Fitness over Health: Are Americans becoming less healthy as we become more fit?

The Spectrum of Health Health is often described in medical literature as the absence of illness or disease. One would assume that at the other end of the spectrum, at the furthest from disease and at our most healthy, is athleticism. Indeed, health markers associated with illness, such as blood pressure, body fat, triglycerides, muscle mass, resting heart rate, and bone density, almost always improve with rising fitness levels. This correlation suggests a continuum from illness to wellness into athleticism as our healthiest goal. Unfortunately, this is always the case- athletes also are plagued with measures of illness and/or disease unique to this population.

The Rise of Extreme Fitness Americans appear poised at two extremes. At one end, as a nation we are becoming more inactive and ill. Rates of obesity, heart disease and diabetes are rising. Diabetes incidence continues to rise, in part due to a worldwide aging population, but also due to rising obesity and lifestyle factors. 1998 marked a 2.9 million person increase in diabetes diagnoses across America. As of 2011, 34% of adults and up to 20% of children are obese. Medical doctors, physical therapists and epidemiologists all recommend increased activity as a prevention and corrective antidote to these diseases.

At the other end of our American experience, we are searching for more and more extreme measures of physical performance. In 1970, 55 persons finished the first ever NYC marathon. In 2019, 53,627 runners crossed the finish line. Endurance races continue to stretch the norms of what is possible for the average American, and ultramarathons and Ironman triathalons have become commonplace in participation and spectators, with live broadcast of the US Kona triathalon every year over network television. Extreme physical contests are not limited to endurance. The Crossfit games, held every summer since 2007, continues to grow in popularity in both participation and viewership as well. In 2011, 26,000 athletes signed up to participate in opening qualifiers, rising to 415,000 participants in 2018. In 2020, Crossfit’s culminating event, the Crossfit Games, was also broadcast on network television in a live 2-hour event.

Extreme fitness is not just reserved for adult athletes. Youth sports is rising in popularity, reported to be a $17 billion industry in 2018, on par with professional football. Travel teams make up the majority of this industry, requiring multiple practice days each week, frequent travel often across states, and an unspoken encouragement for year-round practice and private coaching. The rise of ultra-expensive, ultra-competitive travel teams can unfairly disadvantage children who are not wealthy, causing many of them to discontinue sports. However, one also must question the physical effects on the children that continue to engage in this type of high-level competition throughout the year without rest.

Elite Fitness Is Not Elite Health Information regarding prolonged high-level fitness are starting to become evident. Overtraining, particularly in endurance sports, can have an effect on the adrenal gland, causing adrenal insufficiency with associated symptoms: fatigue, poor sleep, allergies/autoimmune disease, slow illness recovery, and decreased concentration. In fact, a wide spectrum of mental and physical ailments can affect those who overtrain, including asthma, thyroid disease, diabetes disease, iron insufficiency, and hypertension, as well as disordered eating, anxiety and depression. Research remains unclear if moderate long-distance running may cause early arthritis or prevent it. But research has shown that chronic, high intensity and long-distance endurance causes cardiovascular damage to the atria, interventricular septum and right ventricle in many ultra-endurance athletes, potentially leading to arrythmias in these athletes. Sustained high-intensity cardio is also associated with artery wall stiffening and calcification- often the very things cardiovascular exercise is promoted to prevent.

The muscular goals seen in fitness magazines may come at a cost as well. Many former female bodybuilders have discussed how competition requirements of low-calorie diets and high exercise intensity cause a deleterious effect on their hormones, resulting in hair loss, loss of menstruation and rebound weight gain. Hulmi et al. (2017, p. 689) measured decreased serum level levels of leptin, triiodothyronine (T3), testosterone, and estradiol in the female fitness competitors they studied, corresponding with menstrual irregularity in the participants. They stated serum levels only rebounded to pre-competition measurements after 3-4 months of normal eating. On the surface, the inspiring six packs of celebrity trainers may seem like the epitome of health, but they frequently hide the fact that they can struggle with high blood pressure, abnormal liver tests and heart strain, with or without known performance enhancing drug use. Significant left ventricular hypertrophy, caused by high level efforts, is associated with higher arterial blood pressure at the aerobic or anaerobic threshold. This may cause cardiac fatigue or atrial fibrillation if left unmonitored.

A new injury called Rhabomyolsis (aka Crossfitter’s disease) has recently become part of the fitness community’s lexicon, although it is not limited to Crossfit communities only.

Rhabomyolsis is caused by the prolonged overload of muscles past their capacity resulting in kidney depletion and muscle necrosis. It appears in an effort to match the suggestions of guided fitness classes, whether in Spin class or in a Crossfit WOD, we have lost sight of our own internal body cues for what is healthy or sustainable.

Child athletes are also affected by this trend of extreme fitness, with overuse injuries becoming more common, cutting short sports participation or plaguing their young bodies with chronic injuries that may last a lifetime. Adolescents are 70% more likely to experience overuse injuries than other injuries if they specialize in one sport or spend more hours per week training than their teammates. High school athletes are also three times more likely to experience an overuse injury to their hip or knee of playing one sport more than 8 months out of the year. Acute and over-use injuries in high school sports account for 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations every year.

If physical activity is supposed to improve our health, why do many markers of physical and mental health rise with our new fascination with extreme fitness? It seems American culture has presented 2 choices for fitness: inactive spectators of high-level human performance, or reliance on extreme efforts in a quest for maximal health. If high blood pressure, arrhythmias, arterial stiffening, adrenal insufficiency, kidney and hormonal disturbances, and acute/chronic muscle injuries can all be attributed to extreme fitness, it seems neither choice is ultimately healthy for long-term health. As we learn more about the negative effects of stress and inflammation, we are beginning to understand that an unrelenting push of the body’s limits is as stressful & inflammatory as inactivity.


Resiliency is the New Athletic Goal There is an optimal amount of movement and rest that we must find, monitoring short & long-term stress and inflammation, if we are searching for prolonged health and quality of life as a goal. Program flexibility is incredibly important in fitness programs and should include cross training, mobility, non-purposeful movement, non-restrictive eating, and yes- rest days too. Higher level competition may improve health and fitness if it remains episodic throughout the athlete’s year. But this cannot replace the importance of baseline moderate fitness goals for the remaining months and years of one’s life.

Newer medical discussions posit health as a natural resiliency to changing circumstances and conditions. One would hope that using this definition, well-rounded health emphasizing sustainable fitness can become a viable third option in our culture, even as we look to stretch our overall baseline fitness capacity. It is important for high intensity athletes to continue measuring health markers as they are not inoculated from unhealth, despite having advanced coordination, aerobic capacity, strength or muscularity. Resiliency is the ability to protect oneself against injury, illness or disease and recover quickly after stressful events. Focusing on resiliency more than external validation of physical success might help change cultural perception about what is actually healthy. In this way, we may discover that prolonged life quality lies firmly in sustainable fitness across the lifespan.


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