Can Runners Be Fit But Unhealthy?
Running is widely considered to be one of the healthiest activities on the planet thanks to the role it plays in taxing the cardiovascular system, as well as providing an all-around skeletal and muscular workout; but have you ever considered that a runner with a low BMI and strong heart may still be unhealthy? Even more perplexing is the assertion that an elite athlete, or even an Olympian, could fall into the category of physically fit, but wholly unhealthy. Published May 2016, Phil Maffetone (father of the heart rate training method) and Paul Larsen assert1 that an alarming number of recreational, elite, and professional athletes are far less healthy than they appear.
Fit vs. Healthy
First, we must define the difference between fitness and health. According to the paper, fitness is sport-specific and refers to the ability to perform a given activity. Therefore, “fit” will look different for distance runners, football linemen, swimmers, etc. Healthy, on the other hand, concerns the overall state of a person’s wellbeing, including physiological, emotional, and mental factors. From these two definitions, it is easy to see from the outset that disparities can occur between fitness and health, especially among athletes of certain sports.
Overtraining and inadequate recovery are just a few factors that leads to a high risk of biochemical, physical and mental injury. Courtesy of: sportsmedicine-open.springeropen.com
Poor health is usually observed in runners (and athletes in general) who adhere to the old “no pain, no gain” adage. They push themselves beyond a point of typical system stress and this can lead to injuries that are physical, biochemical, and/or mental-emotional. Neuromuscular dysfunctions, endocrine or immune dysfunctions, as well as depression, are only a few consequences. Each injury could cause other issues. While the mechanisms vary considerably across many levels of training ability and history (non-elite, recreational, elite runners), genders, age, and even sports (it’s not just runners who can be fit but unhealthy, one thing is for sure– you need to understand exactly how your body adapts to stress (if it does).
Ryan Hall pounding the pavement. Source: RyanandSaraHall.com
For the nation’s best distance runners, high mileage running combined with cardiovascular-straining speed work is ideal. Runners such as Ryan Hall, who is arguably one of America’s best marathoners ever, frequently ran 140 miles per week while restricting calories and living in an altitude tent. Throughout this process he suffered from chronically low-testosterone, as well as a thyroid disorder. Also take into consideration Ryan Shay, also once a top marathoner in the United States.
Due to an undiagnosed heart condition, he collapsed and died during the 2004 Olympic Marathon Trials in New York. His condition, which comprised of fibrosis in the heart tissue, was undoubtedly exacerbated by his high level of training. At the opposite end of the spectrum are athletes such as football players. While able to produce a lot of force and power quickly, many of these athletes have unhealthy BMIs, often in the “obese” range. Despite these obvious health concerns, the overall health of a professional athlete is rarely questioned.
The Overtrained Runner
When it comes to high-level sport-specific training the main contributor to poor health is overtraining, caused by high volume and high intensity training, as well as poor recovery. Overtraining2 leads to a variety of problems, including chronic inflammation in the body, as well as physiological changes such as decreased thyroid production, inappropriate parasympathetic system responses, and hormonal imbalances. Inflammation is the cause of many issues, perhaps most notably increased injury risk and decreased immune system response. Alarmingly, overtraining syndrome can significantly affect the heart.
One the same note, read “Can I Run When I Am Sick?“.
Chasing the “Ideal” Physique
Another risk factor for poor health is chasing an “ideal” physique because of the mistaken notion that “best for sport” is the same as “best for life.” An example is the long distance runner who equates a smaller frame with faster finishing times, which can be extremely damaging to all systems of the body if too-low a BMI is reached. Another example is the football player, whose regimen might include a continual high protein/low carbohydrate diet, relentless weight lifting, and the temptation to use new and potentially unsafe supplements that can drastically impair health simply for the sake of fitness.
The Effect of Diet
A second factor when it comes to the fit vs. healthy debate in athletes is diet. The fact that many athletes actually gain weight while training due to increased consumption of processed, low-glycemic carbohydrates and the subsequent inflammation should be a major cause for concern among athletes and coaches alike. When athletes train vigorously they often overestimate4 how many calories were burned and then refuel with simple carbohydrate sources, such as cakes, cookies, and pastas. In addition, the majority of “sports”-branded products, such as recovery bars and electrolyte replenishing drinks, are often laden with corn-derived sweeteners, such as high-fructose corn syrup and maltodextrin, which have been shown to spike insulin levels and place athletes at risk for diabetes myellin.
Mental and Emotional Health
Perhaps the most ubiquitous problem among athletes is that they suffer from mental and emotional issues, such as anxiety, depression, disordered eating, and low self esteem at a disproportionate rate5. For many athletes, sport and identity can easily become confused, leading to the runner, cyclist, swimmer, etc. equating performance with personal worth.
Team dynamics and inadequate coaching can exasperate these feelings, causing an athlete to dread a sport that was once loved. When it comes to competition, the majority of athletes face some level of anxiety, placing their parasympathetic system in a regular state of heightened awareness, where the continual release of stress hormones, such as cortisol, can lead to diminished rest, recovery, and ultimately, performance.
While the current state of affairs for Americans shows that we are a sedentary people and that “sitting is the new smoking,” athletes have a tendency to veer too far to the opposite extreme, not resting enough between exercise sessions. Periods of high intensity training should be followed by periods of low intensity, or rest, in order to help the body physiologically adapt to the stresses of exercise. However, when the typical “Type A” personality of an athlete is combined with the misplaced theory of “no pain, no gain” in sports, higher volume training with less rest is often the result. This phenomenon leads to higher levels of inflammation in the body, as well as higher levels of cortisol6 in the blood stream, which increases the risk of injury, chronic fatigue, susceptibility to illness, and diminished performance.
Why is Health Important for an Athlete?
Athletes ask a lot of their bodies, no matter the sport or natural physique. Optimal performance occurs when all systems of the body, including hormonal, biochemical, mental, and emotional, are in sync. Coaches and athletes should be cognizant of the risks that being categorically unhealthy carry, from higher incidence of injury, both physical and mental, to experiencing less enjoyment from an activity that once brought great pleasure. Health and fitness should be treated individually, with a sustainable level found for each unique athlete.
1. Philip B. Maffetone, Paul B. Laursen. Athletes: Fit but Unhealthy? Sports Medicine – Open20162:24 DOI: 10.1186/s40798-016-0048-x Link
2. Laurel T MacKinnon. Overtraining effects on immunity and performance in athletes. Immunology and Cell Biology (2000) 78, 502–509; doi:10.1111/j.1440-1711.2000.t01-7-.x Link
3. Elkington LJ, Gleeson M, Pyne DB, et al. Inflammation and Immune Function: Can Antioxidants Help the Endurance Athlete? In: Lamprecht M, editor. Antioxidants in Sport Nutrition. Boca Raton (FL): CRC Press/Taylor & Francis; 2015. Chapter 11. Link
4. Willbond SM et. al. Normal weight men and women overestimate exercise energy expenditure. J Sports Med Phys Fitness. (2010) 50(4):377-84. Link
5. Martinsen, M., & Sundgot-Borgen, J. (2013). Higher prevalence of eating disorders among adolescent elite athletes than controls. Medicine and Science in Sports and Exercise, 45(6), 1188–1197. doi:10.1249/MSS.0b013e318281a939. Link
6. Hoogeveen A. R., Zonderland M. L. Relationships between testosterone, cortisol and performance in professional cyclists. International Journal of Sports Medicine. 1996;17(6):423–428. Link