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The beneficial effects of exercise are definitely not to be questioned; on the contrary, they should be reinforced. The studies reviewed here...serve to maximize benefits obtained by regular exercise while preventing undesirable effects—just like all other drugs and therapies.” Editorial, Eduard Guasch and Lluis Mont (Thorax Institute, Barcelona), Heart, Published Online First May 14, 2014

How Much Exercise Is Too Much?

My Once-a-Week Weight Routine

Carried too far a good thing can become a bad thing. That’s the case with exercise. The question becomes, how much is too much?

Carol does a balance of strength and endurance training.
  Uphill sprinting is a recent addition to her regimen. She has a good sense of how hard to push herself.

Earlier this year we wrote about mounting evidence that too much exercise can be harmful: Long-Term Marathon Runners Come Full Circle—Extreme Running Linked to Heart & Artery Disease (our article # 384). We now have two more studies, from Germany and Sweden, which help to define the threshold between benefit and harm. While the earlier studies we discussed involved mostly elite athletes, the new studies focus on regular people who exercise, some healthy and others with pre-existing heart disease.

Everyone agrees that doing little or no exercise creates the greatest health risk. But the new findings—increased hazard for those engaging in daily strenuous physical activity—have researchers buzzing. Let’s look at the findings and the likely explanations, starting with the study led by Dr. Ute Mons of the German Cancer Research Center (DKFZ) in Heidelberg. It was published online in Heart on May 14, 2014.

Mons and colleagues queried 1038 patients in a clinical rehabilitation program for coronary heart disease about their physical activity at 1, 3, 6, 8, and 10 years after their hospital stay. New cardiovascular events (heart attack or stroke) were also recorded over the 10 year period.

About 40% were physically active 2 to 4 times a week (the reference group), 30% did more, and 30% did less. Overall, 10% said they rarely or never did any exercise. Revealingly, exercise frequency continuously declined during the monitoring period for those who exercised daily or 5-to-6 times a week; it increased for those who rarely exercised. The most consistent were those who exercised 2-4 times a week, the reference group.

As expected, the least active—less than 2 times a week—were twice as likely to have a heart attack or stroke as those in the 2-4 times a week reference group. Their overall mortality rate was four times as high!

The surprise was that the 5 or 6 times a week or daily exercisers were also twice as likely to die of a heart attack or stroke as the reference group. Rather than a linear relationship between exercise and health, it was a reverse J or U-shaped curve. Risk decreased with exercise, but only up to a point. Risk turned back up as exercise frequency passed 4 times a week.

What to make of these results?

“Our analysis may overestimate the risk for patients in the physically most inactive group, because people who are already sick and in a weak condition will not exercise,” co-author Professor Hermann Brenner (DKFZ) said in a press release. “There is no doubt that moderate physical activity, if possible in a patient’s case, has health benefits,” he added. “Our results also suggest that there is a limit beyond which more exercise does not provide any benefits,” he continued.

“The literature over the last 50 years overwhelmingly point toward moderate exercise being extremely beneficial from a cardiovascular standpoint,” Keith Churchwell, MD, chief medical officer of Vanderbilt Heart and Vascular Institute, who was not involved in the study, told MedPage Today (May 15, 2014). “It is also increasingly clear that extremes on both ends of the exercise spectrum might be detrimental,” he added.

“Physical activity aggravating…heart disease seems counterintuitive, but it is supported by previous studies,” Spanish researchers Eduard Guasch and Lluis Mont wrote in an editorial accompanying the Mons study. They added that patients with pre-existing heart disease, as in Mons et al, may “develop a significant proinflammatory state at lower exercise doses.” They suggest lower volumes of exercise for those with pre-existing cardiovascular disease.

The Swedish study (published in the same issue of Heart) is equally perplexing.

Researchers led by Dr. Nikola Drca (Department of Cardiology, Karolinska University Hospital) quizzed 44,410 healthy men aged 45-79 (mean age 60) about time spent on physical activity at 15, 30, 50, and 60 years of age. They then followed them for an average of 12 years to determine how many developed an irregular heartbeat or atrial fibrillation (A-fib), a known risk factor for stroke.

Somewhat surprisingly, they found that men who did intense endurance exercise early in life were more likely to develop A-fib then men who embarked on a similar exercise regimen later in life.

Men who reported exercising intensely more than five hours a week at age 30 were 19% more likely to develop A-fib by age 60 than those exercising for less than one hour a week. The risk persisted whether or not exercise was continued. In fact, the risk rose to 49% (up from 19%!) for those who did more than 5 hours a week at age 30, but were mostly inactive by age 60.

The good news is that men who walked or cycled briskly for an hour or more daily at an average age of 60 were 13% less likely to develop A-fib than those who almost never exercised.

What’s the take home message?

