Human Limits

The Olympics showed us all the amazing things humans can do as a result of intense training on top of talent.  While performances in the Olympics and other sporting events get better and better the sad reality is that the world as a whole is getting less fit and less active.  Here is a link to a statistics filled analysis of the inactivity pandemic that appeared in the Lancet medical journal just before the Olympics.

This paper was part of a series of articles on physical inactivity and what to do about it.  The article points out that “inactive people would gain 1.3–3.7 years (of life expectancy) from age 50 years by becoming active” and that “with elimination of smoking, life expectancy at age 50 years was estimated to increase by 2.3–2.5 years in the US population”.

These data are consistent with the idea physical inactivity now rivals smoking as a cause of premature death.  Inactivity is also perhaps the major cause of non-communicable diseases worldwide.   In fact regular exercise or even just building more activity into your daily routine can be used to either prevent or treat all sorts of things including:

• Diabetes
• Hypertension
• Coronary artery disease and other forms of atherosclerosis
• Aging associated frailty
• Obesity
• Depression
• Fibromyalgia, Chronic Fatigue Syndrome and POTS.

The figure below shows just how protective physical activity is.  The data are from about 4,000 middle aged men in Great Britain, but all sorts of studies in all sorts of populations have essentially generated curves that look just like this.  The important thing to note is that most of the protective effects of physical activity occur when people go from inactive to moderately active.

The question now is what to do about all of this inactivity?  In a recent editorial on a form of orthostatic intolerance (light headedness and fainting when standing up) I pointed out that, like so many other medical conditions, exercise training appears to make this condition better.   I then argued that inactivity should become an official medical diagnosis.   This would raise awareness of the problem, improve physician training related to exercise, and perhaps stimulate organizations that pay for medical care to do more.  It might also lead to more widespread support of supervised progressive training or “reconditioning” programs and related public health measures.

These ideas are not new, and in fact Dr. Frank Booth, a truly visionary scientist, has been making similar arguments for many years.

Finally forget mortality and the cold hard statistics mentioned above, and ask yourself how many people are leading limited lives because they are unfit, frail, or suffer from preventable chronic diseases?  How many older people can’t chase their grandchildren around the yard?  How many people can’t go for a hike on beautiful but challenging mountain trail or body surf at the beach?   It is a big world and being fit makes it possible to engage fully in the many interesting things that are out there and waiting for us.

Way to go Mo and Galen!

On Saturday, Mo Farah of Great Britain and Galen Rupp of the U.S. broke the East African monopoly on the 10,000m by winning gold and silver respectively.  Their performances raise the general question of “who will beat the Kenyans?”  The short answer to this is the Ethiopians who have shared in this dominance since both countries emerged as distance running powers in the 1960s.  But is what happened in London the start of something new?

Farah was born in Somalia and immigrated to the U.K. as a child, so I want to focus on Rupp who is white kid from Oregon and the first U.S. athlete to medal in the 10,000m since Billy Mills in 1964.  Rupp is also a product of the NIKE sponsored “Oregon Project” which seeks to develop U.S. talent in distance running to compete with the East Africans.  Directed by Alberto Salazar, the idea is to nurture selected people in a controlled and scientific way to combat the hordes of East Africans who seek to use running as a means of very basic economic advancement.

This has happened before.

The first thing that needs to be appreciated is that since reliable world records started to be kept in the early 1900s, there have been three periods of regional dominance in distance running.   A good example is seen in the world record progression for the 10,000m for men.  It shows that runners from Finland held every world record from 1912-1944.  From 1949-1962, the Eastern Europeans held 9 of 10 records.  Since 1977, East Africans are 11 for 14.  Currently runners from Kenya and Ethiopia dominate the list of 25 fastest times for the event and have won the vast majority of Olympic medals in the 10,000m since 1968.

It is hard to compare eras for a number of reasons, but the old days were dominated by archaic amateur rules, limited high quality competition, and later the Cold War.  However, I want everyone to realize that there is nothing new about regional dominance in selected track and field events.

Is there anything “special” about the East Africans?

To answer this question we need to take a quick look into the physiology of what makes an elite distance runner.   There are three factors critical for success, they include:

1. VO₂ max, or maximal oxygen uptake.  This is essentially how big the engine is.
2. The so-called lactate threshold.  This sets what might be called a physiological “red-line”.
3. Running economy or efficiency.  How much oxygen is used to go how fast?

The idea is that VO₂ max sets an upper limit and the fraction of VO₂ max that can be sustained in competition is related to the lactate threshold.  If you know these two values they tell you how much energy a given runner can use for over a given period of time.  If you know running economy you can make a pretty good guess of the speed that can be generated with that energy.   In a couple of scientific papers, my colleagues and I have explored these concepts in detail.  We have focused on the marathon, but the principles also apply to the 10,000m.

So, do the East Africans have exceptional values for any of these factors?  A careful review of the scientific studies shows that their values are nothing special for elite distance runners.  However, many do have outstanding values for running economy, but these values are not better than those seen in the most efficient whites.  Also, no genetic factors have been identified to explain their success.

