Heart Health

Running Into Old Age

September 28, 2009

Running Into Old Age

My wife talked me into running a marathon this year.  As you know, a marathon is a running race that covers 26.2 miles and for many runners is the culminating event in a career of running.  I started training about 5 months ago and now I into my last week—the race is this Saturday.  The marathon I’ve chosen takes place in St. George, Utah and is a beautiful course that descends through the red rock country of the desert southwest.  I ran this particular race exactly 21 years ago and haven’t done it since.  Not learning my lesson from this first painful experience, I then ran several other marathons in different cities but stopped putting myself through this misery about 12 years ago.  My wife ran the Boston Marathon last spring (not long after knee surgery) and was such an inspiration to me that I agreed to sign up for one last race.

I still consider myself a youngish person, but if I compare myself to active professional athletes I come off looking like a wizened old geezer.  Most pro basketball and football players retire in their 30s, most tennis players hang up their racquets in their 20s, and nearly all gymnasts and figure skaters transition into “where-are-they-now?” status shortly after puberty.  Anomalies such as Brett Favre and Michael Jordan manage to drag themselves back for a “post-retirement” second act, and the mere fact that they can still walk makes the front page of the sports section.  In all these sports the athletes peak in their mid-twenties and quickly decline thereafter.

Running (and other endurance sports, ala Lance Armstrong’s return to a strong 3rd place in this year’s Tour de France) may be an exception to this.

Professor Dennis M. Bramble, a running expert from my alma mater University of Utah, poses a question (as cited in the immensely inspiring book “Born to Run”) that I find interesting:

“We monitored the results of the 2004 New York City Marathon and compared finishing times by age.  What we found is that starting at age nineteen, runners get faster every year until they hit their peak at twenty-seven.  After twenty-seven, they start to decline.  So here’s the question—how old are you when you’re back to running the same speed you did at nineteen?”

The answer he came up with is surprising: 64.  The decline in performance over forty-five years is so gradual that the sixty-four-year-old crowd can still compete with the nineteen-year-olds.

My own experience substantiates this.  Three weeks ago I ran a 10-mile road race here in Omaha.  About 150 people showed up—all of them fairly hard-core runners.  Of the thirteen runners who beat me only five were in age divisions younger than my own (40-45) and none were under the age of 32.  Finishing ahead of me were several runners older than I, including a 55-year-old man who bested my time by nearly 2 minutes.  Despite plenty of entrants in their twenties, only two finished in the top 25.

Last week I ran the Corporate Cup 10K (6.2 miles).  Again, I found that the majority of the best runners were over the age of 30 with plenty of top finishers in their forties and fifties.  The winner of this week’s Omaha marathon is 46 years old and a veteran of years of pounding the pavement.

Some of you may be familiar with an amateur runner by the name of George Sheehan who wrote the bestseller “Running and Being.”  Dr. Sheehan, a physician, took up distance running at the age of 45 and went on to great acclaim with his regular submissions to the magazine Runner’s World.  He was also pretty fast—he was the first person over the age of 50 to log a sub-five minute mile (4:47—something I’ve never been able to do)—and competed in countless marathons.  He was able to keep up his competitive 10-kilometer race pace until he was in his mid-sixties.  His key to success?: run, run, run.

This brings me to my point.  I believe your heart, lungs, and muscles are built to sustain amazing stretches of aerobic activity from childhood into old age.  Our problem is that we allow ourselves to slide into sedentary living somewhere in the third decade.  From that point our muscles fall into disuse and our joints deteriorate under the added weight of adipose; our vertebral disks suffer from lack of postural muscle tone; and our heart and lungs reward our physical complacency with poor performance.

Your body was made to move—your heart wants to beat hard, your legs want to burn under the stress of exercise—and if you manage to keep moving throughout your life you will find that your slide into old age will be a far shallower slope.

