More food for thought about the health implicatons of how we exercise

[Symbolic]

Essay: Does training adversely affect long-term health?

Urho M Kujala. The Lancet.: Medicine and Sport Londonec 2005. Vol. 366, p. S55-S56 (2 pp.)

A number of philosophers and physicians living in ancient Greece thought that sport could harm both mind and body. Hippocrates, for example, acknowledged the health benefits of physical activity, but also believed that intense athletic competition had a harmful effect on the heart and other organs, and lowered resistance to disease. That athletes do not have a shorter life expectancy than the general population, however, was not appreciated until the 19th century. In 1873, J E Morgan published the results of his study of 294 British oarsmen who participated in the Oxford versus Cambridge boat races between 1829 and 1869. His findings indicated that these sportsmen lived about 2 years longer than the "average Englishman" of insurance statistics.

Today, many diverse sports are played at the highest level; these sports have different risks of injury associated with them and often have specific physiological requirements. Sports also differ in the ethical standards that their governing bodies demand of them. Cultural factors can affect training regimens and can govern to what degree athletes are expected to devote their life to their profession. Researching the physiological effects of vigorous training on athletes' long-term health is, therefore, complicated.
With Professor Seppo Sarna and colleagues, I have prospectively studied over the past few years the effects of training on the long-term health of about 2500 male Finnish athletes who competed in international competitions between 1920 and 1965. From 1920 we followed-up causes of deaths, from 1970 we used registers of hospital discharges, reimbursable medications, and cancer registries, among other things, and from 1985 we used health questionnaires. We also followed up controls (one per athlete) who were healthy at age 20 years and matched to cases for age and geographical location. We grouped the sports that the athletes competed in by degree of average maximum oxygen uptake as
follows: endurance sports (highest maximum oxygen uptake-long-distance runners and cross-country skiers), mixed sports (medium maximum oxygen uptake-soccer, ice-hockey, basketball, track and field jumpers, and short-distance runners), and strength sports (lowest maximum oxygen uptake-weightlifters, wrestlers, boxers, and track and field throwers). Our aim was to ascertain what the major athletic risk factors were for the most common chronic diseases.

We noted, among other things, a very low risk of coronary heart disease and type 2 diabetes among endurance athletes similar to that noted for hunter- gatherer societies. This finding did not extend to individuals who participated in strength sports, however, who have a different disease risk profile. Athletes who take part in strength sports differ from other athletes not only in their training schedules, but also in their body-build and musculature, which are in part genetically determined and in part training-induced. As such, the associations between physical fitness, physical activity, and disease are also in part genetically determined. For example, genetic factors contribute heavily to the high variability between individuals in the proportion of slow- twitch versus fast-twitch muscle fibres. Strength athletes have a high proportion of fast-twitch (in particular glycolytic type IIb) muscle fibres, whereas endurance athletes have a high proportion of slow-twitch muscle fibres with high oxidative capacity. The proportion of fast-twitch versus slow-twitch fibres is one potential determinant of the type and degree of physical activity a person will participate in, as well as morbidity. A high proportion of slow- twitch (oxidative type I) muscle fibres correlates positively with physical fitness, favourable lipid profile (high HDL-cholesterol and low triglyceride concentrations), and insulin action. Accordingly, men with a natural ability in power sports are at a higher risk of developing cardiovascular disorders than those with a natural ability in endurance sports, irrespective of the amount of exercise undertaken.

Attitude also affects risk. Elite athletes are often willing to push their bodies to the limit to reach the top of their profession. The story of Shun Fujimoto provides an example of this determination. Fujimoto was part of the Japanese gymnastics team who battled for the gold medal against the Soviet Union at the 1976 Montreal Olympic Games in Canada. Despite rupturing the tibial collateral ligament in his knee, Fujimoto managed to complete the floor routine he was doing and to hide his discomfort from his team mates. He went on to receive an overall score of 9.5 on the pommel horse, keeping his team in contention for the gold medal. His last event was the rings with only one weight-bearing move-the dismount. Fujimoto was lifted onto the rings by his coach, performed a near-perfect routine, and did a triple somersault dismount, landing on his broken knee. He did not take pain killers. His score of 9.7 was a personal best. Japan won gold by four-tenths of a point. When asked a few years later if he would do the same again, he replied: "No".

The results of the cohort study of Finish former elite athletes show that, compared with controls, in later life athletes had less disability, better self-rated health, and were less in need of hospital care. The disease risk reduction was highest in athletes who had participated in endurance sports. Also, results of intervention studies indicate that vigorous training bestows many health benefits. But what, if any, degree of physical activity offers maximum benefit in the absence of any risks?

Vigorous exercise can lead to sudden cardiac death due to undiagnosed heart disease and injuries leading to osteoarthritis. It is noteworthy that most studies of the long-term health effects of training have been done in male athletes. Much less research has been done in girls and women, though the so- called female athlete triad-amenorrhoea, osteoporosis, and eating disorders-has received considerable attention. Overall, however, irrespective of the cohort studied, and because of the many variables that have changed over time, we cannot, based on findings of earlier studies, predict the long-term health of today's elite athletes. Use of performance-enhancing drugs, for example, which have serious long-term deleterious effects on health, changes, with different drugs and doses being taken year on year. Heart attacks and suicides are associated with misuse of high doses of anabolic agents today, whereas tomorrow the effects of gene doping used perhaps to alter the properties of athletes' muscle fibres will have to be taken into account.

