RUNNING & FITNEWS®
March / April 2010 • Volume 28, Number 2
Walking Regularly Fends off Stroke in Women
A study from the Department of Epidemiology at the Harvard School of Public Health
has found a link between regular walking and reduced stroke risk in women. While
exercise has generally been inversely related to the risk of developing stroke, the amount
and types of activity that most minimize risk are less well known. For example, the
researchers did not see the same link between reduced risk of stroke and more vigorous
exercises like running, swimming, and biking. There may be something special about the
lower intensity activity of walking that makes it effective in reducing stroke risk.
The data, published first online in April in the American Heart Association journal
Stroke, were clear enough: those women who walked briskly for at least two hours a
week had a 37% less likely chance of developing stroke than women who did not walk.
And women who walked at least two hours per week at any pace still lowered their risk
by 30%. The researchers studied just under 40,000 women over 45 years of age, drawing
on data collected from the Women’s Health Study.
The women reported their physical activity at baseline (from 1992 to 1995), and at 3, 6,
8, 10.4, and 12.4 years’ follow-up. During an average follow-up of 12 years, 579 women
developed incident stroke. 473 of those were ischemic, meaning due to a restriction in
blood supply as from a blood clot or vasoconstriction; 102 were hemorrhagic; 4 were of
unknown type. Proportional hazard models updated over time related physical activity to
the risk of stroke.
Women who burned over 1,500 calories per week in any form of leisure-time physical
activity were at the lowest risk of ischemic stroke. No such associations were made with
hemorrhagic stroke. It was walking specifically—both amount per week and pace—that
was inversely related with both ischemic and hemorrhagic stroke. Though other, more
vigorous physical activity was not related to reduced stroke risk in this study, it is
noteworthy that it did not increase the risk.
Stroke, April 6, 2010,
Children’s Fitness Starts in the Womb
Weight control interventions aimed at school-aged children may be too late, new research
suggests. While it is still important to improve access to healthy food in schools and
increase opportunities for exercise, it might not be enough.
More and more evidence points to pivotal events during the toddler years, infancy, and
even in the womb that can set young children on an obesity trajectory that is hard to alter
by the time they’re in kindergarten. It’s becoming clear that prevention efforts should
start very early.
For several years now, doctors have advised overweight women to lose weight before
pregnancy, which has been shown to lower obesity and diabetes risk in children. But
some past notions about what is healthy for the infants themselves are now being
challenged. Babies who grow rapidly and hold onto baby fat were once thought to be the
healthy babies, and diet or weight restrictions on infants have traditionally been avoided.
That is changing.
There is plenty of evidence and great consensus now that the changes produced during
exercise are helpful to pregnancy. Exercise increases blood volume, both in circulation
and for each beat pumped, and so improves the body's ability to deliver oxygen to tissues.
And regular, vigorous exercise throughout early pregnancy does not increase the
incidence of miscarriage or birth defects.
But now the attention is increasingly being turned on the health benefits for the baby. For
exercised babies, all aspects of fetal growth and development after birth have been shown
to be equal to or better than non-exercised babies. Neither starting an exercise regimen
nor continuing one results in decreased fetal growth—just decreased fetal fat, which does
not result in low body temperatures as was once thought. Also, the blood glucose of these
less plump infants is perfectly normal. What's more, babies of pregnant exercisers tend
to be easier to care for. They sleep through the night earlier, do not typically have colic
and often self-quiet.
This last point may be more significant than just the joy of having an easy to care for
baby. Babies who sleep less than 12 hours are at increased risk for obesity later. If they
don’t sleep enough and also watch two hours or more of TV a day, they are at even
Given that experts say moderately hard to hard exercise routines for 20 minutes a day
three days a week can be sustained throughout the third trimester, how will the baby let
the mother know when the exercise is too much? The baby will not move much after the
exercise. A rule of thumb is in mid- to late pregnancy, the baby should move two to three
times within the first 30 minutes post-exercise. You may also have someone listen to the
baby's heart rate response to the activity, though fetal heart rate has a great deal of normal
variability. Up to the 32nd week, a normal response is an increase of five to 25 bpm.
After that, as much as 35 bpm is probably fine.
Like children and teenagers, babies and toddlers have been getting fatter. One in 10
children under age 2 are overweight. The percentage of children ages 2 to 5 who are
obese increased to 12.4% in 2006, from just 5% in 1980. The rate of obese teenagers is
even higher than that of younger children, 18%. These trends can be reversed by starting
with a healthy, active pregnancy and raising your child to enjoy a lifetime of fitness. (See
the sidebar, “Kids Fitness Equipment” in this issue.)
Exercising Through Your Pregnancy by James F. Clapp III, MD, 2002, Addicus Books,
Omaha, NE, 245 pp.
The New York Times, March 22, 2010, “Baby Fat May Not Be So Cute After All,”
by Roni Caryn Rabin, www.nytimes.com/2010/03/23/health/23obese.html?ref=health
[RON, SEE 3 IMAGES I SENT:]
Kids Fitness Equipment
You can help establish your child’s lifelong love of fitness with a series of innovative
toys designed to teach the joys of the gymnasium.
Various retailers are now selling a children’s treadmill with the goal of inspiring kids
while keeping the treadmilling fun and safe. For safety, the treadmill is not motorized,
but self-propelled. Its features include: an automatic on/off that powers down in 4
minutes if the treadmill isn’t used, a timer, speed displays in both km/hr and miles/hr, and
total distance and calorie displays. The treadmill is made of tubular steel with foam
padding and holds a maximum weight of 100 lbs, with recommended ages 4 through 8
The weight bench for kids is proportioned specifically for junior members of the active
family, and features soft, foam covered bars and weights. The main barbell and additional
weights total about 51 lbs. There’s even a foot bench for lower-body training.
And with inclined, flat, and angled models to choose from, the kids rowing machines
offer a lot of versatility in how your child learns to row with healthful playtime. Each
machine holds up to 150 lbs.
Children's exercise should be fun, exciting, and safe, inspiring them to move and enjoy an
active lifestyle. Good habits with fun and acquired skills as their own rewards can benefit
a child for a lifetime.
