There's a joke amongst sports medicine docs that runners are going to ignore their advice. Standard advice for some types of injuries is to take it easy for a few weeks. Most athletes will be fairly compliant, but many runners won't.

Also, sometimes marathon/ultra people will skimp on sleep and rest, which will have negative outcomes.

Like most things, there’s a U-shaped curve to the benefits and downsides of exercise.

Exercise creates a lot of oxidative stress, and after a while or too much exercise your body can’t handle the oxidative stress and that’s where things start going wrong.

Didn't they link it to pesticide use at golf courses ?

Well I blew my knees when I was 21 doing mountain bike rides where I went up a vertical mile. The summer between undergrad and grad schools I remember riding my bike to a Ross Perot rally and being in agony. I've found a lot of things I can do but I have to be sparing about running and can't even look at a bike anymore. I did enough heavy cardio training to get abnormal findings in my echo and A-Fib observered in a Holter monitor [1]

I've been heavy for a long time despite doing a lot of exercise and the one thing that worked for losing weight before Zepbound was that time I (1) had something like a manic episode and during that (2) discovered the weird pain that had been moving between my upper back, shoulders and neck for decades was really caused by trouble with my TMJ and had six months where I just threw random foods (let's say pork loin, seaweed, carrots and turnip, it was a running gag to put together the strangest combinations I could) into a pot and blend them with an immersion blender before cooking... and it cleared up.

My nutritionist now who is supervising my weight loss is pretty happy that I'm an exerciser but I haven't been doing quite as I'd like lately because I hurt my leg practicing theranthropy [2] and have had to pace myself, like developing isolated kettlebell exercises I can do at home that work my upper body without loading my quads though I am getting better and probably could start doing more whole-body stuff.

[1] ... which I don't quite believe, once I got into biofeedback I learned how to read two-lead EKGs and I can't really make out the P-wave a lot of the time and I don't think 10 bad heartbeats out of 10^6 evaled by a computer means anything

[2] ... if you gotta know I "go out-as-a-fox" to charm people to do street photography and part of that is "walking like an animal" while carrying a heavy loadout of equipment and learning to do that without putting too much stress on my body, it didn't help at all that I tried a pair of New Balance 1080's which were the worst shoes I've ever tried, like they caused more trouble than the high-heel boots I've worn going out in drag for halloween.

I'm an american and I think relying on any long-term medication is a failure of sorts. I know that that's not totally fair and I try not to judge anyone else but that's my feeling for myself. I don't take any prescription meds aside from occasional antibiotics for infections but it's been at least a decade since I even did that. I would not be on board with any long-term prescriptions if I had not exhausted every possible change in diet and behavior first.

Americans are quite bifurcated on this topic, and although the population as a whole might be pretty out of shape there is a fairly large subset for whom exercise is practically a religion.

Falsified. I'm an American and I don't say that.