#8 - Can extreme exercise damage the heart? With Dr Benjamin Levine
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- Опубліковано 11 лют 2025
- Dr Glenn McConell chats with Professor Benjamin Levine who has the best global research track record in Sports cardiology/cardiovascular physiology and exercise. He is the founder and Director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital Dallas, Professor of Internal Medicine/Cardiology and Distinguished Professor of Exercise Sciences at the University of Texas Southwestern Medical Center. He has published over 400 journal articles with a very high H-index of 109.
We enjoyed a broad ranging discussion including:
how the main determinant to be an endurance athlete/ to have a high VO2 max (aerobic capacity) is the maximum stroke volume (how much blood pumped per beat). Their heart and pericardium stretch more (more compliant) which allows a large stroke volume.
Athletes big hearts: Which comes first, the training to increase the heart size or need to have a big heart first?
-Genetic component to being a great endurance athlete? Can’t use genetic profiles, it’s a gene-environment interaction.
-Eccentric hypertrophy (volume load) with purely long slow distance exercise, concentric hypertrophy (pressure load) with purely strength training. But many activities are a combination of volume load and pressure load. Eg Rowers have the biggest hearts, thick walls and large volumes (they have a combined strength and endurance type training stimulus): they have mean arterial pressures of 250mmHg during exercise!
-Resistance trained people do not have a thick walled hearts like one might expect because they only have the high pressure loads during the exercise, unlike people with hypertension that have pressure loads 24/7.
-Three weeks of bed rest has been found to be worse than 30 years of aging for the body’s capacity to do physical work! Aging leads to atrophy and stiffening of the heart and reduced compliance of the blood vessels and life long exercise training prevents this.
-Four to five days a week of exercise the sweet spot for optimizing cardiovascular health (one fun easy 60+ min, 2-3 moderate to vigorous, 1 intense plus sone strength training).
-If been sedentary for a life time (eg 70 year olds) exercise can’t reverse the hearts lack of compliance etc. Starting exercise before the age of 55 is important.
-Walking not hard sufficient load to maintain the hearts function. Endothelial function and exercise training: greater dilation of blood vessels after exercise training.
-For the vast majority of people competitive levels of exercise is good for heart health. In a small amount of people that do an extraordinary amount of exercise, exercise-induced right ventricular cardiomyopathy can occur (this will be discussed more in a later podcast by the expert on this, the Cardiologist Dr Andre La Gerche). Genetic cardiomyopathies and exercise. Higher calcium/calcification in coronary arteries in some athletes but this doesn’t increase mortality and appears to reduce mortality. Higher rate of atrial fibrillation with high levels of exercise training but not greater heart disease risk.
-Exercise can’t be expected to overcome a bad diet.
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Excellent - will listen to this again (and Episode 69 which is what led me here). 0ne big message was that hearts like vigorous exercise. Dr Levine is not only clear, thoughtful and authoritative but wise enough to caution about specific (rare) circumstances where exercise can be risky. Big thanks for valuable insights, and for letting him talk mostly uninterrupted.
Thank you fo r this interview. I have CVD and have gotten no direction from my primary physician or cardiologist and have been using this protocol for the past year. I will continue to use till the day I die (age 107 😎)
This was very informative
“At least live well until your time comes!”👍👍
what a great video, thank you for sharing this. I'm in Melbourne and Im being studied at Deakin uni after I had a stent put in a few months ago and had an episode of afib. I got randomised into the the exercise group so I can't wait to see what effect it has under supervision. I'm measuring everything and exercising every day, biggest improvements in my ECG PVC has been due to daily 90 degree sauna. I now have zero PVC all night. I also have a CPAP that helps protect my heart.
My pleasure. Good luck. Who’s running the study at Deakin University? Did you see my interview with Andre La Gerche? We talked a lot about how higher rates of atrial fibrillation in endurance athletes etc. Despite this, like Benjamin Levine said, Andre pointed out that they live longer etc.
@@insideexercise Dr Kim Way is running the study, I'm also in another study looking into cerebral arteries and the impact of exercise. I'll definitely check the Andre La Gerche video next!
I love running but stents would scare me to death.
After reading reviews I go to run now, although unexpected rain is starting now 😂
I remember being 5 to 10 years old and every time I pushed to improve my body adapted and I became great at it, I think that's the same for the heart for runners. If you don't adapt your heart at the right time you will never adapt it later.
Great info!
awesome interview thank you😊
Fascinating. Love the data based approach Dr Levine takes
Yes, mastery of the data plus a rare ability to put it context and distil a complex story into a few words.
