Run for your life! At a comfortable pace, and not too far: James O'Keefe at TEDxUMKC

Transcriber: Herald Park Reviewer: Denise RQ Hello, it's a pleasure to be here. I'm a cardiologist, but before that, I was an exercise enthusiast. I bet I've exercised practically every day of my

life

. I had two grandparents who were alcoholics. But for me, my way of approaching

life

is exercise. When I'm nervous, anxious, tired, happy, sad or whatever, I exercise, if I have time and sometimes even when I don't. You may have seen me at an airport, waiting for a flight, running up the escalator with my backpack on, to kill 20 minutes. But I always thought that exercise was best for my heart, and I think that's how I decided, at age 15, that I wanted to be a cardiologist.

But now that I am 56 years old and many decades have passed, I have started to have some warning signs in my heart; A couple of years ago I realized this and set out on a mission. I am a research cardiologist and I have a research fellow. We've been working on this for a couple of years, with the help of some of the brightest cardiologists around the country, we've come up with some surprising new insights that seem to be emerging about exercise. This made me think twice about my lifestyle and I'm worried I've made a fatal mistake.

I hope it's not too late, but let me tell you the story. So, like I said, I've been working out for a long time. But if we go back 2,500 years, there's a guy named Pheidippides who ran the 26 miles from a battlefield near Marathon, Greece, to Athens to proclaim the news of a momentous victory over the Persians. When he arrived at the emperor's throne and said, "Victory is ours," he abruptly collapsed and died. Now, you may have heard that story before, but what you probably didn't know is that Pheidippides was an accomplished runner. He had been a Greek herald messenger all his life.

He ran many miles every day and I bet he was the fittest guy in Athens the day he died. That's weird. But let's fast forward two millennia or more. When the Baby Boomers came of age, another boom occurred: the running boom. If exercise was good for you, as anyone could know, then more had to be better, and the ultimate test of running and endurance was a marathon. There was a doctor who became famous in the mid-70s by boldly proclaiming that if you could complete a marathon, you were immune to a heart attack. In fact, this urban myth still prevails among many doctors.

One of my patients and friends is John. He is now 68 years old, but he has been running for 45 years. As he says, if he hadn't run twelve miles in a day, he felt like he was getting weaker. When I saw him, he came to me and I said, "John, let's do a heart scan, a CT scan, a simple, small, non-invasive, fast, high-tech scan of

your

heart. Your arteries, me." I am sure, it will be soft and flexible, clean and healthy. This is what a normal heart scan should look like: There is no calcium in these arteries.

His score was 1,800. it's bad; At 1,800,

your

arteries are harder than your bones. That can't be good, and I had no other risk factors to speak of. People actually die during marathons, but let's be real. If you look at the most recent data, the risk is minuscule: 1 in every 100,000 participants became friends with a guy named Amdy Burfoot. Amdy won the Boston Marathon in 1968. He is currently editor-in-chief. He has been editor of Runner's World magazine for a long time. In conversations we've had in recent months, he has challenged me: "If extreme resistance exercises are so bad, show me the bodies." 1 in 100,000 is a pretty low risk.

But that doesn't worry me so much; Running is supposed to add years to your life, and even life to your years. So could it be shortening your life expectancy? I'm not worried about taking any risks, I'm just trying to do the right thing, I'm a cardiologist, my business is finding the ideal diet and lifestyle. I'm coming to the conclusion that running marathons and doing extreme endurance athletics don't fit that recipe. That being said, let me be clear about this: there is no single step you can take in your life to ensure solid health and remarkable longevity than the habit of daily exercise.

This is a study of more than 400,000 Chinese that was just published last year. We published an editorial along with this later, but they found that vigorous exercise reduces all-cause mortality, the bigger the reduction the better, and this is minutes of daily exercise, so 10, 20, 30 minutes of daily exercise. . At 45 or 50 years of age, a point of greater stagnation is reached, so greater efforts and time do not seem to convey greater improvements in life expectancy. Down here you do light to moderate exercise: walking, doing housework, moving around every day; just get up from your seat and move. More is better there;

It's not as beneficial as vigorous exercise, but more is better. It seems like you can exercise all day, without getting into trouble if you keep it low. So, one of my heroes, I love evolutionary medicine, I believe that if you look into the world of nature and into our deep past, you can find the blueprint for ideal health, even in our modern world. However, Charles Darwin got one thing wrong: it is not survival of the fittest. No, it's actually the survival of the moderately fit, okay? If the best thing you can do is climb a flight of stairs before you have to rest, things aren't looking good.

