Janathon 2013 Day 6 - Negative Pre-visualisation

Gym - various weight exercises, Time - 50m

In some ways Day 4’s post about staying in the present was a bit of a tease because one of the key techniques of the Stoics was pre-visualisation: they anticipated the future in order to prepare for it. This is the same as rudimentary sports psychology, the thing most players do before they set foot on the pitch, but there is a slight twist. The sportsman imagines themselves succeeding: the striker pictures themselves scoring a goal and the  the runner sees themselves crossing the finishing line strong and triumphant. However the Stoic technique turns this on its head and imagines the worst. It has another name: the premeditation of evil and it is done by imagining the things you hold most dear being taken away from you. 

There are three reasons for it. The first is basic honesty. All things are temporary, everything comes and goes and it is an undeniable truth that at some time you and I will both die. It is foolish to close ones eyes and try to forget it will happen as sooner or later you will have to face up to these things. This leads on to  second reason: by mentally preparing for loss you are better able to cope when it happens. The third reason though is not about the future it is about the present and is perhaps the most important reason of all: if you think something might be gone you are likely to appreciate it more keenly. If you were given a good bottle of wine told “After this you will be giving up alcohol for good.” The chances are that you would savour the drink, stretch it out, try to taste every drop and remember it. In other words you would closer attention than if it was just another bottle with just another meal.

“As you kiss your son good night, says Epictetus, whisper to yourself, “He may be dead in the morning.’ 

 Don’t tempt fate, you say.    

By talking about a natural event? Is fate tempted when we speak of grain being reaped?” 

(Marcus Aurelius, Meditations XI 34)

This might sound a bit extreme but the important thing is that it should not mawkish. It is an exercise in appreciating what you have, not an excuse for sentimentality and it should not be a cause of worry and anxiety, i.e. an unreasonable fear of imminent disaster. We not want to end up like Private Frazer of Dad’s Army.

But what is the relevance of this to going to the gym?

It is that, along with a number of other things, I take it for granted. I do it because it suits my purpose and think of it in functional terms. I give no thought to the fact that I am able to run on the treadmill and lift the weights. In this respect I am careless and instead of thinking I should be faster or stronger, I should appreciate what I can do. Being healthy is a colossal blessing and something that should never be underestimated. I once read of a survey  which asked two linked questions: what would make you happy and what would make you unhappy.  The answers for the first was the usual mix: more money, better car, house, holidays,love, job etc however what almost everybody thought would make them the unhappiest was illness. Nowhere on the list of things that make you happy was health mentioned, yet it was the thing you would miss the most. It is not a mistake a stoic would make as they would have already pre-visualised its loss and what it would mean.

In the gym I have reminders to help me. For example a man, partially paralysed down one side, who is constantly working building on the strength he has. Another man who can hardly walk and is helped onto each machine by his wife, will still smile and there is a lady who can barely shuffle but keeps plugging away on the treadmill. I am in awe of all them, as I am of anyone who keeps going in the face of great difficulty. In an instant, by a stroke of fate I could be struck down and face the same battles. Would I be as strong? 

I don’t know. It is something I would have to face if it happened. In the meantime it behoves me to appreciate what I have. 

Is Running Bad For Your Heart?

Now here’s a funny thing: I was about to write a few linked posts about the importance of exercise for health and the difficulties of changing habits and persuading  adults to make even a minimal effort, when I came across an article warning that exercise might have dangers. (Not that there's anything in it to change my plans as only good things can happen if someone moves from inert to 150 minutes a week). No the dangers are for those who are are worried about their health but for those who become intoxicated by the challenges, the idea of pushing back physical limits, and addicted to the feeling of being both physically empty and extremely satisfied.  Doing too much, or more specifically taking part in endurance events like marathons, triathlons, or ultramarathons might not actually be too healthy. There may be some unwanted adaptations to the heart and it is possible there is a dose effect so that just as too little exercise is bad for a body running too much might not be so good!

The origin of the concern was a paper has been published in Mayo Clinic Proceedings entitled ‘Potential adverse cardiovascular effects from excessive endurance exercise’ and many of you might not want to read any further than the title. Feel free to close your eyes, put your fingers in your ears, say “I am not listening!’ or ‘this cannot possibly be right because I don’t want to believe it’. If you write for a newspaper you can do this at slightly greater length. That’s OK as long as you are clear in your mind why you run and know that if you run for more than about 30 minutes a day you do so for reasons other than health.  However although we might want to continue doing what we do we should not treat unwelcome sounding research like and leave it unopened like an unwanted bank statement. We must face it dispassionately to see what the researchers actually say and be prepared to put aside our preconceptions. Before doing so though we can be strengthened by the thought that what is actually proved in any scientific papers is usually very specific within precisely defined limits which often do not bear the weight of the more generalised (and lurid) headlines.

So what to make of the Mayo paper?  Well from my lofty position of a non-expert it looks like a good survey of what is known about the effect of extreme exertion on the heart. It shows evidence that the hearts of highly trained athletes can enlarge and thicken in a way that would be seen as worrying for a normal person and there can also be scarring and other damage. However we don’t know enough about what that means for overall health and longevity, as the authors recognise in the abstract: 

However, this concept is still hypothetical and there is some inconsistency in the reported findings. Furthermore, lifelong vigorous exercisers generally have low mortality rates and excellent functional capacity.