Challenge Your Brain and Body with Orienteering
If you love running trails and are looking for a sport that taxes the body while challenging
your brain, orienteering might be for you. The sport was developed at the turn of the last
century by the Swedish and Norwegian militaries to teach soldiers better navigation
skills. It remains most popular in Scandinavia, but there are orienteering clubs across the
U.S. and Canada.
Orienteering is essentially a cross-country race over unfamiliar territory using a map and
compass to reach predetermined points along the way in addition to a finish line.
Participants punch “control cards” at each site, designated by a nylon flag. There is no
right or wrong way to reach the sites, called “controls,” but there are undoubtedly harder
or easier ways—and figuring that out is where the fun and challenge of orienteering
comes into play.
The sport burns 9 metabolic equivalents (METs), which makes it equal to running 11:30
mile pace, sparring in a boxing ring, or brisk and vigorous cross-country skiing. (Perhaps
due to its Scandinavian roots there is also, not surprisingly, a version of orienteering that
occurs on cross-country skis.)
Orienteers rely on detailed maps depicting streams, forests, boulders, and other natural
obstacles; the maps also show the locations of the 15 or so control sites. As you reach a
flag and punch your control card, you must check the map and decide your next move.
The flags are numbered on the map, and must be reached in order. You might try a long,
easy route; or go for a shortcut over harder terrain, it’s up to you. The clock keeps
ticking, and the winner is the first person across the finish line.
Beginners might simply prefer a leisurely walk in the woods, but make no mistake: the
United States Orienteering Federation (USOF) develops fiercely competitive runners of
all ages as well. The standard race course features a start, a series of control sites, and a
finish. There are often clues to be found along the way. Most orienteering events use
staggered starts to ensure that each orienteer has a chance to do his or her own
navigating, but there are several other popular formats, including relays and events in
which the orienteer must find as many controls as possible within a specified time. In lieu
of punch cards, many orienteering events now use electronic means to verify that a
participant has reached each site on the course in the right order.
If you’re concerned about the environmental impact of orienteering events, the
International World Games Association writes on its website that “[o]rienteers are keenly
interested in environmental protection. The sport is conducted to minimize or eliminate
environmental impact at its events. In doing so, the sport has gained respect in
These games have been held since 1981, often with National Olympic Committee
support, to give athletes the opportunity to compete in sports not currently offered in the
Olympics, orienteering among them. The 11-day World Games enjoys the participation
of 32 countries. The orienteering formats chosen for the World Games are an individual
middle distance competition for both men and women, and a mixed relay for teams of
two men and two women.
The not-for-profit USOF, headquartered in Riderwood, MD, is the national governing
body for orienteering in the United States. They promote orienteering for education,
personal development, and environmental awareness. Their other goal is to continue to
improve the competitive performance of U.S. orienteering athletes to world-class levels.
More than 600 days of orienteering events take place annually in the U.S. Most local
events provide courses for all levels from beginner to advanced, and the sport has been
adapted for small children and people in wheelchairs. You can find a club near you on the
USOF website: www.us.orienteering.org. If you love maps, exploring, and the great
outdoors, give orienteering a try.
U.S. Orienteering Federation, www.us.orienteering.org
Williams College, Williamstown, MA, “What is Orienteering?”
Int’l World Games Assoc., www.worldgames-iwga.org
Harvard: Calcium Not a Health Risk
Calcium is the most plentiful mineral in the human body. Although most of it is locked
into bone, every cell in the body also needs small amounts of calcium. But calcium
sometimes builds up where it shouldn’t, such as in the breast tissue or arteries. When this
happens, a woman may wonder if she is getting too much calcium from food and
supplements. Not to worry, says the March 2010 issue of Harvard Women’s Health
Watch. So far, researchers haven't identified any direct links between the amount of
calcium taken in from food and supplements and calcium accumulation in the breast or
How does calcium get deposited beyond the bones? Benign breast calcifications can
form as a response to injury. When any part of the breast is damaged, fat cells die,
releasing fatty acids that combine with calcium to form deposits. Calcium can also
accumulate in the cholesterol-rich plaque that develops after an injury to an artery wall.
The plaque is usually soft to begin with, but eventually tends to harden and become
calcified. In addition, blood vessel cells themselves sometimes convert into bone-forming
osteoblasts, producing extra calcium on the spot.
Is too much calcium associated with the development of kidney stones? The most
common type of kidney stone is composed of calcium oxalate crystals, occurring in about
80% of cases, and the factors that promote the precipitation of crystals in the urine are
associated with the development of these stones.
Common sense has long held that consumption of too much calcium could promote the
development of calcium kidney stones. However, current evidence suggests that the
consumption of low-calcium diets is actually associated with a higher overall risk for the
development of kidney stones. This is perhaps related to the role of calcium in binding
ingested oxalate in the gastrointestinal tract. As the amount of calcium intake decreases,
the amount of oxalate available for absorption into the bloodstream increases; this oxalate
is then excreted in greater amounts into the urine by the kidneys. In the urine, oxalate is a
very strong promoter of calcium oxalate precipitation, about 15 times stronger than
Still, with calcium, as with almost everything else, more does not mean better. Current
nutrition guidelines recommend that women between the ages of 19 and 50 get a total of
1,000 milligrams of calcium a day; women over age 50 should get 1,200 milligrams.
Harvard Women’s Health Watch, 2010, www.health.harvard.edu
The Lancet, 2006, 367 (9507), pp. 333-344, doi:10.1016/S0140-6736(06)68071-9
BMJ, 2004, 328 (7453), pp. 1420-1424, doi:10.1136/bmj.328.7453.1420,
The First Line of Defense: Portion Control
We all know that eating less means consuming fewer calories, and that is a major factor
in long-term weight management. Still, we face challenges daily in our prosperous land,
with portion sizes being offered to us that are very often way beyond our caloric needs.
Even in not-so-prosperous times we can readily fall prey to the portion problem. In this
economy, “value” is proffered with the assumption that more for less is always a good
idea. But when it comes to eating right, portion size is the first line of defense, and it’s a
good idea to get our expectations in line with a healthy sense of what “normal” eating is,
or at least should be.
