Run Well

by Juliet McGrattan

  Q I had my blood pressure measured at work and was told it’s high and I need to see my doctor. Can I carry on running?

  A The medical term for high blood pressure is hypertension, and regular exercise is crucial in preventing and treating it. Whether it’s safe for you to run right now depends on how high your blood pressure (BP) is.

  A BP measurement is made up of two numbers, for example 120/70. The first number is called the systolic value and reflects the maximum pressure in your circulatory system when your heart is beating. The second number is the diastolic value and represents the lowest pressure when your heart is resting between beats. Blood pressure is measured in mmHg (millimetres of mercury), even though mercury is no longer used in blood pressure machines. When you see your doctor or nurse, if your BP is 140/90 or above, then you will need further tests to confirm the diagnosis of hypertension. The NICE guidelines from 2019 advise that this is done by ambulatory blood pressure monitoring (ABPM), which means wearing a machine which checks BP at least twice per hour during a normal day. BP can be falsely high in a medical clinic (some people get stressed out by the white coats!) and often the ABPM shows that your BP is normal in your everyday life. If your clinic BP is 140/90 or above and your ABPM is an average of 135/85 or higher, then you have hypertension, and need further tests and assessment. If your clinic BP is 180/120 or higher, then you need urgent assessment and possibly an immediate specialist opinion.

  Regular exercise can reduce BP by 5 to 7mmHg. When you stop exercising, BP drops to a little below its normal pressure and can remain there for 24 hours, so regular and frequent exercise is ideal to keep BP down. However, during exercise, your systolic BP initially goes up as the heart pumps harder, so if you already have a high and uncontrolled BP, then pushing it even higher with vigorous exercise, such as running, can potentially be harmful. The safest thing to do in your situation would be to avoid running until you have seen your doctor. Once your doctor has assessed you and determined whether you do indeed have hypertension, then they can advise you about the safety of running. If you have significant hypertension, then they may suggest waiting until it is under control with medication before returning to running. You can drop to low or moderate intensity exercise such as regular brisk walking in the meantime.

  Did you know?

  Your heart beats approximately 115,000 times a day, 42 million times a year and 3 billion times in your lifetime.

  Q I often feel faint straight after a long run and have to sit down. Is this normal?

  A This frequently happens to runners, especially when they stop abruptly at the finish line after a long-distance race. When muscles are working hard during a run they need an increased blood flow to supply them with extra oxygen and to take away the waste products they create. When you stop running suddenly, that increased blood volume can pool in your legs, making blood pressure drop. Low blood pressure is called hypotension and it leaves you feeling light-headed, dizzy and at risk of fainting. If this happens to you, then lie down immediately (where it’s safe to do so) and raise your legs above the level of your heart. Alternatively, you can crouch or sit down with your head between your knees. Have a drink – preferably a rehydration sports drink containing electrolytes and carbohydrates in case dehydration and low sugar levels are adding to your faintness. Allow yourself at least 10 minutes to recover and then get up slowly, moving to sitting before you stand as you may find your blood pressure falls again on being upright. To avoid this situation, make sure you don’t stop running abruptly. Keep moving when you cross the finish line. Have a warm-down jog or a brisk walk for five to 10 minutes to allow your body to slowly adjust to the reduced demands on it.

  Q I’ve been getting a few palpitations from time to time. Is it dangerous for me to run?

  A The term palpitations is used to describe a sensation that your heart is beating stronger, louder or faster than normal or that it seems to be missing beats or jumping around irregularly. The first thing to determine is whether your palpitations are harmful or not. Palpitations are common, usually harmless and tend to resolve with lifestyle changes such as reducing caffeine, alcohol and stress.

  Feeling excited, anxious or scared can cause your heart to thump rapidly in your chest. This can feel unpleasant, but isn’t harmful. If your heart seems to be missing a beat, then this may be harmless too. When the heart’s electrical activity gets briefly out of sync a beat can come a little early and then there’s a pause before the next one. These are called ectopic beats and are common.

  However, there are several warning signs that might indicate your palpitations are more serious. If you experience chest pain or tightness, are very short of breath or faint with your palpitations, then this is a medical emergency and you need to dial 999 for an ambulance. Palpitations that are triggered by exercise or make you feel nauseated, dizzy or out of breath need to be urgently investigated to check for an underlying cause.

  If you don’t have any other symptoms but your palpitations are happening on most days, last longer than a few minutes or your pulse is jumping around in an irregular rhythm (whether it’s fast or slow), then you need to see a doctor for investigations. Unless your doctor is confident that these are ‘benign’ palpitations, they will arrange for you to have some blood tests, an ECG (heart tracing) and possibly an ECG which you wear for 24 to 72 hours. The medical causes of palpitations are numerous and include abnormal heart rhythms such as atrial fibrillation (see here), heart block, underlying heart disease, anaemia, an overactive thyroid and hormonal changes such as the menopause.

  If there are no warning signs with your palpitations and they don’t occur when you’re exercising, then going for a run is unlikely to be dangerous. If you have any concerns or other symptoms, then hold off the running until you have been assessed.

  Did you know?