I plan to keep these thoughts in mind as I drag myself through the final miles of my race this weekend.  I don’t imagine I’ll post a personal record but at the least I’m hoping to finish with a respectable time and beat a few nineteen-year-olds while I’m at it.

  1. Geoff

    Thank you Dr. VDG, and apologies for the numerous typos. Diagnosis: Fat fingers on a tiny iPad.

  2. Eric Van De Graaff, MD

    Geoff, You sound like a very fit guy and I'm impressed with your work-out regimen. You are certainly a far cry from the usual septuagenarian who spends his golden years watching reality TV and slowly depositing cholesterol plaque in his coronary arteries. Your question is a good one and I'd like to rephrase it: "If I'm in good health and exercise routinely without adverse symptoms, is there a peak heart rate that I should be careful not to exceed?" The simple answer is no. The "220 minus age" that you correctly reference is a way for us to estimate a person's peak heart rate, but since it's based on large populations it is frequently erroneous in outlying individuals such as yourself. Your peak HR is probably closer to 190 than to what the equation dictates (153, if my kindergarten math teacher taught me correctly). The more important indicator in your case is what we call "heart rate recovery." The fact that your HR comes down quickly after cessation of activity points toward a very healthy heart and good physical conditioning. My final advice? If you feel good at peak exercise, ignore your heart rate. Geoff, keep up the kayaking and stay healthy! Dr. VDG

  3. Geoff

    DR VDG, thank you for sharing your observations as you have both athlete and physician's perspective. Many sources address younger athlete's issues, but those of us still active in later years find little to inform us when we do not the "norms" for our advancing years. Of corse not, since the vast majority of our peers become inactive. Would you comment on the topic Louann raised, indirectly, and that is high heart rates during athletic events? At 67, I see RHR in the 60s, but in my race kayak 5 k lap around the lake feel as if loafing unless it it in mid to upper 170 s , and easily goes lower 180s. IT drops back very quickly after stopping. (As 180 to 140 in 1.5-2 mins easily). Never smoke drink, eat well, long time weight lifter and always active...but do have high cholesterol. Is high heart rate, far above the old "220 minus age" idea a concern for athletic oldsters? Again, thank you for your really helpful blog.

  4. Puneet Gupta

    I read your article i really appreciate it.Thank you for an informative and inspirational article. I hope you had a great race and are pleased with the results. I too read Born to Run and was heartened by the peak ages for running.

  5. jo

    Read the articles above and noted some, which I would like to offer review. As the article mentioned, the sustainability of a runner past the age of 40 and into their 60's is not profound amoungst avid runners. As a health care provider, I'm an avid runner and active participant over many years of running along with many of my running friends. One observation I found paramount to sustain long distance running is genetics and mechanics(physics). Your posture and gait are valid measures as to your shelf life. Stretching is more important as you age than at the age of 19. If your joints and muscles ache during your runs, the unfortuneate reality may be that your mechanics. Consequently, even with great physical therapy, the correction may not resolve. Genetics and mechanics are so important in our youth and follow us into our elderly years.

  6. Louan

    Dr. VDG, Thank you so much for your feedback. I love Runner's World (my husband just bought their Complete Guide to Running) and I am following a training schedule from their website which includes speedwork and hills (same thing for me). I think I will go ahead and schedule a treadmill test for my peace of mind. Unfortunately I am nowhere near Omaha. Thanks again... Louan

