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How to Reconcile Performance with Longevity [transcript]

Written by Christopher Kelly

Aug. 6, 2018


Christopher:    Hello and welcome to the Nourish Balance Thrive Podcast. My name is Christopher Kelly and today I have not one but two very special guests. The first is Dr. Tommy Wood. Say hello, Tommy.

Tommy:    Hello, Tommy.

Christopher:    And the second is Dr. Simon Marshall. Say hello, Simon.

Simon:    Hello.

Christopher:    I have one very important question that's going to be the subject of this week's podcast. That question that comes from one of our clients is: Performance isn't as much a priority as longevity now but I still love to compete. That is my conundrum. I really like that question. Before we get into that question, Simon, I know that Lesley has been racing in Europe recently. Can you give us an update on Lesley's performance?

Simon:    She just last weekend in Demark raced the ITU, the International Triathlon Union, world championships for off road triathlon or cross triathlon and she won it. She is now the 2018 ITU world champion. So, really excited about that. She was back for three days in San Diego and she is off again. She is now in Colorado racing this weekend. No rest for the wicked. That's great news for her. She is really over the moon. It was exhausting supporting her, I will say that too.

Tommy:    That's awesome.

Christopher:    How long is that event? I was trying to figure that out and I couldn't figure it out. How did she face for? How long does the whole thing last?

Simon:    This event was two and a half hours. That's actually quite short for off road triathlon. Most of them are three and a half, three forty-five. This one was a short, flat, fast course which doesn't usually suit her because she's like a miniature person. She goes uphill very quickly but there's not much muscle mass on the flat but she did really well. Her running has come on and the swim was slightly short and that's her weakness so she didn't lose as much time. Everything came together.

    The week before, talk about Lesley's racing career, but the week before she was racing in France. I was there too. That went like an absolute bag of spanners. Just everything went terrible. She had to rally around and get her shit together for the following week and she did so it's really good news.

Christopher:    How much were you involved in her getting her shit together?

Simon:    I'm always involved, Chris. Come on, what kind of a ridiculous question is that? She's figured this out. She has over the years figured this out how to let go of tough races and move on. Now, it's more second nature to her. It's not something that she has to do a lot of soul searching the day after. You do have to figure out what went wrong and why and how to make sure that doesn't go wrong this weekend and then focus on the controllables and the other stuff that we know. Yeah, that was all good news.

Christopher:    It sounds a lot like growth mindset has anything to do with it.

Simon:    Life is a growth mindset, Chris. I'll bring any discussion. In fact, that should be a little quiz we could play. How quickly can I bring any question back to growth mindset?

Christopher:    I like it. I do enjoy that a lot. Okay, so, back to the question at hand. I'll re-state the question because I think it's a really good one. I want everyone to have it fresh in their mind as we get into this. Performance isn't as much as a priority as longevity is now but I still love to compete. That is my conundrum. So, perhaps we should start with some definitions. What exactly do we mean by performance? What do we mean by longevity? Simon, you're a good guy at nailing down things like this. What do you have in mind when you think about what is performance, what is longevity?

Simon:    Yeah. Performance means, in this context, I guess, for the client anyway, they were talking about sport performance. I think of it more about training, physical training as well as mental training as well to prepare you for a very specific, the demands of a very specific sport. This is improving your fitness and the skill. But the goal of which is to improve your ability in that sport. That's usually to go faster or to do better. It has a very specific focus unlike it might just be some general exercise goals. I see this now more tied to the demands of an activity, competitive activity.

Christopher:    And, Tommy, could you define longevity for us? I think, I mean, longevity is a word that we hear a lot in common use but I don't think anyone really wants to live to be 120 and be frail and laid up in bed for that entire time, do you think?

Tommy:    Yes. You've loaded that question perfectly.

Christopher:    Do you like that?

Tommy:    I did. Longevity, in its simplest description, is just how long you live. Most people nowadays would agree, at least the kind of people that we interact with, probably the people listening to this, would think that health span is at least as important as lifespan. Lifespan, meaning how long you live, and health span being how long you are healthy for.

    There's two parts to that. It is increasing the amount of time that you live for but also decreasing the amount of time that you spend with rapidly declining health. So, the period of time where you become frail, you become unable to go out your daily activities, nursing home, supportive care, that kind of stuff. At the moment, the majority of the population, it seems to be a fairly slow decline once you get maybe into your 70s, but we might prepare to shift that curve along so that we live longer but then the drop off is much more rapid. So, increase in the amount of time that we're healthy as well as the increase in the amount of time that we live.


Christopher:    I can elaborate a bit more on the question because I think it's a really good question because it's one I also have. I think many people listening to this podcast will be thinking the same thing. They probably heard something about AFib and problems that you're going to run into if you do too much endurance. That's definitely something I'm thinking about. What I really care about is health span, what you just described, Tommy.

    Winning bike races is not very high on my list of priorities even if I was capable of doing it. But I do still love to do cyclocross races especially. I think that's really fun. At the moment, I do -- like many of our clients, actually, I believe the same as many of your coaching clients. Simon coaches mostly triathletes in Braveheart Coaching?

Simon:    Well, some runners and cyclists but mainly multi-sport, yeah. Endurance athletes.

Christopher:    Right. And the whole lot of us are doing seven to 12 hours a week of what you would might call training. The question is: Is that going to affect our health span? Should we be doing something else instead? And maybe I should put that question to you, first, Tommy. What do we know?

Tommy:    Before we delve into this, I wanted to set the parameters of the discussion. So, I don't think any of us here would disagree that physical activity is incredibly important for health longevity, maybe the most important thing. By some estimates, less than 10% of individual in the US are engaging in the recommended amounts of physical activity which is 150 minutes a week of moderate to vigorous physical activity.

