Just because the rigors of endurance athletics may be inflammatory doesn’t mean it isn’t fun…

A patient asks, “Doc, do you ride your bike to prevent heart disease.”

I reply, “Heck no, I am hoping to live long enough to get heart disease.”
The non-athletic patient looks quizzically at me as if trying to decipher what I mean, or whether I am serious.  Too long a story, so we move on to the medical problem at hand.
For too numerous reasons to drone on about, it is clear that bike racing does not promote longevity.  Take the results of the sudden decelerations that are ubiquitous to bike racing as a representative example.
I received many thoughtful comments, and specific questions on the cautionary note story. This week, on rides populated with many middle age riders, comments suggested my words are anti-exercise.
On the contrary, I am absolutely, totally, completely (however many adverbs in Thesarus.com there are) convinced that exercise is essential for good health.  Inactivity is akin to a slow growing cancer that degrades one over years.  You probably cannot read this in the Geriatrics literature, but I believe the single most important thing an older person can do for their well being is move–bunches.
There is a difference though, in daily exercise, and training.  I, like many others, love the sensations and camaraderie of bike racing (or swimming, running or nordic skiing.)  Like all other competitive sports, bike racing requires a lifestyle in which a rigorous formatted training program is essential. Herein is the catch.
Training for the rigors of racing requires extraordinary amounts, and intensities of exercise–or at least that is how most racers think and act. The amazing drive that bisects the fairway, perpetually rising till the ball leaves the limits of your vision, keeps golfers engaged in the pursuit of perfection.  Racers in pursuit of similar perfection will always think that the perfect training plan will guarantee success.  It just is this way.  And it likely always will be.
However, just because science is confirming that said mandated training is not healthier, does not mean I am against it.
I am for knowledge.  In medicine, all therapeutic decisions are like “Ys” in a road–left or right.  Us doctors are tasked with clarifying the pros and cons of each path, so that an educated patient can choose wisely.
My purpose in writing on the paradoxically increased incidence of arrhythmias and coronary calcium in athletes, is not to discourage training for endurance sports, but rather to point out that those who repetitively push their bodies to extraordinary wattage outputs–over many years–are not likely preventing disease.  Rather, these endorphin producing behaviors are–in some cases–promoting chronic inflammation which accelerates the aging process.  It’s ok, just know.
How much exercise?
Patients often ask how much exercise is enough. Who knows for sure?  There are the mind-numbing encyclopedic guidelines from many committees of experts, or the Thoreau-like simple rules from a master of the obvious who was trained in the evolutionary biology classes of a liberal arts college.
So, I tell “normal,” non-racer patients my simple rules for exercise…
Exercise should be daily, or almost daily.  It’s ok to exercise each day you eat.

Exercise should make you breathe hard enough so you can’t read a magazine simultaneously.

Exercise should be fun enough to be sustainable.

Exercise should give more life-force to you than it takes away.
JMM