Intense Exercise & Potential Heart Damage (aka Athlete's Heart)

1. Dr. Andy Galpin

   The science and practice of enhancing human performance for sport, play, and life. Welcome to Perform. I'm Dr. Andy Galpin. I'm a professor and scientist and the executive director of the Human Performance Center at Parker University. Today, we're going to start with a story. In fact, it's a ghost story with a character by the name of Caballo Blanco. For those Spanish-speaking friends out there, that, of course, means the "white horse."

2. And Caballo, as he was referred to, terrorized and mystified the Copper Canyon range of the Sierra Madre in Northern Mexico for the better part of 20 years. Many years later, of course, the story would be unraveled as an individual by the name of Micah True, which was also in fact not his real name. But as the lore goes, Micah or Caballo lived most of his life in this desolate Canyon region, and he would live running between 30 and 60 miles from village to village, gathering up resources, and then running back to his hut.

3. And no one really knew what the heck he was doing. Micah himself was running somewhere between 160 to 170 miles per week for nearly two decades. And again, keep in mind, he was doing this in an area where he had no access to running shoes, medical care, or really any advanced technology, nutrition, or hydration strategies, so simply surviving by running large amounts every day for decades on end.

4. Micah's story was made famous by the best selling book Born to Run. You can read more about it there. But really, he became one of the most central and legendary figures in the ultramarathon circles. This launched, of course, an entire generation of ultra runners. But where the story is of use today is the fact that Micah himself, while running those, again, 150 to 170 miles per week for decades, eventually end up dying at age 58 during a very routine 12-mile jog.

5. And if you're from the running community or world at all, you probably know this exact story. If you don't know of Micah himself, you know the bigger plot here. And that is this juxtaposition or paradox between really incredibly, highly cardiovascularly fit individuals, oftentimes runners, who then end up paradoxically dying in mid to early age of cardiovascular disease. And so if you looked at the title of this show and were kind of wondering what it meant, this is really exactly what I'm talking about.

6. It's this phenomenon of trying to understand, well, how are these people who are elite in this physiological area also at extremely high risk? The story itself is really as old as we've understood cardiovascular physiology. And so when we actually get into what's happening here, we don't know Caballo's story itself. It took them several days to actually find him. He was lost in the middle of a canyon somewhere, and by the time they got to him, it was too difficult to perform a proper autopsy.

7. But the prevailing wisdom here is he likely died of something called left ventricular cardiomyopathy. I'll get into what all that means here very momentarily. Where this has gotten more difficult is then cardiologists and other medical professionals have tried to inspire and help the world in the sense of preventative care here. We've also led to confusion and concern about really what is this relationship between exercise, extreme exercise, and cardiovascular health.

8. And so I think the best way to think about this is to split it into two broad categories. The first is the classic case of Caballo, what I just described. These are the folks who are typically between 30 to 50 or so years old. It's generally men, though it can occasionally happen in women, who have this paradoxical extreme cardiovascular fitness, and then they suddenly die in the middle of a race or an activity from cardiovascular disease. You also then have what people are probably potentially more familiar with, and that is the young athlete. So this is your, again, typically 12 to 20-year-old who has no apparent signs and symptoms and then unfortunately passes away during physical activity.

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