Health and Fitness
Striking Health Risks of Extreme Running
Science says too much of anything could be bad for humans. What could we do?
Implications of long-distance, intense, and frequent running
Running was almost killing me. It was my daily ritual, so I got addicted to it. In hindsight, I can see the reason for my unsubstantiated passion. I was addicted to a silent killer.
Running has a robust hormonal effect. So, in addition to fitness goals, it is part of the ritual for some of us. And for some, it is therapeutic.
Unfortunately, many people died from running. Ironically, these deaths occur with the intention of better health and longevity.
I am not against running. I was one of the long-distance and intense runners once upon a time. I used to run very long distances when I was younger, and I loved it for various good and bad reasons.
However, I had to give it up due to some noticeable side effects in my life. The main reason for this was excessive inflammation in my joints. I also experienced several side effects that I explained in the section reflecting my perspectives below.
Some people thrive on running, and good for them. However, some people develop side effects and suffer pain.
Movement is an essential health requirement for humans and animals. Animals do it naturally. They don’t create fitness regimes, sophisticated programs, and contests for exercise. They just move to survive using their instincts.
We humans have a different approach. We add our thinking, feelings, and emotions to exercise. Therefore, we create complexity to the extent of risking our health. While it is good to use cognition and feelings to design and implement our workouts, we face some risks. Unfortunately, running is one of these regimes.
The purpose of this article is not about whether running is good or bad but focusing on what science says about the risks of long-distance, frequent, and intense running. From my understanding, the problem with running comes from performing it too often, too quickly, too long, and too intense that can be against our nature.
In this story, I point out some interesting and valuable studies giving us helpful perspectives on running. As a result, we can learn the risks and make better-informed decisions about running if we are into it.
Running is not just physical activity, but it also has psychological effects. It is related to hormones and neurotransmitters. Hormonal aspects of running make running a more complex workout hence it creates controversy.
Some health experts tout the benefits of running, and some ask us to refrain from long-distance running, especially as we age. I don’t keep anything aside and only present to you what I found from credible studies.
The common belief amongst runners is that you will be immune to heart attacks if you run a marathon. And even medical professionals believe in this myth. I use the term myth carefully, as there is no study proving this claim.
At least I haven’t seen one. But, if there is, I want to know and am happy to change my view on this. This doesn’t mean the idea is correct. I remain open-minded.
As a positive aspect of running, we know that long-term runners can have bigger heart muscles. This is because they have larger arteries and more capillaries pumping more blood.
The health and psychological benefits of running are positive. More interestingly, these benefits usually overwrite risks and potential dangers. Even though the chances are lower, they still exist.
This article published in New York Times was an eye-opener for me in the 1980s. The article’s title is “JAMES F. FIXX DIES JOGGING; AUTHOR ON RUNNING WAS 52”.
Mr. Fixx wrote the best-selling book The Complete Book of Running in 1977.
He contributed to the fitness revolution by popularizing running and jogging. However, he died of a heart attack while jogging at 52 years of age. Many follow-up articles later discussed the lifestyle factors and genetic predisposition for his early death. There was no conclusive finding.
Before looking at the details, when we look at the big picture logically, we can hear the alarm bells. First, it is essential to understand that we are not machines. We are biological constructs.
The human body needs to create energy to meet demands. The biological energy system is very complex. Producing biological energy takes a lot of steps and requires time to process. It does not operate like the energy generators of machines.
We know that people die during marathons. It is not too common, but there are some shreds of evidence for this claim. Some cardiologists believe that we are not born to run but to walk.
It makes sense when we closely look at our biology and millions of years of history through anthropology. Before providing some studies, I’d like to share my experience with running.
My experience with running
I ran for over a decade with the hope of losing my belly fat. During that time, it was the only viable option for me. I followed low-fat diets to speed up fat loss as advised by conventional wisdom at the time.
The advice was “to eat less and move more.” This logical advice made perfect sense to me when knowing nothing about the hormonal effects of fat loss.
