Run for Your Life

by Mark Cucuzzella

  A choice few who are very accomplished at fat burning can be a bit more liberal—with caution—and work out at a maximum aerobic heart rate of 200 minus their age.

  And you may find that getting a test of your VO2 is a very useful tool. By measuring respiratory gases in a physiology lab, it’s possible to determine whether you are running in the aerobic zone. The VO2 max figure that results from this test will give you an idea of your overall aerobic ability. But VO2 levels at less-than-maximum effort may be even more useful as an indicator of whether you are burning fat or sugar. (As glucose metabolism increases, you produce more CO2, which signals that you are leaving the fat-burning aerobic training zone and entering the anaerobic zone.) A local exercise physiologist may be able to test your VO2, or a university sports science department may offer the test for free.

  2. Measure your progress—with one simple assignment

  Assuming you are committed to improving your overall aerobic fitness, then how do you track your progress? For that matter, how can you be certain that you are improving at all? The feeling that you are becoming healthier and aerobically fit is often subjective, especially for those who haven’t been exercising regularly. But once you know your maximum aerobic heart rate, a simple way to measure progress is to apply what’s called the maximal aerobic function test:

  Find a two- to three-mile route, preferably flat.

  As you run (or walk) the route, stay within your optimal aerobic training zone (don’t exceed the MAHR that you calculated above). Record your time over the route.

  Do most or all of your running in this aerobic zone for several weeks—regardless of the terrain or the distances or the places you run; throughout, work on form, relaxation, breathing, and rhythm (as you read about in chapter 6), while staying at or below your MAHR. Running efficiency is all about creating mechanical and metabolic advantage.

  Repeat the test every couple of weeks, timing your original route under similar conditions each time. (Heat will cause the heart rate to drift up, and wind will affect your speed.)

  Record your time. This is your “aerobic speed,” and you will see it gradually progress—just as it did for Adam Porter (at the beginning of the chapter). Some of your improvement will result from the increased efficiency of your metabolism, and some from improvements in form and biomechanics.

  With experience, you should be able to remain in your aerobic training zone simply by sensing your level of effort, without a heart rate monitor. Feel the rhythm of your breathing and your level of exertion, pay attention to your feelings, set mental reference points, and learn the language of your physiology. Develop your own system of biofeedback. One reliable way to do this is to limit yourself to breathing through your nose. If you can maintain a genuine smile, too, you will feel as if you can run forever.

  Once your times on the two- to three-mile course are no longer improving—typically after several months, and sometimes years—you have fully built your aerobic endurance engine! You will notice that you are faster than ever before, yet running at a level of exertion that is as easy and comfortable as the day you began.

  In some instances, it may be necessary for your heart rate to drift above your MAHR:

  At the end of a long training session, especially in warm weather, as long as you are feeling comfortable and can carry on a conversation. Your heart rate naturally kicks up to help cool you.

  During short sprints and drills (of around ten seconds), which I do almost daily. My heart rate climbs for a few seconds, then I allow it to settle down before the next short sprint.

  As a race approaches, I’ll pick up my pace four to six weeks before the event maybe once or twice a week. (See chapter 12, on racing.)

  It’s probably not helpful to train with a group that runs at a pace that will take you above your own MAHR, at least not every day. On a group run, your heart rate will naturally climb as the pace quickens. When you crest a hill or when the pace settles, focus on relaxing and recovering.

  CHAPTER 8

  Move More and “Exercise” Less

  Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.

  —PLATO

  Don’t exercise beyond the limit of your brain’s ability to control a movement properly.

  —DAVID WEINSTOCK, physical therapist and author

  MYTH: You should stretch thoroughly before a workout.

  FACT: This is not advised. Simply jog gently to melt the “fuzz” in the fascia; swing the arms and skip a little to open up the range of motion.

  In this chapter, I’m going to suggest that you don’t need to “exercise” at all.

  Since the invention of the yardstick and the stopwatch, we have been quantifying movement. The government releases important-sounding guidelines on the minimum number of minutes of daily exercise. People rush to their gyms and dutifully perform their routines, while GPS devices track their movements and social media hails their hero workouts.

  Most of us who become committed to a workout regimen subscribe to the popular acronym FIT—frequency, intensity, and time. But often our exercise is too vigorous, at the same time that it doesn’t address the damage caused by parking ourselves in a chair for the rest of the day. Even if we run for 30 minutes, what about the 930 other minutes of daily nonsleep time?

  Modern humans share with zoo animals the diseases of captivity. We exercise to compensate for restricted habitat and range. And we regard exercise as we do nutritional supplements. Just as supplements shouldn’t be the foundation of our diet, exercise routines shouldn’t form the bulk of our daily movement.

  INVISIBLE TRAINING

  We have sidelined movement from our daily routines. For physical health alone, if you simply move through a wide range of motions throughout the day, “exercise” becomes redundant. Our bodies are meant to be used, and movement is what they are adapted for. Exercise is great. But the only genuine, healthful, and sustainable reason to exercise is because you love it.

