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Transforming the human heart with the best medicine

This is a short intro to my latest column over at Trials and Fibrillations on Medscape|Cardiology.


I am not sure why doctors so often look past the best medicine. It’s right there before our eyes. Yet somehow we get sidetracked by the culture of pills and procedures. Modern-day caregivers fail to master the obvious of the human condition.

Researchers from Dallas, Texas just published a beautiful study in the heart journal Circulation. It was a year-long study of 12 sedentary masters-aged subjects. The research team, a group of sports cardiologists, set out to show the heart’s adaptation to exercise turns on training load and not genetics. They did this, but they found so much more.

Tell me you don’t love their methods: The researchers gave the lucky twelve subjects free coaching for a year. The goal was to have them finish a marathon, Olympic-distance triathlon or century at the end of the year. Study subjects were given ze plan: Start slowly; build in longer workouts and intervals after a few months of base training; then start doing some races, long runs (or rides) and finish with high-intensity sessions. Micro and macro cycles of rest were also built-in. The twelve subjects underwent extensive cardiac and fitness testing along the way. For the data-driven exerciser, it sounded like a dream.

This was much more than just another intriguing physiology study.

Serial MRI scans showed the hearts of slackers started to look like those of elite athletes. Fitness testing also showed major improvements–though it is never true that training like Lance makes you ride like Lance.

The striking and surprising findings have major implications for how doctors help patients achieve health.

I hope you want to read more about this study and my thoughts on it. I made strong statements about “normal” commitments to health. Some of this opinion delves into how humans balance life’s expectations. Previously on, my take of lifestyle choices has brought harsh criticism. That’s okay. Achieving health and avoiding excess medical care and harm are important topics for a cardiologist. Surely these are worthy reasons to euphemistically kick the hornet’s nest.

Here is the title and link to the short post: Seeing Exercise as the Best Medicine . . .


4 replies on “Transforming the human heart with the best medicine”

So… athletic heart syndrome, remodeling, and dilation is a good thing for those with high blood pressure and arrhythmias like afib if they are a result of exercise? And exercise will make those two conditions unnecessary? And if the person with afib has a heart that looks like those exercisers, then more exercise makes the patient better? How do you differentiate good and bad remodeling in a patient that could potentially have HBP and exercise induced hypertrophy? Wouldn’t exercise potentially make things worse? I thought I understood these issues. Now I’m confused.

Great stuff, as always! I picture the nurse who called you a sanctimonious SOB for advocating such blasphemy – typing from her motorized scooter while smoking and eating a box of twinkies….(-;
At age 58 and wrestling with some of the maladies of life I have always believed movement to be critical – thanks for shining the light on a topic that is really, at it’s core, a public health issue.
For a great primer on this I would recommend the book “Younger Next Year” by Chris Crowley and his MD Henry Lodge. They detail their seven rules to put you on a course to live healthy into your 80’s rather than enduring the slide into chronic illness most older adults choose. Maybe not a conscious choice initially, but a choice none the less. Move!
Dr. Arthur Agatston – South Beach Diet fame – wrote a book entitled “The South Beach Heart Health Revolution” which details a plan to reverse the ravages of heart disease through diet and exercise rather than a surgeons scalpel.
Exercise creates inflammation. Pete asks what many feel right now; why do I have AF if I exercise? Seems almost cruel to be afflicted by this when you are at least trying. This is how I feel. I do know that exercise at any level I can tolerate will create inflammation, which can exacerbate AF. Confusing, I know. But inflammation at a low level – like the stress and bad habits of modern living is constant and incredibly destructive, leading to the modern afflictions many of us expect our doctors to “fix”. In order for the body to combat inflammation it must become inflamed at such a level that the body has no choice but to adapt and get healthy. This is really the magic bullet of exercise – tear down to cause the adaptations necessary to maintain health as the body repairs the damage caused by exercise.
Why do I have AF? Why did I wear out both hips by age 44? No idea, but those are the cards I have dealt to myself. I refuse to just sit in the chair and try to manage AF. My idea of a good time is to throw a leg over my trusty Stumpjumper and follow my son as we start on a 2000+ foot climb on a nice chunk of single track over a scenic lake here in Eastern Washington. I don’t drink anymore, I am shedding pounds – again – and doing my best to get some rest. I currently treat AF episodes with 50 mg of metoporol and usually convert withing 10 hours. Since I quit drinking beer my only trigger is….exercise! I have 2 consults next month to try and get on a track that will allow me to continue to live an active life.

I believe strongly in the restorative powers of exercise. Pete, I feel your pain. Moderation may be the key thing for guys like us, and that is a concept I’m not real familiar with…(-; Good luck.

The comments supporting lifestyle medicine are not too harsh. Since the vast majority of people are overweight, and 99% do not do sufficient activity (as evidenced by accelerometer studies, not self-reported ones), speaking the truth is now politically taboo. There are far more persons in the audience willing to boo and throw eggs and tomatoes at the messenger now. The population is seeking good news about bad habits constantly, and magic shortcuts, which is why Dr Oz can sell a lot of his raspberry ketones, pine nut and coffee bean extracts.

The corollary of your theme, that good health comes not from more health care but good living habits is that even if everyone received maximal doses of statins and procedures, the diabesity epidemic would continue, along with ASCVD. Since individuals are extraordinarily unresponsive to the message, as evidenced by the comments recently, and authorities are equally resistant, the future is bleak.

The truth needs to be reiterated by someone, so keep up the good work.

Hi Dr. John,

Do you feel there are a lot of cranks on various blogs spreading misinformation about coronary artery disease?

*Some say LDL is meaningless, others say atherosclerosis itself is not a disease , some say if we eat a “Paleolithic Diet” because our ancestors had no coronary artery disease etc.

Could you address the above examples and say whether you feel it is total nonsense?


Jane Sanchez

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