Cycling Wednesday: What makes these people tick?

It was a tough pill to recommend. I prescribe it only in unusual cases.

The patient didn’t want it, and I wished there was another option.

But in this rare case, a very bitter elixir was a necessity.

What therapy could be this bad?

Recently, I had to tell a patient—whose life revolved around physical fitness—not to exercise.  At least for a short and finite period, I suggested that she rest her heart.  Saying such wasn’t easy for me. It goes against one of my most strongly-held tenets: withholding exercising is nearly always a bad way to treat an ailment. Plus, I’d hate that treatment for myself.

In medical practice, however, exceptions to the rule are…the rule.

The patient reacted to my advice viscerally: her tanned skin turned pale, her gaze went south, and I could see her Adams-apple shift when she swallowed. The news wasn’t Cancer, or ALS, or something of the like, but a soundless video of her reaction would have suggested it was equally bad news.

As a lifelong exerciser and confessed exercise addict, I know these people. They exercise regularly, as a matter of normal life. Close the pool or take their bike away and they would run. Put them in a closed space, like the one depicted in Emma Donoghue’s Room, and they might do as Jack did: run in circles at their “threshold” heart rate. If they couldn’t run, they would learn to walk on their hands—anything to agonize their cannabinoid receptors.  (How ironic is that; cannabis and exercise both activate the same receptors in the brain.  No, I’m not going there.)

What is different about the biology of this uncommon cadre of humans?  For them, unlike the growing majority, regular exercise is as vital as breathing, sleeping and eating.

How did they get like this?  Is it nature? Or nurture?

Obviously, genetics play a role. Football parents make kids that are good at football, while long-distance running parents make kids who run cross-country.

But it’s clearly more than just genes.

Countless numbers of masters-aged athletes get “saved” from expanding waistlines and lowT levels by their mid-life discovery of exercise. Many can remember how and when they were transformed. They started, and then something clicked. For some unknown reason they stuck with it. Exercise and healthy living became their norm.  They reached a “tipping point,” never to relapse back to their previously sedentary lives.

We study 100 year-olds in an effort to better understand aging. I suspect that studying the biology of the exercise-dependent would shine a bright light on our epidemic of inactivity.

Yes, that would be a science project.

JMM