Endurance sports are risky and other sensationalist health headlines

When I was a young whippersnapper in j-school, I chose to focus on science and health reporting.  My classwork, my senior honors thesis, my reportage for the student paper, the stories I pitched to local news organizations – all of my work had a health or science slant.  Over the course of those years, I became pretty good at reading science and health reporting with a critical eye, and more often than not, the things I saw left me head-desking and face-palming all over the place.  That dismay has only increased as I’ve spent more years working as a pro journalist and have been exposed to more and more reporting of all kinds.

I could go on for hours about this but I’ll just say that science often includes nuance, gray areas and probabilities, and those are things that do not translate easily into snappy, eyeball-snagging headlines and leads. The end result is science and health reporting that overstates research for the sake of grabbing bits of divided attention, and a public that often finds itself overwhelmed with confusion at conflicting research.  (There’s a reason why the work of Alex Hutchinson of Sweat Science has become so popular.)

I’m writing about this today instead of all other days when the world is graced with questionable health news reporting because a story surfaced that touched on the sport that is nearest and dearest to me: endurance athletics.

On Monday, CNN.com ran an article entitled “Extreme endurance exercise carries health risks,” which focused on a Mayo Clinic meta-study that looked at 50 studies of extreme endurance athletes – ultramarathoners, Ironman triathletes – and found “excessive training and competing can cause cardiovascular damage such as scarring and enlargement of the heart and blood vessels, as well as irregular heart beating.”  The lead author also talks about how some of his patients, who run several hours a day, are also prone to orthopedic problems.

Now I’m not going to argue that extreme endurance sports are always great for your body.  That kind of physical activity definitely puts a strain on the body.  Nor am I going to talk about the Tarahumara tribe and Born to Run, like a lot of the commenters did.  Frankly, if all you want to do is increase your chances of being healthy, you can get away with doing a lot less than train for marathons and long multi-sport events.  I can’t speak for all endurance athletes but I know that I do not run long distances because I think it’s good for me, but because I enjoy it.

Rather, what I take issue with is the way this research has been trumpeted despite the fact that the number of athletes to whom this research applies is vanishingly small.  Let’s look at marathons, which is the shortest, most popular distance event cited as an “extreme endurance” sport.  According to Running USA’s 2010 report, about 507,000 people finished a marathon in the United States in 2010.  The U.S. Census put the population of the United States at over 308 million for the same year.  Three-quarters – or about 231 million – of those people are over the age of 18.   That means about one-fifth of a percent of the adult population of the United States completed a marathon in 2010. 

I looked all over for numbers of finishers for ultramarathons, long-distance cycling events and Ironman triathlons, and I couldn’t find them, but I feel safe assuming that there are way more marathoners than there are of all three of those sports combined. And of the people I know who have trained or are training for these events, few of us take part in the several-hour training sessions cited by the lead author.   Yes, we have long runs but those happen once a week and for only a few weeks while leading up to an event.  Most of us do not train in ways that could be construed as “excessive.”  (I would be curious to know what the researchers define as “excessive.”)

So basically, when we talk about “extreme endurance” athletes, we are talking about a teensy, tiny little fraction of the United States.  Like, put a group of 100 people together to represent the whole United States, and we are talking about risks faced by the statistical equivalent of one of those people’s arms.  (And please do not even start me on the fact that the author of the article mentioned the fact that sometimes runners die during road races, “cover your ass” clause or not.)

Now, contrast this with a story from last month about research that found nearly seven out of ten Americans do not exercise regularly.  (Here’s another one that puts the numbers of people who do the minimum amount of recommended physical activity at a dismal 18%.) That’s a lot of people who are at increased risk for a whole mess of health issues, including the cardiovascular damage cited as a concern for endurance athletes.  In fact, the number of people who face problems because their lifestyles are too sedentary is several magnitudes greater than the number of people who face problems because they work out too much, and the kind of health problems tend to be much more severe.  I’m going to go out on a limb and say the real public health concern here is not the relative handful of people who complete Ironman triathlons each year.

In a perfect world, the average news consumer would look at these stories and go, Okay, so I’ll go work out a few times a week but I won’t get crazy with it.  Unfortunately, that’s often not what happens.  What happens is that people see the headlines, and maybe if they are a bit on the inquisitive side, they read a bit of the article, and then if it confirms biases they already hold (in this case, that exercise sucks), it will become part of the arsenal of information they use to justify their decisions and opinions about the world.  (And I’m not saying this to be superior, because I do it too.  We all do it.)

In fact, this happens so often that both the researcher and the news writer took care to say, hey, you still should exercise!

But the authors were also adamant that these findings should not dissuade people from regular exercise.  Lead author Dr. James O’Keefe, a cardiologist at the Mid America Heart Institute, said, “We want people to understand that this in no way detracts from the importance of exercise.  Physically active people are much happier than their sedentary counterparts. So much so, that they live up to seven years longer.”

According to the Centers for Disease Control and Prevention, adults should get at least 30 minutes of moderate exercise, like walking, five times a week, in addition to two days or more of muscle strengthening activity.

