Financial Review
Running 42.2 kilometres continuously will always be impressive. But for a rising number of extreme exercisers, it is no more than a starting point.
Everyone seems to be running these days, and they’re not just doing park runs. Jaw-dropping feats of endurance are popping up everywhere.
Whether it’s British runner Russ “Hardest Geezer” Cook running the entire length of Africa in 352 days, compatriot Jasmin Paris becoming the first woman to finish the gruelling 100-mile (161-kilometre) Barkley Marathons within the 60-hour time limit, or Australian sparkie Nedd Brockmann running almost 4000 kilometres from Perth to Bondi Beach, long-distance running is having a bit of a moment.
So much so that standard marathons have become almost pedestrian. I say that with tongue in cheek, of course. Running 42.2 kilometres continuously will always be impressive, especially if you race around the course in less than four hours. But for a rising number of people, running a marathon is no more than a starting point. Exercise inflation, if you will, is in full swing.
To be clear, this is mostly a good thing. Many health professionals, including longevity expert Dr Peter Attia, describe exercise as our most powerful weapon in the fight against chronic disease. The evidence is overwhelming that improving our fitness significantly reduces our risk of dying from any cause, and most of us could probably benefit from exercising more frequently. But it’s also possible to push it too far.
The downsides of excessive exercise range from minor bone and muscle injuries all the way through to an increased risk of developing osteoarthritis. But perhaps the largest concern is the link between extreme exercise and heart disorders such as atrial fibrillation.
The overall risk for exercise-related atrial fibrillation remains low, but the relationship between exercise and cardiovascular disease looks like a reverse J-shaped curve on a graph, according to a paper in Missouri Medicine. The risk is highest among people who do no exercise, falls rapidly and significantly when people start doing some exercise, and then starts to creep up again when people do too much. But it’s unclear exactly what amount of exercise is excessive, and the optimal dose will likely differ from one person to the next. (More on this later.)
What is clear, however, is that these discussions are becoming relevant to a growing, albeit still relatively small, part of the population.
Just 24,102 people completed an ultramarathon, defined as any foot race longer than 42.2 kilometres, in 1996, according to an analysis of more than 15,000 events by RunRepeat and the International Association of Ultrarunners. In 2018, that number had risen to 329,584.
Australian Psychological Society chief executive Zena Burgess, a trained psychologist, says common motivations for extreme endurance events include personal challenge, self-discovery, proving resilience, and experiencing a sense of achievement.
“There appears to be a significant correlation between type A personality traits and participation in ultra-endurance sports, as these individuals are often driven by competitiveness, ambition, and a desire for high achievement and/or a need for perfectionism,” Burgess says.
But academic studies also suggest ultra runners are less competitive with each other than athletes in other sports are. A 2022 paper published in Psychology of Sport and Exercise suggests this is because participants are far less likely to finish an ultramarathon than they are a shorter race due to the extreme challenges posed.
“As a result, one of the primary motives cited by previous research into ultra-runners is that of personal challenge and goal achievement, rather than the measuring of one’s performance against others,” the paper says.
“This suggests then, that it may be the orientation of competition (versus self rather than other) that characterises ultra-running rather than necessarily the absence of [competition].”
For 53-year-old Gareth Flynn, it’s not about getting over the line in a certain time, even if it once was. These days, it’s more about the experience of running with like-minded people in beautiful and far-flung locations.
“The trail running events that exist in this country are spectacular,” Flynn says. “They’re in some amazingly wild places.”
The chief executive of human resources consultancy TQ Solutions has focused on ultramarathons since 2018. That same year, just 0.038 per cent of Australians completed one, the RunRepeat study found.
‘A slippery slope’
Flynn’s journey with ultra-endurance events started in the world of triathlons. He competed in both half-distance and full-distance Ironmans for about 12 years before switching focus to ultramarathons.
“It was a slippery slope,” Flynn says, when asked how he got into it.
It began with a short triathlon soon after he moved from the UK to Melbourne. A friend suggested he try his hand at the sport, so he borrowed a bike and a wetsuit and gave it a whirl.
“I absolutely loved it and gradually progressed,” Flynn recalls.
“I started doing more of those shorter distances, then challenged myself to do an Olympic distance. And then the natural progression is, ‘Oh, that was great, could I do the half Ironman?’”
