Research from the Journal of the American College of Cardiology suggests running a marathon for the first time could have several health benefits. The study found that for first-time marathon runners, training and completion of the marathon was associated with reductions in blood pressure and aortic stiffening in healthy participants that were equivalent to a four-year reduction in vascular age, with the greatest benefits seen in older, slower male marathon runners with higher baseline blood pressure.

Arterial stiffening is a normal part of aging, but it also increases cardiovascular risk in otherwise healthy individuals by contributing to increased pulse pressure and ventricular overload, which are associated with dementia and cardiovascular and kidney diseases, even in the absence of plaque in the arteries. While blood pressure medication can modify arterial stiffness in established heart disease, more cardiovascular events occur in individuals without diagnosed high blood pressure.

Regular aerobic exercise is a lifestyle modification that has real-world implications, particularly with the growth in mass participation running as an increasingly popular form of non-prescribed exercise.

The research found training decreased systolic and diastolic blood pressure by 4 and 3 mmHg, respectively. Overall, aortic stiffness reduced with training and was most pronounced in the distal aorta with increases in distensibility–the capacity to swell with pressure–of 9%. This amounted to the equivalent of an almost four-year reduction in ‘aortic age.’ Older patients had greater changes with exercise training, with males and those running slower marathon times deriving the greatest benefit.

The study shows it is possible to reverse the consequences of ageing 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.

Although the study only recruited healthy participants, those with hypertension and stiffer arteries might be expected to have an even greater cardiovascular response to exercise training.

runner drinking drink water

Hyponatremia is a condition of low sodium concentration in the blood. Prolonged overhydration during exercise is the primary cause of all forms of exercise-associated hyponatremia (EAH) and should be avoided. The updated EAH clinical practice guidelines issued by the Wilderness Medical Society stress that individuals engaged in physical and endurance activities should drink to satisfy their thirst (known as “drink to thirst”) to avoid overhydration. The guidelines appear in Wilderness & Environmental Medicine, published by Elsevier.

Review articles and international consensus statements have mainly focused on the incidence of EAH in organized endurance events that are conducted in the frontcountry, where medical tents and local emergency medical services are typically available on site and transport to a local hospital is readily available. However, many prolonged individual exertional activities such as backpacking, ultramarathons, and multiple-day endurance events take place in the backcountry with limited or no medical support and expectations of delayed medical evacuation.

Appropriated management of EAH depends first on correctly diagnosing the condition. The guidelines address the assessment of patients with overlapping or nonspecific signs that can make differential diagnosis challenging, for example, with heat exhaustion or exertional heat stroke.

The guidelines recommend that:

  • Appropriate education and coordination among participants, event directors, support crews, park rangers, first responders, and EMS transport personnel are essential in both prevention and management of EAH.
  • Prolonged overhydration during exercise, which is the primary risk factor in the development of all forms of EAH, should be avoided.
  • Sodium and/or salty snacks should be freely available for consumption along with the appropriate fluids, particularly in long, hot events in non-heat acclimatized persons.
  • Participants should drink enough to satisfy their thirst but avoid overdrinking.
  • Point-of-care testing should be done on at-risk, symptomatic patients, when available.
  • Oral fluids should be restricted if EAH from fluid overload is associated with mild symptoms.
  • Hypotonic fluids are contraindicated with suspected EAH.
  • The use of oral salt or hypertonic fluids may be effective in reversing moderate to severe symptoms of EAH when no IV hypertonic saline (3 percent) is available.
  • Patients should be observed for at least 60 minutes after exercise to ensure no decompensation from delayed symptomatic EAH.
  • Receiving caregivers should be alerted to the potential diagnosis of EAH and fluid management restrictions when transferring care.

EAH is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe EAH being below 120 mEq/L. Symptoms may include nausea and vomiting, headache, short-term memory loss, confusion, and lethargy, altered mental status, coma, seizures, and/or respiratory distress, some of which can be confused with other medical conditions.

foto: Daniel Reche

New research from La Trobe University suggests there is no evidence that changing a runner’s strike pattern will help prevent injuries or give them a speed boost.

