Run Well

by Juliet McGrattan

  If you are struggling with balancing eating and training and think you may have RED-S, then it’s important that you seek help. Specialist input and advice is needed to diagnose and treat RED-S. Your next step should be to make an appointment with your GP who can refer you to a specialist clinic if required.

  Did you know?

  You can’t tell if someone has an eating disorder by looking at them. People who are underweight, overweight or of normal weight can all be affected. Never judge.

  Running and daily life

  Q I love running, but I’m generally just so tired all the time and don’t have enough energy for it. Should I go to the doctor?

  A Feeling tired all the time is one of the most common reasons people see their GP. It’s most definitely a sign of the times, with huge pressures and expectations being put on us from both society and ourselves. While there are medical conditions that cause fatigue, the diagnosis more often than not comes down to lifestyle. Being anaemic (having low numbers of red blood cells) and hypothyroidism (an underactive thyroid) are the two most common medical causes of fatigue, particularly in women. These can be diagnosed by a blood test so if you suspect that your fatigue may be down to more than just a hectic life or you have any of the following symptoms, then you should see your GP:

  • You’re passing more urine than normal or are constantly thirsty.

  • You’re losing or gaining weight without a change in your diet.

  • You have night sweats (and aren’t menopausal).

  • You have any lumps in your armpits, groin or neck.

  • You’ve had a change in your normal bowel habit or blood in your stools.

  • You’re more out of breath than usual.

  • You’ve been getting palpitations, dizzy spells or chest pains.

  • You have heavy periods.

  • You’re excessively tired every day and aren’t able to function normally.

  If there’s no underlying medical condition then it’s helpful to know that even if you don’t feel you have the energy for a run, it might be just the thing you need. Yes, sometimes a rest is best, but running can give you an energy boost. It may be that some time away from life, either solo or with running friends, will refresh you and give you a feeling of wellbeing. It’s also important to do what you can to ensure you’re sleeping as well as possible and eating high-quality foods in enough quantity to fuel your daily life and running. Stress is exhausting too. It may not be one overwhelming issue, just a long-term, low-level stress that is sapping your energy (see here). Trying to get the right balance in life isn’t always easy, but it’s essential to prioritise yourself sometimes.

  Q I know that running is supposed to help sleep. I run regularly, but I still can’t sleep.

  A People who exercise generally sleep better than those who don’t. But, we’re all different and insomnia is thought to be a problem for around one third of the UK population. It’s particularly difficult if you’re a shift worker or have children who can be little sleep thieves. With respect to running, if you exercise late in the day it might be worth changing the time you run. While some studies show that evening exercise doesn’t affect sleep, there are certainly people who find that the surge of adrenalin produced by high intensity exercise makes it hard for them to unwind and get off to sleep. Other things that you should avoid before bed are heavy meals (allow a couple of hours for digestion), looking at a screen (have at least an hour screen-free before sleep) and caffeine (it’s best not to have any after 4pm). Alcohol can also affect both the quality and quantity of your sleep.

  To try and help you sleep, make sure your bedroom is dark and cool; that it’s not cluttered with things that will make you think about all the things you need to do the next day; and that you’ve had a period of winding down doing something relaxing, such as a bath or reading. Relaxation is key – you need to quieten your thoughts. There are lots of relaxation apps you can try, including ones that play the sound of the sea or rain to act as white noise and help you drift off.

  Practise sleep hygiene, which means going to bed and getting up at the same time every day to get your body into a healthy rhythm and habit. Avoid napping in the day, even if the urge is strong! If you can’t sleep or you wake in the night and can’t get back to sleep, then try to stay calm. Worrying about not sleeping will make it worse. Lie quietly and do some relaxation. If half an hour has passed and you’re still not asleep, then get up. Don’t do what so many patients over the years told me they did – make a cup of tea! You need to avoid stimulation and caffeine, so do something you dislike and find boring, such as ironing. You don’t want to reward yourself. Return to bed after a while and repeat the relaxation techniques.

  Sleep disturbance is common and usually short-lived. It’s often related to life events, but it’s worth knowing that there may be a long lag between the event and the sleep issues. Having a longer-term sleep problem is dreadful and can have a huge impact on your life. There are sometimes other health conditions underlying poor sleep. The hormonal fluctuations around the time of the menopause (see here) can cause restless nights for women and an over-active bladder (see here) can mean many night-time wakings. Mood disorders and medication side-effects may also be to blame. See your doctor if this is the case. Remember too that it’s entirely normal to hardly sleep a wink before an important race!

  Did you know?

  Exercise is a powerful anti-ageing tool. As we get older, our telomeres (the little caps on the end of our chromosomes which protect the genetic material inside) shorten. Exercise has been shown to slow down the rate the telomeres shorten, so our DNA is protected for longer and we age more slowly.

  Q I hate running when it’s hot. I sweat so much and get tired really quickly. I’m running a marathon this summer. Do you have any tips?