    But I think that the people listening to this podcast are probably in that 10%. I don't think we need to discuss whether physical activity is good for you because we pretty much ticked off that point. I mean, we can talk about the minimum effect of dose and that kind of stuff. I think that's important. But equally, I think we will also agree that excessive exercise, however that is defined for the individual, can be detrimental both for physical health, mental health, relationships, all that kind of stuff that Simon could talk about probably more than I can.

    The question is finding the balance. What's enough? What could be too much and how do we balance training for performance for certain goal versus longevity? Unless anybody else has anything to say on that, I feel like that's where we're trying to toe the line.

Simon:    Right. I agree. There's no contentiousness at all in that, A, moderation as a general message is a good one, and B, that physical activity and exercise is very good for your health. I think we're talking about the polar ends of the distribution here, the folks on the one hand who do nothing and, on the other hand, the folks who do perhaps excessive exercise for whatever that means. Maybe we'll talk about how we can try and find the definition for excessive exercise. Yeah, I think we're talking of the tails.

Tommy:    If you're looking at the amount of exercise that confer optimal longevity benefits as physical activity increases, you see almost a linear, at least initially you see a linear increase in longevity or decrease in mortality, up to probably about the point where you're doing six to seven hours of vigorous intensity exercise per week. However, how we define that is really important.

    Simon has actively researched some of this but if you're looking at the intensity of exercise, it's often classified in metabolic equivalence and moderate to vigorous intensity is something like more than 100 steps per minute, which is something that Simon has actively published on. We're thinking things like brisk walking, light jogging, cycling, moving heavy weights, some body weight type exercise where it doesn't have to be that you go out and run for an hour a day. That would certainly put you at the upper end of most studies that we have access to.

    So, 45 minutes to an hour a day of that kind of activity seem to be where you get the optimal longevity benefit. We then go to extremes. This is where a lot of the debate comes in. There's a lot of vested interest in terms of the people who think that all running is great and there are people who think that lots of running can be bad for you.

    The quality of the data does vary but there are some people who seem to show that once you're above maybe 18 MET hours per week you might start to see an increase in certain cardiovascular risks particularly AFib and then some people have done studies of running and they show once you get above 25 to 30 miles a week in terms of mileage then you might start to see an uptake in terms of mortality.

    That doesn't mean it's significant. You just look at the shape of the curve. It does maybe start to go up a little bit again. This isn't like something where you can definitely say that's definitely bad for you because there's so many other things that come into play.

Simon:    I think it's an issue of diminishing returns. We don't just go from optimal dose to bad. It goes from less bang for your buck as you go on. It seems to be if we can find some of these thresholds, as Tommy identified, that after those points that you're no longer getting benefits. I think that's quite important to point out rather than it's actively harmful. Once you go above that and there probably is quite a nice dose response once you get above that point so that it does actually become quite detrimental to your health.


    But it becomes from optimal to diminishing returns to probably no benefit over sedentary and then it becomes actually worse. I think that's quite important to point out. Certainly, from a public health perspective, because we're thinking if we look at the proportion of people who fit into these buckets they are quite small.

    They're sort of right hand of that distribution. The left hand, the inactive, there's lots of those. If we believe the statistics, it's probably close to 70% or so of the population who do absolutely no leisure time physical activity. But when you're talking about the right hand tail, those people who are doing extreme exercise, these numbers are nearly are not even close to that.

Christopher:    Tommy, what are the risks? Can we be more specific than all cause mortality?

Tommy:    The main one that people focus on are cardiovascular complications. So, AFib is the most common one, atrial fibrillation, which is in itself a non-life threatening arrhythmia. Non-life threatening because it doesn't mean that your heart will suddenly go into a dangerous rhythm that means you'd lose consciousness or go into cardiac arrest.

    However, particularly as you get older, if you're above 75 years old and you have AFib and if you don't take some kind of anticoagulant medication then your risk of stroke is at least 5% per year. That's because the heart isn't beating properly. You get cough that developed in the heart and then they can be thrown off and go into the brain and cause a stroke. If you have AFib, you're over 75, you are usually, unless you are at high risk of falls or bleeding, you'll be on an anticoagulant medication of some description.

    That's the main one. Peter Backx has been on the podcast before. I know he talked about the fact there are other arrhythmias which can cause sudden cardiac death or cardiac arrest. They don't seem to increase with very high levels of exercise. However, there are some studies looking at the degree of coronary artery calcification in marathon runners. There does seem to be, again, an association between very high levels and -- I mean, we're talking 50 plus miles a week if not more in terms of mileage and running and coronary artery calcification.

    But again, like Simon says, these are fairly small studies in a fairly small part of the population. If you look at marathon runners, about a third of marathon completers, depending on the study, may have an increase in troponin levels, which is the marker of cardiac damage which you would normally measure in somebody having a heart attack. That definitely suggests that there was a stress on the heart in those -- If you're completing those very long distances. And then over time--

Christopher:    Is that not the point though? Is that not part? Is that a normal part of the training response?

Tommy:    Well, certainly not in terms of the training of the heart. Pretty much all of the benefits of exercise seem to come without actually causing direct damage to the muscle tissue be that skeletal muscle or cardiac muscle, particularly cardiac muscle. You don't want continuously elevated levels of troponins because you're running frequent marathons.

    That may then increase your risk of later heart attack and that may be where you start to see an uptake in the cardiovascular deaths. That's probably what contributes to a potential increase in all cause mortality. But pretty much everything else seems to decrease with increase in volume of exercise so it's mainly the heart that people are focused on.

Simon:    Tommy, I don't know if you know any of the evidence, I don't, about the extent to which exercise, extreme exercises, if you've got some congenital heart defect or there's some issue you have, it's the excessive exercise that basically is bringing that out so you're more likely to see that under exercise rather than the exercise per se causing it with no etiology beforehand.

