Indeed, running can be addictive. Researcher David Raichlen and colleagues identified a variety of neurological rewards that are generated by running and by extended aerobic activity. The neurotransmitters dopamine, serotonin, norepinephrine, and acetylcholine are released, along with hormonal growth factors and endocannabinoids, which are related to the active compounds in marijuana. The exercise-activated surge of these chemicals plays a major role in stimulating the receptors in the pleasure centers of the brain. Together, these neurochemicals and their effects serve to boost our calming, parasympathetic tone.
HIT ME WITH SOME NEUROTRANSMITTERS
Sporadic exercise by people who are mostly sedentary isn’t enough to release these neurochemicals. For some, walking isn’t quite sufficient. There may be a threshold of time and intensity—a minimum time off the couch, in effect—that must be crossed before this marvelous physiological response kicks in. The tragedy here is that sedentary folks who find exercise uncomfortable (i.e., difficult to initiate or maintain) may be succumbing to inertia just short of the threshold at which the pleasure-inducing neurotransmitters start to flow. They are within arm’s length of reaching the pot at the end of the rainbow. (Statin medications, especially in high-potency doses, may hold many back from reaching this threshold as well.)
THE RUNNER’S HIGH TIMES…
The term “runner’s high” has stuck with us over the decades, but as running author Jim Fixx wrote in 1978 in the New York Times, “The effects of running are nothing like those resulting from use of alcohol or marijuana. While running, a person feels perfectly sober. Having showered and dressed, he or she can work as a doctor, stockbroker, teacher, lawyer, or whatever, with no adverse effects.”
Fixx went on to write, “Where runners differ from other people, in addition to having efficient cardiovascular systems, is in the euphoric tranquility that is derived from the sport. What a runner feels is not unlike the serenity accrued from a few days’ vacation. The difference is that the runners can summon this feeling whenever they want. Moreover, they do not have to fly to Aruba to find it.”
Dogs share our addictive response to exercise—hence their frantic impatience, when kept indoors for long periods, to run and play outside. Like humans, dogs enjoy variety, which is why you don’t see them electing to run around in circles or on a treadmill.
EXERCISE IS FOOD FOR THOUGHT
What are some of the other beneficial effects of aerobic physical activity?
Briefly, one is angiogenesis, or the growth of new blood vessels and capillaries. This improves blood flow, enhances oxygen and nutrient delivery, and improves the metabolic system’s ability to “take out the garbage,” or process toxic waste products.
Another benefit is neurogenesis, or the growth of new neurons in the brain. Exercise enhances neurotrophic growth factors, which are like brain fertilizer. In particular, BDNF, or brain-derived neurotrophic factor, boosts neurogenesis at the same time that it nourishes existing neurons, and is associated with cognitive improvement and the alleviation of depression and anxiety. Among those who exercise regularly, BDNF levels remain high even when at rest, and will stay high into advanced age as long as a routine of exercise is maintained. (It’s likely that, as in mice, exercise increases the size and number of mitochondria in the hippocampus, where memories are formed and stored.)
No wonder that exercise improves memory and makes you feel better. Exercise may not make you smarter, but your cognitive abilities will improve. And if you fear dementia, don’t stop running. You can even grow new brain cells in your eighties—with exercise. Healthy lifestyle choices (especially exercise) reduce your odds of developing dementia by up to 60 percent. (Note that there is a dose response to exercise: the benefits increase significantly for up to an hour or two of moderate activity a day. Added benefits taper off above that.)
The brain can adapt to a remarkable degree. The concept of neuroplasticity is now making its way into conventional treatments of dementia, Parkinson’s, and stroke. Columbia University psychiatrist Norman Doidge describes what he terms “learned nonuse.” An injury, disease, or stroke, for example, can shut off signaling to the part of the brain that controls movement of a specific area. But when we continually stimulate the interrupted motor circuits and patterns, the brain—because of its neuroplasticity—develops new circuits to work around the faulty ones.
Doidge emphasizes that aerobic exercise in particular promotes the health of two types of cells in the brain—neurons and glial cells (which protect the neurons)—while expanding the gray and white matter in the frontal lobes, which are regions that involve planning and goal-directed thinking.
IT TAKES GUTS TO ADAPT
Much of current medicine is based on a model of the body as a machine, and treatments are crafted in the manner of engineering diagrams. But we are biological beings, not mechanical models. We know that the impossibly complex human body is an organism with parts that can change, adapt, and grow. Indeed, not all of these parts are really “ours.” The microbiome—the remarkable wealth of flora and fauna in our guts—is one of the new frontiers of research, and we’re learning how it affects our metabolism, resistance to disease, and even our mood. (A greater quantity of serotonin, for instance, is produced in our internal biotic environment than is released by our nervous system.)