We have to be willing to engage with the news on a critical, thoughtful level.  For most of us, our only access to health reporting comes filtered through the media, which means we are relying on people who are under pressure as they try to write one story as quickly as they can so they can move onto the next one – and who are often doing this without any specialized knowledge – to disseminate this critical information about our bodies.  The CNN article was written by a medical producer who probably has a decent background, but even so she’s constrained by the demands of working in an online newsroom (constraints I am well familiar with, btw).

The answer isn’t to dismiss all health reporting out of hand nor to accept it all on faith, but to approach it with a critical mindset.  Here’s a good set of guidelines to follow when reading any sort of health and science reporting, courtesy of Emily Willingham at Double X Science.  Yes, it requires more work than just skimming the headline and a few paragraphs, but I think that effort is worth it.

9 responses to “Endurance sports are risky and other sensationalist health headlines

  1. Thank you so much for this post. I get so tired of having to reassure skeptical friends and family members that I am not going to drop dead from slowly and happily running a few miles three times a week. You’ve said so clearly what I’ve been trying to tell them…

    I have already forwarded this to one person and I’ll probably share it with others. Thanks again!

    • Yeah, runners like you or I are not exactly prime to die in the middle of a run (unless we have pre-existing heart conditions we don’t know about, in which I’m sorry for jinxing us?) I’m pretty sure this has been the case with most runners who have died while racing. I’m sorry that you have people expressing those kind of concerns to you, and I hope this helps change their minds a little bit.

      If people really want to talk about everyday activities with a fearsome mortality rate, let’s talk about driving. Now THAT’S something that’s killing a lot of people every day. Truthfully I wish people would take all of their concern for us runners and divert it into concern over the safety of driving, because that is a seriously dangerous activity that has become completely normalized in our culture. (Sorry, driving safety is one of my total soap-box issues, considering what my job exposes me to and all.)

  2. This is the same thing that happened to Crossfit. Anytime a exercise is taken to a more “extreme” level, people come up with something negative about it.

    While there have been more issues among Crossfit athletes than endurance athletes, if you are a healthy individual who knows what he or she is getting into, you will most likely not have any major issues.

    While the media makes it seem like people drop dead from working out all the time, they really don’t. As you said, more people have issues from being too sedentary than too active!

    Great post! I constantly preach to people that you can’t just accept everything you read as fact. Everyone has a bias!

    • I’ve seen the concerns about CrossFit as well, and it seems to me to be much of the same sort of thing – you get a handful of people who get so into it that they throw all caution to the wind and end up with those seriously injuries (like the torn muscles that leak toxins into the body, yikes). I don’t dispute the notion that too much exercise can be problematic, because it certainly can be, but I always worry when I see articles like this about the “dangers of too much exercise” that it translates into the “dangers of any exercise.”

      I guess maybe the reason why this article got so much traction is because it was one of those stories that seems to run against the conventional wisdom, and if there is anything the public eats up, it’s stories that claim to buck conventional wisdom. *sigh*

  3. This puts me in mind of something I read early in my bike commuting journey: you stand a greater chance of death from NOT biking to work, than you do from biking to work. That was referring to death by cars and not heart attacks but I think the gist is the same. 🙂

  4. The pressure to be able to post up breaking news at a pace so fast, every news item becomes breaking news is huge. No doubt, especially in the UK. That’s how the business is like and I feel that the actual usefulness of news that comes in, ie: News I can use, dimishes as the level of sensationalism increases. So when you get a report like that, I know and you know that getting the benefits out of exercises depends on several things that takes time to develop. But it’s lost on “OH NOES! Doing this for 20 hours is bad” type headlines.

    Crossfit and those type of programs I tend to blame more of marketing than anything. Using people who have awesome genetics or not typical results to market to people as if these were typical results. Then the average person only gets average results and is disappointed due to bloated expectations.

    Mind you, a solid amount of people have been able to develop great bodies with crossfit. But that’s almost the same with almost any training-type sport.

    • A lot of fitness oriented products do that! Like those wretched fat-burners, where they show the before and after with the teeny type that says “results not typical.” Damn straight it’s not typical to lose forty pounds in two months, and it should be criminal to suggest that it’s not only typical but desired.

      One of the things that frustrates me about the way health/science news is handled is that it often goes for the cheap eye-grab, and one of the easiest ways to do that is to run counter to “conventional wisdom.” Conventional wisdom says that exercise is good for you, so something that says the opposite is going to be glommed onto as newsworthy. Never mind that just as much research has been done and is always being done showing that, yes, exercise is super good for you. I find it very problematic the way research is cherry-picked for the kind of studies that say things too much exercise is a bad thing and that exercise doesn’t help with depression, especially since the average news consumer trusts the news and doesn’t know to question the whole process.

      • ” and one of the easiest ways to do that is to run counter to “conventional wisdom.” Conventional wisdom says that exercise is good for you, so something that says the opposite is going to be glommed onto as newsworthy.”

        And then… some experts confuse us more by saying contrary to the contrary of conventional wisdom, leaving us all wondering and jaded about the truth.

        And then when you do have something that does work too well, somehow, the method or product is either pegged as a drug or it’s buried deep as something too extreme, even though it isn’t and it works. Ah, lobbying and effective marketing.

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