Tommy:    Yeah. That's incredibly important. It's part of the reason why in certain parts of the world screening for cardiomyopathies before taking part in exercise is really important. In Italy, in certain parts of Italy, they have very high incidence of something called arrhythmogenic right ventricular cardiomyopathy. Basically, everybody who before they partake an exercise, from kids upwards, they have to have an EKG or ECG to check whether heart rhythm is normal.


    There's similar things looking at sudden cardiac death in collegiate athletes in the US. There are definitely things that are going to increase the likelihood there. So, basketball players might have something like Marfan syndrome where there are connected tissue diseases which help make them very tall but also increases the risk of issues with the heart. So, being screened for those things in certain subsets of athletes is really important.

    But that's the exercise triggering an underlying risk rather than if you have a perfectly normal heart to start with you then over time where you're putting stress on it you end up with a different disease mechanism. Yeah, there's definitely a risk in young athletes with certain susceptibilities, but that's an underlying factor that's fairly rare.

Simon:    It's interesting because when Lesley raced in Italy two years ago as a professional she was required to have an ECG before she would be allowed to start the race. Its' quite interesting. That makes sense now.

Christopher:    Tommy, if you had kids, would you have them do an ECG before they started any sport? Is that a good general recommendation?

Tommy:    Probably not, actually. I don't think that's something that everybody needs to do. A lot of collegiate athletics programs will require it. African-Americans in basketball seem to be particularly at risk. If I had kids with my current wife, we both have very good family history. She had a very long athletics career. I've done pretty well at a number of different sports of varying intensities and haven't had any issues as far as I'm aware of.


    I've had EKGs and they looked fine other than some left ventricular expansion because of all the aerobic exercise that I've done but not in a dangerous way. I don't think it's something that everybody needs to do. But if you are in one of the at-risk groups, usually if you're part of a larger program, people are pretty well tuned to this so they'll be doing those tests, anyway.

Simon:    Is it true that the traditional exercise stress test is also may not reveal an underlying cardiac abnormality because I don't just try a one-off test or something like that? Is that true? Is that just a myth?

Tommy:    It should pick up most things, if you do a true cardiac stress test but, I mean, that's definitely not going to be a guarantee because a lot of this stuff kicks in, cause an abnormal rhythm and you suddenly die and the first time you find out about is when that actually happens. Under the stress test, just like the guys who are dying of sudden cardiac death in whatever sport it is, they would have looked sensibly normal on an EKG or a stress test up until that point and then it suddenly happens. It's definitely good to do if you're at risk but it's by no means foolproof.

Christopher:    What about the association between worse coronary artery calcium scans and excessive exercise? Can you posit as to mechanism there or is it not known?

Tommy:    There's going to be a number of different things that could come into play. I think one of the first studies that looked at this, which is definitely worth thinking about, is the fact that more than 50% or maybe it was at 50% of the people who took part of the study were previous smokers. If you imagine, you've led a very unhealthy life up until that point then you're like, "I'm going to stop those bad habits and I'm going to start running because that's going to be good for me," then you look at their hearts, their hearts are in bad shape because of the stuff that they were doing before, not because of the running they were doing now.

    So, that's definitely part of it and that's always going to be a confounding factor, is that a lot of the people who are very passionate about exercise had previously unhealthy lifestyles and that's certainly the case for me. I had an average unhealthy childhood but not much physical activity and then perhaps I over compensated in later life. I think that that's certainly going to be part of it.

    Beyond that, if you are putting stress on the heart in terms of total exposure to adrenaline or restricting blood flow to certain areas based on demands of long periods of time you're going to cause very, very tiny microscopic areas that are like having a heart attack but just obviously not in a bulk way that's going to affect the function of the heart at that small period of time.

    Some people think that it's associated with an increase in gut permeability after a very intense exercise because blood flow juices to the gut, you get, as the volume and intensity of the exercise increases you get an increase in gut permeability both during and afterwards then you get an increase in post exercise endotoxemia which cause an inflammatory stimulus or some people think it's mostly to do with endotoxins from the gut after extreme exercise.

    There's multiple different factors but that's continuous both in terms of catecholamines, adrenaline, cortisol, inflammatory stimulus that's going to be widespread throughout the body. And that's one of the benefits of exercise, is that you create an inflammatory stimulus which then helps to tune the immune system over time but, obviously, like most things, you can overdo it so then it becomes damaging. Again, inflammation after exercise isn't necessarily a bad thing. It's one of the reasons why exercise also good for us, but too much of a good thing could be a bad thing.

Christopher:    Can you talk about the ancestral health lens? What would a hunter-gatherer have done 10,000 years ago? Would they have done marathon training every day?

Tommy:    I was looking at--

Simon:    That’s irrelevant. Come on, man.

Tommy:    It's relevant just because I was looking at some papers on physical activity in hunter-gatherer populations. It's usually the Hadza that gets studied. There are a couple of papers that are looking at the amount of physical activity that they were doing. As I went back to the references looking at how they defined -- they were looking at the amount of moderate to vigorous physical activity every day and the way that they would define that was defined in a paper by the first author or somebody called Simon Marshall.

    It was basically any time they spent walking at more than 100 steps per minute. That was their threshold. They found that in these guys, at that level of activity, moderate to vigorous, and most of it is moderate, it's just brisk walking, for just over two hours a day I think was the average, and then looking at the amount that they're walking or the amount of distance they cover in a day for men it's like 11 kilometers. So, we're talking about maybe seven or eight miles. In women, it's roughly half that. Obviously, the way they're splitting their activity is different.

    Part of what are we used to, we are used to lots of walking, occasional burst of activity which is running after a deer or whatever, playing, we definitely did that occasionally, lots of lifting and chopping and digging and stuff like that if you're gathering some kind of food. But equally, after some large burst of activity, whatever that is, there will often be long periods of rest.

    That's something that's often missing from an athlete's training program although I'd really like to hear Simon talk about this because there's a lot of people who, if you have a good coach, if you have Simon coaching you, you're going to have a structured program which builds in the right amount of rest relative to the amount of exercise that you're going.


