MD Gym/Fitness Surgery

Introduction — Why Run/Exercise?

RUNNING AND EXERCISE can affect almost all of your body’s functions, and usually for the better. To introduce readers to the science and biology of the effects exercise has on the body, which I believe to be a good starting point on this area of work, you will no-doubt note the diverse range of benefits accrued from maintaining a regular programme of exercise

Ageing: Recent studies have shown that your physical decline is just 2-5 per cent per decade. The fact that it is more pronounced in older people is because of inactivity. If you run or exercise regularly between the ages of forty and fifty, you may lose as little as 2 per cent of your capacity, and if you increase your fitness training over that time, you may even get fitter.

Body fat levels: The average man has 22 per cent body fat, the average woman 27 per cent – levels that running and exercise can reduce quite quickly. Running even three times per week for 30 minutes each session can burn over 1,300 calories per week – a possible 17 pounds of body fat lost in a year. And, increasing mileage or the duration of gym sessions can significantly add to that loss.

Bones: Moderate amounts of running tend to increase bone thickness in the feet and legs, although high-mileage runners (i.e. those running over 50 miles per week) can have thinner spines, for reasons which aren’t scientifically clear. For those athletes who do train at this level make sure you do some weight training exercises which stress the spine, in order to strengthen it.

Women runners who train heavily are at risk from osteoporosis in later life. Osteoporosis (literally ‘porous bones’) is the disease which causes the majority of broken bones in elderly people, and women are eight times more likely to suffer from it. Amenorrhoea can also occur in women, particularly if training is heavy, and is an added risk because amenorrhoea reduces bone density. The answer, though, is to maintain a sufficient calcium intake, and to have regular medical check-ups.

Brain: Besides the release of endorphins – responsible for the so-called ‘runner’s high’, senses of calm and wellbeing – studies have shown that running and regular exercise enhances mental functioning: maths and reasoning test scores are higher if done after training sessions.

Circulation: During exercise most of your body’s organs and tissues, except those directly used, are drained of blood. However, during recovery, it’s the opposite story: arteries and veins expand to cope with the higher volume of blood, and direct this blood more efficiently to any organ which needs it.

Electrolyte balance: Generally, running and exercise is likely to lead to improve blood flow to the kidneys, which allows them to keep better tabs on blood electrolyte levels and decrease the risk of deficiencies. However, during periods of hot weather, electrolytes are likely to be lost through increased sweating. Keeping well hydrated with a sports drink, though, does replace lost electrolytes in the blood, essential if performance is to be maintained and the avoidance of cramp and fatigue.

Heart and blood pressure: After running or exercising for a few months, your heart’s walls thicken and the ventricles (internal chambers) increase in size. As a result more blood is sent to your lungs with each heartbeat, and resting pulse can decline by 20 percent or more.

Scientific analysis has shown that if you run for 145 minutes per week, you are 40 percent less likely than a sedentary person to have a heart attack. If you’re overweight when you start running, then the resulting weight loss will lower your blood pressure, taking some of the strain off your heart.

Hormones: If you run above your lactate threshold pace (slightly slower than VO2 max) your body tends to produce more human-growth hormone, which boosts muscle building, accelerates fat breakdown, and speeds the repair of bones and connective tissues.

Running and regular exercise also seems to increase muscle cells’ sensitivity to insulin, a key hormone released by the pancreas. In Type-I diabetics, this improved sensitivity can reduce insulin requirements; in Type-II diabetics, it decreases insulin resistance and promotes normal blood-glucose levels. Running also increases blood levels of a thyroid hormone called thyroxin, which increases protein synthesis, boosts mitochondria production, particularly within the muscles, and encourages the breakdown of fat.

Joints: Running and exercise lubricates the joints to keep them supple and friction-free, but can lead to deterioration of the joint if disease or ageing of the joint is already present.

Lungs: Actually you can’t improve the function of your lungs through training. They are already ‘over built’ for even the most strenuous training, and fail to rush oxygen into your blood when you are working hard only because they are too ‘stiff’ to expand and bring in air at high enough rates. You can, however, improve the function of your respiratory muscles – the diaphragm and the muscles which run between your ribs – which makes breathing feel easier as you get fitter.

Muscles: Running increases the number of blood vessels which supply each muscle cell, raises the number of mitochondria inside cells (which enhances the cell’s ability to use oxygen to produce energy), causes levels of aerobic enzymes within muscles to rise, and stimulates muscle cells to elevate their ability to burn fat for energy.

While running will not alter your own balance of fast-twitch and slow-twitch muscles fibre, endurance running can make fast-twitch cells more fatigue-resistant, i.e. more like slow-twitch fibres.

