Ask a Fitness Dweeb

Dear Fitness Dweeb,

I read somewhere that I should always do my weight training before my cardio. Do you agree?

Justin D, Asheville, NC

Dear Justin,

I doubt it matters very much. According to the CDC, more than 60 percent of U.S. adults don’t get the recommended amount of physical activity, which is 150 minutes per week. Fixating on the order of your activities seems like gilding the lily to me. I will say that doing cardio first might help you warm up, which can prevent injury when lifting weights.

Dear Fitness Dweeb,

OK, I get that you work out a lot. So I’m wondering: do you still have some clothes that fit too tight, and/or some that are baggy?

Whitney P, Santa Monica, CA

Dear Whitney,

Sure I do! Don’t stress if you have this issue. It’s not you, it’s the clothes. Some stretch, some shrink, and even if we’re fit our bodies still do change over time. For example, my suit pants are super tight … I must have been biking up a lot of hills when I had them tailored. But I’ve also got these jeans that I’m practically swimming in, so having those fit better will be a nice silver lining when I gain some weight at some point.

Dear Fitness Dweeb,

During these short, dark, cold winter days my husband works out indoors on his bike trainer, and it’s almost scary to watch. He’s thrashing around with such intensity, and breathing so hard, it’s like an act of violence. Should I be worried? Could he have a heart attack or something?

Kim A, Berkeley, CA

Dear Kim,

As long as your husband is in good shape and warms up properly, it’s probably harmless. It could be that to reach his desired intensity he just needs a super high cadence, or resistance, or both. Maybe he’s working through some stress. See how he is afterward … if he seems mellower, that hammer-fest could be exactly what he needs (click here for details). As far as heart attacks, these do afflict sedentary people who suddenly exert themselves too intensely (for example, every winter you hear about people suffering heart attacks while shoveling snow). There is also some anecdotal evidence of ultra-fit athletes having heart problems, but I don’t think that’s widespread … click here for details. (I’m no real authority, of course … everyone is advised to consult a medical doctor before embarking on a fitness regimen.)

Dear Fitness Dweeb,

Walking is so low-intensity … does it even count as exercise?

Charles D, New York, NY

Dear Charles,

Any activity is better than nothing. Sure, you’ll be better off if at least some of your exercise is vigorous, and if you’re trying to lose weight intensity will definitely help. But it’s so simple to go for a walk, even if you have only 5 or 10 minutes, and it’s such a nice way to shift gears, get some air, etc., it would be absurd to denounce it. I use walks as a way to keep a perfect track record of getting activity every day. Even if you don’t get a chance for a proper workout, it’s never too dark, rainy, or cold to get out for a quick stroll.

Dear Fitness Dweeb,

I’m trying to increase my exercise consistency. Some of my fittest pals tell me the trick is gamification—that is, using a scoring system and/or friendly competition as a way to motivate them. They mention Strava, Zwift, etc. Do you employ gamification and if so is there a specific platform you recommend?

Brad H, Austin, TX

Dear Brad,

In general, I have found gamification to be very powerful. I haven’t tried Zwift (until recently, I thought it was a floor mop of some kind), nor am I on Strava. From what I’ve seen of Strava, it looks great for budding athletes because improvement over time can be very motivational. But as much as I exercise, age is slowing me down year by year, and in the Bay Area where I live there are so many dedicated bike racers, getting a KOM or even a top 50 would be pretty difficult. But regardless of age, level, talent, etc. you can totally employ DIY gamification. This could be as simple as sticking a gold star on your calendar for each day you exercise.

I have a really cool DIY gamification scheme. I host a quarterly online contest with over a dozen participants, all friends or family members, using a shared online spreadsheet. Here’s how it works: we simply enter the duration of our activity each day, and select the activity type from a pull-down menu. The spreadsheet calculates a score based on the difficulty. Here’s a snapshot (click to enlarge):

Formulas, graphs, etc. do the rest. The contest works really well for a lot of us, being very fun and motivational. The youngest participant is 17, and the oldest is almost 85. All but two of us are at or above the CDC exercise guideline, and three of us have more than tripled it. I’m happy to share the spreadsheet template—just email me here. (For what it’s worth, I used to do a far more complex contest that rewarded high intensity, based on heart rate, which led to absurd levels of fitness and suffering as detailed here.)