The first step to rethinking your portions is to learn to visualize what a recommended
serving of food actually looks like. Read the labels on your favorite foods. They always
contain the vital info on serving sizes; it is just a matter of converting the abstract ounce,
cup, and gram measures into practical images you can remember. Then use these images
every day. Before serving yourself a plate of food, actually take the time to visualize the
correct serving sizes. The following chart offers memorable images to represent the most
common foods in their proper serving sizes:
Grain Products What One Serving Looks Like
1 cup of cereal flakes The size of a fist
1 pancake A compact disc
½ cup of cooked rice, pasta, or ½ of a baseball
1 slice of bread A cassette tape
Fruits and Veggies What One Serving Looks Like
1 cup of salad greens A baseball
1 medium fruit A baseball
½ cup of raisins A large egg
Dairy and Cheese What One Serving Looks Like
1 ½ oz. cheese 4 stacked dice
½ cup of ice cream ½ baseball
1 cup serving of milk, yogurt, or The size of a fist
Meats and Alternatives What One Serving Looks Like
3 oz. meat, fish, and poultry Deck of cards
3 oz. grilled/baked fish Checkbook
2 Tbsp. peanut butter Ping pong ball
Fats What One Serving Looks Like
1 teaspoon of oil The size of your thumb tip
Another common mistake is the assumption that one size fits all. After all, in a restaurant,
there is one heaping plate of food delivered to you regardless of age, gender, body
weight, and activity level. But these factors obviously demand significant variations in
how much one person eats over another. Consider the difference between a 50-year-old
male weighing 180 lbs who gets 30 minutes or less of physical activity a day, and the
same-aged female with the same daily activity level who weighs 140 lbs. The man has a
daily caloric need of perhaps 2,200, while the woman needs only about 1,800 calories.
A well-portioned meal for the man in the above example might be: 3 oz. of chicken, 2
cups of green beans, and 1.5 cups of brown rice. The woman’s well-portioned meal might
include 2 oz. of chicken, 1 cup of green beans, and 1 cup of brown rice. These meals
differ significantly because over time, the caloric deficit is greater and greater. This is
precisely how by making small changes to your diet can help you achieve huge health
and fitness gains over a long period of time. The opposite is true, too: adding just a few
extra calories per day leads to weight gain that may aggregate in a noticeable way by
year’s end. When we then consider the out-of-control portions offered to us in today’s
restaurants, the prospect can become truly threatening to our collective, and individual,
In the above example we altered only body weight and gender. Note also that when you
alter more factors such as physical activity and age, the discrepancy becomes even
greater. The first step is awareness of how much you’re consuming in relation to
suggested serving sizes. The rest is up to you, and that can be as simple as an impulsive
decision to put down, rather than pick up, the fork.
AARP, “Eating Well: Size Does Matter—Master Portion Control,”
The First 48: Fighting DOMS and Tendonitis
By Edward H. Nessel, RPh, MS, MPH, PharmD
Muscle and tendon soreness sooner or later will affect virtually everyone, regardless if
you are a serious athlete or engage in exercise on an intermittent, recreational basis. The
widespread appearance of muscle discomfort is due partly to the activities that produce it
and partly to the muscles not being adequately conditioned to handle stressful loads
repeatedly placed upon them. Those who think they are “in shape” usually suffer the
consequences of pushing through bouts of increasing intensity on a too-much-too-soon
basis. They can feel the effects of this as quickly as two hours later or as long as two or
three days later. Within hours post-exercise, “weekend warriors” often develop delayed
onset muscle soreness (DOMS), often lasting about two days.
It is also never a surprise to see tendons become inflamed and sore either right along with
muscle tissue or noticeably before. Tendonitis is a common musculoskeletal complication
of overuse, improper use through faulty technique, or an imbalance of use from having
some muscle groupings pulling harder against others.
Assessing the Damage
Beginning tendonitis associated with muscle overuse usually presents itself as localized
pain after a few minutes into a training session. Early on in the injury process, discomfort
often eases a few hours after training. As the condition worsens, pain, weakness, and loss
of range-of-motion in the affected area become more constant to the point of continuous
discomfort throughout the day.
After a single, intense bout of vigorous activity in a short period of time, DOMS could
occur and still be climbing about 24 to 48 hours after, reaching a peak within 48 to 72
hours. It disappears five to seven days after the activity. Inflammation also increases to
reach its peak in a few days after the bout, and this delays healing. But as the body
becomes exposed to repeated physical effort, recovery happens sooner and full and even
increasing strength return more quickly as adaptation becomes manifest.
Another cause of muscle and tendon soreness occurs when muscle groups are repeatedly
used under force in a certain way day after day with no or very little change in routine.
This is known as repetitive use injury or cumulative trauma disorder. Think of military
boot camp: The young men and women are pushed through grueling body movements
every day for eight to nine weeks. Prescribed increases in physical demand are presented
and expected to be handled, amounting to intense exposure to physical stress at the
expense of everything else. More attention to appropriate recovery in basic training and
in competitive sports would go further in the long run than immediate, intense overload
of the muscles and tendons.
It is usually only after the athlete begins to notice pain, suffer weakness, and endure
limited mobility that he or she realize that steps are needed to get things turned around.
Try and prevent the need for rehabilitation by making the musculature as strong as
possible along with all the supportive connective tissue. In addition, rest and recovery
(even with specific workouts geared to provide this) are always appropriate to allow the
body to catch up with the adaptation process. If the need for medicinal and/or
physiotherapy intervention becomes a given, then the following suggestions should be
heeded. We are now guided by the anagram PRICE where the letters stand for the five
activities that should begin as soon as possible after perceived injury: protection, rest, ice,
compression, and elevation (above the heart).
Choose Heat over Cold
Sandy Koufax, the great fastballer for the Dodgers in the 1960s, was famous for holding
photo ops with ice packs strapped to his elbow immediately following his games. This
probably provided some relief to the tendons in his elbow by delaying the inflammatory
response and lessening swelling to some degree, but in the long run heat would have been
better on a repetitive basis to enhance the blood supply.