This approach worked to some extent but not as I expected and desired. While I lost a lot of weight, especially in the form of valuable muscles and even precious bone density, my belly fat always stayed the same and even increased over time. Running caused me to be half dead.
Through trial and error, I learned that fat loss had nothing to do with calories but a lot to do with hormones. As I pointed out in this article, fat loss revolves around the anabolic hormone insulin.
Once I learned to fix excessive insulin secretion and reduced elevated cortisol with moderate exercise, I lost substantial belly fat with less stress. It was a sustainable solution for me.
And with the contribution of resistance training and HIIT (High-Intensity Interval Training), I managed to have a defined body after the age of 50.
More importantly, I maintained lean muscles with a low body fat percentage. This transformation was like coming back to life again.
When I was running with a low-calorie intake, I was skinny but with a bulging belly that affected my confidence and well-being both physically and emotionally at that time.
I also experienced severe joint paints and excessive inflammation markers that discouraged me from continuing to run.
As pointed out in a paper published in the International Journal of Sports Physical Therapy, Iliotibial Band Syndrome (ITBS) is the second leading cause of pain in runners.
Nowadays, I only focus on joyful exercises for my physical and mental health.
We are all different, of course. Some people thrive with extensive cardio. It is good for them. Too much cardio with too few calories did not work for me.
I feel obliged to share this significant experience as it may give perspectives to people suffering from the side effects of excessive cardio and low-calorie diets.
Common risks associated with long-distance and frequent running
Let’s leave out the aesthetic aspect and other points, instead focus on the health and longevity aspects of running.
Running is supposed to increase longevity. But does it?
One of the contributors to longevity is moderate exercise. After a particular amount of activity, we do not attain longevity goals. It plateaus. Finding the correct dose appears to be the secret to longevity goals.
Cardiologists (heart health experts) have several concerns related to the risks of long-distance and frequent running on cardiovascular risks.
Troponin Complex
One of the concerns for cardiologists is the “troponin complex”.
What is the troponin complex?
The troponin complex relates to two regulatory proteins that are integral to muscle contraction. They are skeletal muscles and cardiac muscle. They don’t relate to smooth muscle. Research studies indicate that running marathons can be associated with increases in serum cardiac troponin levels. Let me share some relevant studies.
A study published in the International Journal of Emergency Medicine confirms that “troponin increases were relatively common among marathon finishers and can reach levels typically diagnostic for acute myocardial infarction”.
In addition, “less marathon experience and younger age appeared to be associated with troponin increases, whereas race duration and the presence of traditional cardiovascular risk factors were not. Further work is needed to determine the clinical significance of these findings”.
Ventricular Tachycardia
Another concern for cardiologists is ventricular tachycardia.
According to the Mayo Clinic, “Ventricular tachycardia is a heart rhythm disorder (arrhythmia) caused by abnormal electrical signals in the lower chambers of the heart (ventricles). This condition may also be called V-tach or VT. The chaotic heartbeats prevent the heart chambers from properly filling with blood. As a result, our heart may not be able to pump enough blood to our body and lungs.”
Some symptoms of ventricular tachycardia (according to the Mayo Clinic) are:
“Dizziness, shortness of breath, light-headedness, feeling as if the heart is racing (palpitations), and chest pain (angina). The article points out that ventricular tachycardia may last for only a few seconds, or it can last for much longer. We may feel dizzy or short of breath or have chest pain. Sometimes, ventricular tachycardia can cause our heart to stop (sudden cardiac arrest), which is a life-threatening medical emergency”.
When I checked the medical literature, I noticed many studies were conducted related to ventricular tachycardia. Therefore, I only introduce a couple here and link some fundamental research in the reference section.
While moderate endurance exercises (aerobic) improve the condition of ventricular tachycardia, excessive activities, especially when our bodies are not adapted, may create risks.
According to this paper published in the American Journal of Physiology-Heart and Circulatory Physiology, “Sudden cardiac death resulting from ‘ventricular tachyarrhythmias’ remains the leading cause of death in industrially developed countries, accounting for between 300,000 and 500,000 deaths each year in the United States.
