Nice discussion and I agree with most of your comments.
I would point out that almost all information in this area comes from observational studies and suffers therefore from inability to account for residual confounding. For example, those who choose to be sedentary differ in many other health-related , lifestyle choices from those who choose to do the recommended 150 minutes of cardio exercise weekly.
You briefly mentioned coronary artery calcium and its increased prevalence in those who exercise a huge amount. I've seen this in many patients who engage in ultra endurance activities and it is currently a source of controversy in the medical literature.
Very much agree the residual confounders are something we cannot get around in the absence of never to be done long-term RCTs. Have seen lots of CAC excess in endurance athletes but very much see the value in CAC as a very good assessment of plaque burden and near term risk. I expect the extreme exercise question will remain unanswered for a very long time.
Super article, thank you! I had to look up what monotonic means. You all did too, admit it! 😀
Was the mortality risk in the last graph all-cause-mortality? I wonder if extreme exercisers get hit by more cars since they're out running on the roads more? A lot of the runners here seem to think that traffic rules don't apply to them.
Thank you for this ! I would also add that most people are also not very good at estimating their effort (RPE) … I always wear a heart rate monitor and would definitely recommend one to regular exercisers
Nice discussion and I agree with most of your comments.
I would point out that almost all information in this area comes from observational studies and suffers therefore from inability to account for residual confounding. For example, those who choose to be sedentary differ in many other health-related , lifestyle choices from those who choose to do the recommended 150 minutes of cardio exercise weekly.
You briefly mentioned coronary artery calcium and its increased prevalence in those who exercise a huge amount. I've seen this in many patients who engage in ultra endurance activities and it is currently a source of controversy in the medical literature.
This article (https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.028750) provides a reasonable discussion and highlights the uncertainty. It advocates not performing CAC for most individuals but I disagree with that recommendation .
Dr. Pearson
Very much agree the residual confounders are something we cannot get around in the absence of never to be done long-term RCTs. Have seen lots of CAC excess in endurance athletes but very much see the value in CAC as a very good assessment of plaque burden and near term risk. I expect the extreme exercise question will remain unanswered for a very long time.
Super article, thank you! I had to look up what monotonic means. You all did too, admit it! 😀
Was the mortality risk in the last graph all-cause-mortality? I wonder if extreme exercisers get hit by more cars since they're out running on the roads more? A lot of the runners here seem to think that traffic rules don't apply to them.
Yes. All Cause Mortality. As for runners and cars. It's why I stick to trails when I can.
Thank you for this ! I would also add that most people are also not very good at estimating their effort (RPE) … I always wear a heart rate monitor and would definitely recommend one to regular exercisers
A heart rate monitor is a game changer for most