By Allison Warren, Staff Writer
One of the defining features of living in New York City is the annual NYC Marathon. This 26.2-mile race, which takes participants over five bridges and through the city’s hills, attracts runners from all over the world. While some may be motivated to run for their health, literature suggests a wider array of motivations, including leisure, hobby, weight control, competition and social connections.
Even at 82 years old, Judith Som still runs the NYC marathon with no plans of stopping. She began her running journey at 34 years old, and now, 48 years later, Som crossed the finish line for her 21st time. At 82, Som describes how an accomplishment of this magnitude “really gives you a sense of purpose and a sense that you could do just about anything you want.”
As a sport, running offers a plethora of favorable health implications. Marathon runners, compared to those that lead more sedentary lifestyles, benefit from enhanced metabolic fitness, aerobic performance, exercise metabolism, higher mitochondrial protein levels in skeletal muscle, and extended longevity.
For those that regularly partake in recreational running, it has been found to positively affect body weight, body fat, blood pressure, blood glucose levels, insulin sensitivity, blood-lipid profile and musculoskeletal health. From a mental health perspective, running may positively impact mood and overall well-being. Distance running has also been associated with the prevention of chronic diseases by lowering risks, including cardiovascular disease, and various types of cancer. Those that reap these health benefits are associated with running longer distances and doing these endurance runs regularly.
The American College of Cardiology found that runners had a 30% lower risk of death from any cause and a 45% lower risk of death from heart disease or stroke. The runners that were studied had low running levels of one or two hours per week.
There is conflicting data with respect to which race distance is associated with maximum health. A study sought to determine which race distance secured the greatest health results, and the results found that 10-km runners were leaner than those that run marathons and ultra marathons.
Half marathon runners scored higher for body weight, mental health, chronic diseases and hypersensitivity reactions, medication intake, smoking habits and health care utilization, having an average health score of 77.1%. Yet 10-km runners and marathon/ultra-marathon runners scored close behind with a score of 71.7% and 72% respectively. The researchers concluded from these results that “the optimal state of health across all race distances supported the notion that endurance running contributed to overall health and well-being.”
Despite all these advantages, literature also suggests potential negative effects of distance running. These negative effects, that might increase with age, include musculoskeletal injuries, unintended weight reduction and cardiovascular abnormalities. While the risk for older runners is higher, the incidence of race related cardiac arrest was found to be significantly higher in males than in female marathon runners, however the overall risk is low. One advantage for 10-km runners is their lower risk for injury compared to endurance runners who cover more weekly mileage. Distance runners may also report gastrointestinal complaints, symptomatic hyponatremia, exercise-induced asthma and hay fever.
A prospective cohort study conducted on those who competed in the 1993 Auckland Citibank marathon found several injuries and health problems one may experience due to a marathon. Risks include males developing hamstring and calf problems, and females developing hip problems. One is placed at a greater risk for developing an issue if it is their first time participating in a marathon, if they participate in other sports, if they develop an illness within a couple weeks prior to the marathon, current use of medication and drinking alcohol more than once a month.
A recently published case study of a 77-year-old former world champion marathon runner underscores the benefits of lifelong high-volume endurance exercise on cardiac function. At 77, this runner’s maximal oxygen consumption was comparable to that of individuals aged 20-29, a result of significant ventricular remodeling that enables a high cardiac output during exercise, despite a lower maximal heart rate. While such extreme remodeling may increase the risk of atrial fibrillation, the researchers argued that the long-term health benefits of vigorous exercise throughout the athlete’s life outweigh the risks, contributing to an extended health span and potentially greater longevity.
Due to the range of potential benefits and adverse effects, running marathons has been a source of controversy in the health community. The articles “Marathons: In the Long Run Not Heart Healthy!” and “The Goldilocks Zone for Exercise: Not Too Little. Not Too Much” take the stance that “frequent exercise is extremely important to health but in moderate amounts at low to moderate intensity. Long duration-high intensity exercise is not heart healthy. Moderation in intensity and duration is especially important after 40–45 years of age.”
In 2014, researchers Schwartz, Kraus, and O’Keefe discovered that veteran marathon runners have higher coronary artery calcium scores (CACS) than their age counterparts that do not run in marathons. CACS are found via CT scanning and are indicative of coronary artery plaque burden. A healthy person should have a value of 0 and values higher than 100 are cause for concern regarding coronary artery heart disease and increased risks for myocardial infarct, serious arrhythmias and sudden death. Further studies have corroborated these findings and suggest that excess exercise is associated with elevated CACS. For those exercising at an extreme, cardiovascular events may be more common than in non-exercisers.
Dr. DeLong, an internal medicine physician and alternate delegate for the AMA Senior Physicians Section, emphasizes the importance of listening to your body – if you experience pain or swelling, you may be pushing yourself too hard too quickly. Dr. Sinsky advises gradually increasing your mileage each week, with Dr. DeLong recommending no more than a 10% increase in mileage per week. Both doctors stress the importance of following a structured training plan.
Dr. Sinsky also recommends warming up before your run and taking walking breaks as needed, which allow the mitochondria to get more oxygen. Additionally, she suggests incorporating strength training into your routine to reduce the risk of injury. For fueling your runs, Dr. Sinsky advises eating carbohydrates beforehand. Runners receive essential fuel for their runs from muscle glycogen. By “carbo loading,” they can maintain an optimal pace for an extended period before tiring. Before a marathon a runner may choose to lessen their exercise and spend 36-48 hours prior to the race consuming 10-12 g/kg/day of carbohydrates.
The key to reaping the benefits of marathon running while minimizing risks lies in moderation, proper training and listening to one’s body. For those considering taking up running, expert advice emphasizes the importance of gradual progression, proper footwear, adequate hydration and strength training. Whether running for fitness, fun, or a personal challenge, finding the right balance is essential to crossing the finish line – both in the race and in maintaining a long, healthy life.
Photo Caption: Runners at a N.Y. marathon
Photo Credit: Flickr