Another research paper published in Sports Medicine titled Sudden Arrhythmic Death During Exercise: A Post-Mortem Genetic Analysis points out that:
“Sudden cardiac death is a natural and unexpected death that occurs within one hour of the first symptom. Most sudden cardiac deaths occur during exercise, mostly as a result of myocardial infarction. However, some cases, especially in the young, are diagnosed as cardiomyopathies or remain without a definitive cause of death after the autopsy. In both situations, genetic alterations may explain the arrhythmia”.
Myocardial infarction means blockage of blood flow to the heart muscle.
A study titled “Intense sports practices and cardiac biomarkers” is published in Clinical Biochemistry. It points out that:
“Biomarkers are well established for diagnosing myocardial infarction, heart failure, and cardiac fibrosis. There are indications of higher cardiac risk in poorly trained athletes than in well-trained athletes. Whether regular repetition of intensive exercise might lead, in the longer term, to fibrosis and heart failure remains to be determined. This review summarizes the leading research on the effects of intense exercise (particularly running) on cardiac biomarkers (including troponins, and natriuretic peptides). The study found that cardiac fibrosis biomarkers seemed to be the most informative regarding the biological impact of intense physical activity”.
Hundreds of studies go into detail about these conditions. Unless we have a few Ph.D. degrees in cardiology, physiology, and sports medicine, it can be tough to see the big picture.
However, I found a meta-study more useful to have better conclusive results for exercise regimes. Like anything in life, it is all about moderation. Finding the correct dose produces the optimal results.
The typical moderation wisdom is depicted in this study published in the Journal of the American College of Cardiology, titled “Dose of Jogging and Long-Term Mortality: The Copenhagen City Heart Study”.
Physically active people have at least a 30% lower risk of death during follow-up than inactive ones. However, the ideal dose of exercise for improving longevity is uncertain.
The study findings suggest “a U-shaped association between all-cause mortality and dose of jogging as calibrated by pace, quantity, and frequency of jogging. Light and moderate joggers have lower mortality than sedentary non-joggers, whereas strenuous joggers have a mortality rate not statistically different from that of the sedentary group”.
While coach potatoes have high risks of cardiovascular disease, so do the extreme runners trying to complete marathons in the shortest time with high intensity and too frequently. We need to find the U curve for exercise. It boils down to moderation.
A critical view from a credible cardiologist
I want to share what a reputable cardiologist and athlete says about running using his medical knowledge and his own intense exercise experience in a TED Talk.
Dr. James O’Keefe Jr. is the Preventative Cardiology Fellowship Program Director and the Director of Preventative Cardiology at Cardiovascular Consultants at the Saint Luke’s Mid America Heart Institute.
Here is the summary of the talk for readers who don’t have time to watch the video: Dr. O’Keefe’s main message is it is time to change our thinking about exercise.
Dr. O’Keefe points out that the fitness patterns for conferring longevity and robust lifelong cardiovascular health are distinctly different from the patterns that develop peak performance of marathons and superhuman endurance. Extreme endurance training and racing can take a toll on our long-term cardiovascular health. It may be best to have more fun and endure less suffering for the daily workout to attain ideal heart health.
Please enjoy.
A comment attracted my attention in this video.
“Great research! I’m one of those marathoners who doesn’t want to hear it, but I need to. I adore running. Longevity obviously matters much more, though. Thanks a lot for the bad news!! Lol!” Source
Conclusions and Takeaways
Exercise is essential for our health and overall well-being.
We know that the dose makes a difference in exercise, nutrition, fitness, medication, and supplementation. So, consumption of anything in very high doses can create health risks.
Too much exercise can cause oxidative stress. Too much good nutrition can cause imbalances, high doses of medication can cause health complications, and high amounts of supplements can create adverse effects. Nothing is new in this view.
Running appears to have health risks such as cardiovascular diseases, inflammation, and injuries. But, if running is risky, so what could be the alternatives?