In a bid to avoid shin splints, sore knees and other injuries, many runners have adopted a toe-to-heel trend, running on the balls of their feet. This is often encouraged by coaches and health professionals.

However, in research out this week in Sports Medicine, La Trobe injury researcher and physiotherapist Dr Christian Barton found there is no evidence to suggest running on the front of your feet reduces injury risk or improves performance.

The comprehensive review suggests that telling someone to run on the ball of their foot instead of their heel may make them less efficient, at least in the short term. Additionally, there is no evidence either way on whether running on the balls of your feet reduces injury.

Dr Barton said switching your running style shifts the body’s loads but doesn’t make them disappear.

Running toe-heel might help injuries at the knee, where loads are reduced. However, it may cause injuries to the feet and ankle, where loads are increased.

Put simply, when it comes to running style: If it ain’t broke, don’t fix it.

Morning run

Researchers from the University of Copenhagen have learned that the effect of exercise may differ depending on the time of day it is performed.

We probably all know how important a healthy circadian rhythm is. Too little sleep can have severe health consequences. But researchers are still making new discoveries confirming that the body’s circadian clock affects our health.

Researchers from the University of Copenhagen – in collaboration with researchers from the University of California, Irvine – have learned that the effect of exercise may differ depending on the time of day it is performed.

There appear to be rather significant differences between the effect of exercise performed in the morning and evening, and these differences are probably controlled by the body’s circadian clock. Morning exercise initiates gene programs in the muscle cells, making them more effective and better capable of metabolising sugar and fat. Evening exercise, on the other hand, increases whole-body energy expenditure for an extended period of time.

The researchers have measured a number of effects in the muscle cells, including the transcriptional response and effects on the metabolites. The results show that responses are far stronger in both areas following exercise in the morning and that this is likely to be controlled by a central mechanism involving the protein HIF1-alfa, which directly regulates the body’s circadian clock.

Morning exercise appears to increase the ability of muscle cells to metabolise sugar and fat, and this type of effect interests the researchers in relation to people with severe overweight and type 2 diabetes.

On the other hand, the results also show that exercise in the evening increases energy expenditure in the hours after exercise. Therefore, the researchers cannot necessarily conclude that exercise in the morning is better than exercise in the evening.

Poor cardiorespiratory fitness could increase your risk of a future heart attack, even if you have no symptoms of a lifestyle illness today, a new study has found.

A strong link was found between higher fitness levels and a lower risk of heart attack and angina pectoris over the nine years following the measurements that were taken in a study by the Norwegian University of Science and Technology’s (NTNU) Cardiac Exercise Research Group (CERG).

The study results have been published in the European Heart Journal.

Even among people who seem to be healthy, the top 25 per cent of the fittest individuals actually have only half as high a risk as the least fit 25 per cent.

Between 2006 and 2008, CERG researchers measured the cardiorespiratory fitness of 4527 men and women who participated in the HUNT3 population-based health survey in Nord-Trøndelag. None of the subjects had cardiovascular disease, cancer or high blood pressure, and most were considered to be at low risk of cardiovascular disease for the next ten years.

Nevertheless, 147 of the participants experienced heart attacks or were diagnosed with angina pectoris by 2017. These diseases signal that the coronary arteries in the heart are narrowed or completely blocked.

The researchers analysed the participants in groups based on their level of fitness in relation to others of the same age and gender. The risk proved to decline steadily as patient fitness increased. The correlation between fitness and cardiovascular risk also held after adjusting for other factors that differed between the most and least fit participants.

One of the greatest strengths of the study is that the test used maximum oxygen uptake to measure participant fitness. Earlier studies that have linked fitness level to disease risk in healthy populations have largely been based on less precise calculations of fitness, or on self-reported physical activity information.

