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A-Fib and the Master Endurance Athlete

Read a very interesting article linked to Joe Friel's blog post today.  I've seen a couple of articles on the topic of A-Fib and the fact that it is prevalent in very active people. The doctor's blog post mentioned in Joe's blog is worth the read, including the comments section.  The doctor is a cardiac electrophysiologist and cyclist.

It's got me a little nervous!

http://www.drjohnm.org/2014/05/exercise-over-indulgence-and-atrial-fibrillation-seeing-the-obvious/

Comments

  • These articles are getting redundant, instill fear, but don't give specific recommendations. If you read the comments and Dr John's answer, he has not changed his training/racing so...
    I may just go back to trying to ignore these articles.
    I wish I had an emoji of an ostrich with its head in the sand.
  • I need the same emoji. It makes sense to me that doing things in moderation are likely best, and IM training or Ultra training most likely tips over the edge of good to detrimental for some things...

    One of the problem with this study is that it just looks at A-Fib. I'd be curious to see what the ratios were for overall longevity. For instance, maybe you're 5x more likely to have A-Fib, but are you more or less likely to have heart disease, cancer, strokes, etc, etc, etc? If the answer is yes to all of them, then I probably still won't change anything, but at least it will make me think a lot harder.

    I still think given that I'm an "all on" or "all off" type of guy, that I'm better off long term eating healthy and training "too much".
  • Yeah, I agree with JW and Sabo. I read this when you you posted it on FB. The issue I had was how much is too much? To my civilian friends (non-triathlon crowd), I seem like a super human nut relative to exercise volume, but compared to some around here (I am looking at you Cronk) I feel like a piker.

    What are the volume recommendations?
  • Coming at this from two angles - as a giant nerd, and as somebody taking an interest in what (some folks claim) may, y'know, kill me.

    I'm a little slow sometimes, so I like to pull apart the threads and simplify wherever I can. So at the risk of sounding patronizing, here are the basics as I understand them after reading all the studies I could lay hands on (JW - stay tuned to the end for the really important stat):


    - Afib happens to a very small number of people in the population. We don't know why - we can make educated guesses - but we don't really know why. You can have zero risk factors at all and still have it happen to you.



    - Pay close attention to this part: afib does not kill you. We do know, however, that episodes of afib tends to happen to some people with heart disease, or to people before they have a stroke, or sometimes before a heart attack. Afib *does not cause or predict* these conditions, but it gets a really alarming rep because of the company it keeps. So when afib shows up to the party, peeps be getting nervous.


    - When you run the stats on the very small percentage of the population that afib happens to (remember - this is episodes of afib, not heart attacks, strokes, or y'know, dying) you notice a counter-intuitive trend. There are more dudes, 50+ who are also: former elite athletes, or a masters athlete with a long history of sports participation, or an endurance athlete - than you would expect. This is the "5X more likely" part. I know that sounds huge and alarming, but again, remember - this is among the small number of people who had an episode of afib happen, not a slow horrible death.

    - Even if you are one of the very small number of guys, 50+, who are also former elite athletes, or a masters athlete with a long history of sports participation, or an endurance athlete that has an episode of afib, it's treatable. You can reduce activity, take some drugs, or get a procedure to prevent it from happening again and continue on your merry way.

    - Now here's the answer to JW's question, and more importantly, the key point to silence the obnoxious know-it-all's at the cocktail party: when you dig into the studies, even if you happen to be one of the small number of athletes that has an episode of afib, **your mortality rate is still lower**. Like a whole lot lower. Like, 1.7% vs 8.5% (in the regular population).


    So, I'm with John - I'll take my hard-core salad and exercise, please.



    P.S. Happy to send citations if you're a nerd like me and want them
  • I believe that I am in the "5x more likely" population but, at the same time, I have always thought that if I was going to kill myself from heart issues it would have happened in my 20s due to the intensity and run volume that I trained at for many years. Now that I am old and slow, I don't believe that I stress myself nearly as much, but I have no clue if I've done damage to my heart over decades of endurance training. If I develop A-Fib, I will take it seriously and retire from competition. But until then, I tend to file this sort of data in the bucket of "typical shoddy medical research". Seriously, as a PhD myself, I've always wondered how much training MDs and Exercise Physiologists have in research methods. I've just read too much crap in the medical literature over the years to give them a pass on any claim. So while the A-Fib research might be legit, the medical community has cried wolf one time too many and have lost all credibility. It wasn't all that long ago that doctors seriously believed that running would shake up your internal organs and that women could not run more than 3000m without damaging their reproductive system. And even today, Noakes still dismisses the value of sodium supplementation for muscle cramping despite the testimony of literally thousands of athletes. So yeah, when Robert finds that ostrich emoji, pass it to me.
  • Evan - thanks for the digestion.
  • Comments much appreciated everyone - I've learned a lot!
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