Guidelines for healthy marathon running

Marathon running has seen a surge in popularity, with participants nationwide nearly doubling in the last decade. This has brought a new crop of runners into the fold and with it unfortunately exposure to high rates of injury. Running-related injuries, or RRI, can be seen in upwards of three quarters of participants in training cycles for distance running events. One size fits all approaches previously geared to experienced runners have traditionally been the norm in training programs for marathons. While serving as a nice framework, more general guidelines as well as alternative means of training may be more appropriate for novice runners. They can also prove useful for more experienced athletes when injuries do occur during training.

The first consideration is what to do before one starts training. An argument could be made that a thorough physical exam and any indicated testing including an EKG should precede training for a marathon or half marathon. 59 cardiac deaths occurred in the US during the previous decade. Hypertrophic cardiomyopathy, coronary artery disease, and male gender were the overwhelming risk factors. I advise any participant with a family history of these two risk factors, and men over the age of 35 to have thorough history and physical before training begins. Further, I highly encourage runners and their training partners/friend/family to learn CPR. Early administration of CPR resulted in higher survival rates in these athletes. Lastly, seek medical attention for any symptoms of heart disease such as chest pain, shortness of breath, or lightheadedness.

Proper equipment should be a runner’s next step. Several properly fitting shoes, which the experts at local running stores can be of tremendous help, should be a mandatory purchase. Gaining adequate correction of any pronation or arch issues should start there as well. Most guidelines suggest running shoes should be replaced every 350-500 miles. Every runner is different though. Increasing aches and pains, signs of midsole wear, and significant tread wear should prompt a trip to the running store.





Finally it’s time to train. Many marathon and half marathons, running magazines, and other sources now provide day by day training calendars. They’re available on multiple platforms, from traditional print, to web, and now smartphone capability. They can provide structure and help plan the when, how much, and how long for your training runs. I think most of them are done quite well so will delve into what I think are good, general guidelines for athletes in distance events. My general recommendations are to gradually increase mileage until two weeks prior to the race. During that time two long runs a week should gradually build until that run is 18-20 miles. Shorter runs in between should be in the 4-6 mile range. Perform interval training one day a week with short distances or short mixed into an overall shorter run. Run a maximum of six days a week. A day of total rest will allow recovery. Stretching, warming up, cooling down, and icing should be a part of any runner’s routine.

Within that guideline, I think there is tremendous room for modification to prevent injury. Alternating surfaces to dirt and grass is a start. Skipping a light day of running for alternative aerobic activity like swimming, cycling, and elliptical training can ease aches and pains. Pool running can allow you to continue working on your form and cadence, while taking pressure off of joints and providing added resistance training.

Lastly nutrition is critical to successfully training and competing in distance events. Everyday training will require an increase in caloric intake above average intake. Protein intake of a gram per body weight is often recommended. Maintaining an overall well rounded diet rich in fruits and vegetables will prove beneficial. During competition, carbohydrates are your primary fuel source. Thus the ubiquitous carb-loading pre-race pasta meal. Two recent studies looking at participants in the Eau Claire and London Marathons showed better performance amongst participants who had carb-loaded 24-36 hours pre-race. The authors defined carb-loading as greater than 7 grams of carbohydrates for every gram of body weight. The morning of the race, simple carbs like toast, oatmeal, and bagels. Go low on proteins as they can take too long to digest. Many runners like to throw in a banana for its potassium. After that, hydrate, and good luck!