The Future of Health is Running and the Future of Running is Health. #65 #cong16

By Andrew O’Brien.

Good health can be defined in countless ways, the simplest of which is the absence of illness and pain. The assumption is that in order to have good health, we need a good health ‘system’, but this may not be entirely true. Current health statistics show that cancer, obesity, diabetes, stroke, heart disease, depression and anxiety continue to increase, despite the system working to find cures for all.

What of the ‘prevention is better than a cure’ approach? Sure, we’re told to exercise, eat a balanced diet, quit smoking and reduce our alcohol intake. But is there a genuine way to good health?

To my mind, the future of good health lies in our past. In 2004, Nature published a paper entitled ‘Endurance running and the evolution of Homo’. In the article, Dennis Bramble and Daniel Lieberman put forward the ground breaking theory that running long distances had likely been a primary driver in the evolution of modern man. They pointed to various anatomical traits that suggest we evolved as distance running specialists; large gluteal muscles, long, elastic tendons, and the ability to regulate body temperature by sweating among other things. 

If running shaped our bodies over the millennia, surely it could be a pathway to health.

But damned statistics get in the way again and show that up to 85% of runners are injured every year. If we evolved as running specialists, surely runners should not be injured ever. And it is this fact that should prompt us to look into our evolution as well. For those millennia, we lived a hunter-gatherer lifestyle, with a calorie deficit, covering long distances on foot every day at relatively low intensities. We didn’t sit in cars and at desks, eating too much processed food and going to the gym to ‘feel the burn’ every day.

How then can running be good for health? 

Done at a proper aerobic intensity, running can maintain and improve cardiovascular fitness. This in turn increases size and density of the mitochondria, the energy powerhouses of cells; dysfunction and disease of the mitochondria are closely related to all of the ‘diseases of civilisation’ listed above. More mitochondria equals raised metabolism, prompting weight loss. It is weight bearing exercise, thus helping to maintain bone mineral density as we age. Exercising outdoors has been shown to improve mental health. The list is endless.

Unfortunately the 85% injury rate still gets in the way. How can we be healthy if we are injured? And if running is healthy, why do so many runners look gaunt and downright miserable in the weeks leading up to a marathon?

It is here that we need to look at the second part of the title: the future of running is health. 

As a Chartered Physiotherapist and running coach, I believe we can look at 3 causes of injuries and poor performance among runners: hardware, software, and energy. 

Hardware relates to the foot, the only part of the body to interact with the ground when running. A dysfunctional foot, misshapen from years of wearing ill-fitting shoes is unable to perform its role as a shock absorber or balance point for the body to move over. Thus more muscular effort is required further up the chain. Having Morton’s foot, where the second metatarsal is longer than the first, is directly linked to muscular trigger points around the hip and in increased risk of myofascial pain.

Running software is everything above the ankle. Once the foot is planted it is stationary, but everything above can be easily manipulated in space. The aim of a good technique coach is to teach a runner how to correctly position the body over the foot to reduce injury risk and maximise speed. Often critics will say ‘but everyone has their own style, their own preferred movement pattern’, and in some ways they are correct. But if 85% of runners are injured, then plenty of them are doing the wrong thing. We should be aiming to teach even recreational runners how to move like the best- the East Africans who so easily dominate distance running events around the world. A good running technique results in lower ground contact times, lower impact forces, better force displacement throughout the body and faster times. Surely even recreational runners, and those just running for health would like to go faster as well!

The final factor in the health of a runner, indeed the health of all, is energy. You can have a perfect foot and a perfect technique, but if you burn out the energy system the results for both performance and health can be catastrophic. How often do we hear of seemingly fit, healthy people dropping dead of cardiac incidents in their early forties? My wife’s cousin passed away aged 40 after a training session 6 weeks ago, Anthony Foley passed away the same week. Both were heart related. 

The western world’s obsession with training hard is the big problem here. We’ve been sold a pup with the ‘no pain, no gain’ mantra. Intense exercise is stressful on the body; it uses the anaerobic energy pathway where glucose is broken down to produce energy without oxygen present. This produces energy quickly, but is only useful for short periods and relatively infrequently- it is the ‘fight or flight’ system. Going back to our evolutionary history, this system was used as rarely as possible; hunter gatherers walked as much as possible, and while hunting tended to use the persistence hunt method of just running enough to keep their prey moving in the sun, causing them to overheat and collapse.

Unfortunately, the physiology of stress is the same, regardless of the stress. So an intense exercise session results in anaerobic metabolism, but so do pain, hunger, lack of sleep, psychological stress, poor breathing habits, extreme temperatures and lack of sunshine to name a few. Thus, for many people, athletes or not, modern life is anaerobic: your day to day existence happens without adequate oxygen. And, here’s the kicker…. lack of oxygen leads to mitochondrial dysfunction and disease! Bear in mind that mitochondria turn glucose into energy: damage them and you are less able to burn glucose (diabetes anyone?) or produce energy (impaired performance).

Excessive stress impairs thyroid function- both in terms of the gland itself and in terms of the body’s ability to convert inactive the T4 hormone to the active T3. The thyroid has an important protective role in the body, particularly over the heart, but also regulating metabolism. Poor thyroid function combined with mitochondrial dysfunction are what makes runners look terrible, it’s not the running itself so much as the body’s response to incorrect training loads. 

Thus, for runners the key to improving performance is reducing unnecessary stress- from a physiological perspective. Improving sleep and breathing behaviour (yes, both of those are possible); lowering the frequency with which they train anaerobically, or at least ensuring adequate recovery time between sessions; improving aerobic capacity; improving diet; improving running efficiency; all of these things can be done, and work well to improving the future health and performance of a runner.

Which brings us full circle: run to improve your health, improve your health to improve your running.

CongRegation © Eoin Kennedy 2017 eoin at congregation dot ie