Over the next 12 years, Flynn completed more than 40 half-distance and seven full-distance Ironmans. For the uninitiated: a full-distance Ironman is a triathlon consisting of a 3.8-kilometre swim, a 180-kilometre bike ride and a 42.2-kilometre run. The fastest-ever Ironman was completed in 7 hours, 21 minutes and 12 seconds, but a more typical time for non-elite athletes is about 12 and a half hours.
Flynn says he loved the discipline of his twice-daily exercise regime. And, as an “ultra-competitive” person, he also enjoyed the opportunity to compete against others in his age group. “You can compare every split, every segment … and I loved that,” he says.
Doing Ironmans also helped Flynn satisfy his twin ambitions in life: to push boundaries and inspire others. Could he do an Ironman? Could he beat his previous time? Could he beat that person? He was driven by these types of questions and also wanted to be a fit and healthy role model for his two children. (His 20-year-old son will race the Clare Valley 50-kilometre race with him in July.) “And I’d rather be more competitive in a sport like Ironman than in a workplace where it can turn quite noxious.”
Getting the balance right
Last year, there were more than 16,000 entries into half or full-distance Ironman events in Australia, according to race organisers Ironman Group. This figure, which counts the same person a number of times if they enter more than one race, was 7 per cent higher than the year before and 30 per cent higher than 2019 before the pandemic.
Finishing an Ironman event in 12 hours requires an average of 500 to 700 hours of training a year, or an average of 9.6 to 13.5 hours of training per week, according to a Triathlete article written by exercise physiologist and Ironman coach Alan Couzens. For world-class professionals, those average weekly figures are as high as 23 to 29 hours. (For context, just 22.4 per cent of Australians aged 18-64 did at least 2.5 hours of moderate-intensity exercise or at least 1.25 hours of vigorous-intensity exercise or an equivalent combination of both each week in 2022, according to an ABS survey).
“You become a ruthless time manager because you have to start your day at five [am] or whatever it is,” Flynn says, adding that he used to run to work instead of catching the train to make better use of his time.
“Especially when my kids were young, it was very challenging. My wife did quite a bit of the heavy lifting.”
The HR consultant says his training taught him how to prioritise and pursue specific goals, skills that he says transferred into the workplace.
It also provided an outlet for stress and the space to figure out complex business problems. On a long ride or run, there were no emails or phone calls or questions from colleagues. There was just time to think.
“But I also reflect that it probably didn’t make me the best person as a husband and a father for a few years, which I look back on with a little bit of frustration now,” Flynn says.
That’s partly what led him to ultramarathons. The endurance aspect of the sport still scratched an itch. But focusing on a single discipline meant Flynn could get away with less training. Studies put the average training distances in adult ultra-runners between 66 and 83 kilometres each week.
Running in ‘special’ country
So far, Flynn’s favourite race has been the Run Larapinta Stage Race, which traces parts of the Larapinta Trail in the MacDonnell Ranges near Alice Springs in Central Australia. The hilly course passes red gorges, dry savannahs and wide valleys encased by rocky mountain ridges. The short version covers 82.5 kilometres over four days; the longer one, 127.5 kilometres over the same timeframe.
“It’s a really challenging event because the terrain is just unbelievable. But the camaraderie and the event organisers and the country you’re running through are so special,” Flynn says.
His most difficult event, however, was a 75-kilometre ultramarathon in regional Victoria in 2019. Part of the multi-race Buffalo Stampede Festival, that year’s 75-kilometre race had an elevation gain of 4400 metres through the hilly Mount Buffalo National Park. It took him 15 hours and 10 minutes to complete it.
“With Buffalo Stampede, the reason it was so physically challenging was obviously the elevation gain. But it’s the descent that’s actually the punishing part for your body,” Flynn says.
“Going up Buffalo, to the halfway point, I was fine, feeling good, feeling strong. But coming down, you’re literally running down a gradient for 14 kilometres with no reprieve ... and that fatally shot my quads.”
The way Flynn sees it, pain is inescapable when running such long distances. Which perhaps begs the question: are ultramarathons safe?
Are ultramarathons safe?
It’s a question that global media outlets asked in unison when a 100-kilometre trail race in Gansu province in China ended in tragedy in May 2021. Twenty-one of the 172 competitors died and another eight were hospitalised when a large storm pelted runners with rain and hail and brought freezing temperatures and wind strong enough to knock competitors off their feet. Runners, some of whom set off in no more than a t-shirt and shorts, said they were blindsided by the conditions.
