What happens to your body during an ultra marathon

[Ito Jakuchu]

A link about what happens to your body during an ultra marathon, but I figured it might be interesting for people into fast packing, speed hiking as well. I haven't had time to really go through this right now, but wanted to share nonetheless. Might be quite interesting, might be a lot of wrong info. Check it out: link

[Jennifer Mitol]

That was pretty good Just keeping my motivation going for my training for a 100-miler for my 50th bday!

[W I S N E R !]

Speaking as someone who has done ultramarathon events on foot and on bicycle and has also had severe issues with atrial fibrillation (which I have since had an apparently successful surgery for), I have spoken to numerous cardiologists about this topic and have done hours and hours of reading… Every cardiologist I've worked with has extensive stories of patients presenting with various arrhythmias after extreme endurance events, primarily Afib, Vtac, and Atrial Flutter. They also have numerous cases in which troponin I and troponin T were found in elevated levels after extreme endurance events (these proteins indicate the onset of heart damage when released into the blood). Not marathon distances typically, but ultras and full Ironman type events. Those I've spoken to suspect that these sort of events can cause scar tissue accumulation in the heart that ultimately interferes with electrical signals. I've since been cautioned away from these sort of events. Hiking all day and night, fine. But not a more highly elevated heartrate for hours and hours on end. My primary cardiologist said even running marathons is OK, but that the trouble seems to begin when people are out and going with high heartrate for 8, 10, 20 hours… It certainly something to think about. From what I understand, the research isn't extensive enough to outright sound an alarm bell amongst these sports because the percentage of the population engaging in these sports isn't high enough to get good data. But many are seeing a high enough correlation that cardiologists, including my own, are starting to warn people away.

[Art …]

Craig – I do hope you're doing ok these days. what constitutes a sustained elevated heart rate ? if long distance hiking is ok. many of us back of the pack ultra runners are probably moving at 60-65% of max in 100's. that's not much more than a fast walk really. I realize, like you said, the data is not all in yet.

[Peter Bakwin]

I'm 53 and have run 80+ marathons & ultras up to 140 miles, stage races, plus innumerable personal "projects" such as the JMT under 4 days. I have a family history of heart disease & have read the reports about heart problems from endurance exercise with great concern. But, so far no problems, thank god. I run & hike because I love being outdoors and the feeling of exertion. It's well documented that exercise offers more health benefits than just about anything (including protection against dementia!) My doc said 70% of wellness is related to lifestyle, 20% to genetics, leaving just 10% for medicine. I don't exercise because it's good for me, but because I enjoy it & the places it takes me. Fingers crossed for the next few decades!

[W I S N E R !]

That's a good question Art… I certainly don't know, nor was I given a definitive answer as to what constitutes a "sustained high heart rate"… As a fellow back of the pack runner it's a bit confusing because I certainly know of plenty of people that can maintain conversational jogging paces for hours and hours on end. Whether or not that's enough stress on the heart to cause issues….? Personally, I find the difference between sustained hiking and sustained jogging to be that my heart has far more down time during hiking and is still generally functioning at a lower rate. You may be pretty elevated while powering over a pass, but it quickly drops afterwards. I know the same is true for running, but I think we're still talking a potential difference of 10 to possibly 20% of max heartrate? I.E., if you're running at 60-65% of max, hiking will certainly be a percentage less. And maybe that's what makes the difference over the long term- a percentage of less stress. From what I was told by cardiologists, apparently intensity is not so much the issue, it's actually the duration (of course intensity AND duration are the worst). But one hour of high intensity is apparently not as much of a risk as 8 hours of medium intensity. Plenty of back of the pack athletes are having these issues, so it's not apparently a matter of the super-elites that are out there charging. But I guess the real question comes back to what personally defines "intensity" or "elevated" heart rate. Or how much is too much…. I can see why it's a difficult topic to get clear data on. There's also the question of being physically predisposed for these issues and ultra running simply being one of many possible triggers…which could be what we're seeing here.

