Run For Your Life!

"As clinicians are meeting with patients in the new year, making a goal-oriented exercise training recommendation—such as signing up for a marathon or fun-run—may be a good motivator for our patients to keep active."
"Our study highlights the importance of lifestyle modifications to slow the risks associated with aging, especially as it appears to never be too late as evidenced by our older, slower runners."
"Our study shows it is possible to reverse the consequences of aging on our blood vessels with real-world exercise in just six months. These benefits were observed in overall healthy individuals across a broad age range and their marathon times are suggestive of achievable exercise training in novice participants."
"Almost everyone benefited. And those people whose arteries needed the most help benefited the most [through the study trials]." 
Dr. Charlotte Manisty (UCL Institute of Cardiovascular Science & Barts Heart Centre)

University College London

A newly published study has found that training for and completing a marathon ran can impact arteries, leaving them more flexible, healthy and biologically younger than they had been before the training and marathon run. The effects were that immediate; the completion of a first marathon was sufficient to rejuvenate a major artery; a monumental plus for heart health, along with overall health condition.

Arteries carry oxygenated blood from the heart. When the arteries are  healthy and pliable they expand and contract as blood pulses through them at a steady flow. They become compromised with age, beginning to stiffen and blood starts to crowd against the inflexible walls of the blood vessels, causing blood pressure to rise and organs requiring an even, gentle blood stream, such a the brain can be deleteriously affected.

There has been past research hinting that exercise could have the potential to alter arterial stiffening related to encroaching age. Older athletes as an example, tend to have relatively supple arteries. What hasn't been clear is whether sedentary people, beginning to exercise, can still improve the health of their arteries. The new study, published in The Journal of the American College of Cardiology, was the result of researchers at University College London setting out to answer that question.

Getty Images

They did so, along with other institutions, by tracking arteries of people new to an exercise routine, singling out first-time entrants in the London Marathon, new to the sport of running, Over 200 of these men and women, most of them in their middle-age, all accustomed to a sedentary lifestyle, were contacted by the researchers, six months before the Marathon.

None of the group of participants who had completed health and fitness tests and a scan of their aortas, showed any signs of heart disease or other serious health problems. Most of the runners began preferred marathon-training programs, jogging several times weekly. Some experienced injuries or other health concerns and saw fit to drop out, but ultimately, 136 men and women completed the race, their average time of 4.5 hours for the men and 5.5 hours for the women.

Post-race they returned to the laboratory to have their initial pre-race tests repeated. Their aortas proved more flexible, their arteries appearing to have shed the equivalent of almost four years of gradual stiffening, in functional terms. Older male runners and those whose finishing times had been slower, turned out to show the mos marked improvements, which did not depend on changes in fitness or weight which had been negligible throughout training and the actual run.

The only issue that had impacted on the beneficial outcome appears to be that they all had maintained their training and had gone on to complete the race. "The benefits of exercise are undeniable.
Keeping active reduces your risk of having a heart attack or stroke and cuts your chances of an early death. As the old mantra goes, 'If exercise were a pill, it would be hailed as a wonder drug'", said Professor Metin Avkiran of the British Heart Foundation (BHF), which funded the study,

Over the course of every week, adults should do a minimum of either:

• 150 minutes moderate-intensity exercise, such as brisk walking, doubles tennis or cycling
• 75 minutes vigorous exercise, such as running, football or rugby

People should also do strengthening activities - such as push-ups, sit-ups or lifting and carrying - at least two times a week to give muscles a good workout.

Getty Images    Lead researcher Dr Charlotte Manisty said: "People with known heart disease or other medical conditions should speak to their doctor first.
"But for most people, the benefits of taking up exercise far outweigh any risk."

 

Running a Marathon -- Cut the Run-Distance by One-Third!

"In one of the largest recent studies, published in January, Canadian researchers recruited 129 non-elite runners in Winnipeg and tested their blood just before they ran a half or full marathon. Their blood markers for heart injury were normal. By the time they’d reached the finish line, though, according to blood tests done there, most of the half-marathoners and even more of the marathoners displayed elevated troponin and other blood markers of heart damage, and after an hour, when they were tested yet again, even more of both groups, especially the marathoners, showed blood indicators of cardiac damage."
"'We measure those same blood markers when someone comes in to the emergency room and we suspect a heart attack', says Davinder S. Jassal, MD, an assistant professor of cardiology, radiology, and physiology at the University of Manitoba medical school in Winnipeg and lead author of the study. Blood profiles like those displayed by the runners, he says, 'are similar to those in a very mild heart attack'."
PhysEd columnist Gretchen Reynolds,  “Are Marathons Good for the Heart?" 

