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Comment by andrewstuart | Hacker News Reader

On the topic of how overexercise can damage the heart by James OKeefe, a cardiologist and lifetime obsessive runner:

Notably he points out that they tested people blood after doing long distance events and found that many of them had chemicals usually found in heart attack victims, indicating heart damage.

Basically he says that the long term overexercise/heart damage means the heart muscle constantly has microtears which heal up and the healed tissue is scar tissue which is hard and not like normal heart tissue - much harder and less elastic. So people who overtrain end up with a heart much older than their physical age.

https://www.youtube.com/watch?v=Y6U728AZnV0

Transcript:

https://singjupost.com/run-for-your-life-at-a-comfortable-pa...

Another video:

https://www.youtube.com/watch?v=9g8eEYwtfSo

And from another author on extreme exercise and the heart:

https://www.newyorker.com/tech/annals-of-technology/extreme-...

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I'm a big fan of walking. Unless you are literally wheelchair bound, most people can walk.

Most of us don't do enough of it and it's one of the safest forms of exercise. We really should be designing our cities and built environments to be more walkable so more people get in 30 minutes of brisk walking daily just from running errands without really trying to exercise per se.

People would be healthier. Pollution levels would be lower. Studies show that walkable, mixed use neighborhoods foster higher sales for local businesses and are thus typically more prosperous. "Eyes on the street" is a known antidote to crime and you get that primarily by having a pedestrian-friendly built environment.

And I don't believe walking has any track record of fostering heart attacks.

During lockdown, if allowed, a walk can be really nice. Some fresh air. Not sitting. Its a complimentary reason to get a dog (I don't like dogs, do like walking, so don't opt for one). Also, you can combine it with an audiobook, podcast, meditation (I got taught a mindfulness technique focussed on walking), music, or just the sounds of nature or the city. Or combine it with public transport, or an errand. My daughter is almost 3, she loves walking outside.

While you're right from an exercise standpoint, you're dead wrong from a design one, at least if you want to apply it broadly. A lot of us live in places where summer days can easily top 100 degrees, and the better part of the year it's just too darn unpleasant to walk outside. I suppose it's possible if one works at an office with showers and lockers to allow for changing clothes, but even then it's unpleasant and still unsuitable for everything else.

Historically, Middle Eastern cities were built on plateaus above the desert floor and streets were oriented such that prevailing winds cooled them. That plus other design decisions helped keep streets at tolerable temperatures during the day, even when it was above 100 degrees Fahrenheit out on the desert floor.

We have forgotten how to do that kind of thing, but that doesn't mean it cannot be done. There is a lot we can do to mitigate urban heat island effect and use design to make even our outdoor public spaces pedestrian-friendly in terms of local weather.

I'd like to read more about this, and just wondering if you could point me in the right direction.

I don't really have anything at my fingertips, but a quick google gets me this piece that looks decent on a quick skim:

https://halshs.archives-ouvertes.fr/halshs-00380121/document

I run r/UrbanForestry. It's brand new and we are likely to talk about passive solar design at the city level as part of what we do there. I already mentioned the thing I stated above about Middle Eastern cities. You are welcome to join us there.

Some terms that may be helpful in a search: Iranian vernacular architecture; desert vernacular architecture; passive solar.

It is something I hope to put more information together on, but one challenge is that I imagine a lot of primary source materials from that region of the world are not in English and I never learned any of the major languages of that area, like Farsi and Arabic.

I do occasionally speak with Middle Eastern planners and the like and ask them questions, but I haven't yet hit pay dirt in a big way. My recollection is that articles about Iranian architecture have generally been the most useful and promising so far. Iran was previously known as Persia and it is one of the older cultures on the planet and has a rich history.

Edit: I threw some more articles together here: https://www.reddit.com/r/UrbanForestry/comments/jhmmuz/the_d...

This is a lot of great information, and I'll check out that subreddit when I'm at a computer. Thank you!

That's a very good idea, until you realize how specialized the modern city is. How many people does a single supermarket serve? How many a bakery, dentist, bicycle shop, etc.? Walkable means about 2-3km away, and that's not as the crow flies. If you really want that kind of city, you end up with something pretty dense. Personally I would prefer a tad more space.

