Is running 20+ miles not safe??
August 18, 2014 8:31 AM   Subscribe

I saw my sports therapist doctor who is a respected doctor in his field. i told him that i wanted to run a marathon someday but he said that marathons are unsafe for hearts/muscles/bones and encouraged me to stick to shorter races. He also said 12-20 miles a week is the sweet spot for running and anything over that loses health benefits. he said he wrote a paper on it. Does anyone on this site who has experience in sports medicine know what race is the upper limit for avoiding undue health risks?

He said something like "running is healthy up to a point - do the marathon if it is a dream of yours but understand that there may be a price to pay with your body down the road" . based on what he said, i will probably give up on the marathon but wanted to get some second opinions. I might still want to try a half marathon but what he said gave me pause.

i know that any kind of exercise has a risk of problems, but the doctor said that the marathon length in particular is dangerous since humans aren't meant to run that much. I am at 25 miles a week now and love it, and don't want to go down to 20 but i will if i have to. but 25 isn't too much higher than 20, so maybe it is still okay? Is a half-marathon dangerous too? Maybe i should stick to 10ks and 5ks? i wish I asked him these questions when i was with him, but i also wanted to get the opinion of other people who have sports medicine experience.
posted by Thanquol180 to Health & Fitness (24 answers total) 15 users marked this as a favorite
This is an emerging area of research, so (a) people who are on one side of the debate will tend to be STRONGLY on one side of the debate, and (b) it's possible to find sources to support just about any position you want to take.

For example, on the pro-long-running side, a recent study refuting the last set of "running damages your heart" studies. Many of the past studies had confounding factors -- e.g. comparing the runners to healthy but sedentary controls (which is not a great control, because people who are sedentary and still healthy in their 50s probably have some good genetics going on).

The best-supported side-effect from running marathons is immune system suppression but I'm assuming your doctor wasn't thinking of that, as he specifically mentioned bones, heart, etc. In any case, most of the science suggests that that's a temporary effect.

I like the blog Sweat Science for a (relatively) unbiased look at studies as they come out.
posted by pie ninja at 8:43 AM on August 18, 2014 [7 favorites]

There's definitely a lot of research out there to look at. However, I would suggest that you get a PCP or sports therapist doctor who is a runner or an Ironman.
posted by roomthreeseventeen at 8:55 AM on August 18, 2014 [3 favorites]

What's your definition of undue health risk? There is too much research on this to easily summarize, but running long distances certainly does put you at risk for some different health problems - the most obvious ones are not long-term problems. At every marathon some people will suffer injuries and dehydration/heatstroke type of illness. Can you give your doctor's name? If so, we can look at his article and give you comments.
posted by treehorn+bunny at 9:06 AM on August 18, 2014

I would suggest that you get a PCP or sports therapist doctor who is a runner or an Ironman.

OP, in my experience, those who compete in triathalons and/or regularly run marathons or 5K's will nearly always be in the "the benefits outweigh the risks" camp. The advantage in going to them is that they're typically quite knowledgeable. But as a general rule, if you're looking for an unbiased perspective about a sport, it pays to find a doctor (sports medicine / sports therapist) who is not personally invested in doing the thing you're looking into.
posted by zarq at 9:39 AM on August 18, 2014 [10 favorites]

I just read this article last night about this topic. There is not a consensus just yet, but the studies that showed damage appear to be flawed.

Personally, I haven't let it stop me from running marathons. And I feel much healthier and more energetic than when I was sedentary.
posted by barnoley at 10:04 AM on August 18, 2014

So, I remember your username, and although you're asking for general evaluations of the risks of distance running for the average person, you might consider that you aren't the average person: you are you. One issue that your current sports doctor may not be factoring into the equation is the benefit of structured, intense cardiovascular activities like running for your mental health, as mental health struggles are also associated with long-term strain on your physical well-being--including your heart and musculoskeletal system (sometimes directly, and sometimes associated with medications prescribed for mental health).

If distance running is currently beneficial to your mental well-being, both as an activity and in the motivation/goal-setting/accomplishing aspects, and it is the activity that keeps you exercising regularly, then even if there are shorter and longer-term risks to watch out for and manage, it may very well be worth continuing at the level you prefer if it helps allow you to maintain an acceptable quality of life.