[W I S N E R !]

Absolutely right though Peter, doing nothing is the greatest risk. That's why I'm certainly not quitting, just re-evaluating the duration/intensity question and seeing what happens. Not trying to scare people or be hyperbolic here. It's just something people should be aware of. Ultra type sports tend to attract the type that likes to power through their suffering….which is also likely the type that's going to ignore certain symptoms that could be an issue. That was certainly my case.

[Anonymous]

"I don't exercise because it's good for me, but because I enjoy it & the places it takes me. Fingers crossed for the next few decades!" Very well said, Peter. In the end, nobody gets out of here alive anyway, so live the life you were born to live and let the chips fall where they may. Never better expressed than below, IMO. Happy the man, and happy he alone, He who can call today his own: He who, secure within, can say, Tomorrow do thy worst, for I have lived today. Be fair or foul or rain or shine The joys I have possessed, in spite of fate, are mine. Not Heaven itself upon the past has power, But what has been, has been, and I have had my hour. "Happy the Man" by Horace, from Odes, Book III, xxix. Translation by John Dryden. Public domain

[jscott]

I had my first afib event after nordic skiing pretty hard for three days at–for me–elevation (7,000~ft–I live at sea level). I had been doing this for decades, plus swimming and hitting the elliptical pretty hard over that time as well. And of course backpacking at elevation a lot. There's no known cause for my afib events–but I suspect that pushing my heart rate pretty high for many years may be the underlying cause. (I've had an ablation and with luck the worst if past.) this is going to be different for everyone. I certainly didn't push my rate for 10-20 hours as Craig reports. But there have been quite a few studies on marathon runners and nordic skiers who operate at the back of the pack, as Craig says, that nevertheless develop problems. I seem to be being a bummer in my posts these days. I'm just going to suggest that people who push a 90% threshold for several days of the week for many hours at a time over years might want to think this through. Again, no one prescription fits everybody. It's just, you really really don't want to get into heart arrhythmias.

[Greg Mihalik]

Google "ultra running and heart disease" to find Many articles on this subject. Learn the difference between Absolute risk and Relative risk Learn the difference between Observational studies and Random Blinded studies. I suggest starting with a New Yorker Article to get a feel for how to look at this issue. And remember, we're all better off than the guy just exercising the remote.

[Mike M]

I had an unusual experience (turns out it wasn't unusual actually). Two days after a tough 65k I was scheduled for a routine health screening at work (if you went they reduced your insurance payments). A couple of weeks later they sent the results of the blood work, I had several numbers that were skewed- enough so it recommended seeing a physician. It hit me that just maybe it was the ultra that might be responsible, so a little digging on the internet showed several studies done on blood work pre and post ultra events (the post testing was done right after and then daily for a week). All of the numbers I had skewed, also showed skewed on the study- the good news is that within a week all numbers came into normal range :) but I think this upcoming season I'm going to sprinkle more of these races in and less at ultra distance.

[Art …]

Mike – if you're willing to share, which blood work numbers were skewed (I get pretty in depth blood work 2-3 times a year and am curious). if you'd rather keep it private, no problem.

[Mike M]

Art- I don't think I have it anymore, but I'll look. The only parameter I recall was bilirubin, but there were 2-3 more that were out of whack as well. When I googled it, sounded like it was pretty common and within days, maybe a week- all the parameters came back to normal. If I had the blood work taken a week after that event, I'm sure it would have come in normal- it's the only time I've had blood work done just after an event. Mike

[Peter Bakwin]

