What doctors wish patients knew about healthy running

AMA News Wire

What doctors wish patients knew about healthy running

Jan 27, 2023

One option for staying physically fit and healthy that many often turn to is running. Whether you are new or an experienced runner with several races under your belt, it is important to know how to remain healthy while running to avoid injuries. 

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The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.

In this installment, two physicians who have been active runners took time to discuss what patients need to know about healthy running. They are:

• Douglas DeLong, MD, an internal medicine physician in Cooperstown, New York, and alternate delegate for the AMA Senior Physicians Section.
• Christine Sinsky, MD, vice president of professional satisfaction at the AMA.

“Different people need different types of shoe support because of the unique ways our feet and ankles are constructed,” said Dr. Sinsky. “Many running stores have equipment that can help you determine the details of your foot structure and analyze your gait.

“And then they match your foot structure and gait to the shoes that are best designed to fit you,” she added, noting that “some shoes have more cushioning, some have more stability, some have more ankle support.”

“Having someone at a running store help you choose the running shoes is a very good first step,” Dr. Sinsky said.

This is “really critical ... particularly if you’re just starting out ,” Dr. DeLong said. “There’s often enthusiasm about New Year’s resolutions and people overdo it and then they hurt themselves. Then they’re done.”

“The main warning signs are  pain and swelling,” he said, noting that “if you’re uncomfortable, there’s something that needs attention and almost always is because you’re doing too much too fast.”

“A little bit of stiffness and soreness is part of the training process, but most of us can recognize when a pain or discomfort is more than, ‘Oh, I'm a little stiff today,’” said Dr. Sinsky. “If every step hurts, then you need to stop.”

“Things like heel pain are very common, and can come from conditions such as plantar fasciitis. Plantar fasciitis is more common when people ramp up their distance faster than they've been able to ramp up their body hardening,” she explained. “So, listen to your body. If you feel like you're having something more than the minor little stiffness, it is best to take another rest day.” 

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“It’s also important to go slow,” said Dr. Sinsky. “You may want to be able to run five miles, but it’s not a good idea to do that on your first day out.”

In the beginning “walk for five minutes, then run for a minute, walk for five minutes, run for a minute,” she said. And “each time out, extend the amount of running time between walking time.”

“A general rule of thumb is you don’t want to increase your mileage for a week by more than 10%, and that’s really pushing it,” said Dr. DeLong. For example, “training for a marathon or half marathon, you start off really slow and you gradually work your way up.” 

“There are many programs online that give you a plan to go from “couch to a 5K run in three months” and following those gradual progressions can be quite helpful,” said Dr. Sinsky.

“I’ve run more than 30 marathons and even more cross-country skiing marathons, which are even longer,” Dr. DeLong said. “But the very first one I did … there was a three-month program that I followed from Runner’s World magazine.”

How it worked was “it’d be hard day, easy day, hard day, easy day, off day,” he said. “And you just are ratcheting your way slowly, ever upwards. I really tried to follow that closely for guidance.”

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“I’ve been running for a really long time now and the one thing that has kept me running and not really getting burnt out is because usually I had some goal in mind,” Dr. DeLong said. For example, “I wanted to run five miles, or I signed up for a marathon.”

Having such goals “gave me more of a purpose for running. It was a really helpful thing,” he said. 

 “A brisk walk is probably one of the best and most practical ways to warm up for a run. I like to walk the first two to three minutes before I start to run,” Dr. Sinsky said.

“I also like to do some floor exercises that help me warm up and get some of the stiffness out of my body before I go out and walk,” she added. “Then there are some specific things, like doing a couple simple lunges and hip exercises before heading out for a run. It gets good range of motion going.”

“I went to a medical conference before doing the Boston Marathon where there were presentations on different aspects of the physiology of running,” said Dr. Sinsky. “One physician researcher described how the mitochondria have a chance to get a little bit more oxygen when you take that walking break.

“So, taking the walking break helps a micro-recovery at the mitochondrial level,” she added, noting “that's always stayed with me as a nice mental model to use for letting your body have these small moments of recovery, for example by walking through the water stations, during a marathon.” 

