Why running a marathon is good for midlifers

The first irritating comment you get when you mention that you’re running a marathon is “it’s not good for your knees”. But to those smug armchair naysayers, there’s new evidence: actually, it is. Particularly for midlifers.

A new myth-busting study of novice, middle-aged runners by researchers at University College London and Barts Heart Centre has found that training for and running a marathon not only wasn’t bad for their knees, it actually improved them. But there’s more; the team found that marathon running also helped improved middle-aged runners’ arteries, and the more unfit and older they were to start with, the better the results.

“One of the biggest things that we’ve helped prove with the evidence is the fact that, contrary to popular opinion, marathon training programmes are actually good for you,” Prof Alister Hart, consultant orthopaedic surgeon, says.

The results of the study, which has been published in two separate journals, with more findings to come later in 2020 on hip health, came about through Hart’s personal fascination with running. Now 49, he ran his first marathon in New York when he was 41. “I was desperate to beat the four-hour time, and I did it, just. But for two weeks afterwards I could hardly walk, which isn’t a good look when you’re dragging yourself around an orthopaedic ward,” he says with a laugh. “I recovered and ran another marathon, but I started to think that perhaps I should avoid running, so I started doing cross-country ski marathons instead.”

But it was a chance meeting at a medical conference with a fellow doctor who was studying the cardio effects of novice marathon runners that piqued his interest in looking into just how bad running was for knees and hips. “He told me he was going to repeat the study the next year, and I asked if I could join him.”

The team started tracking 138 healthy people who ran the London Marathon for the first time in 2016 or 2017, first scanning them with a high-resolution MRI four months before the marathon — “before they started training” — and then again afterwards. The results were astonishing: the middle-aged runners’ knees were actually healthier after training for and running a marathon.

“I couldn’t believe it when I saw the bone marrow oedema [a fluid build-up in the bone marrow that is typically a response to an injury such as a fracture or conditions such as osteoarthritis] actually improving,” Hart says. He published the results in the British Medical Journal at the end of 2019.

Then, in a different paper published in the Journal of the American College of Cardiology published earlier in February, the same team showed that the same participants had experienced other benefits too: major improvements in their blood pressure and arterial stiffness. Arteries normally stiffen with age and can be a key predictor of heart and circulatory problems in later life. But the study found that marathon training reversed, or at least limited, age-related damage to arteries, while blood pressure fell as much as if the participants had been prescribed medication.

“We know that the effect of training reduced blood pressure in our participants by about as much as taking blood pressure medication, which over a 10-year period equates to about 10%-15% reduction in stroke risk” Dr Charlotte Manisty, consultant cardiologist at the Barts Heart Centre and University College Hospitals in London says. “[The training] rejuvenated the arteries by an average of four years, and that seemed to be greater in those who had more to gain; those runners who were older and slower.”

The study found that marathon training reversed, or at least limited, age-related damage to arteries, while blood pressure fell

She stressed that all the participants of the study were healthy, with no pre-existing heart conditions. “If you do have a heart problem, it is possible to run marathons, but you should talk to your doctor first.”

What is most remarkable about both the results — the anti-ageing effects on the knees and arteries — is that there was no fancy training plan. The participants all followed the standardised programme on the Virgin London Marathon website, which builds up run times gradually over 16 weeks, with no other conditioning exercises.

It is heartening news for runners, such as myself, who will be tackling the London marathon for the first time in 2020: this year there are just over 27,000 middle-aged runners signed up for the marathon. I have previously run a marathon — the New York marathon in 2015 — and I followed a simple training plan. I didn’t have any problem with my knees, but like Hart, did have problems walking the next day. He says that was probably down to my quads, and that “the key could be in developing those areas more”.

He adds that he would personally add cycling into a training plan: “Cycling is good for helping keep the kneecap aligned safely in the groove of the knee.” Other experts would add in more training for optimal health. Zana Morris, trainer and founder of The Clock says that midlifers need to add in resistance training, alongside cardio, to help counterbalance the fact that after the age of 30, we lose between 3% and 5% of muscle per decade.

If you are marathon running, then it’s important to get your body strong and fit — the extra muscle, strength and fitness will help support and carry you through the run
— Zana Morris

“Extended periods of running can increase that breakdown of lean body mass,” she says. “If you are marathon running, then it’s important to get your body strong and fit — the extra muscle, strength and fitness will help support and carry you through the run and help account for muscle lost while training.”

She advises weight training, focusing on hamstrings, glutes, lower back, abdominals as well as calves. She also advises looking at supplements, “especially magnesium to help keep muscles relaxed, glucosamine to help reduce inflammation and repair tissue damage, and vitamin E to help with oxygen uptake and repair tissue damage and scarring”.

I’ve decided to add in weight training this time round to keep my strength up, and hopefully improve my time.

But while our knees and arteries are improved by marathon running, what about the sudden deaths we read about every year while taking part in endurance events? Hart says middle-aged runners should consider it as “an absolutely tiny risk”. He is backed up by US research that looked at nearly 11-million runners who participated in marathons or half-marathons between 2000 and 2010. Researchers found that 59 runners had a cardiac arrest, of which 42 died. “In these rare cases, it’s often that younger people have an undiagnosed heart muscle disorder, while older people it’s more likely an underlying coronary artery disease,” Manisty says.

More of a concern, Hart points out, is fluid intake during longer runs and the race itself. “There are several dangers if you take on too much water, because you can dilute the amount of sodium in your body and equally if you are dehydrated,” he says. Official advice from Virgin London Marathon is to drink 250ml of water or sports drink in the half-hour before the start of the race, then for runners with a sub 3.30 expected finish, to drink 500ml of fluid an hour.

But, warnings aside, Hart says the headline news is that marathon running is good for you — particularly if you’re middle aged. “It made me think I should get back into running myself,” he says. “I realised that the last time I ran, it wasn’t my knees that were in agony, but my quads, so I need to work on those muscles. I did a half-marathon last October and I’m thinking of doing more full marathons when I enter my fifties.”

Excuses out the way, all that’s left to do is start the training.