Exercise Risk in Perspective

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The_Saint Feb 2020 9:42am, 27 Feb 2020 6,486 posts	0 The_Saint Every 18 months or so (you can set your calendar by it) we get headlines about how dangerous "vigorous" exercise is, this leads to discussions on running forums where you get a range of views, some of which seem to rely heavily on anecdotes about what people who don't exercise think or worse the "Uncle Norman and the last person (you'd expect)" fallacy. This study from the American Heart Association aims to put this in perspective. ahajournals.org The PDF is the big red button on the left. From the conclusions - simplistically - the more you do, the better. "Cardiovascular risk is reduced 30% and 64% in the most active and fit individuals (Figure 2), respectively, and elite CRF is associated with an 80% reduction in all-cause mortality. Life expectancy at 50 years of age is 7 to 8 years greater in the most physically active individuals. The benefits of exercise are not limited to healthy individuals, because regular PA reduces recurrent events in patients with diagnosed CVD."
HappyG(rrr) Feb 2020 2:51pm, 27 Feb 2020 34,286 posts	0 HappyG(rrr) The problem is that stats are always outweighed in press by a good anecdote or sensational story. And public likes to be told "drinking wine makes you healthier" or "12 seconds of exercise more beneficial than 3 hours a day on a treadmill". We'll always get that guff. Also, for those of us who do exercise, and aren't completely thick, the statistical lack of likelihood of the outlier conditions like cardiomyopathy and other heart irregularities either brought out by, happening during by complete coincidence or actually partly caused by in some cases, vigorous exercise do matter. If you are the 1 in 1,000,000, then statistically unlikely isn't much of a consolation when you're dead on the running track, finish line of marathon, trail in hills! G
cackleberry Feb 2020 9:30am, 28 Feb 2020 1,717 posts	0 cackleberry Rather die of a heart attack while running than of boredom on the sofa, with high blood pressure and aching knees!
Dr PhFleecyD Feb 2020 6:41pm, 29 Feb 2020 48,606 posts	0 Dr PhFleecyD Unfortunately, people are not very good at assessing risk, and they seem to be getting worse! Vaccines, coronavirus, exercise, unhealthy eating, driving, you name a behaviour and so many people have stupid and hysterical views which either follow the negativity in media outlets (including social media) or they choose to believe the narrative which fits their preferences...
Nellers Feb 2020 6:52pm, 29 Feb 2020 35,828 posts	0 Nellers This is important information, but people are much more likely to react to something urgent, like a runner dropping dead on the Mall in April. That's an evolutionary bias in humans. The risk of their being a tiger in the grass is very low so it would be sensible to assume that the tiger isn't there, except sometimes there is a tiger so the sensible people get eaten and don't breed. Also humans are good at identifying patterns and connections, even when they're not actually there. That makes a runner dying of a heart attack a big issue because of their running (pattern mis-identified) whereas your unfit inactive mate having a heart attack on their sofa is just a sad thing to happen because there's not a dramatic immediate cause (actual pattern not identified). We're crap at this stuff, generally.
macca 53 Mar 2020 1:21pm, 4 Mar 2020 27,326 posts	0 macca 53 Would that be a Leicester Tiger, Nellers; I’m pretty sure they’re extinct in my neck of the woods 😀
macca 53 Mar 2020 1:29pm, 4 Mar 2020 27,327 posts	0 macca 53 Perhaps we assess the risks differently as we, ahem, age. A GP friend related the principal causes of death for men at various ages: 65-75. Heart attack 75-85. Cancer (lung or prostate) >85. Alzheimer’s/dementia As I’m in the youngest of those groups already, dying of a heart attack sounds significantly less bad than the later options.......
Canute Mar 2020 4:58pm, 4 Mar 2020 2,031 posts	0 Canute That article from the American Heart Association is very balanced. They emphasise that exercise improves life expectancy. They conclude that inactive people with and without heart disease, should be encouraged to develop a gradually progressive exercise program. They comment favourably on the increasing public engagement in exercise. They advocate avoiding potential barriers such recommendations for medical check-up for healthy people prior to moderate exercise. They encourage continuing engagement in exercise into old age, and also provide guidance about risks. They provide a realistic discussion of the main cardiovascular risks of exercise. For those of us who have engaged in exercise for many years, this article is both re-assuring but also cautionary. On page 613 they state: ‘Emerging evidence, however, suggests that over time, high-volume, high-intensity exercise training can induce cardiac maladaptations such as an increased risk for AF, coronary artery calcification, and myocardial fibrosis.’ They summarise the evidence for these risks well. For a person in my situation, in my mid-seventies with a history of many decades of fairly high volume moderately intense exercise behind me, the lessons are fairly clear. I should continue moderately intense, regular exercise, but be cautious about either very intense exercise, or excessive volume (e.g. risk of atrial fibrillation increases with volume greater than 80 met-hours per week; typically, running at 6 miles/hour for 1 hour = 10 met-hours.)
The_Saint Mar 2020 3:28pm, 6 Mar 2020 6,489 posts	0 The_Saint I think, just like with the obesity epidemic, I would rather take my chances with dying of something caused by leanness/exercise than the overwhelmingly greater risks the opposite behaviours have. I get a bit sad when people who should (and I suspect do) know better rubbish stats they don't like using the same tired old cliches. Some new fresh cliches are needed.
Canute Mar 2020 4:02pm, 6 Mar 2020 2,032 posts	0 Canute As I see it, both professional and public understanding of the value of exercise, and the quality of recommendations regarding a healthy approach to exercise, have improved substantially over the past decade. I think this article from the American Heart Association sumarises the current evidence regarding cardiac benefits and risks very well. Whatever choices we make about personal egagement in exercise, we cannot predict the health outcome with certainty. But at least we now have a large body of useful information to help us make an informed choice about a healthy approach to exercise if we wish to do so.