  The heart has three layers:

  Endocardium – the inner lining

  Myocardium – the muscle layer

  Pericardium – the outer lining

  Q How do I know if the pain in my chest is coming from my heart?

  A It can be impossible to tell. Typical heart pain is a pain felt in the centre of the chest. It’s often described as a dull pain, like a heavy pressure on the chest or a tight band around it. There might be associated symptoms such as pallor, nausea, sweating or palpitations. Pains that originate from the lungs are usually sharper, worse on breathing in or coughing, and cause more shortness of breath. However, and this is important, we don’t all conform to text book descriptions. Heart pain may present in different ways, particularly in women.

  Heart pain happens when the cardiac muscle isn’t getting adequate blood supply, so it’s more likely to happen when you are stressing the heart with exercise. Any chest pain that comes on when you are exerting yourself should be checked by a doctor. If the pain is sudden, severe, spreading to your arms, neck or jaw and not easing after 15 minutes, then it could be a heart attack and you should dial 999. There are many other causes of chest pain, such as indigestion, anxiety and muscular pain, but it’s always best to have heart pain excluded, so make an appointment with your doctor if you are concerned.

  Real-life runners

  I was trying to slowly increase my running, but I kept getting central chest pain. The coach at my running club advised me to get it checked out by my GP. I was subsequently diagnosed with a very rare heart condition that I’d been born with. Just over a year after my open heart surgery, I ran in my first ever 5km race, having slowly regained my fitness through rehabilitation and running.

  Lisa Huddleston, mum, nurse and farmer

  Q I get really cold, white fingers when I run in the winter. My gran says it’s bad circulation.

  A Your gran is partly right. This sounds like Raynaud’s Disease. There is plenty of blood reaching your hands, so there is nothing wrong with your circulation per se, but what happens in Raynaud’s is that the tiny blood vessels in your fingers constrict and spasm in response to the cold, reducing blo
od flow. This can happen to toes, ears and noses too. It can be very frustrating for runners, especially during the winter months, because as well as turning white and blue, fingers can go numb, making pressing sports watch buttons or retying shoe laces really tricky. It can also be painful when the blood returns to the fingers as they warm up again. The best bet is to try to stop your hands getting cold in the first place with insulated gloves, glove liners and warmers, and making sure your whole body is warm.

  Q Can I exercise with varicose veins?

  A Varicose veins are swollen veins near the surface of the skin. They can be straight or wiggly, narrow or wide and are dark blue in colour. They may not cause any symptoms at all but sometimes they can ache, throb, itch or even bleed. Varicose veins develop when blood backs up in a vein. This usually happen when the valves inside the vein, which are designed to prevent back-flow of blood, become weak. Valves weaken with age but being overweight or spending lots of time on your feet increases your risk too. The changing female hormones during pregnancy and the menopause cause relaxation of the vein walls which can make them swell. There’s often a genetic link too so you might be able to blame your parents for your varicose veins.

  Exercise helps to reduce the chance of developing varicose veins and you shouldn’t stop exercising if you develop them. Regular exercise is an important part of treatment. It works the lower leg muscles which act as a pump, pushing blood back up the veins to the heart. If your legs ache or your varicose veins are more swollen, painful or tender after exercise then it’s a sign you have done too much. Elevate your legs for half an hour to ease any discomfort. Off-road running can be more comfortable than high-impact road running. There’s little evidence that low grade sports compression socks will stop varicose veins getting any worse but they may make you feel more comfortable. If you knock a delicate vein it may bleed. Don’t be alarmed. Elevate your leg and press firmly over the bleeding point with a clean cloth. If the bleeding doesn’t seem to be reducing after a few minutes then seek medical help.

  Q I gave blood yesterday. Can I run today?

  A It’s best to wait 24 hours after donating. You can then run if you feel OK, but do bear in mind that you have donated just under a pint of blood, which is 10 per cent of your total blood volume. The body quickly tops up the plasma (fluid) in your bloodstream to maintain your blood pressure, but the red blood cells, which are required to transport oxygen around the body, can take six to 12 weeks to return to normal levels. Try a short, easy run and see how you go. If you feel weak, light-headed or out of breath, then take a few days’ rest, drink plenty of fluids and eat iron-rich foods to help red blood cell formation. Remember that your performance will be affected for two to three weeks after you’ve given blood, so plan your donations during the recovery time after a race rather than in the weeks before. It’s also useful to know that the blood service ask that you don’t do strenuous exercise just before you donate. This is to ensure you are well hydrated and rested to prevent light headedness during donation and help you recover more quickly afterwards.

  Real-life runners

  I gave my 30th blood donation and decided that the half marathon three days later would be OK if I just went steady. The wheels came off at nine miles into the Conwy Half Marathon. My energy drained away totally. I found myself jogging slowly back, being passed by all my club mates, who looked puzzled as to why I was so much slower than usual. The last four miles seemed to take about a week to cover...

  Graeme, UKA group leader, co-founder of Crewe parkrun

  Did you know?

  It’s the haemoglobin in red blood cells that gives them their red colour. Normal levels for a male are 130-180g/L and 115-165g/L for a female.