  A Some of us tolerate running in the heat better than others. You’ll hear of runners heading off to the Marathon de Sables spending time running in a heat chamber to prepare their bodies. The most helpful thing is to practise so our bodies adapt, but as we don’t have long, reliably hot summers in the UK this is hard to achieve. Here are some things you can try to make your summer marathon easier:

  • Adjust your plan First up, be realistic. If the temperature is set to soar and hot running isn’t your thing, then don’t be over ambitious with your race goal. You will most likely have to slow down. It can be a risky business aiming for a PB in conditions that aren’t optimal for you.

  • Pick the right gear Light, breathable fabrics that you’ve practised in are best. Women are sometimes reluctant to run in shorts, but they’re a lot cooler than capris or tights. Vest tops will let your skin breathe more, but some people prefer a t-shirt to keep the sun off their shoulders.

  • Use cream and lube You’ll need sunscreen on any exposed skin. Avoid too much on your forehead because if it runs into your eyes it can sting. Use lubricant on areas that are prone to chafing, such as inner thighs (if you’re in shorts) and vest and bra strap areas. You’ll be glad of it when your clothes get wet with sweat and water.

  • Hats and glasses A cap with a brim to keep the sun off your face can be a lifesaver or use a visor if you prefer to leave the top of your head uncovered.

  • Start cool Precooling means lowering your core body temperature before you exercise and there is evidence that it can help performance in the heat. While applying cooling packs or sitting in cold water before a race isn’t practical, you can drink very cold drinks or ice slushies to cool you from the inside out.

  • Keep cool On hot days, races will often have shower sprays that you can run through or wet sponges and ice being handed out. Put some ice in your cap, and let it melt and slowly trickle down your neck for a couple of miles. You can put ice into your drink bottle too.

  • Drink to thirst You’ll need more fluids than you would on a cool day, but don’t put yourself at risk of hyponatraemia (low blood sodium levels) by over drinking (see here).

  Q I had to pull ou
t of a half marathon recently, ­because I got so hot. Someone said I probably had heat exhaustion. Is this the same as heat stroke?

  A Heat exhaustion can lead to heat stroke if it isn’t treated. Our body has a core temperature (around 37°C) at which all its systems can function normally. The body has numerous thermoregulation mechanisms that it employs to keep the temperature as stable as possible, such as sweating, faster breathing and dilating up blood vessels to take as much blood to the surface of the skin as possible. When you exercise, your core temperature increases. Your skin is vital to help get rid of excess heat, but if it’s a particularly hot day and your skin temperature rises too, then it becomes harder to shed heat.

  The first thing that might happen when your core temperature increases, but is still less than 40°C, is heat cramps. You might feel very thirsty, have a fast heart rate and your muscles will cramp, but you will otherwise be OK. Rest, cooling and rehydrating with an isotonic electrolyte drink may be all that is necessary. Next is heat exhaustion. Your core temperature is high, but still below 41°C. Your body is still trying to get rid of heat so you’ll probably be hot, flushed and sweaty with a fast heart rate, and you won’t feel well. Weakness, dizziness and a headache are common with heat exhaustion, but you may also feel sick, clumsy or irritable.

  The next stage is heatstroke, where the core temperature is at least 40.6°C and, frighteningly, the body’s mechanisms for shedding heat may have switched off. Confusion and poor co-ordination are prominent. Seizures may occur. Rather than feeling overheated you may feel cold and stop sweating (you are usually in a critical condition by this stage). Once the core temperature goes over 41.5°C then things are very serious, with many organs in the body at risk of failing, potentially leading to severe damage or even death. Heatstroke obviously needs to be urgently treated in hospital where steps will be taken to rapidly cool the person, and to monitor and support their organ function. Interestingly, although rapid cooling helps, the target temperature is 39°C, which is above normal body temperature. There’s the risk of a rebound temperature if it goes too low too quickly.

  The key is to avoid heat cramps and heat exhaustion. Follow the steps to running cool in the question above. Knowing how to treat heat exhaustion and prevent it progressing to heat stroke is vital, and potentially life-saving.

  TRY THIS

  AT HOME

  Treating heat exhaustion

  Treating heat exhaustion can stop it progressing to the serious condition of heatstroke. Here’s what to do to help someone with heat exhaustion:

  1 Move them to a cool place. Find somewhere out of the sun or a car with air conditioning.

  2 Lie them down and elevate their legs above the level of their heart.

  3 Give them fluids to drink – water, rehydration drinks, whatever is available, and if it’s cold then even better.

  4 Loosen clothing to let air circulate around them.

  5 Use cool water to sponge them down and fan them with whatever you have available. If you have access to cold packs, then you can put them on the soles of their feet and palms of their hands.

  6 If they aren’t feeling better within 30 minutes or they are confused and unwell then you need to dial 999 for an emergency ambulance.

  7 If they become unconscious while you’re waiting, put them in the recovery position and keep checking their breathing (see here).

  Q I’m a fair-weather runner. I hate being cold, but this year I have to run through the winter because I have a spring marathon. How can I keep warm?