It could be a bumpy road in the coming years. On the other hand, if you can dance, swim lightly, or even jog six miles per hour, that's a ten-minute mile—it's a pretty

comfortable

pace

, right? Your mortality plummets, and if you, after warming up on a treadmill, can reach a speed of seven to seven and a half miles per hour, when you look at the results, you are practically bulletproof. In fact, greater gains in physical fitness do not translate into greater increases in life expectancy. It stabilizes. In fact, there is even a small trend that it could even go up a little.

So the important concept is that the dose produces the poison. It's true with a lot of things, and if we could find a pill that provided all the benefits we get from exercise, I'd be looking for a job. In fact, exercise not only cuts your chances of premature death in half, it also reduces your risk of heart disease, Alzheimer's, osteoporosis, and depression. It is an amazing drug, but like any drug, there is an ideal dosage range. If you don't take enough, you won't get the benefit. If taken too much, it could be harmful and even fatal.

When you're sitting here, listening, sitting like most Americans do, doing nothing, heart beating, just idling at a gallon a minute, about four or five liters a minute. If you went for a run right now and ran hard, that would be multiplied by four, five, or even six. Five or six gallons a minute! That's an exercise, your heart is working hard, but that's what it should do, intermittently. You know, maybe 5, 10, 30 minutes and maybe even 60 minutes, but at 60 minutes something starts to happen: the stretching in the chambers starts to be overwhelming, the muscle's ability to adapt, the catecholamine levels and Adrenaline rises, free radicals flourish, and the heart begins to burn.

It begins to burn and inflame the inside of the coronary arteries. In reality, we are not cut out for these sustained levels of exercise, for hours at a time. If you go to a marathon, and you have done this several times, you take a troponin level at the end of the marathon, more than half will have elevated troponins. What is a troponin? Troponin is a sacred chemical for us cardiologists. When we see that a troponin rises it means one thing: the heart muscle has died. Normally, we jump into action because that usually means there's a heart attack, we need to open a glass!

In this case, these are small micro-tears from stretching and singeing, and it's no big deal if you do it once. They are small microtears, they heal; A few days later it disappeared and the heart returned to its normal size. But if you do this over and over again, the chambers begin to enlarge, scar, become stiff and thicken. If you look closely, you can see that these little white spots on these veteran extreme endurance athletes build up, and in people who have been doing this for years and decades, their heart ages before its time. We are asking too much of you, it is exceeding the capacities of the heart.

This is a fascinating study by a cardiologist I know whose son is also a cardiologist. These two were avid finalists in Minnesota. They did a study looking at CT scans, as I showed you of John, they looked at a group of marathoners who had been doing this for at least 25 years, at least 25 marathons in that time, compared to secondary controls. You can see here that they had 62% more plaque despite having fewer risk factors. People say, "That can't be true." In fact, a German cardiologist just replicated this study showing 108 marathon runners with similar findings. Hard to discard.

Veteran endurance athletes also have a five-fold increased risk of atrial fibrillation, a dangerous irregular heart rhythm. There's kind of an epidemic of this among runners because we've only been doing this for a few decades and it takes a while to develop. Even worse, when we see this, as cardiologists, our pupils dilate, our heart rate increases; This is ventricular tachycardia, which is a life-threatening rhythm, and we can see it in scarring in the ventricle in some endurance athletes. So "Born to Run" is a book that was published, a nonfiction book, published just in 2009. The hero of this story is a guy named Micah True.

He abandoned American culture and went to live with the Tarahumara Indians in northern Mexico, in the Copper Canyon. He was an epic runner, legendary for his ability to run long distances and hundred mile races. The Indians there nicknamed him "White Horse" because of his skill and notable endurance. So Micah True sadly died, at age 58, on a routine 12-mile run in the New Mexico desert in March of this year. When they did the autopsy, they found an enlarged and thickened heart with scar tissues. The coroner said, "idiopathic cardiomyopathy." But I looked at that route report and it seems like a description of the pathology we might expect to see in some extreme endurance athletes.