Acknowledgments
The Finnish Ministry of Education funded the study discussed.

[Reference]
Further reading
Morgan JE. University oars. London: MacMillan, 1987
Kujala UM, Kaprio J, Koskenvuo M. Modifiable risk factors as predictors of all- cause mortality: the roles of genetics and childhood environment. Am J Epidemiol 2002; 156: 985-93.
Kujala UM, Sarna S, Kaprio J, Koskenvuo M. Hospital care in later life among former worldclass Finnish athletes JAMA 1996; 276: 216-20.
Kujala UM, Marti P, Kaprio J, Hernelahti M, Tikkanen H, Sarna S. Occurrence of chronic disease in former top-level athletes: predominance of benefits, risks or selection effects? Sports Med 2003; 33: 553-61.
Saltin B, Gollnick PD. Skeletal muscle adaptability, significance for metabolism and performance. In: Peachey LD, ed. Handbook of physiology.
Baltimore: Williams and Wilkins, 1983: 555-631.
Wang Y-X, Zhang C-L, Yu RT, et al. Regulation of muscle fibre type and running endurance by PPARd. Plos Biology 2004; 2: e294.

[Author Affiliation]
Urho Kujala is a former international-level orienteering runner, and Professor of Sports and Exercise Medicine at the University of Jyväskylä. He specialises in the different health effects of physical activity, focusing on exercise therapy for chronic diseases.
Department of Health Sciences, University of Jyväskylä, PO Box 35 (LL), FIN- 40014, Finland Jyväskylä, Finland (Prof U Kujala MD)

Correspondence to:
Prof Urho Kujala
urho.kujala@sport.jyu.fi

[OldGuy]

Point?

[ninja]

Those were daunting paragraphs. Too daunting...

[Irishdazza]

He makes the distinction himself that the genetic predisposition to the two different sports is also reflected in their susceptibility to disease.

So basically...he says people who exercise live longer than those that don't.

[Ogedei]

Originally Posted by Irishdazza

He makes the distinction himself that the genetic predisposition to the two different sports is also reflected in their susceptibility to disease.

So basically...he says people who exercise live longer than those that don't.

THAT is QUITE the revelation.

guess I will have to start exercising....

[Lost Dog]

Essay: Does training adversely affect long-term health?

Does not training adversely affect long-term health, too?

[HairyMike]

Originally Posted by Lost Dog

Does not training adversely affect long-term health, too?

As far as "living more healthy years," not getting too fat along with walking an hour per day is thought to yield the most bang for the buck. Beyond that, you get diminishing returns and it's more about looking better and/or the enjoyment you get from the activity.

So, if "not training" means being a fat couch potato, then yes, it adversely affects health. But, the hard-core-athlete or gym-rat is no better off (from a health perspective) than the non-fat, casual-activity guy.

[Lost Dog]

I suppose I don't train like a hard-core-athlete, so I'm golden!

I wonder how the diets of these athletes plays into this. Would a "hard-core-athlete" who ate well be better off than the non-fat, casual-active guy? Then, compare a healthy eating, non-fat, casual-active guy to the other three.

[HairyMike]

Originally Posted by Lost Dog

I suppose I don't train like a hard-core-athlete, so I'm golden!

I wonder how the diets of these athletes plays into this. Would a "hard-core-athlete" who ate well be better off than the non-fat, casual-active guy? Then, compare a healthy eating, non-fat, casual-active guy to the other three.

Dr. Dean Edell is big on this. He talks about it all the time on his show and in his books. His conclusion?: The difference gained in extra, quality life for doing everything perfect (as opposed to being unfat-casual-active-guy) is probably months rather than years.

[Lost Dog]

But Dr. Dean just said, last week, that taking creatine and protein powder and working out regularly with weights is a sign that I'm obsessed with my body image. No kidding.

In fact, if your kid takes creatine and protein powder, you've got trouble. He doesn't say they are bad, in and of themselves, but they are the warning sign...

[Lost Dog]

Oh, yeah. He thnks granola is healthy, too.

Again, not that granola can't be a healthy part of your diet, but it not really "healthy."

[RobLL]

Originally Posted by Lost Dog

Oh, yeah. He thnks granola is healthy, too.

Again, not that granola can't be a healthy part of your diet, but it not really "healthy."

Always enjoy listening to Edell, but he is a bit cranky on more than a few points. LD, think your double negative qualifier on granola tells most of the story on that stuff. Rob

[HairyMike]

Originally Posted by Lost Dog

But Dr. Dean just said, last week, that taking creatine and protein powder and working out regularly with weights is a sign that I'm obsessed with my body image. No kidding.

In fact, if your kid takes creatine and protein powder, you've got trouble. He doesn't say they are bad, in and of themselves, but they are the warning sign...

I missed that one, but I've heard him speak on creatine, andros, obsessive behavior, etc. before. I think the main point is that he doesn't like people obsessing over minutia, or going overboard for the wrong reasons. Like kids who wind up taking steroids to look good because they think it will help them get more girls and be more popular. . . . . which they do, but that's a different story.

He pretty logical. I couldn't picture him arguing against anything healthy and enjoyable that an informed adult would do.

I wonder what he'd say about folks who post on various internet training boards.

[rookie]

""Essay: Does training adversely affect long-term health?""


Who cares? I enjoy it! Isn't that what matters most? To do the things that bring you joy.

[DKing]

Health is for pussies.


Danny

[ninja]

Originally Posted by DKing

Health is for pussies.


Danny

Agreed.