“As you build your distance, it’s important to realize that part of training is building up your cardiovascular fitness and your muscle strength,” said Dr. Sinsky. “But part of training is body hardening, which is where you’re getting your joints and ligaments used to the effort.”

“You develop a lot of microtrauma during a run and then when you rest, it heals. And then you do it again,” she said. “That’s a cycle of body hardening, and part of that whole preparation is strengthening your muscles by doing strength training such as weightlifting.

“I found that doing strength training once or twice a week can help prevent some of the injuries from running,” Dr. Sinsky added. 

“There have been many studies that have looked at all the different kinds of diets and meal plans,” said Dr. DeLong. “And for the most part, the one that keeps coming up over and over again is the Mediterranean diet.”

It’s “a diet that’s low in red meat, higher in fish and healthy fats, so olive oils, fruits and vegetables,” he said. “That’s what I always recommend to my patients and what I try to do myself.”

“If your goal is to lose weight, eat lots of fruits and vegetables, lean protein, healthy fats, whole grains,” said Dr. Sinsky. “But it is really important not to avoid carbs if you're going to do a lot of running because you do need the carbs to fuel yourself.

“And if your body doesn't have carbs, it will be tough,” she added. “Particularly if you're going to go over an hour, you should bring some sort of fast-acting carbohydrate like a gel along with you so that you decrease your risk of injury.”

Some runners, particularly, have died during marathons. “One cause is related to water toxicity,” said Dr. Sinsky. “It’s what is called hyponatremia, or low sodium in the bloodstream from having ingested too much water, and is more common in slower runners who are on the course for four hours or longer.”

“Most runners do run a little dehydrated and that's normal. And then you rehydrate afterward,” she said. “For three or four hours of running, it's probably best to use thirst as your guide, so that you don't end up over drinking and putting yourself at risk of hyponatremia.”

“Running does help many people sleep better, so it works in that direction,” Dr. Sinsky said. “And sleep is good for running because it helps you recover.

“A lot of the tissue healing happens during sleep,” she added, noting that “you will run better if you've had a good night's sleep and you will sleep better if you've had a good run.”

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“There is some risk of overdoing it, but for shorter periods of time, more intensity seems to have specific benefits,” Dr. DeLong said. “In running there’s a term called ‘fartlek,’ which is Scandinavian, and it means speed play.”

“So, for instance, if you’re out on a run you might say: I’m going to sprint to the telephone pole and then I’m going to jog after that,” Dr. DeLong explained. “And that’s just something to do to change your pace.”

“Every week you should have at least one full rest day, but for many people it's two or three full rest days,” Dr. Sinsky said. “Maybe one of those days, you do some cross-training to allow your body to heal on that cycle.

“And then every four to six weeks, you should have a week where you cut back and do less. Even if you're building up over time,” she added.

“Your body does need to periodically take a little break,” Dr. DeLong said, recommending “you should try to schedule that in if at all possible because it is important to have a routine as much as possible without being so rigid about it.”

“Those who run regularly, even modestly, are at much lower risk of dying from heart disease,” said Dr. Sinsky. “In fact, a study from the American College of Cardiology looked at 55,000 adults who ran and compared them to nonrunners.

“Runners had a 30% lower risk of death from any cause and a 45% lower risk of death from heart disease or stroke,” she added. “The running levels were really low—like one or two hours a week—so it wasn’t extensive.”

“Not everyone was born to be a runner. I certainly have known people who wanted to be runners, but their bodies were just not runner’s bodies,” said Dr. DeLong, noting “they often had some sort of knee misalignment or other mechanical issues” that prevented them from running without injury.

“Running can be extremely healthy and is to be encouraged, but you shouldn’t feel discouraged if running is just not your thing,” he said. “Some people physically have tried many times and they end up with overuse injuries or some sort of mechanical problem that just keeps them from doing so.”

“Everyone can enjoy some type of rhythmic aerobic activity, for example biking, swimming, walking or even dancing,” Dr. DeLong said. “The most important thing is to just get out there. And related to me by a good friend is, ‘Running is the rhythm of life.’”