For me--and this may not be the case for you, nor is it for everyone--I have to baby one of my MCLs, but distance running is extremely beneficial to my psychological well-being, and it is a pastime that keeps me motivated enough to keep going back to it and stick with it. Endurance running is beneficial enough to limit the level of polypharmacy I use (polypharmacy=multiple medications), and keep some of my medications' doses lower than they had been in the past.

When the issue is framed for my physicians as "'distance running' versus 'adding on an antipsychotic to bump up your current antidepressant, and maybe add something extra for sleep, on top of your other medications'", I don't get pushback about the health risks of running. Turns out Type II diabetes isn't exactly peachy for the immune system, heart or musculoskeletal system, either. And polypharmacy is associated with a greater risk of SUDEP (sudden unexplained death in epilepsy, which I also have). Running and participating in running events and clinics and the rest of it gets me going out more and commits me to being social even when that's not easy for me, and more social connections also benefits mental and physical health. It gives me something to talk about and connect with people over.

So I have carte blanche to run as many half- and full-marathons as I want, until my age/joints/whatever stop me, from all of my doctors and specialists. In other words, even if the data comes back as "distance running IS riskier for your health," and that might be good knowledge for the average person, that advice is not be right for me.

You need to consider what's important to you, and what risks you're willing to take for what benefits, for your overall long-term health and well-being.
posted by Uniformitarianism Now! at 10:05 AM on August 18, 2014 [19 favorites]

Your doctor is probably referring to the studies linked in this article. Marathon running is a fairly modern phenomenon.
posted by the jam at 10:07 AM on August 18, 2014

Some doctors give out bad advice.

When I was training for my second marathon, I got injured and had to sit out the rest of the season. When physical therapy wasn't helping, my doctor told me I'd never be a runner and I should just give it all up.

This was in 2010. Since then, I've run 7 marathons, and I'm qualifying for Boston next year.

Running is not inherently dangerous. The fact that your doctor wrote a paper on it means that he's emotionally invested in running being dangerous - if it were safe, he'd have to admit to being wrong!

Don't be swayed by this doctor. If you want to run a marathon, find a local running group with a good first-timers program, and do it right.
posted by grateful at 10:53 AM on August 18, 2014 [1 favorite]

it pays to find a doctor (sports medicine / sports therapist) who is not personally invested in doing the thing you're looking into.

Authoring articles which oppose something is enough of personal investment to consider if bias exists. He's on one side of an evolving body of research.

Note: username aside I gave up running at the marathon distance for 2 years based on the guidance of my endocrinologist. However, my endo didn't really have a strong bias on endurance sports overall, but that it wasn't a good choice for me at that time.
posted by 26.2 at 10:54 AM on August 18, 2014 [5 favorites]

Authoring articles which oppose something is enough of personal investment to consider if bias exists. He's on one side of an evolving body of research.

Excellent point.
posted by zarq at 10:58 AM on August 18, 2014

I just read this article last night about this topic. There is not a consensus just yet, but the studies that showed damage appear to be flawed.

Alex Hutchinson, who wrote that article, has a very good book that looks at the science behind a lot of the truths and myths surrounding exercise.
posted by TORunner at 11:08 AM on August 18, 2014 [1 favorite]

"running is healthy up to a point - do the marathon if it is a dream of yours but understand that there may be a price to pay with your body down the road"

I know it's anecdotal evidence, but Dick Hoyt is pretty good evidence to the contrary.
I met him this past weekend before the Falmouth Road Race. He's 74 and told me that he's slowed down and would only be running 12's. That's 7 miles in 12 minutes each while pushing his adult son in a race chair.
posted by plinth at 11:14 AM on August 18, 2014 [1 favorite]

Indeed, it appears the issue is not settled. There is no ironclad proof that running in excess of 20 miles a week is suboptimal for your health. However, there are suggestions it may be so - whether ultimately it's a valid concern, or some kind of statistical artifact, we at present don't know. And let us understand that health damage *might* occur only at very high levels of exercise (extreme, even), and we are talking about possible *suboptimal* outcomes, such as the elimination of some or all of the health *advantages* of exercise.

Some of the articles/studies linked so far in this askme, which purport to refute the studies showing concern, are of terrible quality:

What Running Can Do for the Heart - The Taylor study attempts to characterize the subjects and cohorts by the proxy of their spouses - the idea being that their lifestyles and diet must be similar - wow, this is utter crap. To begin with epidemiological studies are easily confounded, but this attempt of a proxy once removed on top of that is just, to put it plainly, worthless.

