Review: Your Hardcore Run May Be as Dangerous as Sitting Around Doing Nothing

Study Goals and Design:

This study uses data from the Copenhagen City Heart Study. The goal of the study was to look for
associations between exercise quantity/quality and risk of cardiovascular-related mortality. The design of the
Copenhagen City Heart Study was an observational, prospective cohort study that examined 20,000 men and
women. This research looked at 5,048 of the 20,000 people and further narrowed it down to 1,098 healthy joggers
and 413 healthy but sedentary non-joggers. The researchers excluded those with heart disease, stroke, and diabetes.
Study Quality Strengths and Weaknesses:
One strength of a cohort study is that it is clear that the exposure (exercise) preceded the outcome (death).
The individuals in the study were also picked in such a way to reduce potential biases. For example, those already
diagnosed with heart disease, stroke, and diabetes were not picked in order to control for self-selection bias. People
with these diseases may choose to exercise more after their diagnosis, which may bias the sample because the
exercise group may have a greater proportion of people likely to die sooner, thus skewing the data.
Because the study is a single observational study, it is difficult to establish causality. The wording in the
paper hints at a causal relationship between strenuous jogging and mortality rates - vigorous running could be
almost as harmful as sitting around doing nothing. The news article suggests that cardiovascular-related mortality
is the intended measurement, given that the article noted the stress that intense exercise can put on the
cardiovascular system. However, the results report all-cause mortality risk. Thus, the deaths reported may have
nothing to do with jogging status leading to cardiovascular problems (e.g., cancer). To show that strenuous jogging
leads to increased all-cause mortality, one must come up with a biologically plausible explanation for why
strenuous jogging impacts non-cardiovascular related death.
One of the biggest weaknesses of the study is the potential for confounding variables that occur with
observational studies and alternative explanations to the data. The paper does not mention alternative explanations.
Even though strenuous jogging may be associated with increased mortality rates, those strenuous joggers may also
have other lifestyle habits or genetic factors that may have caused the increased mortality rates. For example, the

group of strenuous joggers may have a higher proportion of type A personalities, who tend to have higher blood
pressure and a higher risk for cardiovascular disease. So although the study tried to control for potential
confounders like diabetes, stroke, and heart disease, there are other potential confounders that may affect the
outcome. Since the researchers excluded those with certain diseases, it also limits the generalizability of the
findings those with the excluded diseases may in fact benefit from strenuous running.
Another potential problem is the study may have been a fishing expedition. The original study looked at
thousands of people that have been the basis for many reports on cardiovascular health sifted through 12 years
worth of data. This suggests that the original study looked at many measures that might relate to cardiovascular
health. The researchers may have sifted through many variables, each with a 5% probability of showing up as
significant by chance alone, given an alpha value of 0.05. Perhaps the relationship between jogging and mortality
was just due to chance.
According to the news article, we only know that 128 out of the 413 healthy (.3) sedentary non-joggers
died, and 28 out of the 1098 (0.02) healthy joggers died. The article does not mention absolute risk values of
mortality for the further subdivisions within the joggers (light, moderate, and strenuous joggers) and only displays
relative numbers (via hazard ratio) in a figure in the beginning of the paper. The paper does not explain what the
hazard ratio is. The news article should have reported absolute risk values for mortality, which is more informative
because they show the total number of people in each subcategory.
It is crucial to report absolute risk values. For example, the strenuous joggers group may have contained
very few people compared to the non-jogger group. Because we are measuring all-cause mortality, a few number of
deaths in the strenuous jogger group could be due to non-cardiovascular related incidents. For example, the deaths
could have been due to car accidents entirely unrelated to either cardiovascular problems or jogging. Because there
is a small sample size, those few deaths could artificially inflate the risk of mortality for strenuous joggers. If this is
the case, the title of the news article, Your Hardcore Run May Be as Dangerous as Sitting Around Doing Nothing

 is misleading. Furthermore, a small sample size inherently contains a large variability in the data. This is
reflected in a large confidence interval.1
Additionally, the news article does not state any details about the method of gathering details about
jogging status. If there is a large time gap between each questionnaire, the participants may simply forget how
often they jog, or there may be a social desirability bias to report more exercise. Over such a long period of time
for the study, it is likely that the jogging status fluctuated. If so, it is unclear from the news report what jogging
status the individual is ultimately placed into. This may distort the number of mortalities observed in each category
of jogging status.
Quality of the Source and Reporting:
The paper, for which the news article derives, is sourced from the Journal of the American College of Cardiology,
which is a peer-reviewed journal. This establishes some credibility on the results of the study. The news article
does not report the source of funding for the research study. The main problem is that the title of the news report
and the claims toward the beginning of the article imply a causality that is not justified by the results and
observational study design. The news article does not provide any information about how the participants were
selected were they randomly selected to minimize bias?
The news report does a good job providing context for the study by presenting different viewpoints and
criticisms. Throughout the news report, the editors point to other research that supports either side of the argument.
For example, they point out that other research has shown that taxing workouts may put excessive strain on the
heart, but also note that plenty of studies have also underscored the many health benefits of exercise. They also
bring in third party experts, such as David Bach, a cardiologist, and Duck-chul Lee, who wrote an accompanying
editorial. These comments moderate the overall stance of the news article, but are strategically placed toward the
end, after the extreme introduction, vigorous running . could be almost as harmful as sitting around doing
nothing. Since most news-browsers focus on the headlines and the first page or two of the article, the presentation

1 In fact, the confidence interval for strenuous joggers reported in the actual study was
1.97 [95% CI 0.48 to 8.14], which includes values (< 1) that indicate a protective
effect!

of the information is likely biased to favor the more newsworthy stance of too much exercise is bad, rather than
the conventional exercise is good stance.