American author and cardiologist James O’Keefe on Run for your life! At a comfortable pace, and not too far at TEDxUMKC – Transcript
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James O’Keefe – American author and cardiologist
Great to be here. I’m a cardiologist, but before that, I was an exercise enthusiast. I’ve exercised, I bet, pretty much everyday of my life.
I had two grandfathers who were alcoholics. But for me, my way of coping with life is exercise. When I’m nervous, or anxious, or tired or, happy, or sad, or whatever, I exercise, if I have the time, and sometimes even when I don’t. You might have seen me in an airport, waiting for a flight, running up the down escalator with my backpack on, to kill 20 minutes.
But I always thought that exercise was the best thing for my heart, and I think it’s how I decided, at age 15, I wanted to be a cardiologist actually. But now that I am 56 [years old], and a lot of decades have gone by, I’ve started to have a few warning signs from my heart. A couple years ago I noticed this, and I got on a mission. I’m a research cardiologist, and I have a research fellow. And he and I have been working on this for the past couple years. And with the help of some of the brightest cardiologists from around the country, we had come to some startling new insights that seem to emerging about exercise.
This made me think twice about my lifestyle, and I’m worried I may have made a lethal mistake. I hope it’s not too late, but let me tell you the story.
So, as I said, I have been exercising for a long time. But if we go back 2,500 years, there was a guy named Pheidippides who ran the 26 miles from a battlefield near Marathon, Greece, into Athens to proclaim the news about a momentous victory over the Persians. When he arrived at the Emperor’s throne and said, “Victory is ours,” he abruptly collapsed and died.
Now, you may have heard that story before, but what you probably didn’t know is that Pheidippides was an accomplished runner. He’d been a Greek herald messenger his whole life. He ran a lot of miles everyday. I bet he was the fittest guy in Athens the day he died. That’s strange.
But now let’s go forward two millennia or more. When the Baby Boomers came of age, another boom happened: the running boom. If exercise was good for you as anybody could know, then more had to be better, and that was — the ultimate sort of test of running and endurance was a marathon. There was a physician who became famous back in the mid-70s by boldly proclaiming that if you could complete a marathon, you were immune to heart attack. This urban myth actually still holds sway with a lot of physicians.
One of my patients and friends is John. He is 68 now, but he’s been running for 45 years. As he puts it, if he hasn’t run 12 miles in a day, he felt like he was wimping out. When I saw him, he came into see me, and I said, John, let’s do a cardiac scan, a CT scan, simple, little, non-invasive, quick, high tech scan of your heart. Your arteries, I’m sure, will be soft and supple, clean and healthy. So that’s what a normal cardiac scan should look like: no calcium whatsoever in these arteries. His is over here; his score was 1,800. Anything above zero is abnormal, anything over 400 is severe; at 1,800, his arteries are harder than his bones! That can’t be good, and he didn’t have any other risk factors to speak of.
So in fact, people do die during marathons, but let’s be realistic. If you look at the latest data, the risk is minuscule: 1 in 100,000 participants. I’ve gotten to be friends with a guy named Amby Burfoot. Amby won the Boston Marathon in 1968. He is currently editor-in-chief and has been a long time editor at Large at Runner’s World Magazine.
In conversations we’ve had in recent months, he has challenged me. “If endurance extreme exercises are so bad, show me the bodies.” He’s got a good point; 1 in 100,000 is a pretty low risk. But I’m not so worried about that; running is supposed to add years to your life, and even life to your years. So, could it be shortening your life expectancy? I’m not worried about dropping into a risk, I am just trying to do the right thing, I’m a cardiologist, I’m in the business of finding out the ideal diet and lifestyle. And I’m coming to the conclusion that running marathons and extreme endurance athletics do not fit into that recipe.
So, that being said, let me be clear about this: there is no single step you can take in your life to ensure robust health and remarkable longevity than a habit of daily exercise. Okay, and this is a study of over 400,000 Chinese that was just published within last year. We published an editorial along with this afterwards, but they found vigorous exercise — this is all cause mortality reduction, the more reduction the better, and this is minutes of daily exercise, so 10, 20, 30 minutes of daily exercise. At 45 or 50, you get a point of further plateau, so further efforts and time do not appear to convey further improvements in life expectancy.
Down here is light to moderate exercise: walking, housework, day to day moving around; just get off your seat and move around. More is better there; it’s not quite as beneficial as vigorous exercise, but more is better. You can exercise all day it seems, without getting yourself in trouble if you keep it down.
So, one of my heroes, I love evolutionary medicine, I think if you look in the world of nature and into our deep past, you can find the template for ideal health, even in our modern world. Charles Darwin was wrong about one thing though: it’s not the survival of the fittest. In fact, it’s the survival of the moderately fit, OK? If the best you can do is walk one flight of stairs before you have to rest, things are not looking good. It could be a bumpy ride in the next few years.
On the other hand, if you can dance, or lightly swim, or you can even jog six miles an hour, that’s a ten minute mile, come on, that’s a pretty comfortable pace, right? Your mortality plummets, and if you, after warming up on a treadmill, can achieve a speed of 7 to 7.5 miles an hour, you are pretty much bulletproof, when you look at outcomes. And in fact, further attainments of peak fitness do not translate into further increases in life expectancy. It plateaus out. In fact, there’s even a little trend that it might even go up a little bit.
So, the important concept is that dose makes the poison. It’s true with a lot of things, all right? And if we could come up with a pill that gave all the benefits that we got from exercise, I’d be looking for work. In fact, exercise not only cuts your chance of premature death in half, but it reduces risk of heart disease, Alzheimer, osteoporosis, depression. It is an amazing drug. But just like any drug, there is an ideal dose range. If you don’t take enough of it, you don’t get the benefit. If you take too much of it, it could be harmful, maybe even fatal.
When you’re sitting here, listening, sitting around like most Americans do, doing nothing, your heart’s pumping, just idling along about a gallon a minute, about four, five liters a minute. If we went out, went for a run right now, and you ran hard, that would go up four, five or even six-fold. Five or six gallons a minute! That’s a workout, your heart is working hard, but that’s what it’s meant to do, intermittently. You know maybe a few minutes, 5, 10, maybe 30 minutes, maybe up to 60 minutes but by 60 minutes something starts happening: the stretch in the chambers starts overwhelming, the muscle’s ability to adapt, the catecholamine levels, the adrenaline levels rise, the free radicals blossom, and it starts burning the heart. It starts searing and inflaming the inside of your coronary arteries.
So we’re not really meant for these sustained levels of exercise for hours at a time. If you go to a marathon, and this has been done several times, you take a troponin level at the end of the marathon, over half of them will have elevated troponins. What’s a troponin? Troponin is a sacred chemical to us, cardiologists. When we see that a troponin goes up it means one thing: heart muscle has died. Normally, we hop into action because that generally means there’s a heart attack going on, we need to get a vessel open! In this case, these are little micro tears from the stretching and the searing, and it’s not a big deal if you do it once. These are little micro tears, they heal; a few days later it’s gone, the heart’s back down to normal size. But if you do this over and over again, and the chambers start dialing up, they get scarred, they get stiff, they get thickened.