I live in a small town. America used to have a lot of thriving small towns with lively downtown areas. I am interested in seeing more support for that sort of thing.

Not everyone lives in the big city. Not everyone needs to. Even within the big city, there is lots of room for improvement.

And making it possible for more people to run some of their errands on foot doesn't mean "You aren't allowed to leave this 5 square kilometer area and can never drive or use public transit." It just means some of the things you do normally can be reached on foot (for a greater percentage of people than is true currently).

I should have mentioned that I live in europe. By US standards, our cities are extremely walkable. That being said, I have three super markets that I regularly buy from. Two of them are in walkable distance (when carrying few groceries). For the third, cheapest, I have to use either a car or a cargo bike.

If you start adding up how much of that space between you and your destination is parking lot space and not a building/home, you'll realize that you could still have some space in your home but have a business area that is not 70% asphalt with white lines.

There is no parking space between me and my usual targets that can easily be removed. The little parking space there is is part of the roads and removing it would consequently move the buildings far closer together, by about 2m out of 10m to 15m, I guess. I don't want to have the building on the other side of the road be 10-20% closer, I like my sunlight and some privacy.

All of the science I've been seeing lately in this area seem to say, 1. short-term high-intensity training (sprints, for example) and 2. weightlifting are the best forms of exercise for general health.

Running marathons and the like do not seem to promote health and can actually harm the body. And anecdotally, I've known a few folks that are obsessive long-distance runners and cyclists, and they physically look older than others in their age group.

Them looking older is probably just the gaunter look associated with endurance sports (low muscle mass, low body fat). It's especially noticeable in the face, where cheek & jaw bones will stand out. I happen to like the look; gives people's faces more character. Sun damage probably also contributes.

to add, the sports listed also typically involve long periods of sun exposure.

>Running marathons and the like do not seem to promote health and can actually harm the body.

I mean, the literal original Greek Marathon Runner who ran the 26 miles to warn of the war/invasion, according to lore, actually killed him upon his delivery of the message....

It was to announce the end of a battle.

Did it kill him?

Yes, it states so in the original article.

If you are training properly at running however, then you are doing high intensity exercise. The track repeats, the hill reps, they are that high intensity interval training, with easier runs the rest of the time.

The idea that running is just shuffling along at a steady pace is a straw man, and looks nothing like what actual runners do!

The whole point of HIT is that you get all of the cardiovascular benefits of endurance sports without the repetitive stress injuries.

And the current evidence is that your maximum exertion is what matters, not time spent exercising. So someone that does a few sprints, to max intensity, over 20 minutes actually will have better cardiovascular health than someone that runs or jogs for an hour or more.

If you’re sprinting at full exertion for a few minutes, you’re able to hit a much higher max than you would if you were running long distance.

GP's point is that long distance runners are also doing HIIT if their training is managed properly.

> The whole point of HIT is that you get all of the cardiovascular benefits of endurance sports without the repetitive stress injuries. And the current evidence is that your maximum exertion is what matters, not time spent exercising.

This cannot be true, it contradicts literally all the best training knowledge for distance runners. NCAA cross country coaches and professional distance coaches have their runners doing high mileage easy days and intervals on hard days, and as someone who has experienced this training first hand, you absolutely cannot do the hard days at a proper intensity if you haven’t built up your aerobic capacity through a LOT of easy to medium effort long runs. If they could get all the cardiovascular benefits from HIT, they would only be doing that. The teams that win college championships and the pro teams sending athletes to the Olympics are the ones with the fittest runners, the fittest runners are the ones with the best training. They are doing the majority of their mileage in long easy efforts.

Anecdotally, myself and many teammates I’ve known have seen our biggest jumps in performance come from increasing weekly mileage (more easy miles) and while keeping the volume of hard efforts the same. Time spent exercising matters very much.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6763680/

> HIIT (high-intensity interval training) and sprint interval training (SIT) for 6-8 wk increase VO2peak more than or at least comparable to MCT (moderate-intensity continuous training).

