Physical exercise has been said to be healthy for the heart even in patients with various forms of cardiac disease [1–5]. A recent study published online in the European Heart Journal suggested that already being fit during the transition from the teenage years into adulthood may protect against heart disease decades later [6]. Men who had lower aerobic fitness levels when they were examined before entering mandatory military service at age 18 were more likely to have a myocardial infarction during a median follow-up of 34 years. Genetics likely play a large part in the aerobic fitness of teens but it could also be that men who are in good shape in their teens have adopted the sort of lifestyle that will keep them healthy later in life [7, 8]. What about the effects of extreme exercise, such as long-distance running [9], in particular marathons [10], or even longer distances than that, on health and physical well-being?
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