Nevertheless there is enough in this paper to get one thinking. But it must be emphasised that the authors are not warning about exercise of itself, instead they are raising the question as to whether there can be too much of a good thing. They explicitly offer no excuse for the couch potato to remain inert as their opening sentences make clear:

Regular exercise is one of the cornerstones of therapeutic lifestyle changes for producing optimal cardiovascular (CV) and overall health. Physical exercise, though not a drug, possesses many traits of a powerful pharmacological agent. A routine of daily physical activity (PA) stimulates a number of beneficial physiologic changes in the body and can be highly effective for prevention and treatment of many of our most prevalent and pernicious chronic diseases, including coronary heart disease (CHD), hypertension, heart failure, obesity, depression, and diabetes mellitus.¹ People who exercise regularly have markedly lower rates of disability and a mean life expectancy that is 7 years longer than that of their physically inactive contemporaries.

The point needs to be emphasised because there is no way you want a simplified message that running is bad for your health to seep into the public consciousness. It shouldn’t from this paper, which is a restrained academic review that does not editorialise. However that is done by the authors in the BMJ journal Heart, where they are clearer in describing the effect of exercise as a U curve where too much high intensity work loses some of the gains of a more moderate regime. (It can be found here but unless you have a subscription or access from a library it is not worth the £24 they want to charge. Instead watch the TED talk that covers the same ground). 

The article has caused more controversy because it inspired the article in the Wall Street Journal I previously mentioned. As is common for newspapers the headline and opening paragraphs were overly alarming, even if there was more balance further down the piece (as is also common in newspapers). This has been a push back with some people to contest the conclusions (e.g. here and here) and a little flurry of concern.

My take (for what it’s worth - and that is very little because it is just the intuitive response of someone who runs about a bit) is that I am very ready to believe that there is a sweet spot for exercise to offer maximum health benefits, which might not accord with the amount of work needed to fulfil other ambitions. It is very likely that more might not mean better especially for those of us over 50. But I am not sure if I have to worry too much. I may be old but the amount of running I do faster than 8 min miles is vanishingly small. I, like most people, am probably well within the boundaries of exercise being a good thing. However the problem is we cannot precisely define where those boundaries are. Take for example easy exercise: apparently we can walk as much as we like without hitting  a point of diminishing returns but does that also apply to slow, low intensity running?  If so the majority people who run marathons have no worries because, from the middle to the back of the pack, the long slow running dominates training (and the race). For most people the debate about a U shaped exercise curve is irrelevant because we don’t run hard or fast enough to reach the bottom of the U. The people at risk are the seriously competitive and they are the very people whose motivation has nothing to do with wellbeing or health. But the amount of that risk, if at all, is not yet known. 

It is all neatly summed up in an article in Outside about the original Mayo review: “high-intensity, high-volume exercise is really, at this point, a black box in terms it what it does for you over the long haul.”

Janathon 2012 Day 20: Exercise and Health

Janathon 2012 Day 20:Run - 3.6 miles, Time - 44min, Weather - cloudy, windy, bleak

Another day, another slow run keeping the heart rate down. There were signs of progress as I managed to run quite long segments with a flat heart rate. Huzzah! Us runners are very simple folk - all we need is a little bit of encouragement and everything seems brighter, even if the weather is dreich. 

Over the past few days I have been superficially looking at the evidence for the benefits of exercise. i started with a video that suggested exercise was a magic treatment - the single most effect way of improving general health, followed it with a correction which said the evidence wasn't quite as dramatic as presented. This was followed with a couple of Cochrane Reviews that looked at the effects on specific complaints.

This is not good enough - there needs to be more of an overview. In 2004 the Department of Health published a report 'At least five a week: Evidence on the impact of exercise and its relationship to health', which can be downloaded.  Table ! summarises the level and strength of evidence for a relationship between physical activity and a number of chronic conditions

For me the most important thing is the distinction between the preventative properties of exercise as opposed to its use as a therapy because this makes it clear that there is much stronger evidence for the role of exercise in preventing illness rather than helping with a cure.

P.S. The photo is another one from Monday - some blossom to balance up the greyness of the day.

Janathon Day 18: Avoiding feeling bleak

Janathon Day 18: Run - 2.92 miles, Time - 32min 47sec, Weather misty moisty

Another picture from Monday as I took none today - it was too grey and oppressive. At the moment I am trying to avoid feeling bleak.

Today's run was a help, just because I did it. It would have been so easy to continue to mope about yesterday but I didn't. I adopted the shock tactics of rolling out of bed, into my running kit and out the door before my brain could start to argue. Still dazed I pushed the start button on my watch and was off. 

Just like yesterday my heart rate started to go a bit crazy but this time I decided to run 3 miles whatever and pay more attention to the heaviness of my breath. I stopped and started a few times but the heart rate eventually evened out and I ended feeling that I had achieved my goal, even if it was on average a few beats higher. Far more important than an arbitrary number was the feeling that I was doing something

The feeling you get from running links in with another Cochrane Review about the effect of exercise - this time on depression. The overall conclusion was that it has a positive effect but one that is difficult to quantify. It is hard even to say what exercise is the most effective. There is thus plenty of scope for more methodologically robust trials to discover dose and effect

It is interesting that Cochrane Reviews, which are the nearest thing we have to a summary of the current state of knowledge on health matters, seem to show that we know very little for certain. Yet people still have to make recommendations and the current one of 30 minutes a day of any type of exercise seems to be prevalent.

My next task is obviously to try and find out where it comes from