> The clinical and physiological benefits of HIIT compared with those of MCT are shown in Table Table1.1. In multiple RCTs, a wide range of targets, including skeletal muscles[19-22], risk factors[21], vasculature[19-22], respiration[22,23], autonomic function[24], cardiac function[20,22,25-27], exercise capacity[26], inflammation[27], quality of life[27], physiological markers such as VO2peak, and endothelial function, showed better improvements with HIIT than with MCT.

This is true even though the HIT groups were spending just minutes sprinting a few times a week, vs the MCT groups that spent 30 minutes to an hour running or jogging.

I'd love to see links to this research because it contradicts everything I know and have read regarding physical adaptations in our aerobic and anaerobic systems. Specifically, it is my understanding that you need the minimum effective dose in both to force those adaptations and then maintain them.

I'm naive in the space so take this with a grain of salt, but I believe the original Tabata study[0] showed comparable increases in participant VO_2 max compared to non-HIIT, with only a 4 minute workout.

Put that alongside evidence that sustained exercise (how sustained I have no idea) has negative effects (as per above comments), and the argument seems plausible.

[0] https://en.wikipedia.org/wiki/High-intensity_interval_traini...

I am familiar with the original Tabata study. I guess my point here is that it's been widely accepted, at least for the last decade or so (Dr. Maffetone was figuring some of this out in the early 80s, FWIW...), that HIIT (and strength training) cause concentric cardiac hypertrophy, whereas LISS primarily causes eccentric cardiac hypertrophy. I'm speaking very generally here, but... 1 increases the size of your heart, thus the volume of blood and therefore oxygen (it has to pump less to deliver oxygen to your muscles leading to a lower BPM), and the other makes your heart stronger (it can pump all of this extra blood). This is all of course a very unscientific explanation and I'm not an expert.

Training properly for long distance runs is different than training properly for high intensity runs. The two forms of exercise cause different adaptations. To get better at running long distances, one must run long distances.

I think we are talking cross purposes here. Training for running races, even long distances, involves some long running, lots of medium runs, and a good amount of intense work. Human physiology is complex and to get the most out of it, you have to train it all. If all you do is long runs, you will get nowhere near your potential. Marathon runners will regularly run 400m repeats on the track - speedwork helps in so many ways!

That does not make marathon healthy thing amd it does not make long distance running into HIIT.

It also doesn't mean it is unhealthy. And yes long ditance running itself isn't HIIT, but if you are training to race a long distance, you will invariably be doing a lot of high intensity work.

You might not call it Tabata training, or HIIT, but once a week you are probably doing 6x15second sprints, every other week will do something like 10x60 hill repeats (which others might call a sprint), and most weeks will be running some form of speedwork. This could be 8x800m/2 minutes, some form of pyramid (1min, 2min, 3min, 2min,1min, 2 sets), or some other combination. All of these though come down to going unsustainably hard for a short period and then having a recovery period. Is that not what HIIT is?

The same applies to many other sports where this simple caricature is applied. Most sports, done right, do involve high intensities, and recoveries.

I can concur, I've had family members who ran obsessively and they looked 10 years older than they were. They weren't causal runners, their lives revolved around running.

I'm surprised (okay, maybe completely unsurprised) just how much evidence keeps pointing me towards the same conclusion about how to maximize for a long, fulfilled life: all things in moderation.

The trouble with "everything in moderation" is that moderation is an ambiguous, catch-all term. It means different things to different people. It's the mantra of the obese and unhealthy.

Ultimately we strive for moderation, but ought not without consideration as to what it should entail.

Yes it is incredibly important to qualify what exactly moderation is. Which is why these studies are rather important.

The {sp?} Haji tribe in Africa walk ~30+ miles a day - and they are said to have the best heart health...

Imagine, a Japanese (mostly fish+seaweed) diet + walking 30 miles a day, and how healthy that pop would be...

citation for the tribe please. i can't find anything.

Here you go: https://www.theguardian.com/society/2017/mar/17/tsimane-of-t...

Hadza probably. Foragers.

Anecdote I was told by a hospice medic is athletic people's hearts tended to outlast their life, i.e. at the end the only thing going was their heart.

Also, there is supposedly a study showing 30 min of jogging 4 times a week halves a person's heart risk.

Serious competitors will accept any risk in order to win. That might not be ideal for long term health but look how many take PEDs despite the side effects. It's the same thing with intense training programs.

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