Susan Tusa/Associated Press The starting line of the 2009 Detroit Marathon

"There’s no doubt the marathon is a very hard, stressful event."
"We’re confident that exercisers have lower heart risks than non-exercisers, but the truth is we don’t know this for sure about marathoners."
Dr. Paul Thompson, director of cardiology, Hartford Hospital, Hartford, Conn.

"We've done an incredible amount of work in terms of raising the profile... flagging that anyone that had any symptoms or history in their family or felt unwell in the run up to it that they would go to the doctor, they would get checked out and no one would come to the start line with any risk to their health."
"We can only reiterate that really, it's cast obviously a big shadow on what was otherwise a very good day for Cardiff."
"We've had 16 years and until last year we hadn't had incidents of this kind, they have happened before in big events, unfortunately it is something that does happen when you get this volume of people running."
"Everyone at Run 4 Wales is devastated. It's terribly sad news... not just our thoughts but our support is with the family at this really difficult time."
"It was an incident at the finish line, yards away from the primary medical centre so it was an instant response."
Run 4 Wales chief executive Matt Newman  October 7, 2019

A record number of runners took part in Sunday's Cardiff Half Marathon   BBC

In two half-marathons, one taking place in Montreal the other in Ottawa, both on the same day, male runners collapsed at or close to the finish line, leaving both men, in their 20s, dead of sudden death syndrome. Rare, but events that do disconcertingly occur from time to time at marathons and half-marathons. What shocks people hearing of these events, rare though they are, is that these are young, robust people in excellent physical shape who suddenly perish while engaged in exercise.

This is a phenomenon that has attracted the attention of researchers in the hopes of extracting valuable insights into the incidents with the hope of prevention. One of the initial studies reviewed 26 marathons that took place across the United States over a 30-year period and based on 3,292,268 runners. The result was that the overall risk was calculated as one death for every 126,626 marathon finishers and that the average age of the runners who failed to survive the events was 41, with 81 percent being men.

Another study published in 2012 included 10.9 million runners who competed in 40 marathons and 19 half-marathons, with the outcome of the research concluding the incidence of sudden death to be 1.01 per 100,000 runners in the marathon category as opposed to 0.27 per 100,000 in the category of half-marathon races -- with most victims male; the average age of death calculated as 39. While determination of age and gender are vital statistics, what else emerged from the studies was of critical importance.

The majority of cardiac arrests occur between the 37-kilometre mark and the end of the 42-km distance. It is the latter part of the race when the majority of cardiac arrests take place. Cardiovascular disease being the common reason for the most part, that runners' hearts fail when an endurance event takes place and no one knows precisely how the event is triggered. A common theory that running stress initiates a release of inflammatory biomarkers which can increase the chances of cardiac arrest, particularly in men over 40, stands out as the likeliest answer.

Ben McDonald and Dean Fletcher died after crossing the finish line within minutes of each other in 2018   Family Photos

How such adverse health events build toward the final blow is perhaps attributable to the physical stress inherent in the buildup of training distances, where the possibility exists that daily stress with the additional stress of race day itself may be responsible for the creation of a very special set of conditions, adding additional strain on a compromised heart. Until the day of the race itself, most marathoners don't make the full effort of the 42-km distance. Most training programs bring runners to about 30 km, or three hours of running.

It is the final 10 km when the body begins to feel the influence of the stress of a prolonged run at race pace. Hypertrophic cardiomyopathy, a structural abnormality seen in a thickening of the heart muscle, making it more difficult to pump blood represents yet another cardiac condition known to increase risk of sudden death during extreme exercise. Also rare, this is the condition that often strikes younger marathoners, running without knowledge of their 'hidden' condition.

Whether or not runners who experience sudden cardiac arrest are known to experience symptoms during training or during the marathon event itself is not known, given that those symptoms can readily be taken as the results of physical exertion, not just a poorly functioning heart. Fatigue and shortness of breath, symptoms of a faltering heart, are also symptomatic of transitory stress results of extreme exercise.

Among women and slower runners, hyponatremia, caused by the intake of excess fluid, can be a common condition which can be fatal, but runners are advised to drink only when thirst calls, rather than to prevent thirst. Another serious health issue faced by runners is the possibility of heat stroke, though rarely does this result in death. In recent years race organizers take steps to deal with overheated temperatures on marathon day, through increased water station numbers, modifying race time, cooling stations and cancelling races.

