,000 marathoners suffers cardiac arrest, the researchers said, but a high proportion of all exercise-induced cardiac events occur during marathons — especially in men ages 35 and older. The Boston Marathon and other major races place defibrillators along the course.

“We typically assume that marathon runners are healthy individuals, without risk factors that might predispose them to a cardiac event during or after a race,” writes Dr. Juan Del Coso, the study’s lead investigator, who runs the exercise physiology lab at Madrid’s Camilo José Cela University. Running shorter distances, he says, might reduce the strain, especially in runners who haven’t trained appropriately.

Dr. Kevin Harris, a cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital, says he had a patient preparing for the Twin Cities Marathon who struggled to exceed 10 miles (16 kilometers) in training. The man’s family doctor insisted he get a stress test, and he wound up needing double bypass surgery to detour around dangerous blockages in his arteries.

“Running is good, and we want people to be active. But your running doesn’t make you invincible,” Harris says. “The bottom line is that individuals with a family history — especially men who are older than 40 and those people who have symptoms they’re concerned about — should have an informed decision with their health care provider before they run a marathon.”

That family history is crucial.

Fixx, whose 1977 best-seller, “The Complete Book of Running,” helped ignite America’s running boom, was 52 when he collapsed and died. An autopsy showed he had blockages in two of his heart arteries. He had a mix of risk factors. His father died at 43 of a heart attack, and although Fixx quit smoking, changed his eating habits and dropped 60 pounds, it turned out he couldn’t outrun those risks.

Facebook COO Sheryl Sandberg’s late husband, tech entrepreneur Dave Goldberg, was 47 when he died while the couple was vacationing in Mexico in 2015. Goldberg had been running on a treadmill when he fell, and an autopsy revealed he had undiagnosed heart disease.

Former U.S. House Speaker Paul Ryan, who is 49, has said his own strong family history of heart disease is what motivates him to work out regularly and watch his diet. His father, grandfather and great-grandfather all died of heart attacks in their 50s.

“If you’re going to take on strenuous exercise later in life, and especially if you have active heart disease, it’s clearly in your interest to be tested and make sure you can handle it,” says Dr. William Roberts, a fellow and past president of the American College of Sports Medicine.

McGillivray says his doctor has cleared him for Monday’s 123rd running of the Boston Marathon, which he’ll run at night after the iconic race he supervises is in the books. It will be his 47th consecutive Boston, and this time, he’s trying to raise $100,000 for a foundation established in memory of a little boy who died of cardiomyopathy — an enlarging and thickening of the heart muscle.

“Heartbreak Hill will have special meaning this year,” McGillivray says.

“My new mission is to create awareness: If you feel something, do something,” he says. “You have to act. You might not get a second chance.”

It’s common knowledge that running is one of the most efficient forms of exercise. Many people enjoy running, myself included, and it’s proven that aerobic exercise is good for the heart.

But is it possible to run too much?

I’ve completed 54 marathons during my lifetime, including one in every state. But in 2012, new research about how running marathons affects your heart convinced me to stop. As a cardiologist, I knew my heart health had to come first.

The truth about running is that it is indeed good for your heart — to a point.

From couch potatoes to marathon runners, how running impacts your heart

If a heart attack occurs, a marathon runner is more likely to survive than his or her sedentary counterpart, but the same can be said of people who engage in other kinds of regular activity. Exercising regularly puts your heart in a better place to survive a cardiac event.

But endurance running has actually been linked to poor heart health. Studies have found that the hearts of lifelong male endurance athletes may contain more plaque or other signs of heart problems, such as scarring and inflammation, than the hearts of less active men of the same age.

So, while running marathons may give you a better chance at surviving a heart attack, it’s not going to prevent one, and it may actually increase your risk of having one.

Marathon runners increased risk of heart attack

About 25 percent of the population may be at risk for a condition known as runner’s cardiomyopathy.

For these people, the right atrium and right ventricle dilate and there are elevations of blood troponins and B-type natriuretic peptide, suggesting there is temporary injury to these chambers at the end of a marathon. This is due to three to five hours of volume overload for these thinner chambers while the individual is running a marathon.

When this damage occurs repetitively over time, scar tissue may build up in the heart muscle, which can lead to sudden death. Marathon runner’s cardiomyopathy is not related to age, gender, degree of conditioning or speed. Thus, the only way to know if you’re at risk is to undergo a cardiac MRI and or have blood tests at the end of a race.

