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He still felt confident that his running had provided protection. A calcium score of 100 or less is considered mild calcification, and 400 is considered extensive. His score was 1,606.
“As a physician and a runner, I felt betrayed,” he said. “I thought I was out there exhausting myself, building an absolutely indestructible heart.”
Hagan is 70 now and no longer runs, but he walks 30 minutes nearly every day and regularly swims and lifts weights.
“Do a marathon if it’s on your bucket list, when you’re young,” he said, “then cut way back.”
Moderation is key
Two years ago, in a report published in the journal Mayo Clinic Proceedings, O’Keefe and fellow authors cited evidence that extreme endurance training may cause structural damage to the heart, making it stiff and enlarged. That paper showed that running moderate distances two to five times a week at moderate speeds offered the best health benefits and that even 15 minutes a day of physical activity was helpful.
Eladio Valdez, coach of the Runner’s Edge training group in the Kansas City area, said he is aware of recent research about the potential ill effects of years of long-distance running, and last year he held a clinic for his clients on the topic.
“I told my runners, ‘We can’t ignore this research,’ ” he said.
While such studies don’t offer definitive answers yet, Valdez said, the research is “sobering,” and he encourages his long-distance runners to see their cardiologist and to consider getting a heart scan.
Argument for exercise
Running fewer miles also reduces overuse injuries, and Valdez has seen clients gravitate to more moderate regimens.
“Moderation may be the answer in running, as with everything else in life,” he said.
A runner for more than 30 years, Valdez has cut back his miles from about 40 a week to between 20 and 25. He plans to run one more marathon this fall — the 25th anniversary of his first marathon — and then no more.
“I feel I have one more in me,” he said.
O’Keefe worries that some will use the findings to argue against exercise. But they would be ignoring the overwhelming evidence that being sedentary is clearly dangerous for the heart, he said.
Most people will never have the super-exercisers’ issues. For every person who is overexercising, there are 19 people not getting enough exercise, O’Keefe said.
Running about 15 to 20 miles a week provides optimal health benefits, O’Keefe said. Or walking can provide benefits, from 2 miles a day to as much as 40 miles a week. Virtually all types of exercise and activities can be protective, but moderation is best for long-term benefits, he said.
“So this really knocks the props out from under anyone with the excuse ‘I just don’t have enough time’ or ‘I’ve never been an athlete,’ ” O’Keefe said. “You can train up to be the most ultra-fit endurance athlete ever, but that’s not what’s required for longevity. Moderate exercise is.”