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Run for your life … at a comfortable speed and not too far
  1. James H O'Keefe1,2,
  2. Carl J Lavie3,4
  1. 1Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
  2. 2University Of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
  3. 3Department of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
  4. 4Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
  1. Correspondence to Dr James H O'Keefe, Saint Luke's Mid America Heart Institute,4330 Wornall Road, Suite 2000 Kansas City, MO 64111 phone: 816-751-8480 fax: 816-756-3645 jokeefe{at}

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During the Greco-Persian War in 490 BCE, Phidippides, a 40-year-old herald messenger (professional running-courier) ran the 26 miles from a battlefield near Marathon, Greece, into Athens carrying momentous news of Greek victory. Upon arriving at the Acropolis, he proclaimed: ‘Joy, we have won!’ and then immediately collapsed and died.1 Fast-forward about 2500 years to an era when the baby-boomer's came of age and long-distance running boomed. The prevailing logic held that aerobic exercise is clearly good for one's health and that, if some is good, more must be better. In 1975, Dr Thomas Bassler, a physician/runner, boldly proclaimed that, if you could run a marathon, you were immune to death from coronary heart disease (CHD).2 This urban myth has long since been disproven; indeed an emerging body of evidence suggests the opposite: extreme endurance exercise may exact a toll on cardiovascular (CV) health.

‘Show me the bodies’

After our recent articles on this topic,1 ,3–5 Amby Burfoot, winner of the 1968 Boston Marathon and Editor-at-Large for Runner's World Magazine, challenged our assertions about the dangers of extreme endurance efforts by demanding, ‘Show me the bodies’. Amby has a good point: the risk of dropping dead in a marathon is remote, about 0.5 to 1 in 100,000 participants.6 But the occasional marathoner or triathlete who dies while strenuously exercising is the ‘canary in the coal mine’. Chronic extreme exercise appears to cause excessive ‘wear-and-tear’ on the heart, inducing adverse structural and electrical remodelling, which offsets some of the CV benefits and longevity improvements conferred by moderate physical activity. Thus, even though chronic extreme exercise may not kill you, it may erase many of the health advantages of regular moderate exercise.

Indeed, regular vigorous exercise is probably the single best step a person can take to ensure robust CV health. In a …

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  • Contributors JHO and CJL contributed.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note A video presentation on this topic is available on the internet: You Tube, TEDx Talk, James O'Keefe, Run for your life… at a comfortable pace and not too far.

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