CW: Writing about the science of exercise

It is risky.

Stay fresh. Avoid repeating yourself. Don’t rant. Never preach. These would be the ‘rules’ of supposedly good blogs.

And, of course, doctors that dare to take a stance on health issues risk being perceived as pretentious. I get this.

So it is with trepidation that I write a follow-up to last week’s CW post about right ventricular damage immediately after an extreme race effort. Notwithstanding the pompousness concern, I also wish to avoid being labeled anti-exercise. Few believe more strongly in the healing powers of exercise.

But last Wednesday’s comments (both on the blog, Facebook and here on Dr. Val Jones’ BetterHealth blog) were just too good to let rest.

On the assessment of studies:

One writer, a friend and fellow endurance cyclist, asked about the ‘full text’ availability of the study in question. His point is well taken. When it comes to evaluating science the details are important. Reading the entire study, especially the ‘methods’ section, allows one to better judge a trial.

In the overwhelming majority of cases I read the entire study before making any public comments. I am extremely fortunate to work at a hospital that still chooses to maintain a medical library and librarian. (Quality measure here?) Within hours, my hospital library can email me a PDF file of a study. But it would be illegal for me to publish this on the Internet without permission from the journal. Readers may be able to get the full text copy from a University or Public Library. (Or of course, one can pay for full access.)

What’s my motive when writing about exercise and science?

It’s simple. I love exercise. I like to compete. Training with a goal helps me. I also love learning. As a heart rhythm doctor, I live a paradox: on the one hand, I spend a good part of my office day reassuring staff, patients and other doctors that the human heart is tough and durable. (It beats 100,000 times per day and in most cases, tolerates much of what patients and doctors put it through.) But on the other hand, I see a steady stream of over-achievers present with heart rhythm problems. Why? How? Is it genetic; or was the late Dr Fisch right when he said chronic exercisers were simply using up heartbeats, which of course, is just another way of saying “wear and tear.”

My motive? Call it, curiosity.

My quest to avoid preaching:

In the category of writing about prodigious exercise and folly, I feel highly qualified to opine. I have made the dumb mistakes:

1. Running myself into nearly every overuse injury possible. (For years, I could almost recite the chapter on running injuries in the biblical-length Lore of Running.)
2. Having endured–many times over–the agony of sudden deceleration when crashing my bike. That’s inflammation!
3. And yes, I have even ‘tri-ed” myself into the medical tent–more than once.

Ah, all these mistakes spring from the common amalgam of being gifted with only average mitochondria but a headstrong ethos that believes: if you ride as much as Lance, you should be able to ride like Lance. This, my friends, is a dangerous combination, which if not treated, may transform regular people into Iron people.

And these would be only the exercising errors. As a fellow human sharing the same over-scheduled world, I, too, struggle with executing healthy behaviors. Things like getting enough sleep, eating too many sweets and being too quick to anger are just a few of the unhealthy habits that give me fits.

As a doctor, I know the plan. As a bike racer, I have felt the plan’s power. As a scientist and learner, the evidence backing the plan intrigues me. But as a human, I often trip while striving for personal bests.

So, please don’t mistake my words for sanctimony.

Lastly…

On how much exercise is too much?

Here, I concur with commenter, DrD, who smartly stated the answer is unknowable. He goes on to offer that Ironman is clearly too much, while, what the majority in the US do each day is too little.

The main reason for not knowing the exact ‘best’ dose of exercise lies in our diverse human make-up. We are all so different. As in using medicines: what’s too much for one patient is not enough for another.

That said, I can offer this admittedly far-too-simple Mandrola trifecta on dosing exercise:

• If health and longevity, not racing across America, is your goal, 30-90 minutes of daily exercise, which incorporates aerobic (cardio), strength and flexibility movements seem most logical.  “Exercise each day that you eat.”
• The best exercise is the one that can be sustained and embraced over the long-term. Think fun.
• Ask yourself this simple question after exercising: Did the endeavor enhance or detract from your life force? (Confused: Go visit a medical tent at a Marathon or Ironman and ask the patients athletes.)

We all have different goals for our health. That’s okay.

As a doctor who believes in patient-centered medicine, my goal is to educate well, then let patients choose what’s right for them.

It’s the same for the blog.

JMM