Our body uses oxygen to drive metabolic processes that create energy for the muscles. Maximum oxygen absorption is simply the maximum amount of oxygen the body is able to absorb during physical activity. Heart, blood vessel and muscle functioning are all important for oxygen uptake.

The study suggests that even a small increase in fitness can significantly improve health. For each increase of 3.5 fitness points, the risk of heart attack or angina decreases by 15 per cent.

Even if you never get in such good shape that you can say you have optimal protection, the study shows that participants’ risk was lower the more fit they were.

To measure maximum oxygen uptake accurately, you have to breathe into a mask while running on a treadmill, where the speed increases or the incline gets steeper every minute. As you work at higher and higher intensity, your body needs more and more oxygen. The test ends when you can’t run anymore, or when measurements show that the oxygen uptake is no longer increasing even though the treadmill speed is.

But why does the fitness number mean so much for your future health?

Researchers use a treadmill and a special mask to measure a person’s maximum oxygen uptake, which is considered an important measure of fitness.

By estimating a statistical model for male and female marathon world record progressions a study found that 1:58.05 is likely the fastest time that any living human being will be able to run this distance.

Published today in Medicine and Science in Sports and Exercise, the American College of Sports Medicine’s flagship journal, results show that the chance of a female athlete ever breaking the two-hour mark is less than 1 in 100, with the fastest all-time female marathon time estimated to be 2:05.31.

The study by Monash Business School is the first to address all three related aspects of world record marathon performance in one modelling framework – the sub-two hour limit, the limits of human physiological running capacity and gender equivalence.

It also highlights the potential barriers elite female athletes face in marathon running resulting in a something of a “world record drought”, with Paula Radcliffe’s 2:15.25 mark, set in 2003, still standing. A ‘sub-130 minute’ project (2:10.00), advocated in this study, would empower female long-distance athletes.

The marathon has an official distance of 42.195 kilometres (26.219 miles) and was one of the original Olympic events in 1896. More than 800 marathons are held across the world each year, with tens of thousands of participants taking part in this physically gruelling event.

As part of the study, Dr Angus, Associate Professor of Economics at Monash Business School and ultramarathon runner, applied a robust non-linear economic model to all official IAAF world record marathon performances of men and women since 1950 in order to calculate record-breaking prediction intervals.

From there, Dr Angus was able to reconceptualise the ‘sub-two hour question’ as one of odds – for example, when will a given time be run with 1 in 10, or 10% likelihood.

Using these figures, Dr Angus was then able to determine the limits of human performance for the male and female marathon; the performance gap between the current male and female world record to the limiting times; and the equivalent of the ‘sub-two hour’ threshold for women and when this will be achieved.

The economic model is, on average, accurate to within 1% for men – or around 70 seconds – across a 66-year period which saw a 19 minute reduction in the world record time. For women, accuracy is within 3% – or roughly 200 seconds – across the same period where the world record dropped by one hour and 22 minutes.

A statistical findings for the sub-two hour male marathon are noted as:

OddsChanceWhen
1 in 425%March 2054
1 in 1010%May 2032
1 in 205%June 2024
1 in 502%April 2017
1 in 1001%January 2013
1 in 2000.5%June 2009

The current male world record holder, Eliud Kipchoge from Kenya, is just a fraction outside the sub-two-hour mark with a time of 2:01.39 – a record he set at the Berlin Marathon in 2018. By inspecting the prediction lines on the economic model, there was only a 2% chance that the sub-two-hour record would be broken at that point in time.

Using the same economic model and 10% likelihood approach, Dr Angus calculated that the likely human performance limit for male and female marathon times is 1:58.05 (performance gap to current world record of 2.9%) and 2:05.31 (performance gap of 8.6%) respectively.