Nice New Yorker article. It points to 2 apparently different problems: heart attacks and arrhythmias like A-fib. For some reason the whole A-fib thing scares me much more & I sure wish there was better info on this. Everything seems to be entirely anecdotal. Cardiologists see people with heart problems, and if they see a lot of relatively young athletes (seems to be only men???) with A-fib they may surmise that this is a big problem. Yet, it may still be a small percentage of male athletes in that age category. One cardiologist in the article suggests these activities might increase your risk of A-fib to 1.5%. To me that's probably an acceptable risk, but it also sounds like a guess not based on hard data. Here people are saying the problem comes from running even slowly for many hours, while elsewhere I've read that regularly running faster than about 7 min/mile is a risk factor. Again, it seems like there just isn't the data to support firm conclusions. Personally, I know many guys who have been doing this stuff as long as or longer than me, but know of only 2 who have arrhythmias – one guy who was in his 50s and ran a lot of fast marathons (always under 3 hours) but not many ultras, and another guy in his 30s who developed V-fib after running only a few ultras. I have friends in their 60s who have done this stuff for decades and are fine. I myself started doing endurance activities in my teens. ??? Again, fingers crossed!

[jscott]

I'll just mention that when I brought this up on a nordic skiing forum, a fair number of the regulars mentioned knowing someone who was a racer that developed afib, or did so themselves. This is anecdotal. But I was somewhat surprised. Nordic pushes your heart rate big time. There have been studies that seem to establish a link with endurance exercise. The thing is, afib is poorly understood. My guess is that better studies are upcoming. Turns out I have two people with afib issues in my extended family, so there's likely a genetic component with me.

[Ito Jakuchu]

Thanks for sharing all your experiences. I would definitely not consider not doing long distances because of my heart, but it is interesting to read about. I always thought more that since the distance is so long, you're not pushing at such a high rate of your HRMax. Though at normal training I do during intervals. I like to keep my speed very similar no matter if I climb or not, just for the added push I need to give. Not sure it's the best way, but I like it. From the article by the way: "The lower intensity is measurable. Marathoners’ hearts often beat at 75 to 85 percent of their maximum heart rate for the duration of the race, Joyner said. That’s not a sprint, but it is a moderately hard effort. Ultrarunners, he said, spend a lot of time at 50 to 65 percent of their maximum heart rate, with elites on the higher end and the just-happy-to-finish folks at the lower end. This is probably a main reason heart problems show up less often during ultras than in marathons, according to Martin Hoffman, who has studied the medical side of ultrarunning as research director for the Western States 100-Mile Endurance Run." (I'm really not that efficient though. I'm at a lot of steep trails so I think my average is more around 65-70).

[Mike M]

I should also mention that in my new job I have to pass an annual physical, one test is a 12 lead eck (ekg)- they always ask if I'm a runner- low RHR (45-50) and something that shows up on the ecg- possible left ventricular hypertrophy- this could be bad or good, bad- hypertension, narrowing of arteries, poor elasticity, etc OR a condition, sometimes called "Athlete Heart" of the left ventricle that allows for a larger stroke volume based on endurance conditioning a followup with a echo cardiogram shows all is good :)

[matt kirk]

Interesting discussion. I'm in my mid 30s and a year ago almost exactly, I started having "episodes" where it felt like my heart was pounding at rest. Of course there's the positive feedback of adrenaline when the mind gets involved. Long story short, I went into doctor, had ekg, found a "right bundle branch block" (insert posive feedback!) Next up echocardiogram $$$, which finds nothing. Was going to start wearing an event monitor, but symptoms went away. Still a mystery. I do believe 2013 AT effort (serious undernourishment) had an effect on my health as did moving to FL where running in heat and humidity caused some scary side-effects (blogged about fall 2014 matthewkirk.blogspot.com) anyway, I should do more research myself, but appreciate input/articles as I explore sub-6 minute mid distance… Also don't plan to stop doing longer adventure runs… As mentioned: pros beat the cons! Heres to happy & healthy trails!

[Greg Mihalik]

"As mentioned: pros beat the cons! Heres to happy & healthy trails!" Provided genetics and/or pathology, where n=1, don't come into play. Due diligence, informed decisions, and all of that…

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