While you should apply cold immediately after trauma to reduce swelling and lessen
tissue damage at the site, cold therapy is not the treatment of choice for non-acute muscle
problems, such as muscle soreness and repetitive-use syndrome. Here we need heat
application which dilates blood vessels and increases blood flow to the affected area to
provide true warmth and soothing and to allow certain enzymes and cellular types carried
in the blood to be sent to the injured site to help in the clearing away of damaged tissue.
When choosing the method of applying heat, note that moist heat penetrates tissue better
than dry heat, so a moist heating pad is best—but caution must be taken to prevent skin
burns. An extended hot shower provides good relief if only for a relatively brief period.
What has proved to be the best source of heat application is the recently-developed
therapeutic heat wrap (e.g., ThermaCare). This product has disks of iron salts that oxidize
when the package is opened, providing a safe 104 degrees of sustainable heat which
should not burn the skin over the extended eight-hour wearing time. After the eight-hour
wearing, most patients usually experience pain relief for a full 24 hours.
There’s the Rub
As a practicing pharmacist for 30 years I have never found rubs of any kind that provided
substantial reproducible pain relief, and none have helped in the repair process. I do not
believe external irritants benefit athletes in any way except to provide a superficial short-
acting warming sensation where applied. Active ingredients in these familiar products
include menthol, eucalyptol, camphor, methyl salicylate, trolamine, capsicum, and
capsaicin. They all carry the potential to do more harm than good. They can irritate the
surface of the skin more than provide relief to the underlying muscle and can produce
contact dermatitis at the place of application.
Analgesics and NSAIDs
Damaged tissue emits pain which causes most muscular tissue to go into spasm, and that
in turn leads to more pain. This escalating cycle can be broken with analgesics. Quell the
pain sufficiently, and you might prevent muscle spasms which lead to further damage.
The most common and relatively safe product is acetaminophen (e.g., Tylenol). Four
grams (4,000 mg) is the maximum safe daily dose for an extended period with half that or
less if this drug is consumed in proximity with alcohol to prevent liver toxicity. Aside
from this and assuming no allergy to the active ingredient, acetaminophen should be the
first product taken for pain relief on the road to recovery.
NSAIDs can be safely taken in concert with acetaminophen to enhance analgesia. The
two act in different sites in the brain and body and actually provide a positive synergistic
effect. The NSAIDs have an added benefit of providing an anti-inflammatory effect
which helps to keep swelling and internal damage somewhat under control.
These enhanced pain and inflammation antagonists bring a few cautions with them. Since
they interfere with blood circulation and tissue repair throughout the body they must be
taken with food to protect the stomach lining. They also carry a caution limiting the
number of days taken because they can diminish blood circulation to the kidneys over
time. Administer for five consecutive days, if needed, with a two-day “drug holiday.” If
continuous treatment is needed, then this cycle usually can be safely repeated up to two
more times in otherwise healthy patients with no intestinal ulcerations or decompensated
As they interfere with circulation throughout the body, NSAIDs can have a delaying
effect in the absolute healing process, presenting a bit of a double-edged sword: reducing
inflammation, which is what we want, but, with continuous use, delaying total healing at
the injured site. This, again, emphasizes the need to be cautious with administration over
There is another class of products that has as its primary use the lessening of cold and
allergy symptoms but that can produce a positive outcome on healing trauma.
Antihistamines act, as the name implies, to reduce the release of histamine—which is
usually secreted in areas of inflammation, whether in the nasal passages or at any site of
trauma. The sooner these products are taken, the better. Histamine causes blood leakage
into the affected area with concomitant swelling. An antihistamine that can reduce
swelling can aid in the body’s ability to recover. The stronger the antihistamine, the better
it can perform but this brings along the side effect of drowsiness, so much so that some
products in this class are used to as sleep aids.
While supplements like glucosamine have had mixed results in the literature, the one
healing supplement that truly seems to work with some consistency is found naturally in
tropical fruit, mostly pineapples. It is the enzyme bromelain. Initially found to aid in
digestion, subsequent research has shown that the enzyme helps the body clear itself of
dead and damaged tissue almost anywhere, thus accelerating the healing process.
Consumed regularly, bromelain has proved its worth in athletes training hard, aiding
them to recover from both injury and the “planned trauma” of intense workouts.
There are several syndromes designated to body parts and to activities where muscle and
tendon become adversely affected due to excessive usage: tennis elbow (outside aspect of
the elbow joint), golfer’s and breaststroker’s elbow (inside aspect of the elbow joint),
jumper’s knees, breaststroker’s knees, bowler’s thumb, and swimmer’s shoulder—just to
name a few. These usually occur around and in the actual articular systems (joints) proper
which bear great force against which the athlete must propel himself. With the help of
these treatment strategies, you can minimize pain, spasms, and swelling to get through
“the first 48” and back in the game, with, hopefully, many happy returns.
Ed Nessel is a nationally known swimming coach with forty years experience coaching
age-group, high school, collegiate, and masters swimmers of every ilk, including Olympic
gold medalist Cullen Jones.
Tape on Skin Will Never Manage a Running Injury
By Bruce R. Wilk, PT, OCS
Every year I run many different races in cities all over the world. Over the past few years,
I’ve noticed a growing trend—runners covered with tape. I’ve seen tape in every color of
the rainbow, taped in every direction possible, but no matter what the color or style,
usually by the end of the race the tape is hanging off and the runner is limping across the
finish line. That is, if he or she even made it there. Taping represents one of the biggest
problems when it comes to the management of running injuries: the quick fix. People
want a fast cure with little to no work; hence, magical tape!
Even when used appropriately, taping is never meant to be a cure for any injury.
Specialized taping such as the McConnell and Kinesio taping techniques have been used
by physical therapists as an adjunct to other therapies for treating various conditions.