My colleague who wrote some of these articles with me, Peter McCullough, coined the term "Phidipides cardiomyopathy." That's what he had. There are a couple of articles that will be published in the next two months and we will also publish a couple of articles. They are going to change the way you think about exercise. This is one of them from Chip Lavie, one of my colleagues and perhaps my best friend. He was at the Oshner Clinic in New Orleans and this is a look at 50,000 runners. 52,000 people followed him for decades, an average of 15 years but up to 30 years.

They compared the non-runners, about 38,000, with the runners, about 14,000, and what they found was that the runners lived longer, 19% longer, but if we look closer, we will see that the runners, compared to the non-runners . runners, for the risk of death, the reference is one. If he ran more than 25 miles a week, his benefits disappeared. Only a 25-27% reduction in the mortality rate was obtained. If you were running 5-20 miles per week, 10-15 miles per week would be ideal. When we looked at running speed, sure enough, if you ran too fast, more than eight miles per hour, which is a 7:30

pace

, the benefits disappeared.

Now, they weren't any worse than the non-runners, but hell, if you ran that much, you'd think you'd get some health benefits, but no, you have to go back at a pace of six or seven miles per hour. , which is a run of approximately ten miles per hour. Interestingly, how many days a week? If you run seven days a week, the benefits disappear. You need to run fewer days, ideally two to five. Another study that will be published soon is this one from the other side of the pond. The Copenhagen City Heart Study compared non-runners to runners and found the same thing; the relationship is very similar to that of alcohol.

Mortality is lower in people who practice moderate jogging than in those who do not jog or those who perform extreme exercise. Moderate runners had a 44% reduction in mortality, living six years longer, but it disappeared if they did too much. So the truth is that exercise confers powerful benefits and the belief is that "more is better." But we are learning that in this case more is not better. One of my good friends, Meghan Newcomer, is a triathlete from New York City. She grew up next door, she is a dear friend of the family and is one of the best triathletes in the country.

Last year she participated in ten races and is 30 years old. She won half of them. The other half of her collapsed from heat exhaustion, dangerous heat exhaustion near the end of the race. I told Meghan:"Meg, if you want to be in the real Olympics, which you very well could be, keep working, maybe improve your game a little. But if you want to be alive and well for the 2052 Olympics "In 40 years, you will need go back and slow down your pace and find a healthier exercise pattern." So there's one last study I want to tell you about.

This is a study from last year that looked at mice. They beat these mice, made them run until they were tired, all days, for four months, and you know what? This replicated the same findings that we saw in Micah True and the other findings that I told you about. But what gives me hope is that when they took these guys out of their training regiments. of the iron mouse, their hearts returned to normal. The fibrosis even disappeared and their tendencies to ventricular irritability and atrial fibrillation disappeared. Well, I'm a man, not a mouse, but I hope that works in humans too.

Anyway, we're not meant to run. We weren't born to run, I should say. We were born to walk; We need to walk more today. We need to walk, we need to move our body instead of sitting. Whenever you can, get moving and do some high-intensity interval training every now and then. But personally, I found that what I do now is shorten my runs. When I run, I run anywhere from a distance and a half to, at most, three miles, but usually about two miles. I slow down and walk with my wife, play with the kids, stop in meadows or parks and do some yoga.

When I swim, instead of thrashing around, I lie on my back and do some nice smooth strokes. I watch the clouds pass above me and I see the birds flying in the sky, and I can feel my heart relax, heal and improve. So everything in moderation is not a new concept. This was something one of the contemporaries of Pheidippides, the father of medicine, said 2,500 years ago: "The right amount of diet and exercise, neither too much nor too little, is the surest path to health." So never in my 30 years as a cardiologist have I presented such controversial data.

But the truth is that it is a U-shaped curve. Couch potatoes use this as an excuse to continue their sedentary behavior. Then there are all the extreme athletes, people like me, who don't want to hear this mess; in fact, they want to kill the messenger. I have received many adverse comments about this research. But do you know what I have decided? It's just that you need to curl up in the safety of the middle of the U-bend when it comes to exercising. Or when it comes to anything else in life. For me, I have decided that running too fast and too hard will only accelerate my progress toward my life's goal.

So I've decided to call it quits and hopefully enjoy more sunrises and sunsets. Thank you. (Applause)