  In medical school, I was taught anatomy and the configuration of the human body—a static human body. And as a doctor in the clinic, I “examined” patients who were sitting passively on a table, without assessing their movement. Only later would I begin to understand the fluid mechanics and marvelous interconnectedness of a body in motion.

  When I’m asked, “What is the best position or movement?” I respond by saying, “Your next one.” If you have remained in any single position for more than twenty minutes, change it up. As you do, expand the ways you reposition your tissues and load your joints. Each time you stress and move new areas, local blood circulation increases. Mix up the ways in which you interact with the environment—just as our ancestors did constantly.

  Running alone isn’t enough to get you to a state of excellent health. In addition to running, we need to engage in a variety of activities and movements. Walking, lifting objects (properly), gardening, squatting, crawling, climbing stairs—all of these “supplemental movements” should be done briskly and with graceful ease, and at frequent intervals throughout the day. In other words, apply the level of attention that you bring to your running form to all of your movements, and regard yourself as in a constant state of “invisible training.”

  The “isolation training” that many people do in gyms often consists of programs for narrow, specific purposes, and isn’t always healthful. Instead, by teaching the body to link its movements and become one machine, not a Frankenstein-like assemblage of parts, you will be far more suited to many functional and athletic tasks.

  A STANDING ORDER

  For a moment, let’s tag back to the most damaging habit that we’ve subjected our bodies to: chronic sitting. As we discussed in chapter 2, sitting is associated with a number of physical problems
and chronic ailments, and prolonged sitting increases the likelihood of an earlier death. Consider plane flights: typically, we drive (in a sitting position) to the airport, cram ourselves into an airplane’s economy seat, then again drive (while sitting) to our destination, in order to sit at a meeting or sit around with friends. It surprises me to see people without roller bags in airport terminals congregate at the base of the escalators, when the wonderful opportunity of stairs—which are generally faster—waits nearby, unused. We should all be taking every opportunity to move.

  After hours in a chair, our muscles and fascia essentially reprogram themselves, misaligning our entire kinetic chain. Hips tighten, hip flexors shorten, and the gluteus maximus gets “remodeled,” such that we lose the optimal tension, spring, and range of motion that is needed for efficient walking and running.

  In what some researchers have termed the “active couch potato” phenomenon, the negative effects of prolonged sitting may cancel out the gains accrued from exercise, even when the exercise includes training for a marathon or half marathon. (Emerging research that traces the roles of inflammatory- and fat-regulating enzymes, such as LPL1, also supports this.) Runners and others who train vigorously may be at higher risk: they tend to be professionals, confined to long hours at a desk or in a car. They may rationalize, however subconsciously—but incorrectly—that their extraordinary exercise efforts more than compensate for any risks from a mostly sedentary life.

  Prolonged muscular inactivity, as experienced on long plane rides, can also place someone at risk of deep vein thrombosis (DVT), or blood clots. A flight from New York to Germany entails less sitting than an eight-hour workday at a desk. We may need to start seriously examining the health effects of our ubiquitous sedentary daily lives.

  A stand-up desk is a partial antidote to sitting, and I have used one for over ten years. The desk holds my laptop, phone, and papers, and I keep a stool beside it to elevate a foot to change position while I read and type. At home, I rarely sit in chairs, and take every opportunity to sit on the floor and change up my position, as if in a yoga class. We can all do this. Visualize yourself as an ancestral human—unassisted and unconstrained by chairs and tables—versus the modern zoo human.

  THE SPICE OF LIFE

  Our neuromuscular systems are adaptive and trainable. They enable us to react to, temper, dissipate, redirect, and stabilize large forces. Nerves control muscles (what’s meant by “neuromuscular”), and the more we practice and build proprioception and balance, the more neuromuscular control occurs locally—reflexively, automatically—without the intermediate step of engaging the thinking brain.

  Fascia plays a role with this (see chapter 5), because it relays signals about when to tighten, loosen, or stabilize, without us needing to cogitate on it. Proprioceptors and mechanoreceptors in our feet and throughout the body sense load, pressure, and blood flow. To some degree, all of this movement and countermovement trickles down to individual cells, and may even affect which genes get turned on and off. Gene expression, we’re learning, is a product of what we do, not just who we are.

  When you’re walking or running, proprioceptive mechanoreceptors, which generally sit at the nerve endings, send signals to the cells of the muscles in the feet and legs. The cells (which are mostly water) behave like a sponge, and are refreshed by constant filling and squeezing, in just the right amounts. Disuse of the mechanoreceptors (as occurs in prolonged bed confinement) can result in a pressure sore or bedsore. Fluid accumulates in the ankles. The sponge is wrung out or overfilled, and isn’t refilling properly. Simply changing up one’s position helps move lymph and fluids and blood through the tissues.