Often taping is used in conjunction with other treatments to enhance body awareness
training, maintain proper posture, and achieve optimal joint biomechanics during low
impact, low velocity activities. In this case, it’s not what the tape does, it’s about how it
reminds you of what you should be doing. That said, practicing conscious awareness of
your body will achieve the same result without the sticky mess. Unfortunately the
widespread misuse of therapeutic tapes has lead to the misconception that they are a cure
for any given running injury.
Tape manufacturers will claim that their tape pulls the skin away from muscles allowing
more circulation and blood flow, thus promoting healing. In reality, nothing causes more
vasodilation and blood flow than running. Why use tape for increased circulation when
this is a natural response to running anyway?
Another claim of tape manufacturers is that their special tape will support the muscle,
realign structures, distribute forces, etc. No matter what the color, size, or “special
materials,” it is still tape on the skin and it will never be able to control muscles during an
activity as powerful and dynamic as running. Once we begin actively moving and
sweating, the false sense of stability the tape initially provided is gone, the tape peels off,
and we are left with a decorative streamer trailing behind us.
Placebo medicine works very well for self-limiting problems, but it never works for an
ongoing problem like a running injury. Not only will tape not cure the injury, it could
make it worse. The tape provides a false sense of security and stability, and by running
with tape you could be doing more damage to your existing injury. Not to mention those
who wrap the tape so tightly around their leg that they create a tourniquet in order to run
through pain. The only way to properly manage a running injury is to address the injured
structure itself and fix the components of running that are distressed. This can be
achieved by seeking the help of a skilled, professional physical therapist with experience
treating running injuries. There is no quick fix, there is no secret cure, and there is no
magic tape. It is still tape on skin, and it will never manage a running injury!
Bruce Wilk is a board-certified physical therapist, a certified running coach, and director
of Orthopedic Rehabilitation Specialists in Miami, Florida.
Family Exercise and Diet: A Health Care Plan for the Long Term
By Jeff Venables
The recent passage of health care reform is seen by many as a good start toward
improving and protecting our national health. To some, the bill is fraught with conflicting
interests, in large part because it still works within a for-profit system. Our political
leaders spoke optimistically two years ago when they stressed the importance of non-
medical wellness strategies as a cornerstone of any health care reform bill, but by and
large it hasn’t happened. Long-term problem solving in the health care sector—such as
education about and subsidy for diet and exercise programs—is in its infancy, remaining
more or less out of reach.
In the April 5 issue of the New Yorker, Atul Gawande, MD, shows how sensible, low-
cost prevention techniques and non-medical treatments get ignored; they are not directly
medical interventions, and so there is little to gain for insurance companies, hospitals,
doctors, and other providers by offering them. It is arguable that until there is a not-for-
profit health care system, funding for these practical and effective strategies will always
be backburnered. Gawande writes, “The reform package emerged with a clear
recognition of what is driving costs up: a system that pays for the quantity of care rather
than the value of it.”
Meanwhile in Boston, clinicians at Children’s Hospital are helping children with asthma
with a bundle of preventive measures, including home inspections for mold, and
providing vacuum cleaners for families who lack them. Yet insurance would cover just
one: prescribing an inhaler. The hospital agreed to pay for the rest (most far cheaper than
medication). Here’s the problem: After a year, the hospital readmission rate for these
patients dropped by more than 80% —but an empty hospital bed is a revenue loss. Under
the current system, this sensible program could threaten to bankrupt the hospital!
In the March 31 NEJM, Molly Cooke, MD, explains further that new diagnostic and
therapeutic procedures account for two-thirds of the growth in health care expenditures.
Dr. Cook writes, “One might imagine that medical educators have attempted to
incorporate cost consciousness into their teaching, but such efforts have been remarkably
For now, it’s up to us to deploy preventive strategies and to see that our young people
adopt them. Private funding for youth wellness programs that focus on diet, exercise, and
health education is more important than ever. Everything else must occur at home.
Prevention Lies with Us
Active adolescents and teens are less likely to become sexually active or get pregnant.
They enjoy improved self-esteem, are less likely to initiate cigarette smoking,
and even experience greater academic success on average. What can you do to help
children eat right and stay active? Barbara Brehm, EdD, Associate Professor of Exercise
and Sport Studies at Smith College in Northampton, MA, offers several tips.
Children are creatures of habit. Once you establish new routines, like no television after
school, the routines run themselves. Dr. Brehm says, “Several studies have found a strong
link between television viewing time and obesity. Kids burn fewer calories watching
television than they do just sitting still! And commercials for food products urge viewers
to eat, and we all know people love to snack in front of the tube.” Restricting television to
certain hours and favorite shows is an important first step.
Then, Dr. Brehm suggests enjoying physical activity as a family on weekends. “Be active
yourself, and get out with your kids. Play soccer, run races, go sledding and skating,
bicycle, play games, go swimming. Take family walks and hikes. Help your child find
activities that are fun.”
Don’t Forget the Fun
In his thoughtful book Advances in Motivation in Sport and Exercise, Glyn C. Roberts,
PhD, writes that a child’s “personal agency beliefs” are a key component of fitness
motivation. Essentially, for motivation to stick, the child's evaluation of his capability
must result in the belief that the goal can be attained. The studies Roberts cites
overwhelmingly support the idea that a task-focused approach to performance evaluation,
as opposed to an egocentric one, is critical to a child’s long-term commitment to—and
enjoyment of—a sports activity. A child’s task focus evaluates performance based on
task completion, and not on how they perform compared to others.
The key is that a task-involved participant won’t see their current ability as particularly
relevant; the focus is on mastery, and therefore improvement. The child is more likely to
persist in the face of failure and to select challenging tasks. These behaviors foster
perceptions of competence and result in increased interest in the activity.
On the other hand, an ego-orientation can result in behaviors that ultimately undermine
achievement. With an ego approach, Roberts writes, “demonstrating ability with little
effort…is evidence of even higher ability. Thus the ego-involved person is inclined to use
the least amount of effort to realize the goal of action.” This sabotages prolonged effort.
If the child’s perception of ability is low, he avoids the challenge, does not persist in the
face of difficulty or drops out of the sport. Roberts wisely notes that these behaviors are
maladaptive for achievement, but adaptive to the participant because they disguise a lack
Take advantage of the fact that when they are young, both boys and girls find running
around and engaging in sports the most natural thing in the world. Later, being a member
of a sports team is a great way for children to become physically active and learn
important lessons about teamwork and discipline.