    But in the general population or people who aren't being coached, there's often this feeling that you just go out and you run really hard for an hour and you do that every day and that's going to be good for you. But then you're potentially getting towards that point where you're going to see negative effects. We are used to strenuous activity and potentially very long burst but then there's always going to be a rest period of perhaps several days afterwards which we're maybe not allowing ourselves.

Simon:    I agree with everything that Tommy said. I think that if you're training for performance, again maybe my perspective is for triathletes, and most what we call age group triathletes, so that's just a general moniker given to people who are amateur, the vast majority are doing seven to 12 hours on average, ten hours a week of training. That, obviously, includes some very low intensity exercise and some very high intensity or interval like training as well.

    Yeah, it's finding that fine line between giving them enough recovery, making sure the sessions are still quality. To be honest though, a coach's perspective is not really thinking -- and this is more of an admission rather than something to marginalize it, is that you're thinking about their long term cardiac health. You're thinking about how do I best prepare this athlete for a race in six months time often with little concern or thought? It's not necessarily a negligence but it's really not on the radar until fairly recently about what are some of the long term consequences of doing this. I think that's an interesting point.

Christopher:    Why did they do? Why do I do it? Why do people do so much exercise if what we're saying is what you really need to do if your goal is health span is so much less? Why do people over exercise, Simon?

Simon:    Well, that's a loaded question because you've used the word over exercise. I think, listen, motivation to train for performance is varied. In my experience with coaching, and Lesley's especially with coaching and performing, is that when you talk to athletes about -- this is the classic intake interview that you do with athletes. What are your goals? What are you trying to get at?

    You can have this discussion. What's important for coaches to be aware, the first goal is to find out what that athlete wants and needs from you? An athlete might say that they want to go to Kona, which is the Willy Wonka's golden ticket of triathlon, if you're an Ironman, but actually they may be doing that solely because that's what they think it takes to be considered to be a triathlete.

    It's about identity. Once they've experienced the training or they've been exposed to other parts of triathlon, not just long distance slogging in the heat, they might get turned on to a whole different experience. There are some people who do have exercise dependency. I don't like to use the word addiction but exercise dependency, in the sense that they don't just want to do it but they need to it and they show all of the signs of what we know about behavioral dependencies, about tolerance, and overload and those sorts of things.

    Most athletes that we coach don't fall into the exercise dependent. They are, obviously, serious about it. They are sticking to a training goal. But it can be motivated initially by health transformation, they've been overweight their life. They look around and they see this is the ultimate challenge to get into triathlon or it's just in that -- it is fashionable now to do that or some of their friends do it or so on.

    Or they just like the gear. There are very few opportunities in sport where you get three different bites of the cherry to feel good. Some of us come from, who've experienced, if you've been an athlete as a kid you've either biked, ran or swam at some point in your life. Most of us can say, "Well, I'm probably better at one of those. I know I can do one of those. How hard can it be for the other two?" Unlike saying, "I want to start tennis," and I've never picked up a racket before.

Christopher:    I see.

Simon:    I think endurance sport, that is intuitively appealing because the motor coordination and the action to do them is exceptionally simple. We all know how to ride a bike and to run and many of us know how to swim. In that sense, it could be appealing. And there's lots of them. We know that if you've ever been to a big triathlon and there's some special about seeing all the people there and there are people watching and clapping and there are other people cramming themselves into wetsuits just like you.

    There is something, the competitive part, is meeting a need as well. I think that there's a bigger issue here about the move in triathlon in the US, anyway, that's becoming more and more dominated by Ironman distance. I have a few darker more conspiratorial theories about why that is rather than simply because it represents the ultimate challenge and endurance.

Tommy:    Can you share them with us?

Simon:    I think that people, they like the idea of competition but they don't like the idea of getting beaten. And so when you go long, it becomes more of a self referenced challenge. The goal of an Ironman for pretty much 99% of Ironman triathletes is to finish, is to get through it, and hopefully do a time that you beat a time before. If there are 3,000 athletes in an event and the podium, so to speak, is three to five people, the chances for most of us to even get close to having some sort of formal recognition of how you compare is minimal.


    Yes, you can, "Look, I finished 475 and I beat Jimmy who is my neighbor." I think most of us like the idea of being out there pinning on a number, having a little bit of a head to head competition during a race, the last mile or the middle part of the bike when you're backwards and forwards or so on, but ultimately the finish, it isn't an ego crushing outcome.

    If you look at other sports, take any event on the track, for example, or any event even in cycling, it's a potentially ego threatening environment. It's very clear whether you're getting dropped or you're last because everyone can see it and the race is over pretty quickly. The longer you go the less it becomes, the less ego threatening it is, but you still get the juices flowing of competition.

Tommy:    That reminds me of the first marathon that I did, which is in my 20s, and it was because I hadn't been doing any running recently because I had been rowing so I knew I couldn't beat my half marathon time so I thought, well, I'd run a marathon instead, go longer, it's less threatening to my previous performances I'd done to compare myself to myself and worry about going slower because I've got nothing to compare it to.

Simon:    And even the folks who are doing shorter running races, say a 5k or 10k, some athletes are paralyzed by the thought of I have to feel I have to be in perfect shape before I enter my local 10k. Why? Because all the athletes I know in my local club, they'll know how I've done and they'll be saying, "Oh, they're not as good as I thought they were." There's some expectations.

    And so often you'll say, "Listen, let's find a 10k in a different town when nobody knows you." And suddenly the appeal of that is returned. You get to see, you get to expose quite clearly the extent to which someone's ego is on the line and when you remove some of those barriers, you can race fairly anonymously, suddenly it becomes a whole different proposition for them.

Christopher:    That's amazing. I was going to ask you. That was going to be my next question, is like how do you handle this? How do you get people back into the shorter distance events in triathlon? Maybe you just told me.