  7. Dr. Van De Graaff

    Louan, Thanks for the feedback on our website. I've seen a number of people with an unexplained high resting heart rate. The term "inappropriate sinus tachycardia" is the tag we apply in this situation. The problem is akin to having a car with the idle control adjusted upward. In general, there is no harm that comes from this and it has no real clinical significance. Another possibility (far less likely) is something like hyperthyroidism, a problem that is relatively easy to check. At 44 years of age and in good health I'm not sure how helpful a stress test would be for you beyond just providing some peace of mind. That, however, may be a good enough reason to submit to a simple treadmill test. If it comes back normal then you don't have to worry about your heart when you're dragging through those last few miles of the November marathon. The fact that you've hit something of a plateau in your running may be a training issue. Not knowing what your running regimen is I won't be able to offer any particular critique (and I'm not sure I'm qualified to offer much in the way of training tips anyway) but you may want to check out some articles in Runners World or on marathon training websites such as http://www.halhigdon.com/marathon/Mar00index.htm You may need nothing more than to insert more speed and short distance work into your training schedule. In the end I think you'll do just fine. If you live in the Omaha area give us a call if you'd like to come in to try out our treadmill! We're happy to schedule it. Good luck in November! Dr. VDG

  8. Res

    This article gives hope to everyone looking to run into older age but it won't apply to many dedicated runners, unfortunately. There was one doctor in my area who said that most runners he's seen are finished by 40 or so due to knee problems. People age at different rates, have different health issues. Sometimes the damage brought on by excess running will also prevent other forms of exercise like longer walks, bicycling or swimming. If you're a dedicated runner I wish you all the best for decades of running. If for some reason you can't run or can't run nearly as well as in an earlier age I really wish you all the best. Maybe it would be time to start a new chapter in your life.

  9. Louan

    Thank you for an informative and inspirational article. I hope you had a great race and are pleased with the results. I too read Born to Run and was heartened by the peak ages for running. I don't know if this is an appropriate place to ask for feedback but I will give it a shot. I'm 44 years old and I started running 4 years ago. When I first started I had an echocardiogram because a doctor once detected a murmur years earlier so I thought it would be good to know. They detected slight leakage (don't remember where) but not MVP (my mom has) although they told me I should still take antibiotics before having dental work. I seem to have peaked at a 10:18 pace during a half marathon only 6 months after I started running and since then I can barely run 10 miles faster than 11:00. I also don't feel like my cardiovascular health is improving. While other runners around me have resting heart rates of 40 and 50 mine is 80 - 90. When I saw my sister and my mother at Christmas I found out that they have high resting heart rates which makes me think it's hereditary. It feels like it doesn't take much for me to reach my maximum heart rate when I'm running and I get out of breath easily. I signed up for a marathon in November and am considering seeing a cardiologist and taking a stress test to see how my heart performs while exercising. I would like to find one like you who is a cardiologist and a runner. A little more about me: I have been a vegetarian for a little over two years. I thought maybe that is an issue but I'm pretty good about meeting my nutritional needs (my husband is vegetarian and a runner about the same length of time and he just ran 15.5 miles at a 8:20 pace). I also tend to have low blood pressure. My question is, if I have a naturally high heart rate how does that affect my ability to improve my running? Thank you for listening and any feedback would be greatly appreciated. Louan

  10. Dr. Van De Graaff

    Res, Thanks for the comment. You bring up a very good point that I've neglected. Many people with the will for running just don't have the knees for it and must try other methods of fitness. I've been very fortunate with my joints but will someday undoubtedly succomb to joint degeneration. Thank goodness for elliptical machines, although I think I'll go out of my mind if I'm stuck inside a gym on a sunny day. Dr. VDG