But that was just one event. A 2021 study focusing on ultramarathons through mountainous terrain in Western Europe offers some perspective.
It found that 51 people died training for and competing in these types of races between 2008 and 2019. Between 2016 and 2019, the fatality incidence rate worked out as one death for every 10,000 participants.
That compares with a risk of sudden death of 1.5 per 100,000 people in triathlons and 0.8 per 100,000 people in marathons, according to a presentation to the American College of Cardiology in 2009.
The most common fatality in ultra-running is sudden cardiac death. But the same is true across all types of exercise and not just in ultramarathons, says Tony Blazevich, a professor in biomechanics at Edith Cowan University in Perth.
Blazevich says the stress of doing an ultramarathon could potentially lead to a very small increased risk of cardiac issues, particularly if you have an undiagnosed but already existing problem. But the many health benefits of ultra-running and long-distance triathlons would outweigh the risks for most people.
“First of all, physical activity in itself is really essential,” he says. “Fitness is a far, far more important [predictor] of your life expectancy and [health] outcomes than fatness, for example.”
Stress-reduction benefits
Ultra-running also helps reduce stress more than other types of exercise. Blazevich says this is partly because it gets people outside and partly because training for such events involves doing a lot of “long and slow” exercise – often referred to as zone one or zone two-type training – during which heart rates stay reasonably low.
“You’re moving at a pace that you could theoretically move at for hours and hours without problem. And that type of exercise, done for several hours a week, is really, really effective at improving health and reducing stress levels,” Blazevich says.
This is because long and slow exercise increases the time our nervous system spends in our “rest and digest” parasympathetic state relative to our “fight or flight” sympathetic state.
“That long, slow exercise that everyone’s stopped talking about is actually the best way to improve parasympathetic drive,” Blazevich says. “And the data are very, very good that having a high sympathetic and low parasympathetic tone is bad for cardiovascular risk.”
Another major risk is hyponatraemia, a condition that occurs when sodium levels in the blood drop too low. “It’s not the loss of the water that ends up causing the big problem,” Blazevich says. “It’s the fact that while you’re exercising you’re losing both water and electrolytes, and then you [only] replenish water, and you therefore have an imbalance.” Electrolyte drinks reduce the risk but don’t eliminate it entirely, so Blazevich says it’s important after your race to recover the electrolytes that you lost during it.
It’s one of many reasons why training for ultramarathons should involve more than just clocking up enough miles on the road, says Kate Edwards, a lecturer in exercise science at the University of Tasmania who has completed ultramarathons.
Edwards says competitors must plan and practice consuming the food and drinks they intend to take during a race, and think about the equipment they need for the terrain and environmental conditions they will likely experience. Having a clear nutrition plan, and practising parts of it during training, can mitigate the risk of hyponatraemia and gastrointestinal issues. A 2021 review of the potential long-term implications of ultra-endurance races, published in Sports Medicine, found between 50 per cent and 80 per cent of ultra runners experienced nausea, vomiting and/or diarrhoea during a race.
“When you’re doing such long events, there is so much potential for stuff to go wrong because you’re running for a really long period of time [and] environmental conditions can change from one day to the next ... but you can greatly reduce the risks both in training every day and [during the race] by being prepared,” Edwards says.
The most common setbacks that ultra runners and other endurance athletes face are overuse injuries, which occur when athletes build up the volume and intensity of their workouts faster than their body can adapt to them. The Sports Medicine review found that roughly 90 per cent of injuries in ultra-running are related to overuse.
Most injuries are minor and affect the lower limbs, especially the foot, ankle and knee. But Blazevich says runners should mitigate their risk by listening to their bodies and attending to minor issues quickly. “[Taking] short breaks to keep the body fit is better than pushing through and then losing long periods of training to a significant injury,” he says.
People are at greater risk of overuse injuries if they’re old, overweight or have a history of previous injuries. Other risk factors including running volume and running form (“biomechanics”). And there may also be “a dose-dependent association between competitive level of running and knee and hip osteoarthritis”.
“A moderate (recreational) running regimen has been shown to be associated with a lower occurrence of hip and knee osteoarthritis compared to that seen in the general population,” the Sports Medicine paper explains.
“However, endurance (competitive) running has been associated with a higher occurrence of hip and knee osteoarthritis compared to that seen in the general population.”