Resistance to disease and infection: If you run 15-30 miles per week you have a lower risk of infection than your sedentary neighbour. However, if you’ve just run a marathon, or are in heavy training, then your risk of infection actually goes up, because your immune system is not working at maximum efficiency as it recovers from the stresses of training or competition.

Respiratory systems: Running causes the mucus within the sinuses and the Eustachian tube (which leads to the middle ear) to be dislodged – that’s the coughing and spitting which normally accompany your first couple of miles. However, you should be aware of pollution – try to avoid running, if you can, during hours of peak traffic, don’t jog at traffic lights, and run on the building side of the pavement. And running is more likely than other endurance sports to cause exercise-induced asthma. But, your running need not suffer if the condition is controlled medically.

Skin: Running improves your ability to sweat, tolerate heat and regulate body core temperature, and helps you withstand the cold in winter. It also improves conditions such as teenage acne, eczema and psoriasis.


TWO

DIFFERENT TYPES OF TRAINING

THE GREATEST ULTRA-DISTANCE RUNNER, Arthur Newton, is credited with the saying:

…Train first for distance, then for speed.

Being able to run for about an hour non-stop should be the first priority for those new to running. But after that, assuming that you don’t want to follow in Newton’s footsteps and compete in the 56-mile Comrades Marathon in South Africa, you’ll need to think about introducing some variety into your training if you want to improve, no matter what your goals in running are.

Coaches and athletes are constantly experimenting with techniques and training methods to improve performance, but there are some tried and tested principles and training aids that I aim to introduce into this section that you may want to consider.

  • FARTLEK

FARTLEK is a Swedish term meaning ‘speedplay’, literally playing with your speed during training. It’s done without a watch, but rather according to a rhythm that is not pre-determined. For example, you may choose to train on a golf course and vary your speed, from gentle jogging to all-out sprinting, according to which hole you’re on. Or, in town, you can try quickening your pace when a bus passes you, maintaining that speed until passed by another, at which point you slow down. In this way, you have no way of knowing how long each session will be. Speedplay usefully mimics the demands of a race, when the decision to surge or break away from your own pack in a race may be taken by another runner.

  • HILLS

HILL TRAINING can be beneficial whether your aim is actually to compete over undulating terrain, or simply as a means of improving overall fitness and leg strength.

Hill training forces your body to work harder, and your leg muscles to contract more powerfully than normal because they must overcome gravity to move you upwards. Research has shown that hill training will increase the concentration of ‘aerobic enzymes’ in your leg muscles – the chemicals which allow muscles to function at high levels for long periods without tiring.

For best results you need to find a short, sharp hill of at least 25 metres, and a hilly course (sand dunes, countryside) where you can run up and down almost continuously for at least 30 minutes, and to try and incorporate one hill session into your training per week.

The short hill session is brutal but brief: after a jog warm-up of 10 minutes, run up the hill at faster than 10-kilometre pace, and recover by jogging back down. Surge up again when you feel you’re ready, and aim for four or five repetitions at first. Increase difficulty by adding reps, or cutting down on recovery time.

The longer hill session requires nothing more than to attack the rolling terrain for 30 minutes at a pace slightly slower than 10-kilometre race pace.

  • IMPROVING V02 MAX

YOUR BODY uses more oxygen as the intensity of exercise increases, and, at a point shortly before you reach maximum capacity, or speed, the rate of oxygen consumption reaches a plateau and does not increase further. That point is where you have reached maximum oxygen consumption. Typically that point is at around 3-kilometre race pace – your heart is sending as much oxygen as it can to your muscles. If you run faster than 3-kilometre pace, energy is supplied anaerobically, i.e. without oxygen.

Increases in mileage and increases in intensity of training can both improve VO2 max levels. However, research has shown very little uplift in runners running over 70 miles per week, whereas a reduction in overall mileage with a corresponding increase in training intensity has proven a sure way to increase the level of VO2 max.

Quite simply, faster training puts more pressure on the heart and muscles to improve, in particular your IIa muscle, or, ‘fast twitch’ fibres. These cells help you to run explosively but normally are bad at using oxygen. Faster training helps them to ‘learn’ how to use oxygen more efficiently.

How fast should you train? Between 90 and 100 per cent of your VO2 max is best, which equates to equal or faster than your 10K race speed, up to but no faster than your 3-kilometre pace.

And how often? No more than two sessions per week at between 90-100 per cent or you will overtrain. For your other sessions, train more moderately.

  • INTERVAL TRAINING AND REPETITIONS

INTERVAL TRAINING is a more structured version of fartlek, usually done on the track, alternating effort with recovery, although the possibilities are endless – Hungarian coach Mihaly Igloi was said to have 40,000 separate individual workouts documented! Nevertheless the basic elements to be arranged remain constant: the distance of the fast run; the recovery or interval between the efforts; how many repetitions of the effort; the speed of the efforts; the activity during the intervals, i.e. complete rest, jogging or walk recovery. If done on the track, exact comparisons can be made between sessions.

