Relationship of distance run per week to coronary heart disease risk factors in 8283 male runners - The national runners' health study

Background: Official guidelines from the Centers for Disease Control and Prevention and the American College of Sports Medicine state that every adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week. Objective: To examine the dose-response relationship between coronary heart disease (CHD) risk factors and vigorous exercise above the recommended minimum levels to assess whether further benefits accrue. Methods: Physician-supplied medical data were compared with reported distance run in a national cross; sectional survey of 8283 male recreational runners. Results: Compared with runners who ran less than 16 km (10 miles) per week, long-distance runners (greater than or equal to 80 km/wk) showed an 85% reduced prevalence of high-density lipoprotein cholesterol levels that were clinically low (<0.9 mmo/lL [(35 mg/dL]), a 2.5-fold increased prevalence of clinically defined high levels of high-density lipoprotein cholesterol (ie, greater than or equal to 1.55 mmol/L [greater than or equal to 60 mg/dL], the level thought to be protective against CHD), a nearly 50% reduction in hypertension, and more than a 50% reduction in the use of medications to lower blood pressure and plasma cholesterol levels. Estimated age-adjusted 10-year CHD risk was 30% lower in runners who averaged more than 64 km/wk than in those who averaged less than 16 km/wk (42 vs 61 events per 1000 men). Each 16-km incremental increase in weekly distance run up to 64 to 79 km/wk was associated with significant increases in high-density lipoprotein cholesterol levels and significant decreases in adiposity, triglyceride levels, the ratio of total cholesterol to high-density lipoprotein cholesterol level, and estimated CHD risk. Conclusions: Our data (1) suggest that substantial health benefits occur at exercise levels that exceed current minimum guidelines and (2) do not exhibit a point of diminishing return to the health benefits of running at any distance less than 80 km/wk.