Run Well

by Juliet McGrattan

  Q My dad had a heart attack when he was 50. Does this mean I shouldn’t run in case it happens to me?

  A Your family’s health can have a direct impact on yours, both through the genes that are passed on and through the living environments you share. The fact your dad had a heart attack doesn’t mean it will definitely happen to you, but it does increase your risk. Immediate family, such as your parents and siblings, are called first degree relatives and their medical history has the biggest influence on yours. Because your dad had his heart attack when he was less than 55 years old (it would be less than 65 if it was your mum), then you are classed as having a strong family history of heart disease and we know this puts you at increased risk.

  You can’t change your genetics, but you can change your environment through making healthy lifestyle choices. Family history is only one risk factor for heart disease. Others include smoking, type 2 diabetes, high blood pressure, high cholesterol and being inactive or overweight. Remember that regular exercise such as running is a very powerful tool for reducing all of these risk factors.

  Your family history certainly doesn’t mean that you shouldn’t run, but it would be sensible for you to take some steps to have your personal risk formally assessed. If you are aged between 40 and 74 then you can have this done during an NHS health check at your local GP practice. Your blood pressure, weight, blood cholesterol and blood sugar will be checked to help identify risk factors that need treatment, and you will be given lots of advice. If you have never run before, due to your strong family history, I suggest a check before you begin. However, if you are already running regularly then don’t stop, but make a routine appointment.

  Q Why do some people die suddenly in marathons? What are the risks?

  A A death during a marathon is always tragic, but be reassured that it is rare. The New England Journal of Medicine published a study in 2012 assessing cardiac arrests during marathons and half marathons in the USA between 2000 and 2010. In the races studied there were 10.9 million runners and 59 cardiac arrests, 42 of which were fatal. This means that approximately one person in 260,000 died from a cardiac arrest in the population studied. According to a table of everyday risks in the British Journal of Medicine, we have a one in 250,000 risk of being hit in our own home by a crashing aeroplane. There were more cardiac arrests in the marathons than the half marathons and more in men than women. Most of the cardiac arrests were due to cardiovascular disease (more common in the older runners) and to hypertrophic cardiomyopathy (HOCM). This is an inherited condition where the heart wall becomes thickened. There are often symptoms of breathlessness, palpitations and chest pain, but it’s a common cause of sudden cardiac death in those under 35 years old. If a diagnosis of HOCM is made, then genetic testing and screening may be offered to close relatives. Some sporting organisations screen their young athletes for HOCM. Remember that not all cardiac conditions that cause sudden death can be detected.

  A narrative review of the literature, including the study above, was published in a journal called BMJ Open in 2019. It looked at deaths during or within 24 hours of completing a marathon (no other race distances were included). This found the risk of death to be approximately one per 102,000 in men and one per 244,000 in women. The conclusion was that the risk of death from participating in a marathon is small, higher for men and greatest in the final few miles of the race.

  TRY THIS

  AT HOME

  First aid

  Consider going on a first aid course to learn basic life support. A few hours of your time could save a life in the future. Find a course near you and book a place. St John’s Ambulance runs first aid courses up and down the country.

  Q What should I do if the runner in front of me during a race collapses?

  A Stay calm and follow these basic life support steps:

  1 Check it’s safe. Look after yourself first. Don’t trip yourself or others up in a bid to reach the casualty.

  2 Call for help. Shout to other runners or a nearby marshal to help you.

  3 Talk to the runner. Perhaps they’ve just gone down with a severe leg cramp rather than a cardiac arrest. If they can talk and tell you what’s going on, then you can assist them to get the help they need. If they’re talking but delirious and not making sense, then lie them on their side in the recovery position. Keep talking to them while you summon medical help. Ask them if they have any medical conditions and check the back of their running bib or any medical alert jewellery (bracelets, shoe tags or necklaces) for this information too.

  4 Check for breathing. If they aren’t responding when you talk loudly and directly to their face while gently shaking them, then they are unconscious and this is an emergency. You need to see if they are breathing normally, so roll them onto their back and open their airway by gently tipping their head back with one hand and lifting their chin with the other. Now LOOK, LISTEN and FEEL for signs of breathing for up to 10 seconds. If they are breathing normally, then put them in the recovery position and keep checking them while you call and wait for the paramedics.

  5 If they aren’t breathing normally. If they are unconscious and not breathing normally, then there are three things that need to happen:

  • You need to dial 999 and state that the casualty is not breathing.

  • You need to locate an AED (Automated External Defibrillator). The emergency services call handler will tell you where one is located if you don’t know. Race marshals may be able to radio to base to summon one.

  • You need to start chest compressions.

  If you are on your own, then carry out these steps in this order. Defibrillation is the priority. If you have people around you that can help, then all three can happen simultaneously. You can tell someone to call an ambulance and another to get an AED while you commence chest compressions. Put your phone on speaker mode and the emergency call handler will talk you through it.