  YOU GOT TO MOVE IT…MOVE IT!

  So, if you’ve been on the couch or at a desk for years and want to expand your range of motion, where do you begin? Just move, and you will improve. Bend. Compress. Twist. Pull. Push. Lift. Squat throughout the day, whenever you can. I squat to rub my dog’s belly—it’s as good for me as it is for her. One hundred squat-jumps in the gym aren’t required.

  Undertake all of this movement within a safe range of motion. Remember that the body adapts gradually. Never make a sudden or outsized change to your routine or movement patterns (or to your footwear).

  The perfect, most accessible movement is walking. It helps us in every way—mechanically, metabolically, psychologically. If you walk outside, all of your senses are stimulated. I am one of few physicians who still does traditional walking rounds: I walk from room to room visiting patients, instead of “rounding” at a circular table with laptops. (“Rounds” originated at the original Johns Hopkins Hospital, where the halls of the ward were configured in a large circle.)

  Physical therapist Gary Gray coined a term for the motor control that we need in order to prevent injury and excel in sports: mostability, a blending of mobility and stability. It describes the ability to take advantage of just the right motion, at just the right time, at just the right speed, in just the right plane, and in just the right direction. The objective is to elongate the muscles and move the joints through their full range of motion, while using skillful motor control to manage the forces that are generated.

  By contrast, instability can be referred to as any degree of mobility that isn’t fully controlled.

  Core instability, exacerbated by fatigue, causes the right knee to dive in and left hip to drop, leading to decreased motor control and efficiency—like a tired spring.

  TO STRETCH OR NOT TO STRETCH? THAT IS THE QUESTION.

  There’s been a lot of discussion about whether one should stretch before running. The current consensus is that it’s not necessary, and may even be counterproductive.

  Some of the confusion arises because stretching can refer to a variety of routines and movements. In static stretching, a specific position is held for ten or more seconds, as in many types of yoga, and can be harmful if done prior to running. In active isolated stretching, on the other hand, a muscle is contracted and held only for a moment—at most a few seconds—and then is lengthened. Repeated several times, this kind of stretching can release neurologic inhibition in the muscles and fascia. (This inhibition, which may feel like tightness, can indicate that your nervous system is preventing a joint from moving fully—and may be protecting it from injury.)

  Active isolated stretching can open you up to a wider range of motion, though it may help only modestly. The goal is to loosen, not stretch, and the best way to do this is to simply run at an easy, relaxed pace. At the start of a run, swing the arms and skip a little to open up the range of motion, then start out jogging slowly to melt the “fuzz” in the fascia. As your body warms up, your mobility and range of motion will expand naturally. Add a few skips, lunges, and even a few short pickups (ten-second sprints), in which you lengthen your stride and test your full range of motion. This is dynamic stretching—and is done mostly when you’re warmed up.

  Indeed, simply keeping your body limber, supple, and active throughout the day is more important than a dedicated program of stretching, or a rigorous menu of positions, yoga poses, and movements. Especially now that we are learning of the increased risk of mortality—early death—from the benign-sounding activity known as chronic sitting, we should pay special attention to daily movement.

  Remember the tensegrity principle. The body wants to remain in a balanced state between tension and compression. Thus stretching needs to be viewed in the context of what, exactly, needs stretching.

  Commonly, I see tightness in the anterior hips, or hip flexors. Think of your pelvis and femur secured into a “comma” position, caused by shortened hip flexors that accompany long periods of sitting. (Your frame should be erect, with a flat, neutral pelvis when you stand upright, as in the illustration that follows.) Now combine that comma position with a tight and sore upper hamstring. One might think that stretching the hamstring is a priority, but this will only exaggerate the curve in the “comma” and r
esult in more imbalance and compensation.

  The “comma,” or tilted pelvis, at left, is an artifact of prolonged sitting—compared to a flat, neutral pelvis, at right.

  Ron Clarke, who set seventeen world records, said that he never stretched before running. Yet to watch Ron run was to watch stretching in action. He ran with perfect balance and a full range of motion. You can see (this page) that his stride angle (the angle of separation between his thighs) is greater than 90 degrees.

  Ron retired from distance running in his prime, at age thirty-three. Meb Keflezighi qualified for the Olympics for the fourth time at age forty. Like Ron, Meb didn’t do stretching and mobility work when he was younger. Now, however, he does an extensive series of drills similar to the ones I prescribe, in order to maintain balance and range of motion. He does them all in a dynamic and relaxed way, never pulling hard on his muscles.

  Ron Clarke (#2) in full flight

  Similarly, you don’t want to take your exercise into the exhaustion zone, as your muscles will tighten up on you. I want the final mile of every run to be the most fluid and relaxed of all, with the fullest motion and longest stride. This applies to walking, too. No need for long post-workout stretching sessions. You just stretched, while in motion.