Can the organisms living in our guts actually affect the way we feel (and maybe even our body weight)? The gut is not simply an entryway for nutrients. Our intestines offer the largest surface area of interface between ourselves and the outside environment (more than the skin, for example). Trillions of organisms are harbored here, and they regulate and interact metabolically with our nervous and endocrine systems. The human microbiome has even been described as the “second brain” or “second endocrine system.” The microbiology isn’t well understood, but a healthy gut is an indicator of a healthy brain and good hormonal function. This emerging topic is explored in detail in the books and peer-reviewed articles of bacteriologist Dr. Martin Blaser and neurologist Dr. David Perlmutter.
ENGAGE STRESS TO DESTRESS
Everyone wants to avoid stress. In addition to the psychological hazards, chronic stress (a heightened state of cortisol production) leads to greater insulin resistance and enhanced production of betatrophin, a protein that blocks an enzyme that metabolizes body fat. This reduces metabolic efficiency, while making it harder to lose weight.
But is all stress bad?
A moderate exposure to stress is needed to survive and thrive. According to Dr. Kelly McGonigal (The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It), it’s the way we perceive stress and respond to it (and how long it lasts) that makes the difference.
If you think your stress is going to kill you, it just might. When stress is perceived as negative, with a feeling of loss of control, then the fight-or-flight (adrenaline) response is activated for prolonged periods. Cortisol, other glucocorticoids, and clotting factors are stimulated. Severe sympathetic stress can even switch off neurotrophic growth factors, to the degree that even exercise won’t restore a stable state. You end up marinating your daily life in a damaging biochemical stew.
Dr. McGonigal offers some straightforward advice: view your body’s stress response as vital to your health, as something that will make you stronger. Envision the stress as helping you to manage, learn from, and grow. Then you must relax. Your stressful, crazy life is not unique. Moderate stress should be welcomed as a daily challenge—as long as it doesn’t control you.
When lions spot their prey, they’re not thinking about resting. And when they are resting, they’re not thinking about their next prey. Humans, on the other hand, seem to have it backward: when we’re resting, we think inordinately about our stress, and when we are stressed we become fixated on resting.
EXERCISE FOR ANXIETY AND DEPRESSION
When you suffer physical or mental stress (which
can be caused by inactivity), you may seek relief through medications. But when we look carefully at a broad range of studies on the effectiveness of pharmacotherapy for stress, depression, anxiety, and cognitive impairment, drugs offer little, if any, benefit. (Pharmaceutical companies often design their own trials, and they publish and promote results selectively. Studies with negative or questionable results often go unpublished.)
The use of drugs can lead to dependence, side effects, downregulation of response (the drugs become less effective), and relapse. At best, they simply aren’t as effective as physical activity (and healthy eating, and sleep) at expanding the beneficial neurotransmitter delivery system. When consistent exercise is part of a treatment plan for these disorders, relapse is uncommon—especially in comparison to medications and most other conventional therapies. Among committed runners and athletes, mood disorders are rare. A crowdsourced hub for patients’ perspectives on effective (and ineffective) treatments can be found at a site called CureTogether.
This chart is based on nearly 32,000 people who self-reported suffering from anxiety. In the aggregate, exercise was the clear winner in terms of both effectiveness and popularity.
RUNNING FROM ADDICTION, ADDICTED TO RUNNING
In West Virginia, as around the nation, opiate addiction, mostly from opioid-based prescription drugs, has destroyed lives and families. What’s supremely frustrating is that it is difficult to treat. I’m sometimes asked if I know anyone who has been weaned successfully from opiates without substitution of another drug (which is usually opioid-based, too).
I know of one person. Travis Muehleisen hadn’t chosen to take pain meds. In 1997 and 2004, physicians prescribed them following back surgeries from spinal stenosis, which he acquired from injuries while working in the steel industry. After being disabled in 2007, he had two more back surgeries and was prescribed more drugs. Over that period, he became severely depressed, grew obese (330 pounds), and developed high blood pressure and coronary artery disease.
“I didn’t care for this way of life,” he told me, “but I knew no other way.” After thirteen years of opiate addiction and declining health, he knew that he had to change or he would die.
Travis is now addicted to running. “In 2010, I began walking on the treadmill in my sister’s basement, a mile at a time. Within a month, I worked up to three miles. Then I began running around the local high school track, a lap at a time. One month later, I ran four laps—a mile. Gradually I increased my distance, and in 2011 I ran my first half marathon.”
He combined exercise with healthful eating and lost more than a hundred pounds. He no longer takes medications, and has returned to working full time. In an 8K race, he placed within the top 10 percent of his age group, then followed that with a marathon—26.2 miles—which he finished without stopping. In the past four years he has run sixteen marathons, and in 2017 he ran the JFK 50 Mile—only to miss the time cut, at the 46-mile mark, by a minute.
For Travis, running means going all in. If he doesn’t run, and run hard, he literally feels pain. It takes a run of six miles, he told me, before sufficient endorphins kick in to act as an opiate substitute for him. Endorphin means “endogenously produced morphine.” You produce the morphine.
Travis is the only person I know to work his way off disability (despite the disincentive to work when getting a paycheck not to). Desk job? No way. Travis builds bridges. He needs to work to keep his brain and body engaged. He’s been free of opiates for seven years.