Dear Fitness Dweeb,

Given how much time you apparently spend exercising, do you ever contemplate what your regimen is displacing? In other words, what are you giving up to worship at the altar of fitness?

Laura M, Minneapolis, MN

Dear Laura,

I have contemplated this, but not at length, because for me it is an article of faith that exercise is worth making time for. I suppose there are insanely busy people, like the scientists who developed the COVID vaccine, or single mothers working two jobs to feed their families, who really cannot afford the luxury of daily workouts. But for the rest of us, trying to reduce exercise hours would make sense only after first cutting back on all the time wasted indulging in clickbait, binge-watching video entertainment, and being glued to the 24-hour news cycle.

Dear Fitness Dweeb,

Why do you settle for such an unflattering moniker? Don’t you feel demeaned? Why not “Exercise Advisor” or something? Just curious…

Rob R, Topeka, KS

Dear Rob,

When I first pitched this column to my editor, I proposed something like “guy who actually exercises.” He laughed in my face and said, “Sounds pretentious, which is especially annoying coming from a dweeb like you.” He reluctantly agreed to let me do the column, but only if I called myself The Fitness Dweeb.

Dear Fitness Dweeb,

My girlfriend wants to get an e-bike, not just for commuting but for actual exercise. If the point is fitness, isn’t an e-bike kind of like putting an escalator or moving walkway in a health club? Can you set her straight?

Monica L, Phoenix, AZ

Dear Monica,

Actually, I disagree with you. If an e-bike makes your girlfriend more likely to exercise, it’s a good thing. We all have to fight our natural aversion to unpleasant duress, and if that one big hill on her route is just too much to face before or after a long workday, why not get a little help surmounting it? I tried out a friend’s high-end electric-assist road bike once, and it was a total blast. I was still pedaling, still working, but I just flew along; more than anything, it made me feel young again. My impulse wasn’t to loaf; it was to go even faster. Look, when you compare cycling to a truly difficult sport like running or swimming, it could seem like the bicycle itself is cheating. Where pedal-assist bikes are concerned, I say go for it. (But that other kind of e-bike with no pedals, that’s like a scooter … forget it, that’s just a vehicle.)

Dear Fitness Dweeb,

Do you get a lot of hate mail?

John P, Detroit, MI

Dear John,

Of course I get some negative feedback, but most of it is positive. Here are a couple of recent comments:

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Dear Fitness Dweeb,

I am an avid runner but don’t have the ambition to do any races. Can you suggest some S.M.A.R.T. goals to help me improve over time?

Jill M, Lafayette, CO

Dear Jill,

To be honest, even when I was a pretty serious bike racer, I didn’t put much stock in long-term goals. As detailed here, that approach covers the rest of my life as well. I think that devoting myself to the process, without worrying about where that might take me, has always been enough. For example, instead of worrying about next year or five years out, why not just make each run as fun and challenging as you can? More recently, I’ve concluded that SMART (i.e., specific, measurable, achievable, relevant, and time-bound) goals might be the worst kind. As I describe here, when setting long-term goals such as New Year’s Resolutions, I favor DUMB ones: duplicate, unimpressive, mealy-mouthed, and best-effort. For example, my goal for this quarter is to try again to beat my brother Geoff in the humble online contest I described earlier … and if I fail, who cares, because it means he got a lot of exercise too! All this being said, if you want extra motivation for your running, maybe sign up for a Fun Run that’s longer or hillier than what you normally do.

Dear Fitness Dweeb,

After a workout I feel so good, I’m already looking forward to the next time … but then when the next time comes around, I find I’m dreading it. What gives?

Thomas B, Seattle, WA

Dear Thomas,

I struggle with that myself, and have for decades. It’s just the way we humans are wired, I’m afraid. But as I describe here, it may be possible to mitigate this dread a bit by making sure your workouts aren’t too long or too intense. In the moment, when we’re caught up in all the adrenaline and endorphins of a great workout, we’re often tempted to dig deeper and/or go longer, which is all well and good until we viscerally recall that experience later, when the adrenaline and endorphins have worn off. Then we seem to mainly remember the brutality of it. So I make a point to keep my regular workouts more reasonable, to exercise self-compassion, and to save the big efforts for when I ride with friends (i.e., when I struggle to keep up).