Though undoubtedly a team sport in many important ways, running may be the ideal
activity for encouraging a task focus by virtue of its often solitary training imperative.
According to ARA Clinic advisor Dr. Francis O'Connor's Textbook of Running Medicine,
The American Academy of Pediatrics has a simple approach to determining age-
appropriate distances in young runners: if the child enjoys it and is asymptomatic, there
are no limits on how far she can go.
Kids should be given a liberal warm-up and cool-down, with plenty of stretching. This
has as much to do with establishing a lifetime of good habits as it does injury prevention
in the pediatric population. Children should start at a low intensity for several weeks, and
progress at the often-quoted rate of 10% a week.
Children are not small adults and require special consideration. Their bones have growth
plates that contain a great deal of cartilage, which can make permanent, debilitating
injury a concern if they are overtrained. Psychologically, they need time to grow too.
Athletic parents should be wary of projecting the passions of a lifetime onto a child who
hasn’t had time to completely figure out his likes and dislikes. Jordan Metzl, MD,
medical director of The Sports Medicine Institute for Young Athletes, advises that we
always “let kids set the thermostat on how much they want to do.”
To facilitate good dietary choices, offer a variety of healthful foods at home. Modeling
healthful eating habits yourself is a powerful weapon against empty-calorie snacking. But
Dr. Brehm notes that admonishing children to eat less can backfire. “Food restriction
does not appear to offer a long-term solution to obesity,” Dr. Brehm says, “but can create
an unhealthy focus on dieting and body image, and can even lead to eating disorders.”
All in a Life’s Work
Perhaps no one has seen so clearly and so early on that diet and exercise are preventive
medicine than Kenneth Cooper, MD, MPH, founder and chairman of the Cooper
Aerobics Center and the Cooper Institute in Dallas. When Dr. Cooper published his book
Aerobics in 1968, the relationship between cardiovascular fitness and longevity was
poorly understood. That year, only about 100,000 people were jogging in America.
Runners now number more than 30 million nationwide.
Dr. Cooper has spent his career advocating a shift away from disease treatment and
toward disease prevention through aerobic exercise. His philosophy is that “it is easier to
maintain good health through proper exercise, diet, and emotional balance than to regain
it once it is lost.”
The Cooper Institute is responsible for over 600 peer-reviewed publications on the
management through diet and exercise of obesity, hypertension, and diabetes.
Dr. Cooper has spearheaded research on exercise’s role in everything from cardiovascular
disease prevention to cancer treatment and improved mental function.
In Texas, Dr. Cooper got physical education back in schools through the passage of
Senate Bill 530. Cooper also led the charge in eliminating trans fats from the Frito-Lay
snack line, and other companies have followed.
This year the American Beverage Association, an industry alliance of soft drink
companies, announced new School Beverage Guidelines, removing full-calorie sodas
from schools and replacing them with “a range of lower-calorie, nutritious, smaller-
portion choices.” The beverage industry currently reports a 95% reduction in shipments
of full-calorie soft drinks to schools. Due to juice and similar soda replacements, this
means an 88% decrease in total calories contained in all beverages shipped to schools
nationwide—a significant achievement for obesity prevention. You can learn more about
the soft drink industry’s efforts at www.ameribev.org.
And so the fight continues. For most people, the for-profit health care system will remain
expensive. In 1965, health care consumed just 6% of U.S. economic output; today, the
figure is 18%. Nearly all the gains that wage earners made over the past three decades
have gone to paying for health care.
The silver lining here is that following in the footsteps of Dr. Cooper and turning to
physical activity and diet as primary strategies makes more sense than ever. The link
between exercise and health over a lifespan has never been clearer. Good diet and regular
exercise still remain the two strategies available to everyone—and there is no better time
than now to deploy them.
Jeff Venables is the editor of Running & FitNews®. He currently runs 35 miles a week.
Can I Run Through Rehab?
I’ve been diagnosed with plantar fasciitis. I try to run 40 miles weekly, but that number
sometimes winds up being closer to 20. I’ve already been running in very well-cushioned
shoes. I get the pain after I’ve been running for about 15 miles, and it does stop when I
stop running. I am a female weighing 125 lbs. I’d love to fix this problem once and for
all, but mainly I want to know if there is a way I can continue running while still allowing
it to heal.
I suggest you decrease your mileage. The fact that the symptoms only begin after you’re
well into your long runs would seem to indicate that you could continue running, only
shorter distances. Essentially, the ligament running along the bottom of your foot from
your heel to the base of your toes has become overstretched or inflamed. This requires
that on your runs you stop before the symptoms begin. The injury will only progress
Pronation pulls on the plantar fascia so you might benefit from shoes that control motion;
you currently have shoes that absorb shock. An orthotic can help control pronation also,
so check with a podiatrist to determine whether that may help. It’s also important to
stretch your Achilles tendon both before and after your workouts. And don't be surprised
if the reduced mileage and motion control shoes still take six weeks to alleviate the
problem. Patience is often the hardest thing to hold onto when recovering from injury!
Gene S. Mirkin, DPM
This is the start of pool season and so I would encourage deep water running. The
buoyancy will allow you to run without too much stress on the fascia. In addition I
suggest adding a strength-building yoga class to your regimen.
Ben Pearl, DPM
Minimizing Rotator Cuff Pain During Presses
When I perform the military press during my regular weight training, I experience pain in
my shoulders. I have had arthroscopic surgery on one shoulder twice, due to an injury to
the rotator cuff 15 years ago. However, the pain from the military press is in both
shoulders. I am 46 and have been lifting weights since my early teens. As I have gotten
older, I’ve reduced the amount of weight I lift. Still, I would rather not give up the
military press, unless you know of a weight training exercise that would give me similar,
pain-free results to the same muscle group. I did notice that if I skip a week of weight
training, I can usually resume the routine pain-free.
