Run for your life … at a comfortable speed and not too far

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Abstract
After our recent articles on this topic,1 , 3–5 Amby Burfoot, winner of the 1968 Boston Marathon and Editor-at-Large for Runner's World Magazine, challenged our assertions about the dangers of extreme endurance efforts by demanding, ‘Show me the bodies’. Amby has a good point: the risk of dropping dead in a marathon is remote, about 0.5 to 1 in 100,000 participants.6 But the occasional marathoner or triathlete who dies while strenuously exercising is the ‘canary in the coal mine’. Chronic extreme exercise appears to cause excessive ‘wear-and-tear’ on the heart, inducing adverse structural and electrical remodelling, which offsets some of the CV benefits and longevity improvements conferred by moderate physical activity. Thus, even though chronic extreme exercise may not kill you, it may erase many of the health advantages of regular moderate exercise.