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Extreme Exercise

Mar 12, 2016

A professional society looks into how much physical activity is good for a healthy lifestyle.

According to a clinical perspective published in the Journal of the American College of Cardiology from the ACC Sports and Exercise Cardiology Leadership Council, people should be more alarmed by the impending harm from a lack of exercise than of any harm exercise may possibly cause. Modest amounts of physical activity are linked with a lower risk of cardiovascular disease, but even more exercise (moderate-intensity to vigorous exercise) leads to a greater reduction in risk of death from cardiovascular disease. Researchers find that many individuals who undergo chronic health issues will limit themselves to lives of humble (non-intense) activity or no activity at all, with the false mindset that robust exercise is perilous, or that they do not have the stamina for it. New studies and investigation denotes the complete opposite of this long-held myth, proving that high-intensity exercise may be even more beneficial than regular aerobic activities for many patients with conditions including: heart disease, diabetes, stroke, pulmonary disease, arthritis, and even Parkinson’s disease. The studies suggest that a more demanding, more efficient, and often more enjoyable form of exercise (high-intensity interval training) is not only innocuous for many patients, but even more effectual at counteracting or reversing the deficits accompanying many chronic ailments.

In this report from the American College of Cardiology Sports and Exercise Cardiology Council, the researchers looked into the volume and intensity of aerobic exercise required for favorable cardiovascular health. They also examined the question of whether or not there is a particular amount of exercise that increases cardiovascular disease risk due to the rise in partaking in endurance races over the past decades. What they were able to find was that moderate and robust-intensity exercise in amounts less than the 2008 Physical Activity Guideline recommendations still considerably lowered overall mortality risk in various populations around the globe. Increases in the amount of moderate-intensity exercise an individual partakes in resulted in an overall reduction in cardiovascular disease mortality. The researchers concluded that “even small amounts of physical activity, including activities such as standing, are associated with lower CVD risk. Exercise volumes of 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic exercise, such as recommended in the 2008 Physical Activity Guidelines Advisory Committee Report, further reduce CVD mortality.”

A major concern highlighted in this recent publication is one that a few limited studies have addressed previously: that high volumes of exercise may actually do the opposite and harm, not help, a patient. However, according to their findings, the actual probability of an excess amount of exercise / extreme exercise being harmful is low, even for many of the lifelong endurance athletes; the benefits still manage to outweigh any proposed risk. Social media has also contributed greatly to embracing the notion that exercise may harm, which has significantly diverted attention away from the benefits it holds in heart disease prevention. Michael S. Emery, M.D., co-chair of the ACC Sports and Exercise Cardiology Council was quoted stating that, “the available evidence should prompt clinicians to recommend strongly low and moderate exercise training to the majority of patients…equally important are initiatives to promote health at large through physical activity across the lifespan, as it modulates behavior from childhood into adult life.”

Comment from Dr. Sheri Colberg (Advisory board member):

Sheri Colberg, PhD, FACSM, specializes in research on diabetes and exercise and continues to conduct extensive clinical research specifically in Type 2 diabetes and exercise with funding from the American Diabetes Association (ADA), NIH, and others.

The latest research confirming that engaging in more exercise leads to a greater reduction in death from cardiovascular disease comes as no surprise. The surprise is that they claim that high-intensity exercise may be even more beneficial than regular aerobic activities in people with diabetes and other chronic diseases. High-intensity interval training certainly seems to save time if you only do 10 one-minute bouts of exercise per workout, but it burns fewer calories overall than doing a continuous activity for longer in most cases.  It may not save much time either, since you still have to add in rest intervals in between and a warm-up and cool-down.

Moreover, not everyone is going to be able to do it, and it likely will lead to a greater incidence of overuse injuries in those who can participate in harder intervals regularly. Luckily, moderate exercise may be equally effective at reducing cardiovascular risk if done regularly, and it’s a lot more sustainable as an activity for most people over a lifetime than high-intensity work is.

Personally, I think we should stick with the “Grandmother Test”: if I can’t imagine my obese grandmother with type 2 diabetes doing it over the entirety of her lifetime (or even at all), then it’s likely not a viable option for the majority of people who are older and likely overweight.  The good news is that all types of physical activity appear to benefit cardiovascular health, so it just pays to be active however possible.

Practice Pearls:

  • People should be more concerned about the lack of exercise in their lives, instead of potential harm it may cause.
  • Significantly lower mortality risk was observed in populations who perform moderate and vigorous intensity exercise at levels recommended by the 2008 Physical Activity Guidelines.
  • Health care professionals should encourage at minimum low to moderate intensity exercise for all patients to help combat heart disease.

Researched and prepared by Javeria Fayyaz, Doctor of Pharmacy Candidate LECOM College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE


Eijsvogels, Thijs, Silvana Molossi, and Michael Emery. “Exercise at the Extremes.” Journal of the American College of Cardiology 67.3 (2016): n. pag. Web. 17 Feb. 2016.

Phend, Crystal. “The Right Amount of Exercise Is …” Medpage Today. N.p., 19 Jan. 2016. Web. 17 Feb. 2016.