I asked him what he had learned over the past two decades. “Running has shown me that you can be stable and productive after addiction. If you want a good life bad enough, it’s up to you to take control of it. You have to believe in yourself, recover your self-esteem, and mend the damage you have caused to family and friends. Find something that challenges you physically and mentally, and dive in.”
FUSION ENERGY
Indeed, the biggest benefit of running may come down to self-confidence and peace of mind. In 1978, Dr. George Sheehan—a cardiologist-runner who became a writer after tiring of continually referring patients for bypass surgery—daringly suggested that most runners don’t really run in order to become healthy. In examining their motivations, he classified runners into three groups: (1) A jogger is someone who is “born again” physically, and seeks to convert and reform by preaching running’s benefits of longevity and reduced heart disease. As new challenges arise, the jogger desires to be (2) a competitor, which offers him an even longer break from the office or a boring daily routine. This stage chooses performance over health, and no sacrifice is too great. Then the jogger or competitor who is no longer obsessed with specific health benefits, and no longer needs the excitement of events, becomes (3) a runner. Finally, she sees running in perspective, Sheehan explains, as “the fusion of body, mind and soul in beautiful relaxation.”
REBOOTING IS NOT JUST CHANGING YOUR FOOTWEAR
Most of us wouldn’t benefit from trying to follow the stress-inducing regimen and schedule of an elite athlete. I maintain a fairly high level of fitness and run competitively, but I regard running (I deliberately shun the word “training”) mainly as my daily reset button.
The harder and busier the day, the more I look forward to a run, and the more relaxation and immunity from stress I derive from it. Running is the perfect response to being overextended in work and life. (If running somehow brought on more stress, it simply wouldn’t be sustainable.) Nowadays, busy, challenging lives are the norm. Running must fit seamlessly—and voluntarily—into the weekly schedule. Most important, it must make us feel better.
DRILLS
Breathe
One of the best stress-reduction exercises—which can be done at work and throughout the day—is relaxed abdominal breathing. Breathe in through your nose and fill your belly completely, then exhale fully with pursed lips, as if inflating a balloon. Work up to five seconds for each inhale, hold it for a few seconds, then ten seconds for the exhale. Notice your pulse drop as your parasympathetic system kicks in.
Run for stress relief
More than 85 percent of runners run to relieve stress. One simple drill is to focus purely on releasing stress while you run. Find a quiet, calming route. Focus on relaxed, rhythmic breathing. If you like running in a group, meet up and join them. I have a small group of busy friends, and every week or two we meet up for an early-morning run in a natural setting.
Be a lion
A few times a week, do something with high intensity, even if brief. My favorites are sprints and burpees. Knock off a few of these, just enough for a bit of fatigue. It invariably has a calming and rejuvenating effect.
Zone out
Running can be a great escape, a chance to “zone out.” Plug into some music, a podcast, or an audiobook, and distract yourself from worries, obligations, endless to-do lists, and the monotony that can accompany a long run.
Zone in
Be 100 percent present, and deeply connect to the moment. Running makes an ideal movement meditation, beautiful in its simplicity and accessibility. Practice mindfulness by simply observing. (This may be especially relevant when you are trail running.) Embrace whatever appears before you and whatever sensations, thoughts, and emotions arise.
(Zoning out and zoning in: With thanks to Elinor Fish, author of The Healthy Runner’s Manifesto. As Elinor says, “Stop striving and start thriving.”)
Sleep
Sleep builds our capacity to respond and adapt quickly to a stress. There’s no substitute. Relax, and do it well and completely.
CHAPTER 14
Outsmart Injuries with Prevention
Why are pain and movement linked? In the presence of acute injury and/or pain, if the nervous system concludes there is a threat to the tissues, then movement is the primary mechanism by which the nervous system can react to that threat.
—Grieve’s Modern Musculoskeletal Physiotherap
y
MYTH: Running wears out the joints.
FACT: Joints benefit greatly from stress and impact, in the right amounts.
More than half of all runners are injured each year.
Let’s take a look at one subset of active people: enlisted men and women in our Air Force. In 2010, running ranked only behind basketball as the leading source of injuries. (Many of those b-ball injuries are running-related, too.) But that’s minor compared to what the armed services see overall. The Department of Defense reported 8.3 million days of missed duty between 2005 and 2009 from preventable musculoskeletal injuries. These include overuse injuries, sprains, strains, dislocations, tears (ACL/cartilage), and spine problems, costing the military $1.5 billion a year in labor replacement, medical care, and long-term disability.
CHASED BY AMBULANCES
What’s going on with all this injury? Why do so few medical studies adequately explain their complicated causes, and why does the medical profession offer little beyond reactive, symptomatic treatment? Running injuries are typically treated with rest, ice, injections, painkillers, stretching, MRIs, fancy tests, and various devices and shoe orthotics. But despite all this medical “care,” evidence-based trials show that much of it doesn’t work. Runners continue to get injured at consistently high rates.
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