According to many health experts, gentle movements like walking, yoga, gardening, and swimming can benefit long-term health, fitness, and longevity. In addition, these mild and moderate impact workouts can be less risky than running.
My preference for fitness is calisthenics and moderate weight lifting. While running caused me muscle loss, calisthenics and lifting helped me gain lean muscles. As a result, my fitness improved, and my body got a better definition.
The best body shapes are observed in bodybuilders, gymnasts, and short-distance sprint runners using HIIT (High-Intensity Interval Training).
The body composition and definition of long-distance runners and other exercise enthusiasts such as bodybuilders, gymnasts, calisthenic athletes, and short-distance runners give us clues on sustainable workouts.
These athletes have different body shapes. For example, bodybuilders, calisthenic athletes, and gymnasts spend their energy on resistance training such as weightlifting and calisthenics. Many gymnasts don’t usually run long distances either.
Muscle and low-fat percentages determine body shape. We need both in the right balance. Too much muscle with too much fat does not show attractive body composition. Too little fat and too little muscle produce the same undesirable structure. Good body composition is made up of lean muscles and with low-fat percentage.
However, cardiovascular, muscular, and skeletal health (preventing injuries) are more important than body composition for long-term health, fitness, and longevity.
Despite the risks, some people love running. Some are even addicted. Running for some resembles using drugs due to its hormonal effects.
In this case, as this paper titled “Mortality during marathons: a narrative review of the literature” points out, millions of community-dwelling individuals run marathons each year. There are infrequent deaths, often reported widely, and may create unnecessary alarm about the potential risks. Equally, sensible planning for such eventualities is essential when staging an event. The risk of death from participating in a marathon is small. Men are more at risk than women. Deaths tend to occur later in the race.
Knowing the risks and planning activities looks like a sensible approach for runners.
Thank you for reading my perspectives.
Please note that this story is not health or fitness advice. I shared my personal experience and reading from the literature for information purposes only. If you have symptoms of health issues related to fitness and exercise, particularly running please consult your primary health care professionals, physiotherapists, or training coaches.
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References from the Literature
Injuries in runners; a systematic review on risk factors and sex differences
Running and Knee Osteoarthritis: A Systematic Review and Meta-analysis.
Running Dose and Risk of Developing Lower-Extremity Osteoarthritis.
Risk and Protective Factors for Middle- and Long-Distance Running-Related Injury.
Kinetic risk factors of running-related injuries in female recreational runners.
Exercise addiction and its related factors in amateur runners.
Calf muscle strain injuries in sport: a systematic review of risk factors for injury.
An epidemiologic study of the benefits and risks of running.
Prevalence and incidence of low back pain among runners: a systematic review.
The relationship between the use of running applications and running-related injuries.
Benefits and risks of running among women: an epidemiologic study.
Meta-Analyses of the Effects of Habitual Running on Indices of Health in Physically Inactive Adults.
Management and prevention of bone stress injuries in long-distance runners.
Can the “Appropriate” Footwear Prevent Injury in Leisure-Time Running? Evidence Versus Beliefs.
Reasons and predictors of discontinuation of running after a running program for novice runners.
Bone health in endurance athletes: runners, cyclists, and swimmers.
Is Participation in Certain Sports Associated With Knee Osteoarthritis? A Systematic Review.
What are the main risk factors for running-related injuries?
Development and Prevention of Running-Related Osteoarthritis.
Effects of running retraining on biomechanical factors associated with lower limb injury.
Youth Distance Running: Strategies for Training and Injury Reduction.
Running and Osteoarthritis: Does Recreational or Competitive Running Increase the Risk?
Acute changes to biomarkers as a consequence of prolonged strenuous running.
Risk Factors and Protective Factors for Lower-Extremity Running Injuries A Systematic Review.
Factors related to the incidence of running injuries. A review.
Influence of midsole hardness of standard cushioned shoes on running-related injury risk.
Please note that this story is not health advice. I shared my perspectives and experience for information purposes only. If you have related health conditions, please consult your healthcare professionals.
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