Dear Fitness Dweeb,

I had a gym membership for years because I thought shelling out the money for it would make me actually go … but it didn’t. So now I’ve quit, and I’m thinking hey, maybe I can put the money I’m saving toward something else, like nice gear, that can help motivate me to work out. But part of me thinks that might just be throwing good money after bad. What’s your take? Am I just being crazy?

Sarah D, Portland, OR

Dear Sarah,

No, you’re not crazy. Obviously spending money on fitness doesn’t guarantee results, but if any of your gear isn’t up to snuff, and thus makes your workout less fun, by all means replace it. Are your shoes completely comfortable? And given how much rain Portland gets, do you have the all-weather gear (i.e., groovy technical fabrics) you need? I have zero regrets about the super-cool bike wheels I bought a few years back, and I’m already dreaming of a new yoga mat that’s long enough that I don’t clonk my head on the hardwood floor during the full-body stretch…

The Fitness Dweeb is a syndicated journalist whose advice column, “Ask the Fitness Dweeb,” appears in over 0 blogs worldwide.

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Can Too Much Exercise Damage Your Heart?

Introduction

I get a lot of bike-related articles in my e-mail, mostly via my bike club.  When I get an article from two separate feeds, I know it’s something big.  So it was with a recent front-page story in Velo magazine, “Cycling to Extremes.”  (I read the online version, available here.)  The subtitle:  “Are endurance athletes hurting their hearts by repeatedly pushing beyond what is normal?”

What is normal?  Alas, for American adults “normal” is almost nothing; a CDC survey found that nearly 80% of adult Americans get less than 2.5 hours of exercise a week.

But forget about averages and those who don’t exercise.  The point of this Velo article is that ageing endurance athletes—i.e., guys like me—seem now to be in danger.  The article declares, “In the case of endurance athletes who have competed for years — whose hearts have exceeded the threshold of normal heart rates for decades — going above what is normal defines them.  But it may also be killing them.”

In this post I examine the reactions of my pals to this disheartening article; indulge in some knee-jerk denial; examine some other anecdotal evidence; evaluate the article’s claims on the basis of the literature cited; and (perhaps most importantly) provide a scheme for greatly advancing the study of exercise-induced heart complications among the middle-aged.

 Reactions

My first reaction to seeing this article was, “Oh, crap.  I hope nobody forwards this to my wife.”  (She’s the designated worrier of the family, which leaves me free to pooh-pooh everything.)  But then, I’ve got people depending on me, so I thought I better take the article seriously.  First I looked at how my pals were reacting.  “Hummmm....this is a little scary,” one e-mailed.  Another replied, “Yeah very scary.  I routinely get dizzy when I get up - something that’s happened my whole life but” and here his e-mail ended abruptly.  (Had he collapsed mid-sentence?)  One guy mentioned an athletic 50-year-old pal who suffers from a heart issue like what’s described in the article.  Other responses:  “I have to admit, this article gave me pause, especially the way I like to ride bikes ... hung over, and hammering as hard as possible,” and “Alas, all along I thought I was doing something good for myself.”

Of course it’s tempting to deny the whole thing.  The article has some serious flaws—which I’ll get to in a minute—and I almost shrugged and thought, “Typical FUD, designed to sell magazines.”  But I resisted the urge.  After all, just because an article is flawed doesn’t mean its central assertion is false.  Besides, I respect the cautious position my pals have taken, and this isn’t the first time I’ve pondered the mystery of brilliant athletes suddenly dropping dead.  The article mentions two marathoners who died while running, and I also recall Matt Wilson, a local rider who died while cycling in 2011, and Steve Larsen, a guy I raced with as a junior, who died while running in 2009.

Never mind that my own heart has behaved perfectly my whole life (at least, as far as I know).  It’s possible I’m doing damage now that will only become a problem in ten years.  After all, I know guys who have smoked for years but don’t have lung cancer.  Yet.

I mulled over this article for about a week and a half, and just when it was starting to drift toward unconscious dismissal, I mentioned it to a cycling friend (my age) who said, “Oh, yeah, someone told me about that but said maybe I shouldn’t read it ‘cause it might bum me out.”  Why would it?  Turns out this guy has had a heart problem for some time now:  he’ll be riding along, just cruising, and suddenly his heart rate will go from like 140 up to over 200 and stay there for 30, 40 seconds.  Uh oh.