Even though both were performed on just one shoulder, the two previous surgeries have
no doubt complicated your situation. And even a successful surgery will leave scar tissue
in the shoulder joint. Regardless of surgery, many people feel pain in their rotator cuff
when they lift their arms above their head, a phenomenon known as shoulder
impingement syndrome. The military press would certainly qualify as an exacerbating
You can take action on several fronts to help your condition. For starters, pay strict
attention to posture. Try to keep your shoulders from drooping forward throughout the
day. If you have not been performing seated rows or reverse flies, add them to your
routine. These are scapular retraction exercises, which should help. Eliminate movements
that aggravate your shoulders; though you should perform shoulder and chest stretches on
a daily basis, only stretch to a point that does not aggravate them. Replace bench presses
with incline bench presses, at least for the time being. In lieu of the military press, do
front, lateral, and posterior raises, again hopefully just for now.
Be sure to give it six to eight weeks. If after that your symptoms persist, you may need
more intensive therapeutic treatment and I suggest scheduling a visit with a sports
Doug Lentz, CSCS
The rotator cuff muscles provide the stability your shoulder needs to perform the
movements created by the prime movers of the joint. As you engage in a strengthening
program that includes shoulder presses, your larger shoulder muscles become stronger
and create a greater imbalance of strength between them and the rotator cuff muscles. To
continue with shoulder presses, you could try altering your range of motion, the angle at
which you press, and your hand position, any one of which may take the burden off the
shoulder that had the surgeries. You can accomplish this using dumbbells instead of a
machine, which has a fixed path of movement. As noted above, a regimen of rotator cuff
strengthening exercises should be added to your program. A visit to an orthopedist would
help you both receive a proper diagnosis and get more details on which exercises to add.
Greg Tymon, MEd, CSCS
East Stroudsburg, PA
Running After Brain Stem Stroke
I had a stroke several years ago and though I was very fit before it, about 45 minutes into
my runs now, I experience cramping in my foot and lose control of both the ankle and
foot. I do have some involuntary muscle problems, like balance issues, but generally not
muscle control issues. Any ideas on how I could prevent or reduce this occurrence? I am
44 years old and do not want to give up running.
Muscle spasticity during exercise is not uncommon in your situation, and may represent
blood flow problems triggered by the running. Most neurologists would probably caution
you about running, which is vigorous exercise, but as a runner I appreciate your
addiction. Before asking you to abandon the exercise, I advise you to take a treadmill
stress test—not to evaluate your heart, but your blood pressure, during running. If it is
aberrant, taking an appropriate medication might spare you complications and be helpful
to alleviate your symptoms.
Ron Lawrence, MD
Santa Barbara, CA
Painful Foot Growth
I’ve been a regular runner for over 20 years and a marathoner for the past 10. For the last
six weeks, I’ve had a pea-sized lump on the bottom of the arch of my foot. It’s tender to
the touch, and swells and becomes downright painful when I run or walk long distances.
My doctor believes it may be a ganglion cyst, and after a series of failed conservative
treatments (ice, stretching, night splint, orthotics) my doctor is now considering cortisone
injections or surgery. Is it true that ganglion cysts often recur? I hate to think I may not be
able to put this behind me and run regularly again. I also am still interested in running
long distances at this point in my life. What kinds of success rates—and recover times—
are there for the various treatment options here?
There are lesions in the skin and lesions under the skin. If your doctor diagnosed a
ganglion cyst, the growth must not be in the skin (like a wart). Of the under-the-skin
growths, a fibroma is a more likely diagnosis than a ganglion cyst. A fluid-filled cyst
(ganglion) is rarely painful. You ought to have a diagnostic ultrasound to identify for
certain which type of lesion it is, how big it is, and where it is attached before you can
begin to assess treatment options or get discouraged about time before a return to
running. If the growth is solid and painful, surgical removal is usually very successful
and has minimal disability.
David M. Davidson, DPM
Lesions under the skin include plantar fibroma, inclusion cyst, or ganglion cyst. If the
lump is under the inside of your arch along the plantar fascia, it probably is a plantar
fibroma, the most common lump we see on the bottom of the foot. It develops as a
fibrous little growth and is relatively dense in consistency, whereas a ganglion cyst
develops as a fluid filled sac and is usually softer and more mobile. It comes from the
lining of tendons and joints, and is less likely to be under your arch. The inclusion cyst
comes from something foreign under the skin, usually after a puncture wound. All of the
above are not cancerous and have trauma as a factor in their development.
The fibroma unfortunately may grow and does have a tendency to return. The majority of
them do not return, but the surgery could sideline you for several weeks. Injection of
steroid into the lump is a common and effective treatment for both the fibroma and
ganglion. I would recommend this as the first step. The injections will often soften the
fibroma, or make a fibroma or ganglion shrink. (An inclusion cyst would require
removal. Surgery would be simple and effective.) Surgery for the fibroma or ganglion is
usually effective, and I would not anticipate it would bring an end to your running career.
Richard A. Bronfman, DPM
Little Rock, AR
Boston Marathon and a fast finish.
Not since 1980 have so many runners broken 3 hours; that’s my official note after
talking to our noted Boston Marathon streaker S. Mark Courtney. There was a semi-
tailwind the entire route and temperatures were in the low 50s with no humidity. It
was a great day to run Boston, as evidenced by a smashing of the course record. But
that is not the entire story. Onto S Mark Courtney. Mark and I are the same age (54),
both run, and both have daughters. One big difference exists: Mark has now run 31
consecutive Boston Marathons and run them fast. In fact, Mark is the unofficial fastest
man in the past 31 years. No one has run 25 or more consecutive Boston Marathons
with a faster average time than our fastest medical professional Mark Courtney. His
average finish time for the past 31 years is between 2:45 and 2:49 (Mark has it down to
the second). This year he was trying to join an illustrious if not unknown elite group of
Boston Marathon veterans who can stake a claim to running 5 decades under 3 hours
(*One marathon finish each decade being a SUB-3 marathon). Log-in to Runners
World’s website and search for Amby Burfoot’s blog and you’ll read about Mark’s near
miss and gutty finish. As Mark puts it, he ran 2:60.18 this year. Not 3:00.18 as one
would expect to see it recorded. As we told him, he’s got 8 more years to join a select
group (under 10 as of 2010). He is determined to keep another streak alive.