There is an important caveat here.  A time of 26:40 for 10,000m is 1600 seconds.  A one percent margin would be 16 seconds, or about 100m on the track in a real competition, which would equal a big win.  One percent is also within in the limits of the measurements we can make in the lab that are related to real performance in real competitions.  So, it is possible to determine who is world class in the lab, but very difficult to slice it any thinner than that.

If the East Africans have something special it is likely due to hard and active lives at high altitude from an early age.  A typical story is the one I heard from my college teammate Harrison Koroso from Kenya.  He described, beginning at age 8, running two miles to school, coming home for lunch, running back, and playing soccer for fun; all of this at 7-8,000 feet.   The highlands of Kenya are also likely to be pretty free of video games and carpools to play dates.

My main conclusion is that there is way more to the East African success than some physiological secret sauce.  In fact there is no physiological secret sauce.   I did not go into it here, but there are no secret innovative training techniques either.  Top runners have been training essentially as “hard as you can” since the 1950s or early 1960s.

Plenty of talent in the U.S.?

I also want to argue that there is in fact plenty of talent in the U.S.  If you look at the all time U.S. high school lists they are pretty impressive.  What is also impressive is the number of people on these lists that either faded and never became world class, or became world class but for whatever reason never medaled in Olympic competition.   The video clip at the end of the post is of Jim Ryun setting a world record for the mile in 1967 when he was 20 years old.  His 3:51:1 on a dirt track would be perhaps 6-7 seconds faster on a synthetic track and close to the current world record.  He also ran this fast with no pace maker or rabbit.

Ryun did medal; he got silver in the 1968 games at Mexico City, which is about 7,000 feet high.  He was coming back from mononucleosis and defeated by Kip Keino of Kenya.  Keino ran an Olympic record 3:34.91, a remarkable time at high altitude.  Ryun was tripped in 1972 and failed to advance and his career was over at 25.  Rupp is 26, how would Ryun have faired in the corporate sponsored environment Rupp has?

When you get past the top 10 lists, most people connected to the running subculture in the U.S. know stories about the kid who ran a 4:15 mile in high school with minimal training and never pursued it much further.   We have also heard stories about the kid who was good but not great in high school and blossomed later.  If this talent were harvested and nurtured in the way the Rupp’s has been, what would be the result?

My conclusion here is that there is more than enough talent in the U.S., some of it actually gets identified but what happens after high school is a crapshoot.  There are about 120 million people living in Ethiopia and Kenya combined and the good runners come from selected ethnic subgroups.  With more than 300 million people, there has to be sufficient talent in the U.S. to challenge the East Africans.

Return on investment thinking and who does what.

Per capita income in Kenya is about $800 per year and about $400 per year in Ethiopia according to the World Bank.  Become a good runner, place highly in a few major races and you can feed yourself and extended family for a long time.  If you become truly elite, you are wealthy.   You don’t have to have a Ph.D. in behavioral economics to understand that kind of motivation in poor societies.  If every kid with a shred of talent in the distance running areas of East Africa goes for it, what emerges from the competitive crucible is sure to be exceptional.

What would the equivalent of a $10,000 purse at a midlevel race be in western terms?  How many kids would keep running if the there was a distance running circuit with prize money on the order of that seen in the professional golf?  I don’t know but I bet it would be plenty.

A flip side of the coin is the recent example is Lukas Verzbicas, who is on several of the top 10 lists for U.S. high school runners.  He is also superb at the triathlon and has more or less opted out of running (he had a scholarship at the U of Oregon, a perennial power) to focus on the triathlon.   The speculation is the path to the top is less competitive in the triathlon and fame and glory (and perhaps money) more certain.

Summary

In this post I have argued that the primary factors responsible for East African dominance in distance running are cultural and economic.  The evidence for an explanation based on physiology, training, or genetics is pretty thin.  Is Rupp a one off, or will his impressive performance be catalytic like Greg LeMond’s victories in the Tour de France were?  LeMond won the Tour in 1986.  He came back from a life threatening hunting accident to win again in the 1989 and 1990.    His victories and courage broke the myth of European superiority in cycling and opened the way for competitors from all over the world.

I was on KARE-11 on Saturday morning sharing thoughts on women in the Olympics and tips for the general public to get started on their own athletic endeavors.  Click here to see the live segment.

Recent posts have focused on how elite endurance athletes might be manipulating their red blood cell counts to get a competitive advantage.   About 10 years ago I did a brief article that provides a scientific explanation for why blood doping and EPO work.  The article is still current.

In my 7/22 post I also expressed optimism that the biological passport system might be able to keep doping in check.   My colleague Ilkka Heinonen forwarded a link to a recent paper that paints a less optimistic picture.

While we are on the topic of EPO, there was a major expose in the Washington Post on the overuse of EPO to boost blood counts in patients with anemia.   The story points out that the development of EPO was a major breakthrough in biotechnology and a triumph of converting basic research into improved clinical care.

However, like a lot medical innovations, overuse is a problem and a major driver of health care costs in the U.S.  The best estimate is that about 30% of medical care costs have something to do with use of technology in ways that do not improve patient outcomes.

No matter where you are on the U.S. health care reform debate, the issues related to technology overuse need to be addressed.   During the next few weeks I will be focusing on the Olympics, but let’s not forget the real world while we are at it.