A big problem with many of the studies on both sides of this issue is that they are not measuring health outcomes directly, but rather are measuring biomarkers which are associated with outcomes in the general population. They measure things like troponin levels, heart scarring/thickening, blood vessel calcification/narrowing, arrhythmias etc. and even cholesterol levels, BMI, BP, and from this conclude whether a given group is "healthier" or "less healthy". This of course is quite unsatisfactory, if for no other reason than the fact that exercise influences the body in a very broad way, so even if those biomarkers directly translated into valid CV or pulmonary health measures, it says nothing whatever about things like cancer and diabetes and a thousand other things that exercise influences. So very often we see an intervention be good for one thing, but at the cost for another, so you cannot evaluate any intervention in isolation like that.

Instead, what you really want to look for, is the gold standard - all cause mortality outcomes. You want a decent size sample in every category, and randomized subjects. The problem of course is that you have to wait quite some time to accumulate a decent number of all cause mortality outcomes (basically wait for people to die), which can take decades - it's easier to just measure some biomarker or another and voilĂ . The other problem is that you are dealing with human beings and there are ethical and practical problems with valid randomization, so you end up with confounders which are very hard to eliminate - rats in cages are easier in this respect.

For all that, there have been - imperfect - attempts to do longitudinal studies of f.ex. jogging and all-cause mortality outcomes. The one that comes to mind is the Copenhagen study, which is very strong, though of course not perfect (in addition to the cautions and limitations mentioned by the authors, such as causality, randomization and self-selection, I feel the size of some subgroups is not completely satisfactory for drawing strong statistical conclusions).

I have linked to and discussed this study many times in the blue/green:

Longevity in male and female joggers: the copenhagen city heart study.
Schnohr P, Marott JL, Lange P, Jensen GB.
Am J Epidemiol. 2013 Apr 1;177(7):683-9. doi: 10.1093/aje/kws301. Epub 2013 Feb 28.
PMID: 23449779

It is well-worth studying this paper very closely. It roughly corresponds to what your doctor said, though it sounds like your doctor might have overstated the finality of these conclusions, and not taken sufficient account of you as an individual.

Btw., here's the O'Keefe mentioned in the article, in a talk 2012: Run for your life! At a comfortable pace, and not too far. I'm not endorsing him, just providing it for informational purposes.
posted by VikingSword at 2:09 PM on August 18, 2014 [5 favorites]

I say get a new doctor. I run 80 Miles a week and am fine. So do several of my friends.
posted by floweredfish at 2:44 PM on August 18, 2014 [1 favorite]

Nowadays people are already pushing past the marathon distance with ultramarathons gaining popularity. Science Friday had a segment on ultrarunning recently.

At the annual UTMB race, they welcome about 6000 runners who run one of 3 races with distances ranging from 100 kms up to 100 miles. I know that french scientists were conducting research into how these extreme distances affect the human body. But I don't read french, so I'm not sure whether they've published any conclusions. But in Jan 2014, Stanford published results from their longitudinal study on ultrarunning.

P.S. Two days ago (16th Aug 2014), I ran a 50 mile race. My mileage was 60 miles per week during training.
posted by lahersedor at 3:38 PM on August 18, 2014

Authoring articles which oppose something is enough of personal investment to consider if bias exists.

Often it would be considered a great thing to have a doctor who had personally done research in a field applicable to your life. Be careful not to go looking for reasons to disbelieve him.
posted by the jam at 4:06 PM on August 18, 2014 [1 favorite]

Anecdotal: my dad ran Marathons. He ran between 70 and 90 miles a week. He is now in his 50's. He has flat feet and issues with bone spurs. His knees are shot. His quality of life has decreased due to physical problems from past injuries.

Maybe I got some of his genetics but long distance running especially on concrete is not for me. I get shin splints really easily. I have a messed up Achilles tendon. I also broke my ankle and have stretched tendons on one side that make it easier to break it again.

My dad is very active and shows no signs of major diseases as far as I know (aside from a small stroke he had on a medication that was pulled from the market for causing strokes) on that end he is doing super well. Normal blood pressure, no signs of diabetes, no heart problems.

I think running contributed to that as when I was a kid his diet seemed to be dr pepper and chex mix. And both his parents had significant problems at that age.

So depending on you running could be great. For me it makes me uncomfortable and limits my movement after a certain point and increases a chance of injuries.