  Q I’ve heard running can give you low iron levels. Should all runners take iron supplements?

  A Iron is essential for the high demands of running. It’s not uncommon for athletes to be deficient in iron, which can have a negative effect on performance. You would assume, therefore, that all runners should take iron. There are situations where iron supplements are a good idea, but there are others where this may be harmful. If we explore the theory behind it, things become clearer.

  Iron is required to make haemoglobin, the component of the red blood cell which carries oxygen around the body. Red blood cells are made in the bone marrow. Each red cell survives about 100 days, so new ones are constantly being produced. When red blood cell numbers drop below a certain level, then a person is said to be anaemic. You can become anaemic for two reasons: either you aren’t making enough red blood cells or the red blood cells are being used up too quickly. Thankfully conditions of the bone marrow, where red cell production occurs, are rare. You’re more likely to be anaemic due to a shortage of the ingredients for making red blood cells and the most common cause of anaemia in the UK is iron deficiency. Either your diet is low in iron or your body is not absorbing iron from foods, which can happen in conditions such as coeliac disease or inflammatory bowel disease.

  If red cell production is normal, then losing blood cells more quickly than they are being made is the second explanation for anaemia. An obvious example of this is a heavy monthly period in a menstruating woman. This is a situation when taking an iron supplement is a good idea. Blood loss, however, can sometimes be subtle or silent. Blood lost in faeces or urine is a sign of potential bowel or bladder cancer and needs to be investigated. Taking an iron supplement in this situation could potentially mask the symptoms and signs of cancer, and lead to a late diagnosis.

  Training intensively in any sport can put you at risk of anaemia. Whether running reduces red blood cell levels more than other sports is a little controversial. The mechanism by which it might do this is also unclear as there are conflicting studies. There is a concept called foot-strike haemolysis, where red blood cells are thought to be destroyed by being squashed when the foot hits the ground. A small study of ten male triathletes in 2003 compared the amount of red blood cell damage during one hour of cycling and running. While both activities caused some exercise-induced haemolysis, there was more haemolysis in the runners. The conclusion being that the impact from foot-strike was the major contributor to the breakdown of red blood cells during running. In contrast, a study of 18 male endurance runners after a 60-kilometre ultramarathon in 2012 didn’t show significant changes in red blood cells and haemoglobin, and concluded that foot-strike haemolysis was not an important contributing factor for anaemia in athletes.

  Certainly, with the high demands of regular running, your body needs a great diet to supply all the building blocks to repair and strengthen it, and if your dietary iron is insufficient then you may run yourself into trouble. Generally speaking, with a good diet there is no need for runners to take iron supplements, although if you’re a menstruating woman you might choose to do so. Symptoms of anaemia include feeling tired, being out of breath on exertion and having a rapid pulse. Headaches, dizziness and looking very pale are common too. If you think you might be anaemic, or have any bowel or bladder symptoms, then don’t just reach for the iron tablets. See your doctor first for investigation of the cause.

  TRY THIS

  AT HOME

  Diet tips for boosting iron

  Whether you’re deficient in iron or not, as a runner it’s a good idea to make sure your diet is packed with iron. Here are some simple things you can do to boost your dietary iron:

  • Drink a glass of orange juice with your iron-rich foods – the Vitamin C it contains helps with iron absorption.

  • Snack on dried apricots, nuts and seeds.

  • Remember eggs! Hard-boiled eggs can be left in their shell in the fridge for around a week – perfect for a snack or a packed lunch.

  • Eat lots of leafy green vegetables. Throw a handful of spinach leaves into your salad, omelette or pasta or serve broccoli or kale with your main meal.

  • Don’t forget seafood and fish. We know that red meat contains lots of iron, but so do shellfish such as mussels, clams and oysters. Ti
nned sardines or tuna are an easy option.

  • Chickpeas are your friend. Full of iron and used straight from the tin, you can throw them in salads, soups, curries and casseroles.

  • Garnish excessively! Topping your meal with a large pile of fresh coriander, parsley or watercress adds flavour and also iron.

  • Look for breakfast cereals fortified with iron.

  • Cut back on tea and don’t drink it with your food, because the tannin it contains inhibits iron absorption.

  Q My doctor says I’m anaemic and has given me iron tablets, but said it would take a few months for my iron levels to become normal. Can I run or do I need to wait?

  A You may become anaemic so gradually that you don’t notice any effect on your ability to exercise. However, being anaemic can make you feel tired, out of breath and light-headed. Your heart rate is also likely to be increased as the body is pumping what red cells it has around the body as fast as possible. This obviously makes running difficult and your performance level can drop significantly. It’s a classic example of a situation where it’s best to listen to your body. Be guided by how you feel. If you’re struggling with your breathing, or feeling exhausted or dizzy when you exercise, then you should cut back to something gentler or rest for a while. It can take several weeks for your iron levels to return to normal, so be patient and don’t book any races or tough training sessions during this time. Your doctor will probably suggest that you continue the iron tablets for several weeks after your blood levels are normal, to build up your body’s iron stores. Read the answer about iron supplements and remember to increase the iron in your diet too by following the diet tips.