According to a cardiologist at the Montreal Heart Institute, Rafik Tadros, thoughts of the finish line can bring on a flood of adrenalin or a sudden surge in speed, each capable of triggering heart arrhythmia, which can cause cardiac arrest at later stages of the race. His recommendation is that more volunteers trained in CPR be stationed, as well as the strategic placement of defibrillators along the race route. Dr. Tadros feels the health risks of inactivity outweigh risks associated with running a marathon.

A Montreal cardiologist reminds runners that heart disease or structural abnormalities of the heart — not running a marathon — is the real cause of cardiac arrest on race day. Dylan Buell / Getty Images

Walking on Eggshells

"There has been debate about barefoot running being good or bad, or shoes being good or bad, and this is the wrong debate. It should be about what the costs and benefits of shoes are and how we can better understand how shoes affect our feet, our health, the way we walk."
"We live in this weird world where calluses are bad, like you have a problem with your shoe, and you go to a podiatrist, and they remove them. But until recently it was abnormal not to have calluses." "We’ve lost touch with our bodies in some respects and this is a good example of that. When we tell our results to barefoot people, they say, 'Tell me something I don’t already know'."
"I'm not saying people shouldn't wear shoes." 
"If your feet can’t sense what’s going on on the ground, maybe you’re more susceptible and more vulnerable [to falls], and shoes may be a part of that. If we can give people’s brains, their reflexes, more information, that might help them."
"I find it unimaginable to be barefoot in middle of Europe in the Ice Age, but then again, all the other animals in Europe during the Ice Age were barefoot—so maybe our cousins, the Neanderthals, were able to handle it just fine."
Daniel E. Lieberman, Edwin M. Lerner II Professor of Biological Science, chair, Department of Human Evolutionary Biology, Harvard University

"We tested the sense of touch, the dynamic sense of what you feel on the ground. We found these stiff calluses don’t prevent any communication between the force of the feeling of what you are stepping on and what makes its way to the nerve cell to be transmitted to your brain."
Nicholas B. Holowka, postdoctoral fellow, Graduate School of Arts and Sciences, lecturer in Human Evolutionary Biology

Credit: Getty Images

 A new study recently published in the journal Nature, posits that when people wear shoes it alters their natural way of walking, a manner of walking that nature designed us for, shoeless. The study builds on earlier research whose findings popularized barefoot running. The study conclusion was that when walking, people move differently when barefoot than they do when their feet are encased in shoes. Moreover the sensitivity of the sole of the foot to the ground differs as well. An unclad foot is directly exposed to the texture of any surface being walked upon, whereas the sole of the shoe interrupts that sensitivity to a degree without entirely erasing it.

What the researchers feel, however, is that the differences in sensitivity, in feeling between the sole of the foot and the surfaces being trod upon may have the potential to affect balance (which presumably is compensated for in the way the body responds to the differences) as well as joint loading. One of Dr. Lieberman's takeaways, is that this could lead to arthritis for some people. The intimation is that it may be advantageous to walking and running with bare feet. One of the surprise findings was the advantage of a bare foot coming directly in contact with the ground, is the gradual build-up of calluses.

Yes, those are the calluses that are seen as an impediment to good foot health, that we take as a signal that something is wrong. When calluses develop, on the other hand, as a result of constant direct contact with the ground by a bare foot, they tend to serve as a protective screen, making the foot while not impervious to harm from stones, roots, sharp objects, better able to absorb the shock that interacting directly with those objects results in, on contact.

Dr. Lieberman has wondered at the function of calluses even while most people consider them unsightly, needing to be removed. After mulling the issue over, that the calluses could conceivably be viewed as an advantageously unacknowledged utilitarian purpose, he decided to launch a study to revolve around that hypothesis. He and a team of collaborators took to comparing how a select subject group in Kenya walked, with and without shoes, then comparing the results with a similar group in Boston.

At the Lieberman lab in Boston when male and female volunteers walked on treadmills barefoot their feet hit the g round in a manner very similar to the unshod walkers in Kenya, but when the volunteers wore average cushioned sneakers, there was a subtle alteration in their walking pattern. Their feet struck the ground slightly more lightly initially, yet the stride impacts lingered longer than when the subjects were barefoot. Impacts of this nature tend to move up, dissipating through legbones, ankles and knee joints.

Custom-built device used to measure tactile sensitivity of foot at different frequencies. Credit: Daniel Lieberman

The shorter, sharper jolts felt when people walk barefoot on the other hand, are likelier to rise through soft muscles and tendons in the body, according to Dr. Lieberman. Suggesting that the way people walk is determined by what is worn on their feet. Shoes have a protective function, and absorb the slight pounding that feet undergo while walking, but at the same time they alter strides and over time have the potential to increase pressure and wear on leg joints.

