A recent study touted the heart health benefits of training for and completing a marathon. But is doing an event as extreme as a marathon really the best way to good heart health?
In January 2020, a new research paper from the Journal of the American College of Cardiology suggested that running a marathon for the first time could have several health benefits. Specifically in the realm of reversing age-related aortic stiffening, which occurs when the elastic fibers within the arterial wall (called elastin) begin to fray due to mechanical stress. This is generally associated with increased cardiovascular disease risk factors and aging.
The purpose of the study was to “determine whether real-world exercise training for a first-time marathon can reverse age-related aortic stiffening.” And, spoiler alert—it did!
The study concluded that training for and completing a marathon reduces central blood pressure and aortic stiffness. Even at relatively low exercise intensity, the changes observed were the equivalent to a ∼4-year reduction in vascular age. Even greater vascular rejuvenation was observed in older, slower individuals.
These findings spawned all kinds of sensational headlines like “Want to turn back time? Try running a marathon” or “Ready For Your First Marathon? Training Can Cut Years Off Your Cardiovascular Age.” Those headlines aren't untrue, but they're still telling a different story than I'd like to see them tell.
But before I get into that, here's a story that may explain why I was so attracted to the idea of writing this article.
Back in December of 2003, I got a bit of what was likely viral gastroenteritis (a stomach bug) and was off work for a few days, staying close to the washroom at home ... if you know what I mean. But eventually, I got so sick that the infection moved into my pericardium (the sack around my heart). I had inflammation of the pericardium or pericarditis.
When I first arrived at the hospital, the medical personnel drew some blood and told me they were concerned that I might have had a heart attack. They sent me immediately for an angiogram. It was there that they deduced that it was not an infarction (blockage) but rather an infection that was causing the chest pains, shortness of breath, and sweating.
I spent some time in and out of the hospital over the next one and a half years. During that time I had a recurrence of the pericarditis, was diagnosed with an arrhythmia (called Wenckebach), tested positive to a tilt table test (pictured to the right), and nearly had a pacemaker installed. (Is that the right word for it—"installed?" Maybe it's "implanted.")
At the end of it all, thanks to Dr. Williams, an astute cardiologist who I can never thank enough, I walked away with a completely clean bill of health. But after that much fussing and fretting, I struggled to align my mental health with my physical. Eventually, Dr. Williams suggested in passing—and I will never forget this—“You know what you need to do? Run a marathon or something to prove to yourself that you are indeed okay!”
So I did.
I honestly have no idea if he meant that comment. Looking back, he probably didn’t mean that I should literally run a marathon. He probably meant it metaphorically. But I took him at his word and now, 17 years later, I have run nearly 70 races of one variety or other, and I rarely think about my heart ever.
Did I need to run a marathon?
So, there's my story. A then there's the study I brought up earlier that showed completing a marathon (even at relatively low exercise intensity) reduces central blood pressure and aortic stiffness. Given all that, was I smart to follow my doctor’s offhanded remark? Is that why I am around today to tell you this tale?
Well, no, I don't believe so.
The researchers in this study used a cohort of 138 healthy, first-time marathon runners from both the 2016 and 2017 London Marathon. The would-be marathoners were examined before they began their training and after they completed the marathon to determine if age-related aortic stiffening was reversible with “real-world exercise training.” Let me highlight that it was “real-world exercise training” that they were after. Put a pin in that for a minute.
The participants were 37 years old, 51% were women, and none of them had any significant past medical or cardiac history. The researchers tested all the participants before their six months of training began and then repeated the tests three weeks after completing the London Marathon. This is important because we know that running 42.2 km (or 26.2 miles) leaves some short term cardiac complications which could have confounded their findings.
The participants were given blood pressure measurements and measurements of aortic stiffness by cardiovascular magnetic resonance imaging (MRI). And if you're wondering, biological aortic age is determined by the relationship between the participant's age and aortic stiffness at three levels of the aorta.
Some physical activity is highly beneficial in the prevention and treatment of many prevalent chronic diseases, especially of the cardiovascular system. However, chronic, excessive, sustained endurance exercise may cause adverse structural remodeling of the heart and large arteries.
So at this point, it seems like a great idea to run a marathon, but here’s the rub. Other studies have shown that a daily routine that includes some physical activity is highly beneficial in the prevention and treatment of many prevalent chronic diseases, especially of the cardiovascular system. However, chronic, excessive, sustained endurance exercise may cause adverse structural remodeling of the heart and large arteries.
In fact, it is suggested that any individual considering extreme endurance exercise efforts like marathons, day-long aerobic races, or any other activity that elevates cardiac output continuously over several hours, get regular tests done to screen for ischemia (inadequate blood supply), exercise-induced arrhythmias, or CAC scoring (a measurement of the amount of calcium, or hardening, in the walls of the arteries).
Is exercise enough?
So, in a nutshell, the folks in the study who were categorized as “untrained healthy individuals who were training for and completing their first marathon,” saw a benefit from doing some training. But if they were to keep that level of training up for a few years they may see “adverse structural remodeling of the heart and large arteries.”
Why do we have to be so extreme? Why are we narrow-mindedly focusing these wonderful benefits on running such a long way?
And that is my objection right there. Why do we have to be so extreme? Why are we narrow-mindedly focusing these wonderful benefits on running such a long way?
The participants in this study were encouraged to follow a "Beginner's Training Plan" provided by the London City Marathon organizers themselves. This plan consisted of approximately three runs per week that, like any good training plan, increased over time in the three factors that are necessary for building fitness: distance, duration, and intensity. So when you break it down like that, was the magic in the marathon or was the magic in taking some untrained healthy individuals and getting them exercising regularly?
As I mentioned earlier, I don’t have a problem with marathons or a vendetta against them. I have done many of them and I train people to complete them as well. What I do have a problem with is the message that to reap the wonderful health benefits, like the ones outlined in this study, that we have to sign up for an expensive event, train hard for 6-months, participate in said event and, if we want the effects to last, start the process all over again.
It's all in the messaging
If you want to run a marathon, great! Hire me as your coach. But wouldn’t a better message be one that preaches an active lifestyle? I think it's important to choose a movement style you enjoy—and let’s face it, many people don't enjoy running—and then be consistent with that movement. You'll participate because you enjoy it, not because you think you need to take it like some kind of cardiovascular medicine.
The truth is, simply going for a walk is the gateway to better health for many people.
Too many people I work with end up not doing any exercise at all because they figure if they can’t complete a marathon or attend a CrossFit WoD (workout of the day) five times a week they would rather choose nothing over failure. Or they do sign up for a life-changing workout program and then get injured quite early on. This is unfortunate, especially when the truth is that simply going for a walk is the gateway to better health for many people.
Then after you have done that for a while, try some stairs and hills. Then maybe some bodyweight exercises or yoga in your living room. Get a secondhand bike and start riding around your neighborhood. Go for some hikes on the weekend or do gardening for your neighborhood. If you listen closely, this sounds a little like the training plan the marathoners from the study were on—get regular exercise with a slowly escalating level of difficulty. It's a lot less intimidating and potentially much more fun.
As for me, I'm glad I followed my cardiologist’s advice and ran that marathon—not because it bestowed me with super hearth-health powers but because it expanded my view of what I was capable of. At this point in my life, though, I'm perfectly content to never run that far all at once again. But I am very excited about doing my morning mobility exercises, working at my standing desk, taking some fun and energizing movement breaks each hour, and doing my beloved bedtime yoga routine to keep me mobile and happy.