  There may be someone at hand who is experienced in resuscitation, in which case let them take the lead. Chest compressions (at a rate of 100 to 120 per minute) are more important than rescue breaths, but if you feel able and comfortable to give rescue breaths then briefly stop chest compressions every 30 compressions to give two breaths.

  Remember CPR (cardiopulmonary resuscitation) is tiring and you may already be exhausted from your running, so swap and take turns with others to maintain the quality of the chest compressions.

  Just do your best – it’s better than no CPR at all. If the AED arrives before the paramedics, then use it by following the instructions on the package and the verbal instructions when you turn it on. AEDs will only shock if necessary, so don’t be afraid to use one. They save lives.

  Continue until the ambulance arrives. If the casualty starts breathing again in the meantime, then put them in the recovery position.

  Did you know?

  A shock from a defibrillator within one minute of collapse gives a 90 per cent chance of survival. For every minute after that, the chance reduces by 7 to 10 per cent. Speed is of the essence.

  Q I run a lot of marathons and ultras. Will this ­damage my heart in the long term?

  A Running is definitely good for your heart, but there is probably a point at which too much running can cause harm. What that exact tipping point is, however, is unknown and most certainly different for each individual. The effect endurance exercise will have on our body depends on many variables, including our gender, race, age, training methods and our body’s DNA.

  We know that athletes’ hearts can look different to non-athletes’. Vigorous and repetitive training induces changes called cardiac remodelling. The chambers of the heart can become enlarged due to the sustained high volumes of blood passing through them. There are similar changes evident in life-threatening cardiac disorders, but there’s no evidence that the changes are harmful in athletes. Interestingly, there may be less cardiac remodelling in women, but there’s not enough evidence to confirm that yet. As more and more women are participating in endurance
sports there is certainly more research to come.

  One of the other changes that is seen in the hearts of endurance athletes is myocardial fibrosis. This is patchy scarring in the heart muscle, but its significance is unclear. A study of 12 life-long, veteran, male endurance athletes was carried out in 2011. When their hearts were compared to non-athletes of the same age and to younger endurance athletes too, 50 per cent of the veteran athletes were found to have some degree of myocardial fibrosis. There was none in the non-athletes or younger men. This suggests a link between life-long endurance exercise and myocardial fibrosis, but the endurance athletes were all fit and well with no cardiac symptoms, so perhaps the changes are harmless. It has been suggested that myocardial fibrosis is a cause of atrial fibrillation (AF). This is the most common cause of a persistently irregular pulse and it requires medical treatment, because it is associated with an increased risk of stroke. In AF, the electrical activity which triggers the cardiac muscle of the atria to contract becomes uncoordinated. Rather than having one distinct squeeze, the atria quivers and fibrillates, which makes it inefficient at pumping blood to the ventricle.

  A review published in the British Journal of Sports Medicine examined nearly 50 years of medical literature and confirmed that endurance athletes, particularly older ones, have an increased risk of AF. There were many suggested causes for this. Studies to date have focused on long-term endurance athletes, but there may be a completely different story for the average recreational athlete who does intermittent endurance events.

  Top tips for a healthy runner’s heart

  • Don’t smoke.

  • Exercise regularly. Aim for at least 150 minutes of moderate intensity activity per week. Running counts as vigorous activity, so only 75 minutes per week is required.

  • Maintain a normal weight.

  • Eat a healthy, varied diet full of fresh vegetables and oily fish, and avoid excess salt.

  • Get your blood pressure checked at least every five years (unless you have hypertension or other medical conditions that require more frequent checks).

  • Prioritise recovery on your training plan.

  • Reduce your stress levels.

  • Reduce sedentary time – move frequently and don’t rely on running as your only exercise.

  • Don’t race with a viral illness.

  • Listen to your body.

  FURTHER HELP AND ADVICE

  NICE guidelines: www.nice.org.uk

  British Heart Foundation: www.bhf.org.uk

  Scleroderma and Raynaud’s UK: www.sruk.co.uk

  Giving blood: www.blood.co.uk

  NHS What’s your heart age?: www.nhs.uk

  First aid advice and courses – St John’s Ambulance: www.sja.org.uk

  Resuscitation Council UK: www.resus.org.uk

  BDA: The Association of UK Dieticians: www.bda.uk.com

  Cardiac Risk in the Young: www.c-r-y.org.uk

  Chapter 3

  ......................

  The Respiratory System

  All runners know how it feels to be out of breath. Whether you’re a beginner taking your first running steps or an experienced runner tackling a tough hill repeats session, you know how difficult it is to keep going when your lungs feel as if they’re about to explode. Running is a great way to strengthen our lungs and increase our lung capacity, so in this chapter we’ll explore some of the lung issues that runners come up against. We’ll also take a look at problems affecting the nose and sinuses as these are part of the respiratory system too.