The right amount of running

A combination of both aerobic exercise and strength exercise is best. Exercise helps preserve weight loss, which is good for the heart. Exercise doesn’t prevent plaque buildup or heart blockages, but it does work to make us “tougher” and more likely to survive serious medical illnesses and accidents.

Running is the most efficient source of aerobic exercise, hence its popularity. But only to a certain point. Approximately 15-20 miles per week appears to be ideal — shorter distances and varying speeds are healthier for your heart than endurance running.

Learn more about how much exercise is best for your heart.

Concerned about your heart health? Find the heart care you need today.

Here’s How Running Affects Your Heart

It’s no secret that running is a great way to stay in shape. Pounding the pavement, trail or treadmill provides many bodily benefits, including keeping your heart in tip-top condition. We took a deeper look at what running does for your heart and the risks it can pose, too.

A Healthier Heart

Running’s impact on the heart has long been studied. In 1985, one study concluded that “Regular runners have slow resting pulse rates and a high maximal oxygen consumption.” Echocardiographic studies have also shown that distance runners have “larger, thicker left ventricles and their hearts are more efficient than those of sedentary people, pumping a larger volume per beat.” This phenomenon is called “Athlete’s Heart,” and is a result of intense cardiovascular workouts. No matter the number of miles you log each week, it all adds up to a lower resting heart rate, lower bad cholesterol in your blood and lower blood pressure.

How Running Keeps Your Heart Strong

Most of us know that muscles get stronger with exercise. When we exert ourselves, little tears form in our muscles and are then repaired during periods of rest, with muscles coming back stronger than before. Because your heart is a muscle, the same rule applies. Just like your other muscles, your heart needs time to recover. Experts recommend alternating hard runs with easier workouts in order for your heart to grow stronger. But heed this warning: Without that rest, some studies suggest that excessive endurance exercise can actually damage the heart.

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Small Amounts of Running Pay Off

You don’t need to go out and run thirty miles a week in order to help your heart. In fact, a 2014 study from the Journal of American College of Cardiology found that people who ran just 30 to 59 minutes a week—just a few minutes each day—decreased their risk of cardiovascular death by 58 percent when compared to those who don’t run at all.

Studies also show that runners live on average three years longer than people who don’t run. And you don’t have to be a fast, or even a regular runner, to reap these benefits. If you’re looking to add years to your life, running is the answer.

The Risks of Running

Whenever a seemingly fit runner has a cardiac event while running, it makes the news and stokes rumors that running is to blame. The fear of damaging a healthy heart, or finding out too late about a previously undiscovered heart condition, can be enough to make a would-be runner shy away from the sport. But what are the real odds of experiencing cardiac trouble while running?

While there is evidence to suggest that your likelihood of having a sudden cardiac arrest is higher while running, the overall likelihood of this happening is very small. Still, make sure to pay attention to your body while running. If you feel chest pain, shortness of breath or heart palpitations, make sure to stop running and seek medical attention.

Most ran 30 miles per week or more.

The researchers had each of these runners fill out detailed questionnaires about their training routines, as well as their general health history and habits.

Then they scanned the runners’ hearts to look for atherosclerosis.

Sixteen of the runners proved to have no plaque in their arteries at all. The rest had some deposits, with 12 displaying slight amounts, another 12 moderate levels, and 10 having worrisomely large deposits of plaques.

When the scientists compared the men’s running histories to their scan results, however, they found little relationship between how much they had run overall and how much plaque they had in their arteries. Those men who had run the greatest number of marathons did not tend to have less, or more, arterial plaque than the men who had run fewer races, indicating that extreme running itself had not increased the severity of heart disease.

On the other hand, a history of heavy smoking and high cholesterol was linked to greater levels of plaque, especially in the men who had begun running later in life.

The good news was that these findings suggest that years of hard running had not harmed the men’s hearts, says Dr. William O. Roberts, a professor of family and community medicine at the University of Minnesota, who led the study, which was published in Medicine & Science in Sports & Exercise. Indeed, all that running probably helped to keep some runners’ arteries clear.

But the exercise also had not inoculated those with a history of unwise lifestyle choices, especially smoking, against developing heart disease.

“You can’t just outrun your past,” Dr. Roberts says.

Of course, this study was relatively small and focused on Caucasian men with the physical, economic and psychological wherewithal to run competitively for years. Whether the results apply equally to other people and other sports is unclear. (Dr. Roberts and his collaborators published a small study earlier this year of female marathon runners that found almost no plaques in their hearts.)

Running and heart attacks

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