Simon:    Well, there's another strategy. I don't know if I talked about this on the podcast with you, Chris, where we talked about competitive mindset versus participant mindset, is that we've had a few. We've only had to do this with a couple of athletes. If they're listening to this, they know that it's been sort of the underlying theory behind it, which is what we actually told them. We forced people to miss the start. It's typical in 5k and 10k runners.

    So, if folks are paralyzed by social comparison and you want them to experience developed pacing skills, to have some sense of competition, to try and execute and deliver based on the training that they're doing, suddenly sore throats come on two days before. They have a history of canceling or not showing up or not doing them. And so one thing that we've done with a couple of athletes is we say, "We want you to go to this race but when the gun goes off--"

    I'll tell you a funny story about this. "When the gun goes off, I want you to wait four minutes before you start." You look a bit foolish because it looks like you're late or you missed the start. And so what you're doing, if it's a chip timed event, you have a little transponder, so you're still getting a time that's accurate. You're not adding four minutes. Some of them are if it's a standard gun.

    But then you get a chance to not worry about where everyone else because all you're doing is playing catch up. We wouldn't do the set off three minutes early. One, because you're not permitted to do that. But other way, you just got a pack of barking dogs chasing you down which is ego terrifying for them. So, you force them to miss the start.

    What we often do if they can’t stand the embarrassment of standing on the line and people looking at them, "Why aren't you going? What's wrong with you?" Is that we say, "Go to the bathroom and then I want you to stay in the porta cabin until you hear the gun go off and then go out and then saunter up to the start line." And we've had people run PRs using that strategy.

Christopher:    That's amazing. I could actually give a testimony to that. I've done that in a mountain bike race. I didn't do it on purpose. I'm sure you had people do that. I'm sure people listening have done this. I just spent too long warming up and I missed the start of the race by two or three minutes. I ended up winning that Cat1 mountain bike race because it lit a fire under me. I was so annoyed and so angry with myself.

    And then I never realized that there weren't any more people left that part. I spent the entire two hours thinking I was playing catch up and then when I finished, I'm like, "You won." I'm like, "Holy shit, I didn't know. I thought I was still playing catch up," which is maybe giving away all your best cards now. I was going to sign up as a coaching client.

Simon:    Okay. This happens very rarely. One way it works is because you can take away the social comparison, the head to head between your archrival because they are already four minutes up the road. But one other thing is it controls the tension and stops you feeling anxious. Some of Lesley's best races have actually been when she's -- her goggles are broken like two minutes before the gun goes off or something has happened. She's forgot her cap or something.

    She's a mad sprint back to transition or to try and fix it. Her entire mindset and the attention is focused on just getting, solving this little problem so she can even start the race. And lo and behold, she's often had some of her best races. In fact, the two world championships she's won in XTERRA, both had what might on the face of it be things that have happened to totally wreck the race before it's even started and she's ended up having the best race.


    It's quite an interesting -- I don't recommend doing this for people but it's almost like a little proof or testing a theory of what some of the causes are of the anxiety and how you can reduce them.

Christopher:    So, you're not worried then? Just to summarize to people, you're not worried about people doing seven to 12 hours a week of triathlon training in general? You're much more worried about the people who are sedentary?

Simon:    There's a number of issues here. And coming from public health and research in public health, the messaging of public health is quite important and how people interpret public health messages. When, for example -- this is slightly off topic but I'm going to try and bring it back to that, answer that question, and why this is important. When experts constantly change their mind about what's healthy--

    It used to be 30 minutes a day, five days a week. That was 150 minutes. We used to be able to drink wine and now we can't drink, now we whatever, whatever, and on and on. And so what happens in the way that much of the public interpret these messages, they actually rather than sort of recalibrating their behavior to the new standard they stop doing all of them and say, "Listen, they can't even agree. Until they agree, I'm just going to do what I always do." Which is usually nothing.

    We've got to be quite careful. And this is why some, in the face of new evidence to change guidelines, some expert panels have resisted that because of how messaging is interpreted by populations. This comes back to if we're trying to say, "Listen, we need to make many athletes aware of some of the pitfalls and dangers of excessive exercise," now, if you're only talking to that segment of the population, absolutely fine.

    But when it's a larger message that too much exercise is dangerous, I worry also that the people who are proud couch potatoes over the biggest bang for your buck is getting off the couch and doing some, they're going to take this message to say, "See, even exercise is not good for you." And it almost cements their existing behavior so [0:31:56] [Indiscernible]. That's I think one thing. The messaging is quite important.

    For individual athletes now is that most athletes, certainly the triathletes, the thousand or so that have come across our book over the years, is that rarely is this sort of -- You're talking about lifetime exposure really because ultimately it's not going to be a single marathon. It's not going to be an Ironman triathlon that is particularly damaging. It can be in a very acute sense like an injury or something like that.

    But for illness, it's about lifetime exposure. And so when you look at the data like Tommy talked about the marathon running of coronary plaque, people have run marathons every year for 25 years. The lifetime exposure is important. When you get triathlon, and triathlon is still very much a fad type exercise, and I don't say that disparagingly to triathlon, just saying it's a fairly new sport in terms of how the history of sports go. Sure, they might be in ten, 20 years time people have been doing triathlon for 50 years, but the sport itself really only dates to the '80s in the organized formal sense.

    Most of the triathletes we see is a phase of their life where they decide they want to conquer an event if it gets their Willie Wonka's ticket to Kona or to get a bucket list for an Ironman or to do some local short distance races because they're looking at their muffin top and getting frustrated with energy levels and the rest of it. They might do it for three to five years. Some maybe do it for longer but most of them, their exposure is, yes, it might be 12 hours a week but it's not for that long a period because it's a very--

    Try to eke out 12 hours in most people's lives. It's difficult to do if you've got a family and a job and so on. And so it's simply not that sustainable also or it has to come and go given the other things that happen in your life, job changes, occasions, births, deaths, marriages and so on. There's a little rule of thumb in coaching is that turnover. Athletes generally stick with coaches for about three years. There's lots of reasons why that might be and whether they move on to new coaches or they just move out the sport altogether.