Noting that their data showed no increase in A-fib with moderate walking or biking at any age, Drca and colleagues emphasized the positive effects of physical activity. “Physical inactivity with a sedentary lifestyle is a far bigger health problem for the general population than excessive physical activity,” they wrote. “However, frequent high-intensity exercise could be associated with negative health impact, and [people] with such lifestyle should be informed.”

Dr. Keith Churchwell, quoted earlier, was unconvinced. Calling the link between exercise at a young age and A-Fib “weak,” he recommended starting slowly and working up to 40 minutes to an hour of moderate to strenuous exercise 3- to 5 days a week. “Patients who follow more extreme plans don’t tend to stay with their exercise programs,” he told MedPage Today. “In terms of improving cardiovascular status, the key is sticking with it.”

Editorialists Guasch and Mont, cited above, also stressed the need for more exercise in the vast majority of people. “The beneficial effects of exercise are definitely not to be questioned; on the contrary, they should be reinforced. The studies reviewed here…serve to maximize benefits obtained by regular exercise while preventing undesirable effects—just like all other drugs and therapies.”

My New Routine

A major change in my training routine complements the new findings on the harm of too much exercise. The difference is that some would say that I don’t exercise often enough.

 Clarence pushes himself hard twice a week, once strength and once endurance.

George Sheehan, cardiologist, runner, and fitness philosopher for the ages, may have put it best: The body can be trained to greater performance by induced stress. But the amount of stress and the time allowed for recovery are critical to the success of the process. That’s an elegant way to express the reverse J or U-shaped curve for the benefits of exercise; too much exercise or too little rest and the gains vanish.  

An often quoted passage from our book Challenge Yourself reads: “If I had it to do over again, I would start training with weights only once a week much earlier than I did....For an advanced bodybuilder, I firmly believe that less truly is more.”

After some backtracking, I’ve gone back to lifting once a week: weights on day 1 and aerobics on day 5. That’s it. I do each form of exercise once a week, allowing four days of recovery after weights and three after aerobics. I had been training three times a week: one weight workout, one aerobics, and a combination of the two. So the change is not as radical as it might seem. I’ve cut overall training frequency by one third. Both workouts are high intensity—short and hard.

The maxim “You can train long or you can train hard, but you can’t do both” applies with more force as you move from beginner to intermediate to advanced status. Having trained with weights for over 60 years, I’m about as advanced as it gets. The harder you train—and the older you get—the greater the impact of high intensity training on your system. An advanced—or older—trainer needs more rest to allow the body to recover and rebuild itself as good or better than before.

The physiology is straight forward. High intensity resistance training breaks down muscle tissue. The degree of damage depends on the intensity of the exercise. The higher the intensity the greater the damage. In the process of healing, however, the muscle grows stronger. The end result is more and stronger muscle.

Healing, however, is a multi-step process and takes time. One of the steps, inflammation, actually causes further damage. Soreness is part of the healing process; it discourages you from doing anything to interfere with the healing and growth process. In all, healing can take five days or longer. You can do hard aerobics when the process is in the final stages, but it is best not to lift again for about a week. That explains my new training sequence. You’ll find many more details on the recovery process in Challenge Yourself.

The bottom line is that I didn’t feel fully recovered training three times a week.

The proof of the pudding is that more rest has made me stronger in both weight and aerobic sessions. The seed was planted when I resumed training after the Take Charge conference in Austin. Surprisingly, missing my usual weekend workouts made me stronger the next weekend. I start most workouts on the Concept 2 rower with 10 all-out pulls, which tells how strong I am on that day. I note my best pull and use it to gauge my strength from workout to workout. Expecting it to take a workout or two to get back up to speed, I was delighted to find myself markedly stronger in the first 10 pulls. That got me to thinking about giving myself more time to recover across the board. I didn’t actually make the change until a few months ago, however.

My new schedule includes four different workouts: two whole-body weight workouts, Concept 2 rower/Ski Erg, and finally a foothill workout. Rotating through the four routines—strength on Tuesday and endurance on Saturday—I do each workout twice a month. And it works. I’ve been making progress in all four workouts. As always, I periodize, backing off and altering the routines as necessary. I also stay active between workouts with walking and easy pieces on the rower and ski erg. This keeps my blood flowing and aids recovery.

In conclusion, working out less often allows me to keep training hard, which signals my body that I’m using all of my resources and striving to improve. (Every muscle cell in the body is replaced—or castoff—about every four months; for more about exercise and renewal see our book Great Expectations.)

Another approach is to back off on intensity, and stop pushing your limits. You’ll have less soreness and discomfort that way. The choice is yours. Do what you find most satisfying, what pleases you—and keeps you training.

For an excellent—and unprecedented—articulation of the “maintenance” approach see the August 2014 issue of Dr. Richard Winett’s online newsletter Master Trainer:  http://www.ageless-athletes.com/

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