The “lumping” problem

My chief difficulty in deciding how much to worry, and whether or not to change my approach to cycling, is that of “lumping.”  Is it right to lump myself in with the guys cited in the article, and with the marathoners, and with Steve Larsen?  Is it right to lump runners in with cyclists?  And is it right to lump various heart problems together and treat them like one phenomenon?

Let’s take that last question first.  The Velo article uses two case studies to make its case:  Lennard Zinn, who while bicycling suffered symptoms of “his heart [flopping] like a fish” and beating way too fast; and Mike Endicott, who collapsed and lost consciousness during a cross-country ski race.  Was Endicott’s heart also racing?  Well, not at first.  Endicott’s words:  “Something was beating inside my chest.”  The Velo writer describes it as “his heart still doing something strange inside his chest” which led, after an hour or so, to ventricular tachycardia and “an immediate, unexpected loss of heart function.”  This seems a lot different from what Zinn experienced.  Were these two suffering from the same specific heart problem?  It’s not clear.

The article states that Zinn was diagnosed with multifocal atrial tachycardia, but Endicott’s exact diagnosis isn’t given.  The article talks a lot about atrial fibrillation (AF):  is this the same as tachycardia?  Again, it’s unclear (though this FAQ suggests not).  Moreover, the main study the article cites concerns “myocardial fibrosis, a condition that involves the impairment of the heart’s muscle cells, called myocytes, through hardening or scarring of tissue.”  Does myocardial fibrosis lead to tachycardia and/or fibrillation?  Do Zinn and Endicott suffer from myocardial fibrosis?  Once again, the article doesn’t say.

It’s not just this article that’s vague about this stuff.  I did a tiny bit of research on Steve Larsen’s death, and turned up something surprising:

Google’s big-font summary makes it pretty clear this was a heart attack—but it wasn’t, according to the first article cited.  Nothing else has been written to further clarify this matter; the autopsy itself apparently ruled out heart attack.  And yet people seem to remember it as such.  Two years after Larsen’s death, when I was corresponding with a friend about Matt Wilson, my friend wrote, “Steve Larsen was the guy who had a [fatal] heart attack two years ago here in Bend.”  Meanwhile, I’d always remembered Wilson’s death as having been from a heart attack, but in researching this now (for example, here), I can find no specific cause of death.

A dearth of data

Let’s get back to that Velo article.  My temptation, when presented with such ambiguity, is to read the research articles on which the article is based.  But the article, while making lots of vague references to unnamed studies, doesn’t provide much.  For example:  “Over decades of exertion, the myocardial cells of the heart begin to simply fall apart, and you’re left with an unhealthy ticker. Or so these new studies suggest.”  And:  “Long-term endurance exercise results in a five-fold increase in the risk of developing AF.  A review of the relevant research finds many small studies that correlate long-term sports activity with AF....  While none is conclusive, collectively they indicate a pattern.”  What studies?  What relevant research?  There are no citations given here; no footnotes; no hyperlinks.

The article does cite two specific studies.  One involved rats, and I’m going to dismiss that.  (My heart is bigger than a rat’s; rats don’t live 40 or 50 or 60 years, which is the age group I’m trying to learn about; humans cannot be made to exercise as hard as rats.)  Velo also cites a study published in The Journal of Applied Physiology:  “MRI studies revealed that some 50 percent of the veteran [>50-year-old] athletes had myocardial fibrosis....  In age-matched controls — people of the same age who didn’t compete — and young athletes, there were zero cases of the disease. Furthermore, the fibrosis was significantly associated with the number of years spent training, and the number of marathons and ultra-endurance marathons they had completed.”

Okay, now we’re getting somewhere!  I looked at the study itself to get more information.  You can read it here.  My big issue with this study is that it only included 12 veteran athletes.  Of these, 2 had previous heart conditions (1 probable previous mycarditis, 1 probable previous silent myocardial infarction).  The Journal study is candid about its limited scope, acknowledging that “Like many studies of this type, the numbers of veteran athletes are small (largely because this is a small and unique population), and generalization is difficult.”

And yet, without the ability to generalize, what are we supposed to do with this (largely anecdotal) information?  My frustration is that I feel I ought to evaluate and possibly modify my own behavior based on these cautionary tales, but I have no solid basis for assuming that my behavior matches the profile of the overworked athlete who may be damaging his heart.