The particular calluses that arise when walking shoeless on the other hand, shield the foot from discomfort of coming in contact with objects on the ground while barefoot, even while not reducing contact with and the ability to feel the ground's complex texture. Which suggests that people experiencing concerns over balance, and less concerned over how their feet would appear with calluses might benefit from walking about barefoot at times.

Comparing the foot of a shoe wearer vs. the barefoot walker. In Kenya, researchers measured the biomechanics of the barefoot walker.

Photos by Thomas Milani and Daniel Lieberman

Recreational Pleasure and Health Benefits

"Walking and running provide an ideal test of the health benefits of moderate-intensity walking and vigorous-intensity running because they involve the same muscle groups and the same activities performed at different intensities."
"The more the runners ran and the walkers walked, the better off they were in health benefits. If the amount of energy expended was the same between the two groups, then the health benefits were comparable."
"Walking may be a more sustainable activity for some people when compared to running, however, those who choose running end up exercising twice as much as those that choose walking. This is probably because they can do twice as much in an hour."
"People are always looking for an excuse not to exercise, but now they have a straightforward choice to run or to walk and invest in their future health."
"It takes longer to walk a mile than to run a mile. But if you match them up on the energy expended, they are comparable. If you do the same amount of exercise – if you expend the same number of calories – you get the same benefit."
Paul T. Williams, staff scientist, Lawrence Berkeley National Laboratory, Life Science Division in Berkeley, California

• Running significantly reduced risk for first-time hypertension 4.2 percent and walking reduced risk 7.2 percent.
• Running reduced first-time high cholesterol 4.3 percent and walking 7 percent.
• Running reduced first-time diabetes 12.1 percent compared to 12.3 percent for walking.
• Running reduced coronary heart disease 4.5 percent compared to 9.3 percent for walking.

"Walking at any speed costs some energy, but when you're changing the speed, you're pressing the gas pedal, so to speak."
Ohio State research team

Benefits to walking as a leisure time activity that gets you out and about: breathing fresh air, appreciating an outdoor landscape, bringing you closer to nature, allowing you to relax, your mind to wander and your daily concerns to recede into the background as your mood lifts. Walking is known to help in the reduction of anxiety and depression symptoms; as a mood elevator; being in tune with nature, in a green setting has few parallels. According to some researchers, happiness is boosted when walking becomes a regular feature in one's life.

Women in a study reported having greater energy, were more inclined to be socially active, less likely to surrender to out-of-control emotions, and less hounded by depression once they began routinely walking on a regular basis, amounting to 200 minutes weekly. Researchers from Santa Clara University gathered 176 college students, assigning them a walking schedule, because their study goal was to discover if "a simple walk might lead to more free-flowing thoughts and more creativity".

The walkers, it turned out, were more creative once they returned to their desks, compared to those who didn't participate in the experiment. Creativity flourished while the participants were out walking, regardless of whether they walked in fresh air or used a treadmill instead. The end result was more ideas coming to mind while walking in comparison to those who simply remained at their desks.

Yet another, earlier study undertaken in 2013 took 33,060 runners and 15,045 walkers as participants to determine whether the intensity and energy expended in walking serves to produce similar heart health benefits as running. The Berkeley, California researchers reached the conclusion that "If the amount of energy expended was the same between the two groups, then the health benefits were comparable". Walking reduced risk of hypertension by 7.2 percent as opposed to a 4.2 percent drop in runners.

Runners' risk of high cholesterol was reduced by 4.3 percent, while walkers' risk dropped by 7 percent. As for diabetes risk, it fell by 12.3 percent for walkers and 12.1 percent in runners, while heart disease was reduced by 9.3 percent for walkers and for runners 4.5 percent. So walking most definitely earns its place in the firmament of good health-achieving initiatives, and it can be done anywhere, at any time.

Another bonus comes by way of speeding up the walk for random periods to achieve an even greater health impact. Moving at an average or brisk pace, walkers benefited from a 20 and 24 percent reduced risk in mortality from all causes, in comparison with those who maintained a more leisurely stroll. For adults aged 21 to 40, moderate intensity in walking equates with 100 steps a minute, while 130 steps per minute is considered fast walking.

According to an Ohio State research team, changing speeds during a walking workout can burn up to a 20 percent greater number of calories, in comparison to remaining stuck at a single speed. Monitor walking speed simply by speeding up until you feel a bit breathless, then slow down to allow breathing to return to normal. As simple as all that.