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By James O'Keefe, MD

Daily physical activity is an essential component of a healthy lifestyle. Regular exercise and high levels of physical fitness are also linked to improved life expectancy and lower risks for cardiovascular diseases. Four decades ago Thomas Bassler, MD, an American physician, reasoned that if some exercise was good more had to be better, and famously hypothesized that marathon running confers immunity against coronary plaque buildup and heart attacks. In the current study, Bassler’s theory—long term marathon running protects against coronary atherosclerosis—was tested by quantitatively assessing coronary artery plaque using high resolution coronary computed tomographic angiography (CCTA) in veteran male marathon runners.

Study Design and Results

To qualify for the study the runners had to have completed at least one marathon each year for 25 consecutive years. The inactive control subjects were a contemporaneous group of apparently healthy men who had never been regular vigorous exercisers but were similar to the marathoners in age and other general cardiovascular risk factors. The 50 male marathon runners as compared to the 23 inactive male controls had increased total plaque volume (200 vs. 126 mm3, P < 0.01), calcified plaque volume (84 vs. 44 mm3, P < 0.0001), and non-calcified plaque volume (116 vs. 82 mm3, P = 0.04). In summary, the amount of plaque, both hard and soft, was significantly increased among the veteran men marathoners. Paradoxically, long-term marathon running was associated with increased, not decreased, coronary plaque buildup.

Implications

Exercise might be best understood as a drug with powerful benefits, especially for cardiovascular health. As with any potent drug, establishing the safe and effective dose range is critically important—an inadequately low dose may not confer full benefits, whereas an excessive dose might produce harmful effects that outweigh its benefits. Running marathons for decades may be an excessive amount of exercise, possibly predisposing to an increase coronary artery plaque buildup despite favorably altering many risk factors such as weight, blood pressure and risk of diabetes. A more moderate dose of exercise might be a better strategy for promoting long-term cardiovascular health and durability.

Published April 3, 2014

James H. O'Keefe, MD, is a board-certified cardiologist at Cardiovascular Consultants and Mid America Heart Institute in Kansas City, Missouri, and co-author of The Forever Young Diet and Lifestyle.

Editor's note: This article is part of a special series brought to you by Missouri Medicine, the Journal of the Missouri State Medical Association (MSMA). MedHelp, Missouri Medicine, and MSMA are collaborating to educate and empower health consumers by making the latest scientific studies and medical research available to the public. Learn more about MSMA and see more from Missouri Medicine.

This is a summary of the article "Increased Coronary Artery Plaque Volume Among Male Marathon Runners," which was originally published in the March/April 2014 issue of Missiouri Medicine. The full article is available here.

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