Velo addresses this problem of definition by quoting Dr. John Mandrola, a heart rhythm doctor:  “What’s too much? That’s the $64,000 question. Though I will say it’s a little like what the judge said about indecency: ‘I know it when I see it.’”  Well, this just doesn’t do me much good, because I’m not about to go to Kentucky to visit this doctor, in the absence of any symptom of any problem.

I see four possible ways to respond to this information. 

1. I could completely ignore it—but I think that’s irresponsible. 
2. I could simply err on the side of caution, and ride less often and less hard than I currently do—but isn’t this completely arbitrary, since somebody who rides twice as much as I could similarly tone it down “a bit” and still be riding way more than I? 
3. I could continue riding exactly how I currently do, while adding myocardial fibrosis to the pile of things I regularly worry about (which will increase my cortisol levels to the detriment of my health) while feeling guilty for being such a poor custodian of my body.  No thanks. 
4. I can try to get more information about this, with a whole lot more data, so I can more reasonably evaluate and (if necessary) modify my behavior.

Number four wins, and that’s where my proposed solution comes in.

The solution

We need more information!  We need more than two anecdotes and a lot of vague references to “these new studies” and “the relevant research.”  We need more than studies on rats, and we need studies of more than 10 veteran athletes.  By “we” I mean “society,” and actually society is already really, really good at harnessing massive amounts of data and crunching them to derive useful judgments.  Think of how effectively Amazon predicts what we’ll want, and how well the advertising industry can anticipate, and create, our desires.  What if we could find a ready source of “big data” for studying the effect of gonzo endurance athleticism on heart health?

But we have it already!  It’s called Strava!  This social network has 8 million registered users, of which 1.2 million are active and something like 190,000 have premium accounts.  (These are estimations since the company doesn’t reveal these numbers; click here for details.  Suffice to say, this is a lot deeper pool of data than 10 test subjects.)

 The number of Strava users isn’t even the best part.  It’s the quality of the data set.  Consider the type of athlete who goes so hard, and so long, and so often, that he or she is actually at risk of causing heart damage.  How many of this type wouldn’t be on Strava?  The gung-ho Strava cyclist is exactly the kind of person who might overdo his or her training.  In other words, Strava members comprise the perfect group for studying this stuff. 

I’m envisioning a splash screen that pops up when the Strava user logs in.  It asks, “Are you willing to participate in an anonymous study about heart function and rigorous aerobic exercise?”  I’d guess most users wouldn’t have a problem with this.  And anybody who’s having heart trouble would probably be eager to participate, to better understand it all, and could indicate the nature and frequency of his or her problem.  Such a study could quite feasibly have millions of workouts per day to crunch (the average workouts logged per day being around 6 million last year, as detailed here).  You’ve got your control group and your heart-oddity group both covered, right off the bat.

And what great data there’d be to crunch!  You get exercise frequency; exercise duration; heart rate; and history (e.g., how much a rider’s performance is improving or deteriorating).  You could start to develop very precise profiles of those whose hearts are misbehaving.  Is there an age threshold beyond which these symptoms most commonly present?  Are there frequency, duration, and/or intensity thresholds below which no errant heart behaviors are observed?  What is the rate of heart trouble for riders exactly my age, who ride (on average) just as often, and in exactly the same heart rate zones I work out in?  Of those who work out like I do but who are 10 years older, how many have developed heart trouble?  Five years from now, when we see an even more comprehensive integration of “big data” into our lives, we’d probably have even more ways to correlate the data.  (We might know, for example, whether frequent purchases at Starbucks or BevMo factor in to the cardio health equation.)

Conclusion

For now, I’m going to assume that the hectic pace of my life, my many familial obligations, my relative sloth, and my unaggressive riding style will keep my heart in good shape.  I’m not going to bother shopping my Strava idea around, because I’m confident  that the Strava folks themselves, looking for a way to actually make some money, are bound to get the attention of the insurance people, who I assume are always looking for ways to avoid open-ended batteries of complicated tests.  I envision all of this happening without any effort from me, probably years before I start getting into the dangerous years where my heart starts “doing something strange inside [my] chest.”  And if you want to forward this link around to speed up the process, please be my guest!