In this video, Rohin Francis, MBBS, discusses the potential ramifications of extreme exercise.
The following is a partial transcript of this video; note that errors are possible.
Francis: Can you be so fit that you die? I asked that question in the second ever video I uploaded to this channel, but today I want to ask a slightly different one, which is, can you be so fit that you don’t die, but you have significant health problems? That previous video, which really was my rollaway success — it’s all been downhill since then — concerned cyclists that pushed their bodies so far that they actually placed themselves at risk of death due to a combination of a very slow heart rate and thick blood prone to clotting.
But the key point here is that in the case of elite cyclists, professionals in the 1990s particularly that I was talking about, they achieved this kind of superhuman state with drugs and that if you don’t take performance-enhancing drugs, you’re not going to develop that pasta sauce blood. But does that mean that extreme exercise in the absence of drugs is completely safe? That’s what we’re going to answer in today’s video.
Now, statistically, I don’t think many professional cyclists are watching this channel, but I imagine lots of you are keen on getting out on your bike, just like I am — probably you’re far more serious about it than me — or you’re keen runners or swimmers. As I said, I’m on holiday in India right now and when I go running around the local lake in the morning, I have got loads of company, and lots of people exercising.
We’re seeing an increase in popularity of Tough Mudders, Survival of the Fittest, and all these kinds of races, so I think endurance sport is going through a popular phase right now, which is fantastic. Some of you are doing enough exercise to qualify you as an athlete in medical terms or perhaps that describes a loved one, so this video is for you. Indeed, I have had a lot of requests for this video because there have been some scary headlines in the press that too much exercise is harmful. I think this message is now quite widely believed, particularly in sort of sports circles, but how valid is it?
For those of you that haven’t watched the channel before, my name is Rohin. I’m a consultant cardiologist in the U.K. and I’m going to be focusing on the cardiovascular system. I will mention the musculoskeletal system too, but for reasons that I think are probably fairly clear, you know about the skeletal system already. Because if you’re running so much that you’re damaging your knees, you know about it, it hurts. But with the heart, sometimes it’s not obvious if any damage is occurring until much later, and the videos that I found about this either massively oversimplify it or they’re just plain wrong. I want this to be useful, and I have also divided it up with chapter markings below.
Let me start by clearly stating one thing because I know what you jokers are going to put in the comments, you lazy bums. “Oh, exercise is bad. I knew it. That’s all I needed to hear, doc. Thanks for the warning. Back to the couch for me. Can’t be too careful.” You’re not funny, okay? Exercise is flipping amazing. It has such a multitude of benefits, not just on your heart, but mental wellbeing, diabetes, blood pressure, chronic pain, and cancer risk. These are all based on good evidence. The list goes on and on.
The general recommendation in most countries is half an hour of moderate exercise 5 times a week, which could be as simple as walking, or half an hour’s more vigorous exercise 3 times a week. If you go from sedentary … and let’s be blunt — I think a lot of people these days do qualify as having a sedentary lifestyle through no fault of our own. Office jobs, where they are working from home or sitting in a cubicle, have proliferated in recent years and so we do tend to spend most of our time sitting still. If you go from sedentary to building in any form of regular exercise, you will reap incredible benefits because there is probably nothing else you can do in your life to improve your health more, aside from maybe giving up smoking.
Now, please don’t take up smoking just so you can quit it. It doesn’t work like that. Exercise beats any other activity for its overall effects on health. Until we discover a way to age backwards, it’s the king. It’s definitely more useful than any particular diet your favorite influencer claims made them so attractive. I made a whole love letter to exercise in the form of a video, which you can watch here.
Now, almost 90% of Americans don’t do enough exercise. Fellow Europeans, I know we like to look down our noses at the Americans when it comes to food … and we’re correct to do that. Their food is terrible. But when it comes to obesity, the U.K. is leading the charge to catch up with the U.S. — it’s not that far behind — and Europe is also not faring so well. When it comes to exercise levels, I was surprised that it’s pretty similar across the board. Exercise is good and you should do it. Disclaimer out of the way.
But if exercise is a wonder drug, and it is, does that mean that more of a good thing means more rewards? Well, as with any drug, you can probably guess that’s not the case. You need to aim for the optimal dose — and we talk about exercise dose in the literature — because sometimes that enjoyment becomes an addiction. The euphoria that exercise can produce can make you exercise more and more. Even those of us who don’t compete at a high level, we use apps like Strava, step counters, Apple watches, wearables, and so on, new ways to quantify our own exercise and compete not only with ourselves, but each other.
Of course, excessive exercise can cause other issues like the musculoskeletal effects that I mentioned earlier: sore knees, Achilles tendinitis, tennis elbow, and a chafing bum. I know all of this from bitter personal experience. I completely trashed my knees by 10 years of training several times a week on a very fast, hard athletics track in my youth when I was a serious 400-meter runner. Even many years later, I ran a half marathon about 6 years ago and that took my right knee out, honestly, for about 3 years.
Musculoskeletal problems, of course, dominate strength training, but we’re focusing on EEE, extreme endurance exercise. I’m talking about the marathon runners, the triathletes, the ultra swimmers, the iron men and iron women, the iron people who live in a primitive iron age society where they evolved Nike Vaporflys before the ability to talk about anything except running. We get it, Dave. Stop telling me about it.
Rohin Francis, MBBS, is an interventional cardiologist, internal medicine doctor, and university researcher who makes science videos and bad jokes. Offbeat topics you won’t find elsewhere, enriched with a government-mandated dose of humor. Trained in Cambridge; now PhD-ing in London.
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