    But suffice to say that I think that for the exposure that they have, about ten hours a week, and for, let's say, five years that they're doing it, I'm not too concerned. When you get athletes who are doing it 25 hours and they're doing this for 20 years or 15 years, then it is a concern. And I talk about that from very personal experience because that's my wife. She's a professional triathlete. She trains 20 to 30 hours depending on the time of the year and the season and the races coming up.

    She's been a professional for eight years but she's been doing triathlons since she was 14. She's now 37. She's likely to be doing it at that level for another, at least another few years. She is in this category where she's probably doing some long term damage to her health. She, obviously, has. Unfortunately, she has the out which is the way that, "Well, I'm doing it for my living," so you don't get as much criticism as if she was not doing it for a living because there's plenty of that age group amateur athletes who are doing exactly what Lesley is doing.


    But those types of people, professional or otherwise, who are doing that volume for long periods of time are probably damaging their health. So, the issue then has become, well, without trying to go into a little bit more of an existential what's the purpose of life and meaning and stuff, is that a problem? So, the extent to which we prioritize long term health goals over things that we do that makes us happy and fulfilled and so on.

    And that is a big debate and I don't know if I have the answer to that. But only to say that when you speak to athletes who are doing fairly high volumes for prolonged period, it's very difficult to try and encourage them to take something away or to stop, to strip down when you see how either transformational it is, important it is, and that we can talk about the psychopathology of whether that's healthy or not but, in essence, you're saying this is important part of someone's life.

    They probably intuitively, whether it's rational or not, they've made this distinction or this sort of deal with themselves that that's the risk I am willing to take. That's mental rationalization gaming that you play with yourself. It's not just in sports. We know a whole -- Well, actually, most of the experiences I have are in sport. But we all do this. We make deals with ourselves that we're going to sacrifice some sort of long term health wellness for some short term, fairly short term game, pleasure, fulfillment, or something.

    It doesn't have to be some nefarious thing but it can be something like exercise too. And that's very difficult because then you're in the realm of trying to tell people how to live their life and how they should be prioritizing things. That is not an easy thing to have answers to.

Tommy:    I wanted to build on something that you said earlier which is about the period of exposure. Most athletes, they're seven to 12 hours per week only for a few years. But if we come back the topic of the conversation, obviously, people want to try and build the optimal dose and I can definitely give recommendations for what that is, what it should look like in terms of hours and outcomes based on the research and all that kind of stuff.

    But just doing something for a few years isn't going to give you that health span, that longevity. Maybe can you talk about how we could build habits whereby we're doing the amount of exercise that's most beneficial for our health for long periods of time? Because if people are really thinking about this, they want to do this for decades rather than just a few years.

Simon:    This comes back to now the importance of the role, I should say, the role of endurance exercise. As a general, the public health message, is you want to encourage people to do physical activities that are easily sustainable, they're relatively cheap to do, they don't require much skill, and you can do them with or without other people.

    We're trying to make the exercise as self-sufficient as possible. I'm not saying that it's not beneficial and really great to do around other people or with equipment but if all we're doing, for example, is encouraging people to play golf or to play tennis, there's a whole host of barriers that whole segments of the population they'll be insurmountable for whether it's cost, equipment, access to facilities and so on.

    But anyone certainly can run or walk briskly. Biking, most people have bikes or can have access to bikes. And swimming is slightly different. So, running, I still think is one of the greatest lifelong exercises, or walking, that you can do. When it comes competition, and the original question was about how -- I've got to be honest, I love competition. There is this somehow at odds with my goals of longevity or health span, is that for some people they can run or jog 150 minutes a week at moderate and with some vigorous exercise thrown in at 75 minutes a week of brisk exercise or vigorous exercise thrown in there too, and with no hint of competing, with no desire to put on a number and enter a local turkey trot or run for some other cause.

    But for some people, that is very motivating and there might be some reasons in their experience with sports or they have a history or athletic identity that makes that motivating. I would say if you do have sports competitive juices flowing, A, don't think that you have to put those on the shelf or put them out of the way to be able to enjoy activity and sports and improve your health. You can still do those.

    Now, are we going to be recommending that you train for marathons or Ironman? No. You can easily meet the recommendations for exercise and know more and still have a really good experience competitively, socially and physically by doing events whether local 5k events and 10k events. You can walk them. You can run them. Not for everybody. But if that's what having a goal that's on the calendar that gets you the juices flowing as well, because that might make you a bit nervous or it motivates you to get in shape so you can actually get through it, I say good for you and keep up with that.

    I'm always encouraging folks to set goals that there is a little bit of accountability rather than just it's 6:00 a.m. and I need to go for my 30-minute fast walk or jog around the block. What's wrong once a month or something or even more frequently if finding some local event that may not put you into this danger zone that is still motivating, social, and helps you get those competitive juices flowing?


Christopher:    That's a really good question for you, actually, Tommy. What Simon is saying is very much resonating with me. If it wasn't for the competition I'm not sure I would do anything at all. It's a very powerful motivator for me. First of all, tell us about what you do and then tell us about how you stay motivated.

Tommy:    In terms of my personal exercise?

Christopher:    Yeah, which is really good question for doctors, by the way. Don't ask them what you should do. Ask them what they would do in your situation. Tell us about what you do, Tommy.

Tommy:    So, I currently have a training program that's built for me by Zach who's our relatively new head of strength and conditioning. In terms of the structured exercise that I do, I do aerobic exercise at least half an hour twice a week. I do that on the Airdyne in my gym in terms of the structured exercise and I'll maintain somewhere 300 to 350 watts for half an hour and do some other stuff.

