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“The pattern of myocardial remodeling in elite triathletes reflects the nature of the underlying training, which combines both endurance and resistance components.” Michael M. Lell, MD, et al, Radiology (October 2010)

Combined Strength and Endurance Training Best

MRI Shows Stronger Heart

I’ve long believed that a combination of weights and aerobics builds total fitness. Some claim that one or the other will do the job, but I don’t buy it. Attempts to build both strength and endurance with weight training don’t do either one very well. In my experience, best results come from focusing on strength and endurance separately. The two forms of training make different demands on the body.

A recent incident reminded me of the clear difference between weights and aerobics.

A man in his 40s was here for a two-day consultation, which allows us to do aerobics on one day and weights the next. He’d been weight training for some time and had the muscles to show for it. He had a few pounds to lose, but looked strong.

Except for sporadic walking, he’d never done serious endurance training.

On the first day, I put him on the Airdyne (stationary bike with push-pull arm action) for about 12 minutes of intervals, slowly working up to a near-maximum effort. He did fine and seemed to enjoy it. After a short break we moved on the Concept 2 Rower. He’d never rowed before, but was stroking smoothly after a few minutes. I then had him do 250 meter intervals with 90 second rest periods. He did three progressively faster reps. By the last rep he was flying. He didn’t say much, but he was clearly spent.

The next morning he was all smiles. “I’ve never experienced anything like it,” he told Carol. “I love the way the rower made me feel; I slept like a log.”

*  *  *

A study of triathletes from Germany strongly suggests that a combination of resistance and endurance training is the best way to condition the heart. Led by Michael M. Lell, MD, associate professor at the University of Erlangen-Nuremberg, the study was published in the online and October, 2010, issue of Radiology.

“To our knowledge, this is the first study using magnetic resonance imaging (MRI) to investigate effects of triathlon training on cardiac adaptations,” said Dr. Lell.

The researchers did cardiac imaging on 26 professional male triathletes (mean age 27.9) and 27 non-athlete male controls (mean age 27.3). The controls were recreationally active no more than three hours per week. The triathletes were top national and international competitors with six or more years of continuous training. Triathlons of course consist of swimming, cycling, and running. 

Cardiac images revealed that, compared to the recreational athletes, the triathletes had significantly larger left atria (62%) and larger right (30%) and left (31%) ventricles. Their ventricles also had greater muscle mass and wall thickness.

The atria are the receiving chambers of the heart and the ventricles are the pumping chambers. The right atrium receives the body’s deoxygenated blood and passes it into right ventricle. The right ventricle pumps the blood into the lungs for reoxygenation. The left atrium receives the freshly oxygenated blood and passes it into the left ventricle, which pumps the oxygen loaded blood to all parts of the body.

“The cardiac adaptations in the elite triathletes we studied were characterized by a balanced increase in left and right ventricular muscle mass, wall thickness, dilation (expansion) and diastolic function,” Lell related. “These adaptations reflect the nature of triathlon training, which has both endurance and resistance components.”

Lell says endurance training includes activities such as running and swimming, while resistance training includes weight lifting. Cycling combines both endurance and resistance. (See below) He explained that resistance and endurance training lead to specific heart adaptations. (See below)

The researchers also found that the resting heart rates of the triathletes were 17 percent lower than those of the control group. Lower heart rate indicates a stronger and more efficient heart. “The hearts of the triathletes in our study are stronger and able to manage the same workload with less effort,” said Dr. Lell.

“In summary,” the researcher wrote, “the pattern of myocardial remodeling in elite triathletes reflects the nature of the underlying training, which combines both endurance and resistance components.” 

The difference in how endurance and resistance training remodel the heart is interesting and instructive.

The Athlete’s Heart

The “athlete’s heart,” the researchers write in their report, is the “most striking adaptation...to long-term, frequent physical training.” Endurance training and resistance training produce two types of adaptation. “The volume load in endurance training leads to thickening of the ventricular wall and cavity dilatation [expansion], whereas the pressure load in resistance training induces…increased myocardial [heart muscle] mass and wall thickness, without a substantial change in cavity size.”

As suggested earlier, the two types of adaptation are complementary. Either extreme, however, can be problematic. For example, the researchers point out that “ultra-endurance exercise is thought to be associated with a predisposition to ventricular tachycardia [abnormal rhythm] and sudden cardiac death, which is common in male athletes.”

“Cardiac adaptations in elite triathletes in our study were not associated with sudden cardiac death,” Dr. Lell emphasized.

Again, triathlon incorporates a combination of endurance and resistance training; running and swimming are mostly endurance, and cycling is a combination of the two. Shifting gears or going up and down hill on a bike is like changing the weight on a barbell.

High-intensity interval training, like biking, is a combination of resistance and endurance; see Go Hard, and Go Home http://www.cbass.com/GoHardGoHome.htm 

We already have substantial evidence that interval training is good for the heart; see Intervals for (almost) Everyone http://www.cbass.com/IntervalsEveryone.htm

Clearly, weights and aerobics are a desirable combination. Further studies will be required to determine what combination or combinations are best. It seems likely that many combinations are effective. We can’t all be triathletes and few want to. The key for everyone is regularity and enjoyment. Start balanced training and don’t stop.

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