Who, what & why

The authors of this opinion piece in the Sports Medicine journal have decades of combined experience in coaching and analyzing the performance of elite endurance athletes up to World-class level. Prof Paul Laursen & Dr Phil Maffetone have consistently preached the message that elite level performance needn’t be at the cost of your long term health. They’ve been very enthusiastic proponents of using heart rate variability (HRV) and both gave me encouragement and support during the initial development of ithlete in 2010, for which I will always be grateful!

Their messages about conducting high volumes of training at an easy pace and paying strict attention to diet (including the reduction of refined carbs) have not always been well received, but more and more peer reviewed research is now substantiating their philosophies.

It made sense for them to produce this opinion paper which I would recommend reading in its entirety.

What did they do?

The authors pooled their joint experience and have produced a rationale as to how apparently very fit athletes can also be unhealthy at the same time, running the risk of frequent illnesses, overtraining and shortened athletic careers.

They distilled the key elements of the drive for high performance and how that often translates into maladaptive condition into this figure.


Central to the argument are two pressures present in our modern existence of 10 generations for which the previous 84,000 generations did not adequately prepare us:

  1. A mentality which implies that in order to achieve, you must suffer. In athletes (who often tend to be type A, driven personalities) the famous ‘no pain no gain’ mentality is prevalent. This often leads to an excessive proportion of high intensity training and competition without sufficient recovery. A chronic imbalance of training and recovery leads to stress from neural, chemical and hormonal factors (for anyone unconvinced about how bad stress is for you, read ‘Why zebras don’t get ulcers’).
  2. A diet overloaded with high glycemic, refined carbohydrates and processed foods. It is well established that these lead to high levels of systemic inflammation and metabolic disorders such as type-2 diabetes. We have also been led in the past 4 decades to believe that fats and fatty foods are universally bad for us, whereas our ancestors were well adapted to use fats as fuels during long days of gathering and hunting.

The net effect of these two sets of pressures (as well as lack of sleep, rest and mental-emotional stresses) is maladaptation with increased risk of physical, biochemical and mental-emotional injury.

What did they find?

The key points they raise are:

  1. Fitness describes the ability to perform a given exercise task
  2. Health explains a person’s state of wellbeing, where physiological systems work in harmony.
  3. Excess high training intensity or volume and/or excess consumption of processed/refined dietary carbohydrates can contribute to reduced health in athletes and even impair performance.

The net result is that too many athletes are fit, but unhealthy.

What does it mean?

The autonomic nervous system (ANS) plays a key role in controlling the maladaptive state, with the sympathetic (fight or flight) branch becoming dominant over the parasympathetic (rest and digest).

HRV is a direct way of gauging the current state of the ANS, especially the parasympathetic branch.

The authors’ recommendation for training is to reduce high intensity training and increase volume of low intensity training – in fact many elite endurance athletes practice polarized training, where 80% of training time is spent at low intensity (below MAF or first lactate threshold) and only 20% at high intensity (above lactate turnpoint, HIT). The key idea with HRV here is to perform HIT when your HRV is at or above baseline when your body has the reserves to tolerate it.

When it comes to diet, the authors recommend reducing refined carbohydrate content from an athlete’s diet and replacing these calories with healthy/natural carbohydrate and fat over prolonged periods. It is now recognized that elite athletes can develop fat burning rates of up to 1g per minute (540 kCal/hr) without impairing their ‘top end’. Although research on HRV and food tolerance is scarce, there is good evidence that adopting high omega3 diets such as the Mediterranean can lead to substantial improvements in HRV and other metabolic markers. The opportunity with HRV is to use it as a long term marker of what works for you. A long term trend that heads slightly upwards shows that you are finding improvements in your biological age and prospects for longevity. Can’t be bad!

Full paper available at: Maffetone and Laursen Sports Medicine – Open (2016) 2:24 DOI 10.1186/s40798-016-0048-x