When exercise goes too far
Provided runners build up their training gradually, listen to their body for signs of pushing too hard and prepare for all aspects of a race, Edwards believes the benefits of doing ultramarathons and Ironmans outweigh the risks for most people. But she says there’s also some evidence to suggest it is possible to exercise too much.
For example, emerging research has found that extreme, long-term exercise is associated with an excess of cardiac arrhythmias (rhythm disorders) such as atrial fibrillation.
Andre La Gerche, who now leads the Heart, Exercise and Research Trials (HEART) Lab at St Vincent’s Hospital in Melbourne, told The Age in 2022 that atrial fibrillation was at least twice as common in endurance athletes. But La Gerche, who has a 2-hour-29-minute marathon to his name, also said: “Heart rhythm problems can be life-threatening but the vast majority are a nuisance rather than a risk. Overall, the small excess of heart rhythm problems caused by exercise is vastly outweighed by the risks of not doing enough exercise.”
The tricky part, Edwards says, is that we don’t yet know where the line between optimal and excessive exercise exists. Not least because this boundary will probably vary from one individual to the next.
“That’s where a coach can come in handy because they’re the ones that will give you that feedback and, to some extent, give you permission to take it easy because when you’re trying to do it on your own, you think, ‘oh, but I have to do this long run because it’s on some training plan I got off the internet’,” Edwards says.
“If you’ve got a coach, they’re more likely to say, ‘look, if you’re run down, don’t do it because it’s just going to set you back in your training next week’.”
External voices can also have a negative influence, though.
METS Performance lead scientist Nick Jankovskis, who specialises in coaching amateur and professional athletes to improve their endurance performance, says many people have been inspired to get outside and push themselves after seeing people on social media like Nedd Brockmann accomplish incredible feats of endurance.
This is great, Jankovskis says. But he’s also concerned that videos on social media are encouraging people to push too hard and run through injuries, which could lead to long-term health problems.
He sends me a video on TikTok to make his point. In it, brothers Lachlan, 22, and Stefan Lamble, 25, tell their followers that, on day 63 of their 85-day run across Australia to raise funds for cancer research, “against all medical advice” Stefan ran the equivalent of a marathon with a torn meniscus.
“I’m sure these guys are genuine in their support for good causes, but the glorification of a torn meniscus [to complete] an endurance challenge is the kind of thing you [are starting] to see, whether loudly on [social media] or quietly elsewhere,” Jankovskis says. (The brothers, who lost one grandmother and two close family friends to cancer, have so far raised more than $212,000 for research into the disease across Australia.)
“I don’t want to sound too negative with all of this because the real positive is that people are getting out there and getting active. That’s the part we can’t forget.
“But it’s when it gets taken to the extreme, from zero to 100 very quickly, that’s the concerning part,” Jankovskis adds, noting it’s no longer uncommon to hear of someone attempting seven marathons in seven days or two Ironmans in consecutive weekends. He says many are inspired by the former Navy SEAL and ultra-runner David Goggins, who has amassed a following of 11.5 million people on Instagram by embodying a never-give-up attitude and repeatedly pushing his body to the extreme. His catchphrase? “Stay hard”.
I ask Flynn what he thinks of the social media-fuelled trend of multi-day fitness challenges. Could it encourage some people to imitate what they see on social media without taking the necessary precautions and putting in enough prior training?
“Yeah, look, I love these events. I love what some of these people are doing,” Flynn replies, later referring to James “The Iron Cowboy” Lawrence as a particular inspiration. Lawrence completed the equivalent of 50 Ironman triathlons in 50 days across 50 US states in 2015.
“If someone tries to emulate it, and they haven’t done the training, well, I mean, that’s just stupidity. So, I think there’s got to be a level of personal responsibility when it comes to this sort of stuff,” Flynn adds, saying what the Lamble brothers had done was “great”. “People are doing it normally for a good reason, and it’s normally charity-based.”
The increased incidence of cardiac arrhythmias among professional endurance athletes somewhat concerned Flynn, though. But after looking into it, he figured he probably didn’t have to worry too much as professionals did “a s---load more than me”.
“I was never really overly concerned,” Flynn says, adding that the organisers behind the events he did were “very safety conscious” and he prepared well for each one.
“The only thing that probably was on my mind was, ‘How long can I keep the running going for?’”