    And then I'll lift weights usually four days a week, also squats, dead lifts, sort of compound movements and a few other things. Currently, my motivation is specific strength goals. That's why I enlisted Zach. But throughout my career, I have rotated my goals to keep me interested. I have done everything from marathon running to Ironman distance triathlons, ultra marathons to CrossFit and even to powerlifting, single weight.

    Basically, over time, I've identified something that I haven't done much of and in the past I certainly don't add to extremes. Finding something that's maybe a gap in my current regimen and then bringing more of that in and then creating a goal around that. That's what keeps me motivated. But in terms of other things that I do, I spend a lot of time not sitting. I'm at a standing desk right now. I spend most of my day standing.

    I play with my dogs multiple times a day. We wrestle on the floor. We go around. We run around outside chasing things, throwing Frisbees. I walk a lot. All of those just build into my day. I have the structured exercise part which is based on what my goal is at that time but then all the other stuff should be built in and should just be part of the day too.

Christopher:    Do you think you'd ever go back to doing endurance though?

Tommy:    Competitive endurance stuff--

Simon:    Have you seen the size of him?

Tommy:    Yes, I'm not -- Right now, I'm not really built for endurance. I actually, and I'm sure it's down to my maternal mitochondrial genetics, on my mother's side, a line of very good athletes. I'm gifted in the endurance sense. I can just go for hours and hours and hours. I always joke that I have one speed. I can't sprint that fast but I could just run for hours and hours and hours. That's how I'm built.

    But the tolls on my body that my previous endurance athletics have taken -- I did the world's first ever fully off road Ironman distance triathlon. It actually ended up being longer than because the run was 30 miles. I think I was maybe 25% of the field are finished under the cutoff of 24 hours and I basically lay in a heap hallucinating with borderline kidney failure for three days afterwards.

    I'm definitely not going to do that anymore. I really enjoy lifting weights. Maybe 5ks, 10ks, I'd like to do that stuff in the future but I'll never be that kind of serious ultra endurance stuff that I used to do. Because, I think, we spend so much time working with endurance athletes, I tend to be very strength focused because I think there's really important things in relation to strength and longevity and mortality.

    If you look at the muscular adaptations to long distance endurance exercise, loss of type II muscle fibers, increase in fat within the muscle fibers, intramuscular triglycerides, those look a lot like the muscles of people who are old and frail where you got sarcopenia. I do worry that by just focusing on endurance exercise, you lose some of those muscle fibers that are basically going to keep you upright, stop you from falling over and breaking your hip when you get to your 70s, 80s and beyond, which is one of the deadliest things for people as they get older is falling and breaking something because they dramatically increase your risk of mortality.

    That's been my focus at the moment and so focusing on a lot of people that I work with just because I think endurance exercise, running, that's the easiest one for people to access but then there's the potential for people to not focus on other things that might become more important.

Simon:    I mean, most obviously endurance athletes, they don't just do endurance exercise. I know that we're not talking about athletes per se here. We're talking about the non-competing population in saying that is aerobic or endurance exercise beneficial. But in my world, certainly, cyclists, runners and the triathletes, they all have quite a sizable strength component both gym-based and equipment activity base in it. As you said, it's a critical part of their development as an athlete. Again, any coach worth their salt would be recommending the same thing.

Tommy:    Chris could probably speak to this, at least as well as I can, if not more in terms of the people he's interacted with but we, in terms of our clientele, there have been a large number who focus purely on the endurance aspect and had been neglecting strength training.


Christopher:    Yeah, absolutely. I mean, that's definitely--

Simon:    You can do strength while you're riding, I should say.

Christopher:    I mean, so that's definitely what the endurance athletes gravitate towards, myself included. If you said to me, "Oh, you don't need to go to the gym, you don't need to look after muscle mass, you can just go ahead and ride your bike for 15 hours a week," I would definitely do that. That would work perfectly for me.

Simon:    Well, listen. Power as we know -- Let's take cycling. You brought up cycling. Cycling is a power based sport. It's wattage. Power comes from speed of revolution from your feet, rpms, and force on the pedal. So, the torque that you're generating on the pedal is strength work. By manipulating those two components you can do strength work. You can do lots of drills on hills or otherwise, especially on hills you get torque work, very low rpm, high torque work so you're really trying to maximize muscle fiber recruitment.

    You'll never snap your chain. If you have, you need to change your mechanic. You can do that. And there are some single leg work is actually fairly contentious in coaching. I'm a big fan of it but it's not so much about what single leg versus just riding along does. It's the fact that you can do very specific torque full spaced work on a bicycle. You can do that running as well. You can do a whole bunch of drills. You can do lots of hill running. You can do that as well.

    Swimming is a little bit harder. You can use paddles or t-shirts to increase drag or use a Vasa Ergometer where you can manipulate the resistance and so on. But strength is an integral part of endurance training outside of any gym-based stuff as well.

Tommy:    But if you look at the requirements, the outcomes in terms of strength, if you think about the ability of the quadriceps and the glutes to produce force like a really good way to measure that is a vertical jump. Yes, so you can talk about, say, middle distance runners who they have adapted their musculature at the expense of the type II muscle fibers and they can run very, very fast.

    They can run for hours at the speed that I can sprint at. But if you ask them to jump straight up in the air they can barely go off the ground. It's the same for a number of cyclists. Yes, you can do sport specific power and strength training but does that translate over to if you're standing there and I give you a push, can you quickly stick out a foot and stay upright? Or can you push yourself up off a floor if you fell over when you're 70 years old? I think there's still a specificity when it comes to that kind of strength training.

Simon:    Oh, absolutely, specificity. The Tour de France is on at the moment. If you watch any of the athletes, the sprinters in particular, trying to generate 1800 watts is no mean feat. And the reason they're able to do that, partly obviously genetics, but very specific strength training to be able to do that. Track cycling is another great example. If you look at the track cyclist training who some of them have events from ten seconds up to four minutes, and some actually longer but--

Christopher:    How long do they hold 1800 watts for?