Ultimately no matet what you do with your exercise it will have benefits and risk. It may be in 20 years you will wish you did things that were lower impact. Our or may be in 20 years that you did better cardio. It may be that you wished you did more running. It may be that you'll walk down the street and trip on ice and not be able to run anymore. We have general ideas but no one can predict the future for you. Educate yourself and listen to your body.
posted by AlexiaSky at 4:31 PM on August 18, 2014

Just so I'm clear, we are all still discussing how running 21 odd miles in one go is not bad for you?

This is not bad medical advice. In fact, since our professional always sides on the most conservative side of error (at least historically) I would find it extremely irresponsible if a physician DID advise someone to take up marathons. The role is an advisory one, not an authoritarian diatribe.

Hell, didn't the original marathoner die? Don't people die all the time during marathons?

Repetitive stress injuries are real, but heart disease, high blood pressure, depression and obesity are also real. Like I joke with my coworkers, you're gonna die from something, so as long as you know what you're getting into have fun kids.
posted by hobo gitano de queretaro at 5:22 PM on August 18, 2014

Often it would be considered a great thing to have a doctor who had personally done research in a field applicable to your life. Be careful not to go looking for reasons to disbelieve him.

Generally, I believe this to be correct. However, the doctor presented their research as definitive when the general body of research is not clear. That's troublesome. He's said 12-20 is a definitive boundary. That is not consistently observed in the research. Presenting a selected subset of research isn't a good way to help a patient make an informed decision.

That said, the OP doesn't need to scrap him as a doctor. Another way to address it is to ask if there is contradictory research. Bias is tricky - we don't always consciously know that we're interpreting things based on our own beliefs. Asking for alternative viewpoints can help get a more rounded view.
posted by 26.2 at 5:44 PM on August 18, 2014 [1 favorite]

There is solid evidence that being able to run hundreds of miles per week is one of the main things that we evolved for. And if you are trying to lose weight, there is a ton of extra benefit to every additional mile you run. Among very old people who are far more active and fit than their peers, you always seem to find a disproportionate number of distance runners.

That said, apparently healthy people do drop dead while running marathons with a startling regularity.

There have been studies going both ways and you can't really accuse someone of being crazy for holding either viewpoint. The truth is, your doctor probably read one study and was convinced. Doctor's aren't infallible and this is an open debate. I wouldn't but undue weight behind his opinion here.
posted by 256 at 5:50 PM on August 18, 2014

While this is obviously not your situation, the principle that there is such a thing as "too much exercise" is also borne out in people who are recovering from a heart attack. Patients are advised to exercise - but it that can also be overdone:

Increased Cardiovascular Disease Mortality Associated With Excessive Exercise in Heart Attack Survivors.
Williams PT, Thompson PD.
Mayo Clin Proc. 2014 Aug 5. pii: S0025-6196(14)00437-6. doi: 10.1016/j.mayocp.2014.05.006. [Epub ahead of print]
PMID: 25128072


Running or walking decreases CVD mortality risk progressively at most levels of exercise in patients after a cardiac event, but the benefit of exercise on CVD mortality and IHD deaths is attenuated at the highest levels of exercise (running: above 7.1 km/d or walking briskly: 10.7 km/d)."

Again, the idea that exercise benefits *might* follow a "U" curve is not crazy.
posted by VikingSword at 7:45 PM on August 18, 2014 [1 favorite]

I don't think it's fair to decide your doctor's motivations for writing that research article. He may have gone in open-minded, found it was bad, and wrote what he found. I would think he's probably less invested than the doctor who does run 100 miles every week, but you don't know.

I would seek a second opinion, preferably from a doctor who sees a lot of marathon runners. You could also try to ask your doctor those follow up questions. If you have a high co-pay, ask about a brief phone consultation for a simple follow-up question about running. Some of my doctors have an email system that's very cool - I can message my doctor directly if I have a simple question. You can do your own research if you want, but clearly your questions are based on what your doctor said and you didn't ask him -- I would try to speak with him again.

And the people saying, "I run marathons and I am fine!" are missing the point, because OP's doctor was talking about long-term health, it sounds like. OP needs to get more specifics.
posted by AppleTurnover at 10:50 PM on August 18, 2014

You might want to read this: "The myth of the deadly marathon run"
posted by coffee_monster at 2:35 AM on August 19, 2014

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