Core training plays an important role in the endurance runner’s overall training programme. It improves running form and overall athletic performance and reduces the risk of injury.
The core is much more than just the abs. It includes all the muscles that stabilize and support the pelvis, spine, and trunk.
Core training should generally take place three times per week. Whether you run before or after work, schedule your core training at the opposite side of the day or during lunchtime, so that it won’t detract from your running.
Follow the sequence of exercises, do it twice. Make sure you fully recover between the two sets, rest 15 – 20 secs between exercises. Start with the following repetitions but increase it as you progress:

Dead Bug

20 repetitions

Leg pushaway

20 repetitions

Lying bridge

6 repetitions of 5 seconds each – squeeze the glutes when bringing the hips up

Superman
12 repetitions

Tabletop
12 repetitions

Plank

4 repetitions of 14 seconds each

Side plank

3 repetitions of 10 seconds each

Standing knee hold

20 seconds on each leg

University of Montana Assistant Professor Richard Willy is the lead author on a paper that offers new guidelines for treating patellofemoral pain, often known as “runner’s knee.”

Patellofemoral pain (PFP) affects one in four of the general population every year, with women reporting PFP twice as often as men. The pain presents at the front of the knee, under and around the kneecap. Willy’s paper finds that exercise therapy – namely hip and knee strengthening treatments prescribed by a physical therapist – is the best recovery approach for individuals with PFP.

Willy is an assistant professor in UM’s School of Physical Therapy and Rehabilitation Sciences.

The recommendations were published Sept. 1 as a Clinical Practice Guideline in the Journal of Orthopaedic & Sports Physical Therapy, the official scientific journal of the Academy of Orthopaedic Physical Therapy. The Clinical Practice Guideline aims to improve the quality and standardization of care provided to patients with knee pain while also providing reimbursement guidelines for insurance companies. Key takeaways from the Clinical Practice Guideline include:

  • An exercise program that gradually increases activities such as running, exercise classes, sports or walking, is the best way to prevent PFP.
  • An important way to reduce the risk of PFP is maximizing leg strength, particularly the thigh muscles.
  • Pain does not always mean there is damage to the knee.

Bringing the science of high intensity interval training (HIIT) into everyday life could be the key to helping unfit, overweight people get more of the exercise they need to improve their health, according to an international research team.

From washing the car to climbing stairs or carrying groceries, each of these activities is an opportunity for short sharp bursts of ‘High Intensity Incidental Physical Activity’, HIIPA for short.

In an editorial, published today in the British Journal of Sports Medicine, Emmanuel Stamatakis and colleagues argue that when considering differences in physical capabilities by age, sex and weight, many daily tasks can be classified as ‘high intensity’ physical activity. That is, the kind of activity that gets you out of breath enough to boost your fitness.

They say incorporating these kinds of activities into routines a few times a day will see significant health benefits for the majority of adults.

For the typical middle-aged woman, 60 percent of whom are overweight and/or unfit activities like running and playing with children at children’s pace, walking uphill or riding home from work all expend well over six times as much energy per minute than when at rest, which is the standard measure for high intensity activity.

The authors suggest over the course of the day these activities could be used in the same way that the popular high intensity interval training (HIIT) works by repeating short sessions of high intensity exercise with rests in between.

There is a lot of research telling us that any type of HIIT, irrespective of the duration and number of repetitions is one of the most effective ways to rapidly improve fitness and cardiovascular health and HIIPA works on the same idea.

The authors propose that significant health benefits could be gained by doing three to five brief HIIPA sessions totalling as little as five to 10 minutes a day, most days of the week.

We know from several large studies of middle aged and older adults that doing vigorous exercise has great long-term health benefits, but many people find it very difficult to start and stick to an exercise program.

The beauty of HIIPA and the idea of using activities we are already doing as part of everyday life is that it is much more realistic and achievable for most people.

Other practical advantages are nil costs, no need for equipment and no concerns about a lack of skill or fitness.

It’s just about making good decisions like parking the car at the edge of the carpark and carrying shopping for 50 or 100 metres.”

The editorial, co-authored by academics from the University of Sydney, Loughborough University, University College London, Norwegian University of Science and Technology, and the National Research Centre for the Working Environment (Denmark), was prompted by recent changes to the 2018 US Physical Activity Guidelines, the most comprehensive review of physical activity and health.