Simon:    The traditional measure is the Wingate test which is the five-second peak power test. Most of the markers at lab-based to see whether your power is improving, five seconds and then the decay in that power to 20 seconds. Most of the Tour de France guys who are able to hold those super high watts, the 18 or the two-kilowatt club, that over 2,000 watts, they're probably only holding those wattages for five to ten seconds.

    But still, if you're accelerating off of someone's wheel after getting a bit of an easy ride, a free ride but an easy ride, so you're going from 400 watts to 1800 in a matter of ten to 15 seconds or five to 15 seconds, that's strength. This is mountain biking as well, right?

Christopher:    I just feel so much better. Even though I don't really want to do it, I don't know, maybe I couldn't say that now. With a lot of things, you have to do it for a bit before you don't hate it anymore, do you know what I mean? The strength training, when you've never done it or you've not done it for a very long time, getting back into it is tough. But once you get into it, it feels easier.

    I feel so much better in my body now that I have a little bit more muscle mass and I'm definitely not Tommy's league but a little bit more muscle mass. I just feel better walking up and downstairs. I feel better when I pick up my four-year old daughter. I feel better on the trails. I feel like I can exert more force through the pedals, that movement that's like -- I can't explain it but driving really hard through my heels into the pedals as I want to drop something technical. I can just do that so much better now that I can dead lift 300 pounds or so.

Christopher:    Tell us what you do, Simon. I mean, you're still riding a bike on a regular basis. Tell us what you do.

Simon:    I'm more of an exercise tourist. I mean, I come from a whole -- Actually, not like Tommy, I should say because Tommy, you said you didn't do them as much as a kid. I grew up as a jock but then I eventually got into competitive cycling, did that for many, many years and then met Lesley, was dragged kicking and screaming into the dorky world of triathlon. But now, actually, I found that triathlon type training is a really good all over body training. I'll try and ride my bike twice a week and those rides are from 19 minutes to three hours each time, depending if I'm on flats or hilly.


    Twice a week, I'll be in the gym doing traditional circuit training, compound movements, minute on before rotating to another piece of equipment. I'll try and do that. I find that just as good for injury prevention, overall health and so on. And then I'll run, maybe run once a week, sometimes twice, depending on how I can fit it in or if I'm traveling.

    So, I don't do that much swimming unless I'm going to actually be doing a triathlon because swimming I've never really enjoyed and I don't believe in doing things I don't enjoy unless I'm getting paid to do it. I'll swim the bare minimum to get through but biking and running and gym is the most of what I do. Maybe five to seven hours a week.

Christopher:    That's really well-rounded. I thought you were just one of those guys that just ride your bike for 12 hours a week just like everyone else.

Simon:    No. Not at all. Those days are long gone.

Christopher:    How can we summarize? Did you think we answered the original question in that how can I balance my desire to compete with my desire for health span? I think the answer is you probably don't need to be worried doing the seven to 12 hours a week thing but maybe muscle mass is also important. Perhaps you want to think about adding in some strength training especially those big compound movements, if you're not already doing them. Do you think that's a fair summary? Is there anything anyone would want to add to that?

Simon:    I would add don't shelf your competitive urges, if you're so inclined. You shouldn't certainly force yourself of feeling that's what you have to do but if you feel so inclined, the adrenaline and the accountability and the head to head pinning on a number does, do it. You'll soon know how much of doing that is right or wrong for you because, A, it's expensive, it's time consuming and it's also you don't like putting yourself through the pre-race nerves that often. But doing that a handful times a year, I think it's really good for your motivation.

Christopher:    I absolutely agree. Is there anything you'd want to add to that, Tommy?

Tommy:    The things that we talked about, if you're going for optimal longevity or health span, then I think six to seven hours of vigorous intensity exercise, all those things I mentioned, things that I do, things that Simon does, brisk walking, circuit training, things that you do, Chris, mountain biking, all of that comes under that umbrella. So, that it's structured, so that you can make sure that both your aerobic fitness and your strength are in the top 25% of your peer group. That seems to be where you get the best mortality or longevity benefits.

    And then if you have performance goals, what is it that you -- beyond that training, what you need to add to get the performance you want, think about that. And then you can also think about what can you take away that isn't benefiting your performance goals, still within that sphere. You can still probably do almost all of the training you need to get the performance that you want and still maintain those parameters both in terms of strength and aerobic fitness.

    And then if you want to do a lot more than that, why do you want to do more? What else could you do with that time? Is there some other aspects that's driving your desire to do that? I think that's important. When you're balancing all this, if you want to do this for decades to come, if you're going to do masters level exercise or competitions in your 40s, 50s, 60s, beyond, making sure that you get there in good shape to the start line is actually going to be really important.

    You're going to see your peers drop off because their diet is bad or their other lifestyle is bad or they've been training incorrectly and they're going to get injuries and that kind of stuff. Just turning up to the start line in good shape is going to be a great target for people to have. That's something that's worth thinking about too. Staying at the top of your game for long periods of time means that you get to the start line when other people don't. I think that becomes more of an issue as you get older too. Balancing all that, I think, if you're going to think about it in that way, that's how I'd summarize.

Christopher:    And one thing I'd like to add is, we've gone down one particular rabbit hole here with a specific optimization function, but if the thing that you're optimizing for is performance then don't think that we're going to judge you and say, "No, sorry, we can't work with you as a client." The main thing I care about is that you do what success looks like. That's the hardest thing in my mind, when you got someone that doesn't even know whether they're winning or not. That's really, really hard to optimize for. As long as the function is well-defined then I'm happy.

    Cool. Well, this has been great. Thanks so much, guys. I really appreciate your time.

Tommy:    Thank you.

Simon:    Thank you.

[0:54:15]    End of Audio

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