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Marathon Training a Test of Endurance

Preparation should start at least six months before the race

FRIDAY, Oct. 11, 2002 (HealthDayNews) -- Some 30,000 people will sweat and grunt their way through 26.2 miles, five bridges and five boroughs on Nov. 3 in that annual crucible of endurance known as the New York City Marathon.

If you're signed up for this year's race -- or any of the increasing number of marathons that are sprouting up around the United States -- you've probably been training for the last six months or so. However, if you're thinking of testing your mettle -- and shins -- next year, you'll want to follow some expert advice to make sure you get to the finish line safely.

"Given a baseline decent level of fitness, most people can complete a marathon training program," says Dr. Andrew Rosen, an orthopedist with Beth Israel Medical Center's Insall Scott Kelly Institute for Orthopaedics & Sports Medicine in New York City. This year will be Rosen's fifth marathon, and even he admits: It ain't easy.

However, it can be done. Here's how:

Getting started. It takes at least six months of preparation, perhaps closer to a year, to get ready for a marathon. That includes running several times a week. Before committing to a training program, check with your doctor to make sure that any health conditions, such as asthma, diabetes or blood pressure problems, won't be aggravated by this type of endurance training, advises Dr. Robert Gotlin, director of Sports Rehabilitation at Beth Israel. Start your training gently with workouts at the gym. Move into the formal training five to six months before the actual race, Rosen says.

Gradually increase your distance. "The single most important way to get through training is a gradual increase of weekly mileage leading up to the race," Rosen says. Don't increase your mileage by more than 10 percent each week. Stick to a regimented plan, carefully logging your weekly mileage and watching it increase, then plateau, then taper off again right before the marathon. "That's the conventional, safest, best way to do it," Rosen says.

Select running shoes that fit. The wrong shoes can lead to major blisters and even problems that affect the alignment of the foot and the knee. Ask for shoes that are suited for marathon running -- ones with a lot of cushioning or padding and arch support. Make sure you replace the shoes regularly, every 300 miles at most, Gotlin advises. "The miles are pretty extreme and shoes wear out," Rosen says. "When that happens, the force gets transmitted to the bones and can create stress fractures. It can also cause mal-alignment problems if the outside [of the shoe] is worn out and the inside isn't. That'll force the leg into a position it's not used to being in."

Pay attention to how your body feels. Injuries tend to be less of a problem for first-time runners than for veterans, but certain conditions can be dangerous. Hip pain, for instance, needs to be taken seriously because it can indicate a stress fracture. Also, watch out for anything that might indicate a stress fracture of the knee or lower leg. The majority of running injuries, however, result from overuse and will respond to a decrease in mileage.

Include cross-training activities. This is especially important if you have an injury. "It can iron out some of the rough spots that happen when you're pounding on your knees. These activities also use muscle groups that running doesn't use," Rosen says. Choose low-impact exercises such as cycling, elliptical machines or swimming.

Drink enough water… Staying hydrated is extremely important, especially during summer training months. When the temperature and humidity are both above 80 (80 degrees and 80 percent), your risk for heat-induced injuries jumps, so be especially careful, Gotlin says. During the actual marathon, drink about 12 ounces to 16 ounces of water every hour.

…But not too much. At the other extreme, a runner who drinks too much can get hyponatremia, or "water intoxication." Too much water dilutes the salt content of our bodies. And when you're sweating, you're losing even more salt, which could spell trouble. "Salt is the key ingredient that regulates our body's cells, tissues and organs," Gotlin says. "Too little salt in the body is a problem. Taking too much water and diluting the salt is a problem. You have to come to a happy medium." Gotlin predicts that some 120 runners out of the 30,000 who run the New York City Marathon will end up "drowning" in water. Hyponatremia can be difficult to recognize because most of the symptoms are the same as those of dehydration: fatigue, dizziness and lightheadedness. The telltale sign is bloating in the belly. Another way to gauge: While training, weigh yourself before an hour-long run and then after. If your weight stays the same or goes up, you may be taking in too much water. During the marathon, arrange to have someone hand you a pretzel or a salt pill at mile 14 or 15. You can also alternate water with a sports drink to replenish your body.

Eating. "Carbo loading" before the race may be more of a ritual than a real benefit. "Most of the studies have shown that if it helps, it's not a major factor," Rosen says. "It also depends on what level you're running at. If you're one of these elite runners, than nutrition may play more of a factor." Eating a lot of pasta the week before racing (as Rosen does mostly for tradition's sake) is a reasonable thing to do, but don't bet your whole program on it.

What To Do

For more training tips, visit New York Road Runners or Runner's World.

SOURCES: Andrew Rosen, M.D., attending physician/orthopedist, Beth Israel Medical Center's Insall Scott Kelly Institute for Orthopaedics & Sports Medicine, New York City; Robert Gotlin, D.O., director, Sports Rehabilitation, Beth Israel Medical Center, New York City
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