The priority is to keep the time of the efforts as even as possible, rather than to run each effort flat out, which would be impossible, as lactic acid accumulation would bring you to a stop fairly quickly. You will need to try out a variety of speeds on the track, especially if you are used to running longer intervals, or ‘repetitions’, on the road.

A good sample session would be, say, 6-8 x 4000 metres, with 90 seconds to 3 minutes’ recovery (walk or jog). Your speed should be somewhere between your 10-kilometre and 5-kilometre race pace.

A repetition or ‘reps’ training session is ideal if you’re looking to increase your running speed, and to measure your increase in fitness. Generally an interval session becomes a reps session when the distance run increases to over 1,000 or 1,200 metres, but there is no set distance for either.

Choose a set course of between 1 and 2 miles, run it a set number of times at a fast pace, and include a fixed period of rest in between each run. For example, you might run a 1.5-mile loop six times with three minutes’ recovery between each effort.

Try to find a course which you can use year-round – quiet roads (well lit if possible) are ideal. The same course enables you to measure your improvement, and the distance is an ideal guide to your fitness and your body’s ability to take up and use oxygen.

  • LACTATE THRESHOLD & THRESHOLD TRAINING

AS you run faster than roughly 15-kilometre race pace, lactate begins to accumulate in the blood which eventually will be at such a level that no more oxygen can be delivered to your working muscles. Lactate threshold speed (LTS) is the running speed above which there is a sudden increase in the lactate level in your blood.

Raising your lactate threshold level enables you to hold off this increase and will allow you to race faster over 5 and 10 kilometres, and indeed longer distances. For most runners LTS is closely related to race pace: 5K pace is about 5-6 per cent faster than LTS; 10K pace about 2-3 per cent quicker. LTS is about 2-3 per cent faster than half-marathon pace, and 5-6 per cent faster than marathon pace. A session which helps lower lactate production is a ‘tempo’ run – a session deduced as being one where you run for 20-30 minutes at a pace around 12-15 seconds per mile slower than your 10-kilometre race pace. This pace corresponds almost exactly with LTS and helps the muscles and cardiovascular system to adapt so that less lactic acid is produced.

  • THE LONG RUN

THE LONG RUN forms the cornerstone of almost every training schedule for runners regularly competing in half-marathons and above. It is the long-run which is often seen as the key component for a beginner looking to complete a first marathon, and is the staple club run up and down the country.

But does scientific evidence back up the anecdotal?

Yes and no. There is no doubt that the long-run teaches your body to burn fat and spare glycogen for the marathon distance, as well as stimulating capillary development – leading to more efficient oxygen transport to the working muscles. Long runs also activate your fast-twitch muscle cells – the ones responsible for speed and power – because your slow-twitch fibres begin to tire after about 45 minutes. As a result, the aerobic potential of your fast-twitch fibres increases, which benefits your endurance. Crucially also, the long run gives you the psychological ability to cope with long distances.

Running long distances regularly in training, however, damages your body by breaking down muscle fibres, depleting muscle glycogen, and allowing waste products to accumulate. Research also shows that it is intensity, not duration, which will make you a more effective runner, even at longer distances. Thus, running 8 miles at your marathon pace in training will prepare you better for your 26.2-mile race effort than 16 miles run at a pace considerably slower than your target race pace.

Research suggests that merely plodding along at a slow pace teaches you above all to plod along at a slow pace – long, slow distance making you a long, slow distance runner.

Despite that, the answer is simple: you need merely to inject about 20 seconds of faster running every few minutes, bursts which activate your fast-twitch fibres perfectly, but which are too short to induce any lactic acid build-up which will unduly tire you.

Another session involves running the middle portion of your run at marathon pace, teaching your body to handle and recognise your target speed; for example, five miles at moderate speed, five miles at marathon pace, then five miles easy pace.

  • PEAKING

IF you compete at any level, your race performances will improve if you are properly prepared – and that means adequately rested as well as adequately trained. Obviously the amount you need to taper before a race depends on the importance of that race to you. But the chances are that, no matter how important, you will not have rested enough.

Top runners plan their competitive year well in advance, usually with one or two major goals. For most of us, however, the year is made up of training and racing, and the two often conflict. You may, for example, be in training for a marathon, but also be needed by your club to compete in a 10K.

Using shorter distance races is actually a good way, research reveals, to prepare for the long distance. Running a 5K, for example, some weeks before your target 10K, gets you used to a more uncomfortable intensity, but can also provide accurate advance information on how you’ll do in the longer race, as long as conditions are similar.

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