  11. Dr. Van De Graaff

    Jen, You bring up a very interesting subject. You ask how marathons affect the heart. The positive effect of endurance exercise on the heart could fill textbooks and is not really controversial. It's the possible negative effects that are more interesting. I am quite familiar with the studies cited in the NY Times article you linked. In one, researchers in Germany performed CT scans on the hearts of marathon runners and found a higher amount of coronary calcium (an easily quantifiable marker for coronary disease) in the runners than in age-matched controls. I don't find this research very compelling for several reasons. The average age of the participants in the study was 57 and I know from my experience with cardiac CT that coronary calcium is ubiquitous in patients of this age. Furthermore, the majority of runners in the study were current or former smokers (56%), suggesting that they had not been lifelong health enthusiasts. We know that nascent coronary disease is found in males as young as 18 and 19 year of age and progresses steadily through life--by the time someone decides to turn their life around and start living healthy they may already have substantial coronary calcium. Finally, the number of participants was quite small from a statistical point of view. A more interesting study along these lines would be to evaluate "plaque burden" in marathon runners (using the more advanced coronary CT angiography), a better marker for coronary stability. The other studies, which look at serum troponin at the end of a marathon, are far more interesting to me. Researchers measured in runners the same marker we measure in patients having heart attacks--cardiac troponin (enzymes)--and found a rise suggestive of cardiac muscle damage. My opinion on this is similar to that of one of the doctors cited in the commentary: "But most sports cardiologists are quick to point out that the majority of these studies have been small and the results open to differing interpretations. “We don’t necessarily completely understand what’s going on inside” the hearts of runners during a marathon race, says Paul D. Thompson, MD, the chief of cardiology at Hartford Hospital in Connecticut and one of the nation’s leading experts on sports cardiology, as well as, himself, an avid marathon runner. “It’s possible that the heart may be stressed somewhat” by the exertion of a marathon race, he says, just as quadriceps and other muscles are. But “most folks don’t really think there is serious cardiac damage,” he continues, “although there may be fatigue, transient cardiac fatigue.” It’s also possible that some of the blood markers indicate damage to muscles other than the heart. Injured skeletal muscles produce excess troponin, too, he says, and although the troponin measured in the current studies has molecular qualities that indicate it originated in the heart, “it’s just not really clear yet what’s going on,” he says. He’s still running marathons and has no plans to stop." It's likely that one of 3 possibilities exists: 1. Other muscles in the body release troponin. 2. The heart releases troponin but sufferers no meaningful damage (skeletal muscles release CK with exercise as part of the process of becoming stronger and fitter) 3. I'm absolutely wrong and should stop running marathons right away. In the end I still feel that the research showing the beneficial effect of marathon running vastly outweighs the yet controversial evidence of damage, and I plan to keep it up. Now, wear and tear on the knees might be a different issue. Thanks for your comments!

  12. Jen

    I read your entry the other day, and thought of it again this morning as I read this post in the WSJ health blog: http://bit.ly/43tA0U. I find it interesting that there still isn't a clear-cut answer as to whether or not long-distance running causes heart damage. That being said, I was just curious about your perspective, as both a cardiologist and long-distance runner, about this article or these theories?

  13. Billy

    For another great example of getting and staying in shape later in life just "google" Mariana Phipps. Or go to (http://www.maureenoclark.com/articles/Ex-Smoker_Now_Ironman_Triathlete.html) She lives right here in Omaha and her story is truely inspirational. From what I've heard she's still going strong. In fact she should be in Kona, Hawaii right now for the 2009 world championship Ironman Triathlon this weekend and if my info is correct she'll be in a new age group this year, 65-69. GO MARIANA!

  14. Billy

    Great blog. I'm inspired. Have fun this weekend.

  15. Billy

    I'm 50 and work with Dr. Van De Graaff. I've always tried to stay in shape (with very limited success) but really just got into endurance sports in my mid to late 40s. I've done 5 sprint and olympic distance triathlons now and one half marathon along with a couple of 5k and 10k races. What's great about it is that you don't have to be good or fast. REALLY. I'm getting a little faster now but for the most part I shoot for a 10 minute mile pace(some people walk that fast) and I'm passing plenty of people. So get out there and give it a try. In many of these races(in fact even in H.S. cross-country) the slower you are the more people are cheering for you.

  16. Katrina

    Ok, since I'm not a runner, the only line of encouragement that popped into my mind was the above from "Field of Dreams." But your most interesting post inspires me to get moving more on my level. Good luck...and let us know how it went!

  17. Arie

    What a fascinating post. I had no idea that sustained success could be maintained for so much time. I'm going to have to redouble my efforts (as age is no longer a viable excuse).

  18. Jim

    Enjoy the run, best of luck this coming weekend!

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