I can't believe that training 2-3 times a week has no effect on your cardiovascular system. I usually trained 3 times a week and my form was definitely improving and my resting heart rate went as low as 45 pulses per minute. However these were quite intense training sessions - cycling for 2-3 hours, and often more on Sundays.
@@kantrzyn I thought Ben said that get cardiovascular adaptations if the exercise is above the intensity of a normal walk. What you describe would be expected to result in CV adaptations and the reduction in resting heart rate definitely backs this up.
Paraphrasing, but I think he said it wasn’t sufficient enough to elicit the structural adaptations to the heart muscle itself that make it appear younger than chronological age.
Good stuff 👏 👍
Agreed. Very informative. Great guest.
Interesting but the one thing he doesn't marry with exercise is nutrition, which is equally important. That would be an incredible video, to see how these issues interact.
No one agrees on what a perfect diet is and it's too hard to do controlled studies over long periods of time. There are just too many things and combinations of things that we eat but most people know what's bad - sugar is bad when consumed all the time and even worse mixed with fats. Almost nothing is as bad as cake frosting and doughnuts
I agree, also would have loved to hear him talk about statins.
Is it possible to have been a low EF, but a high SV as a result of a life time of aerobic sports, I.ie., Nordic skiing?
Yes, this has been seen also with elite cyclists. EF of 50% or above can be considered normal in such cases. Below 50% I'd probably investigate.
It makes sense that extreme exercise would enlarge the heart and result in heart failure later in life. Your thoughts?
Not my area but I haven’t heard anything about extreme exercise resulting in heart failure later in life. I think it would have come up if it does. I only saw info re the stuff we discussed.
For older athletes +55, sprint interval training is better long term endurance training. Good to 'run the engine hot' one or two times a week. Heart rate to max for short duration, less chance of developing problems like afib and cardiomyopathy, as we see in life-long endurance athletes. Seems like 95%+ of athletes 55+ are involved in endurance training rather than SIT ... which is actually quite different from HIIT. Probably because it's easier to run slow than fast, and takes less preparation.
An extreme athlete that puts in the 30 hours a week of training that Levine mentions surely has to do the majority of it at lower intensity, given the high overall volume. Helps explain the common 80/20 split between lower and higher intensity efforts, respectively, that are commonly programmed.
@@gdcgdc123 Of course it depends on what you're training for. Endurance athletes, yes 80/20 makes sense. Not so much for a sprinter. And, you can get the same benefits from intensive tempo sprint interval training as 80/20 without the volume and potential orthopedic damage
@@hikerboater No argument here. I’m certainly not an expert, and as I understand it the intervals mainly improve VO2 max/ glycolic function while the low intensity efforts improve mitochondrial efficiency and the number of them. Both energy pathways are necessary to be trained and a strong aerobic base will support a higher VO2 max.
Endurance, strength and mobility are the three pillars of fitness for everybody. Sprinting is, in a sense, a small part of strength training. Your heart rate can only reach its maximum after 60-120 seconds. A sprint takes 10-20, maybe 30 seconds. Otherwise it's not a sprint. Sprinting is a good exercise and everybody should do it, but it certainly isn't "better" than endurance training.
@ My workout standard as a 400m sprinter is often intensive tempo 300m intervals with limited rest (3 min). They are not done at full sprint but 85%. My best interval set (age 63) I'm doing 4x300 avg 49 sec. And yes, the heart rate is at max every time at the end of such a set, mid 180s for me. Even shorter sets of 4x200m w/ 1 min rest avg just under 31 sec, also produce maximum HR. Certainly better bang for the buck than endurance training which is hard on an aging body.
I suppose if one follows a low glycation diet and manages blood sugar properly, heart stiffness can be delayed.. although recently I heard about methylglyoxal being a product of glycolysis, which was really disheartening for me.
Thanks for watching. Not too sure on this one to be honest.
High endurance athletes show higher level of arterial calcification. True or false?
If true, why?
Interesting facts about Jim Fix’s death
So no info for people with hypertension?
Can you over train a muscle? Of course.
Is heart a muscle? Of course.
Can you over train your heart? Of course
Do skeletal muscles rely to a large extent on carbohydrates? Of course.
Does the heart rely to a large extent on carboydrates? Not at all.
Is the heart a striated muscle? Not at all.
Well what is then? The heart is a cardiac muscle.
On what energy source to cardiac muscles rely then? Fatty acids.
What did we learn? Skeletal/striated muscle and cardiac muscle are inherently different tissues.
Nothing happened to me when I over did it.