abrn639lThis post comes 4 and 1/2 hours after completing a marathon. The marathon distance (26 miles, 385 yards)

commemorates the fabled run of the Greek soldier Pheidippides, a messenger from the Battle of Marathon, to Athens.

He died.

Marathoning isn’t for the casual runner. Most people who run marathons are happy if they only spend 4 hours on the course. The flap over Paul Ryan’s misremembering his time had traction, in part, because all of us remember particularly good times and finishing in under 3 hours would have been a really, really good time. To do a marathon well takes about 20 weeks of intensive training for people who are already running, requires continual good health, and requires good weather on the day of the run. My training partner was unable to run today after 20 weeks of training because of an ill-timed stomach bug. I ran into a former resident who is 25 years my junior who confessed that he hadn’t had time to train but he thought he might just knock out a marathon as today was his off-day. Today was hot. He came in over an hour after me.

Marathon runners, though healthy, may put their bodies at a slightly increased risk compared to more moderate runners:

In the new data, presented at the annual meeting of the American College of Sports Medicine, one of the study co-authors, Dr. Carl Lavie, medical director of cardiac rehabilitation and prevention at the John Ochsner Heart and Vascular Institute in New Orleans, reported on the optimal “dose” of running for increasing life expectancy. Among 14,000 runners, the optimal amount of exercise appeared to be about 10 to 15 miles per week. “We were thinking that we would see progressively more benefit the more you ran,” says Lavie. “We thought it would level off at some point. But not only did the runners not get more benefit, but the more they did, the faster they ran, the more frequently they ran, the more miles they ran, they actually seemed to lose any benefit to the heart.”

It is unclear how many of the marathon runners had previous smoking histories, scary family histories, or other risk factors that made them obsessively run but more likely to have an event. You may recall the story of marathon runner Jim Fixx:

Mr. Fixx, whose transition from a heavy young man who smoked two packs of cigarettes a day into a trimmer, middle-aged nonsmoking athlete seemed to insure a healthy life, died at the age of 52 while jogging in Vermont…his father had his first heart attack at the age of 35 and died of another one at 43.

Clearly, in trying to get patients to achieve a healthy cardiovascular workout, counseling people to shoot for a marathon would be silly. Running 10-15 miles a week is probably optimal.  I do not encourage the use of running as a substitute for optimal cholesterol management. When I give exercise prescriptions, I initially ask for 30 minutes a day. Most of my patients are starting at 0, so getting a commitment for 20 minutes of marginally aerobic activity (walk 10 minutes in one direction, turn and return home) with an increase over time (walk a block further this week than you have been doing) is what I hope for. I do not counsel people to run any further than a 10K. I only tell patients that I run marathons occasionally if asked.

Oh, you really want to know? 3 hours and 52 minutes, first place in my age group. Thanks for asking…