Ultra-Marathons Might be Ultra Bad for Your Heart

           In today's fitness community, the majority of people believe that the more intense exercise someone does, the better the health. Many individuals feel obligated to hit the gym or the road to help lose weight and stay fit. As you can tell by all those 26.2-mile bumper stickers popping up around the country, the popularity of marathons/ultramarathons continues to grow. People who run ultra-marathons, compete in Ironman triathlons, ride long distances bike rides (Tour de France), or do excessive endurance exercise often experience heart damage and lethal cardiovascular effects.

           Over time, individuals who do long-running events are exposed to scarring of the heart and enlarged ventricles, which can lead to irregular heartbeats (arrhythmia) and sudden cardiac death. Thus, many ultra/marathon runners experience cardiomyopathy, which makes it harder for the heart muscle to pump blood to the rest of the body (Guglin, 2018). A study showed that long-distance runners usually have a dilated right atrium and ventricle through the use of an MRI (O'Keefe et al., 2012). Often when the right atrium and ventricle enlarge, there is an association of elevated blood troponins suggesting problems with the heart.  Although excessive running can lead to severe cardiovascular problems, studies have shown that shorter distances (15-20 miles a week) and varying speeds are healthier for your heart than long distances running (40+ miles per week) (Sudhakar et al., 2018).

           Ethical values to consider are autonomy and beneficence. It is the individual's own choice to decide how much endurance activities they want to do during their lifetime. Still, it is also the duty of the physician to provide beneficence to help the individual stay healthy as long as possible. When a physician tells an ultramarathon athlete to cut back the miles, it can lead to ethical dilemmas that might not benefit the runner on their point of view. In the end, physicians only want to help the patient live a long healthy life but often don't realize the dedication and miles ultramarathons put into their practice.

Reference:

Guglin, M. (2018). Dyssynchrony-induced cardiomyopathy. Journal of the American College of Cardiology, 71(17), 1944-1945. DOI: 10.1016/j.jacc.2018.02.063

O'Keefe, J. H., Patil, H. R., Lavie, C. J., Magalski, A., Vogel, R. A., & McCullough, P. A. (2012, June). Potential adverse cardiovascular effects from excessive endurance exercise. In Mayo Clinic Proceedings (Vol. 87, No. 6, pp. 587-595). Elsevier. https://doi.org/10.1016/j.mayocp.2012.04.005

Sudhakar, S., Kirthika, S. V., Padmanabhan, K., Kumar, G. M., Nathan, C. S., Gopika, R., & Samuel, A. J. (2018). Impact of various foot arches on dynamic balance and speed performance in collegiate short distance runners: A cross-sectional comparative study. Journal of orthopaedics, 15(1), 114-117. https://doi.org/10.1016/j.jor.2018.01.050