  A Tempting though it is to head out in a down jacket, dressed for the Arctic, you’ll end up overheating. Running will make you warm, so dress for the second mile rather than the first. Check the outside temperature. It’s often warmer than you think and you’ll soon figure out how many layers you need for each temperature and wind chill. Base layers are really important for keeping your core temperature warm, so it’s worth investing in a really good one. On the coldest days, a woollen base such as merino wool will provide warmth, but also wick away sweat and dry quickly. Layers are great. They trap air which provides insulation. You can also take layers on and off, and tie them around your waist if you need to.

  Your body temperature may feel hotter and colder at different points on a long run, particularly if the weather changes or you find yourself running into the wind. Tops and jackets with long zips up the front mean you can unzip when you want to let air in to cool you down or zip up if you’re feeling chilly. Windproof jackets are a good idea too. Look for thermal running tights – some have a fleecy lining. These can make a big difference if you’re someone (like me) who ends up with freezing thighs and buttocks.

  For the coldest days, a hat with a thermal lining is a great addition to keep you toasty – a lot of heat is lost through your head. A light scarf stops the cold air going down your neck and you can cover your nose and mouth with it too. Having freezing cold fingers can be miserable so gloves are essential, particularly for those suffering with Raynaud’s disease (see here). Pre-warm your hat, scarf and gloves on the radiator.

  Don’t forget, though, as soon as you stop running, your body temperature will fall quickly. In combination with the wet sweat on you, you’ll soon feel really cold. Do a cool-down run and walk to bring your body temperature gradually back to normal. Make sure you have plenty of warm layers to put on if you’re away from home, and hop in a warm shower and have a hot drink as soon as you can. Don’t let the winter weather put you off. It’s a great time to be running. A spring running goal will keep you going out on the worst of days. You’ll soon get used to it, and find out what and how much you need to wear.

  Q I don’t have much time to go running, so I don’t usually bother warming up.

  A I think lots of runners are guilty of this and either skip a warm-up completely or just go a bit more slowly for their first mile. It is worth knowing what the benefits of warming up are so you can make up your own mind as to whether it’s something you want to make time for or not. While warming up won’t completely get rid of those ‘toxic ten minutes’ that you experience at the start of a run, it will introduce your body to the idea that it’s about to work hard, improve elasticity of connective tissues, elevate your heart rate and prepare the lungs for what’s to come. There’s a phenomenon called post activation potentiation which means that when you have asked a muscle to contract once, it will contract with a greater force the next time. So, if performance is important to you, then warming up is vital. A warm-up can be beneficial to joints too. Synovial fluid circulates in your joints to lubricate and cushion them, and this is stimulated by activity, so beginning gently and gradually building up intensity will allow time for this to happen.

  Something that you may be unaware of is how warming up benefits your nervous system. Taking time to fire up the pathways between your brain and your muscles and joints can help to lower your risk of injury. Activating muscles, sending feedback about joint position and fine-tuning co-ordination will reduce your risk of tripping and falling.

  Finally, don’t forget that warming up your mind is important too. Think about what you want to achieve, how far you have come and the tone you want to set for your run. You might need positive thoughts and imagery for a race, or deep breaths and thought blocking if you’re running away from a busy day. Either way a bit of time to focus your mind can help you get the most out of your run.

  Warm-ups don’t need to be complicated and you don’t have to do them before you go out or on the doorstep. Ten minutes to walk briskly and run slowly followed by some dynamic stretches is enough. You might find it’s ten minutes well spent.

  Did you know?

  Dynamic stretches are stretches that take a joint through its whole range of movement. They include arm and leg swings, hip rotations and trunk twists.

  Q I run three times a week. Is this enough to keep me healthy?

  A The Chief Medical Officers’ guidelines for physical activity state that 150 minutes of moderate intensity act
ivity or 75 minutes of vigorous intensity activity is the recommended amount for good health. Running is vigorous activity so three 25-minute runs a week will tick that box. However, you shouldn’t spend the rest of your week being inactive. Your three runs a week don’t cancel out the need to do anything else.

  The guidelines now have a new emphasis on muscle-strengthening activities, which should be done on at least two days a week. Running helps to build muscular endurance and strength, particularly in the legs. However, including a couple of specific muscle-building sessions a week will ensure that you maintain muscle and bone mass as you age. This can be done with simple exercises at home, using your own body weight to do exercises such as wall sits and press-ups. You can use resistance bands and weights too, but it’s important to use a good technique so a session with an instructor to advise you is a good idea to get you started.

  The other really important recommendation is to reduce your sedentary time. Too much time spent sitting is bad for your health, increasing the risks of many major diseases, such as heart disease, cancer and in particular type 2 diabetes. With prolonged sitting your body goes into storage mode, holding on to fat. This can be prevented by simply getting up and moving around for a couple of minutes every half an hour or so. Moving frequently also helps to reduce the inflammation in your body. Inflammation results from early cell death when unused energy is released as free radicals, which damage and destroy cells.