As for the race weekend, our 39th year of hosting a Sports Medicine Symposium brought
out more insight into cardiac health and marathon running. Leading researchers and
sports medicine experts joined in to discuss recent deaths in the marathon and half
marathon. Several race medical directors acknowledged that statistics are not
uniformly kept from all road races in the U.S.; yet complied data from several marathons
put the rate of death at a marathon between 1 in 50,000 and 1 in 100,000. Our medical
group was inspired by the talks of several M.D.s, notably Dr Walter Bortz. He is the
carrier of the flame to “Dare to LIVE to 100”. Dr Bortz lecture was captivating and
motivating. His vision of what it takes to keep one going in later life is simple advice for
all Americans. I especially locked into his comment that the most important part of the
human body to maintain and use daily. Not the brain nor the heart but the “legs”. It
makes perfect sense. If we don’t move our legs by walking or running and ultimately
become immobile, statistics show that the brain and heart slow down and deteriorate.
Here is one more reason to get more youth and adults moving on their feet: you can
live a longer and healthier life.
Boston’s winners were outstanding. The men’s winner crushed the course record as he
skipped over the 2:06 barrier and lowered the course best time to 2:05.52 As
mentioned earlier, many runners broke 3 hours this year. Unofficially, I noted over
1300 runners less than 3 hours.
ELECTRICITY SURGE in Philadelphia at the PENN RELAYS
Coming back to America was almost a homecoming for Jamaican Usain Bolt. As a high
schooler the current world record holder in the 100 and 200 meter races ran in 3 PENN
RELAYS. He knew that the crowds filled equally for Jamaican and U.S. runners. To
some track followers, Usain Bolt’s decision to compete at the PENN RELAYS it the
4x100m Relay for Team Jamaica was a welcome surprise. Since his emergence as a
world record holder and Olympic Gold Medalist and global superstar, Bolt’s appeal and
recognition is beyond reach. Most track fans figured that his appearance fees would far
outstrip the funds available for this year’s Penn Relays. One factor was forgotten.
Usain Bolt is a showman and he knew that no other track meet in the world outside the
Olympic Games Finals had more impassioned fans.
On this particular Saturday afternoon in Franklin Field on the University of Pennsylvania
campus Usain Bolt owned the crowd like the Beatles did when they emerged from a
jetliner in 1964 in New York City. Girls swooned and screamed. Cameras clicked and
Jamaican flags waved. It was deafening and the race was an hour away. Bolt was just
arriving onto the track infield to do some light striders pre-race. When it came time to
bring out the USA and other World 4x100m teams, the screams and chants grew louder.
The PA announcer finally stepped in and asked the crowd to be quiet for the start, so
the competitors could hear the gun. He said, “then you can cheer loudly”. All we
officially saw of Bolt running took 8.79 seconds. Smartly, Penn officials had placed an
electric timing device at the start point of the final 100m relay leg to time the anchor leg
for Usain Bolt. 8.79 seconds. It is not an official 100m time, as each relay runner after
the first leg gets a running start. Bolt kept running past the finish and did his own
victory lap on the track, something not permitted for other events. Real track fans
settled back into their seats. The screams were gone and the hysteria had subsided.
There were more intense track relays’ finals to watch.
Seen while running….this spring
Barefoot or “minimalist shoes” are not going away. I ran into my first urban “Five toes
shoes” runner in Boston. As I was headed out for a run over to the trails along the
Charles River, a guy emerges from the hotel elevator wearing the VIBRAMS’ 5 toes’
shoes. I asked him if the shoes were new and he said yes; this was his first foray into a
city sidewalk or asphalt run with the nearly barefoot-looking shoes. In this past
Sunday’s Washington Post Magazine section that focused on getting fit, a personal
trainer at the Mandarin Oriental Hotel talked about running in the VIBRAMS to
strengthen his feet. His comment: traditional running shoes only strengthen you from
the ankle up.
Running into your 80s: Our friend and gerontologist Walter Bortz, MD turned 80
earlier this year and kept his annual marathon streak alive by running the Boston
Marathon in his 8th decade. He ran into a little trouble with a back spasm, but he
finished and is in high spirits for more in the decade to come. His wife Ruth Ann plans
on running Boston in 2011, as she turns 80. She is a notable age group runner and was
the 60-69 female age group winner nearly 20 years ago with a speedy 3:45 finish.
Race Timing moves towards all-disposable chips, tabs or racing Bib stick-ons: if
runners have noticed, many of the competing race timing companies are now leasing or
buying the timing devices that can be recycled or disposed. Many of us get confused by
the brand names. Most runners have now gotten used to lacing or affixing a “chip” to
your running shoes and then removing the “chip” after the race finish and turning it in.
There was always that threat of a $35 charge if you kept the chip. Many runners started
buying their chip about 10 years ago. The 2010 decade will see a full shift to timing
devices that are affixed to your running bib or even a race shirt. The chip or tag that is
currently tied or laced to running shoes will not completely go away. They will continue
the shift to the lower cost disposable chip. The Boston Marathon’s 5K race tested out a
company’s version of the strips attached to the traditional bib number. According to a
BAA release, the timing of the 5K went flawlessly. It will not be long before multiple
timing or race recording manufacturers offer this system to all race organizers.
IPads and medical treatment. Apple® launched its newest device the IPad in the
weeks prior to the Boston Marathon. One published report mentioned that the IPad
could revolutionize bedside treatment and rounds by physicians. The top-flight graphic
capability and web connectivity could make it the device of choice for physicians and
other allied health pros that need to check X-Rays or MRIs. Could we see IPads with
web connections along marathon courses? AED devices are now present at most major
road races and have been critical in saving some recent cases of sudden collapsed
runners. The IPad could assist EMTs and first-scene responders.
The Spring is the time to unwind and run…. RUNNING THE MILE is our rallying cry this
week, so take your friend or family out for a MILE RUN on us and enjoy the run…