  The main function of the respiratory system is to bring oxygen into the body and take carbon dioxide and other waste gases out. There are approximately 1500 miles of airways in our lungs (this is the equivalent of flying from London to Moscow). The journey begins in the nose or mouth where air enters and flows into the trachea, commonly known as the windpipe. This then splits into the right and left main bronchi, which further divide and branch into smaller bronchi, then even smaller bronchioles, where gas transfer takes place in 300 to 500 million microscopic alveoli. It’s here in the alveoli where oxygen diffuses into the blood to re-oxygenate it and waste gases, including carbon dioxide, diffuse out. When you breathe out the waste gases are emptied from the body and water vapour is lost too, which is why you can see your breath when you exhale on a cold morning run.

  Our airways are lined with a special tissue called the respiratory epithelium. This tissue protects us from dirt particles and germs and keeps our airways moist and healthy. The four main types of cell making up this lining tissue are:

  • Ciliated cells These line the trachea and bronchi. Each cell has around 200 cilia (microscopic legs) on its surface, which it waves repeatedly to transport mucous up towards the mouth.

  • Goblet cells Shaped like a wine goblet, these cells produce mucous to trap dirt and germs.

  • Basal cells These small cells are the reserve bench, and can step up and change into any type of respiratory cell, depending on what is needed to keep the epithelium healthy.

  • Alveolar cells These are found in the lining of the alveoli and are specially designed for gas transfer.

  Surrounding the respiratory epithelium you’ll find loose connective tissue containing blood vessels, elastic fibres and smooth muscle. This smooth muscle is under the control of the parasympathetic nervous system, which means we can’t control its contraction or relaxation. Although not strictly part of the respiratory system, we need to acknowledge the ribs, which protect the lungs, and the chest muscles and diaphragm, which allow the lungs to expand and contract.

  The respiratory system is incredible. It ensures that we breathe clean air, deliver it to the bloodstream and get rid of waste products, all in the blink of an eye. As runners, we really put the system to the test and showcase its power, so it’s easy to see how a small issue in one part of the system can cause problems and upset the process.

  Did you know?

  The surface area of your lungs is approximately the size of a tennis court.

  Q Should I breathe through my nose or mouth when I run?

  A When you first start running you’re very aware of your breath, mostly because you can’t seem to catch it! As your fitness increases you can take slow runs while holding a good conversation and not actually think about your breathing at all. You probably don’t even know whether you nose- or mouth-breathe! Next time you’re out for a run, observe your breathing. Most of us mouth-breathe. There is much debate about the ‘right’ way to breathe when you run, with some running coaches saying you should breathe through your nose, others saying your mouth, and others saying a combination of in through your nose and out through your mouth is best.

  A small but interesting study tested 10 runners who had been nasal breathing while exercising for six months. They put them through a series of tests, first while breathing through their nose and then while mouth-only breathing. Runners generally complain that they can’t get enough air in if they try to breathe through their nose, but it is something that takes practice to master. The nose allows air to be warmed before it reaches the lungs and the mucous and hairs in the nasal passages filter out pathogens and particles, so potentially it’s beneficial to breathe in through your nose. The subjects in this study took in the same amount of oxygen during both nasal and mouth breathing, but when they were nose breathing, their breathing rate was slower and their breath more economical. It is certainly easier to relax while nose breathing as it forces you to breathe more slowly. Other studies, however, have pointed out that although breathing rate is slower while nasal breathing, the heart rate can be higher, putting stress on the body in a different way. Without clear evidence either way it seems that personal preference is best, but do familiarise yourself with diaphragmatic breathing (see here).

  Q Why does my nose run when I do?

  A This is a very common problem. A runny nose or rhinitis, to use its medical name, can be triggered by a number of things. Obviously, your nose runs if a virus, such a
s the common cold, irritates it, but the same thing can happen when it’s exposed to dust, pollen, pollution, chemicals or cold air. Sometimes a runny nose is triggered purely by exercise itself and this is called exercise-induced rhinitis. Nasal mucous does have its purpose, though. It’s not simply produced to annoy us! It protects us by stopping dirt, dust and germs entering our system as we breathe in rapidly during running. The slightly frustrating thing is that when you run, your body is trying to get as much oxygen as possible into your lungs, so your nostrils flare and nasal passages open up, allowing more air (and more irritant) in with every inhalation.

  Work out what your trigger is and then try to avoid or minimise your exposure to it. This might involve avoiding running beside queueing traffic, or covering your nose with a light scarf to warm the cold air before you breathe it in or to stop pollen reaching your nose.

  Make a trip to your local pharmacist – there is a range of products for rhinitis that can be bought over the counter. These include nasal sprays containing decongestants, antihistamines or corticosteroids. Oral (tablet or liquid) antihistamines are also useful. Your pharmacist will advise you which would be best for you. You could also try nasal irrigation, which means washing out your nasal passages with salty water. Again, the pharmacist can advise you on how to do this. Rhinitis that doesn’t improve with treatment or involves smelly or blood-stained nasal discharge (particularly from one side) should always be checked by a doctor. Some winter gloves have an absorbent pad for wiping away the snot or you can shove a tissue in your pocket, use your sleeve or master the ‘snot rocket’, but please check there isn’t anyone behind you!