Saturday, February 23, 2008

Doctor’s Orders?

I’m not a doctor; I don’t even play one on TV. So I’m not going to claim to be qualified to dole out medical advice. Unfortunately, when it comes to running, a lot of doctors aren’t experts, either. It’s become almost reflexive to say that anyone thinking about starting a running program should get medical clearance first. Well, I’m going to be a bit different and not take cover under that blanket statement.

Why? A few reasons, none of which are meant to put down the medical profession. But consider this statistic: Even after the last 25 years of the fitness boom, less than 30 percent of doctors advise their patients about exercise and nutrition. Doctors are trained to fight disease, not prescribe health. I’ve had more than one doctor ask me if I’m amazed that my knees haven’t given out yet.

There’s a kind of philosophical basis to my argument. To me, it seems that saying that everyone has to get medical clearance before starting to run implies that running is some dangerous activity, not one of the best things you can do to take control of your health. You’re preparing to go outside and use your body as it’s meant to be used, not preparing to be sent to battle.

Why do so many people say that you should run only with a note from your doctor? In part, the reason is because running is portrayed so inaccurately in the general media. Every year, about 30,000 people run the New York City Marathon. Every few years, one of those runners has a heart attack during the race. Sadly, sometimes the runner dies. This tragedy is what gets play in the papers.

But did you know that at the University of Michigan’s home football games, the medical teams expect to treat two heart attack patients per game from the stands? That’s what the law of averages would tell you is going to happen when you have 100,000 people together in one place. Do you then see the media warning about the risks of watching football games?

If I sound a little sensitive here, it’s partly because of the attention the media gave when Jim Fixx died of a heart attack while running in 1984. Because Fixx was the author of the best-selling The Complete Book of Running, he was a spokesperson for the sport. I know a lot of people who subsequently quit running, because they figured that if running killed Jim Fixx, who wasn’t at risk?

I knew Jim Fixx. What was not reported was that heart disease ran in his family and that even with dying at age 52, Fixx had already outlived his father by nine years. More important—and here I might win back some of the doctors I’ve just angered—is that Fixx thought that his marathon running made him immune and so ignored his medical history. He had been a heavy smoker before he started running, and his cholesterol levels were way above normal. He also ignored chest pains that he sometimes got while running, as well as pleas from Kenneth Cooper, M.D.,(sometimes called the father of aerobics) to get regular check-ups.

Am I contradicting myself here? Not at all. Everyone should know their medical history, as well as that of their family. I’m assuming that you get regular physicals, know your blood pressure and cholesterol level, and so on. If you don’t, and if starting a running program inspires you to see a doctor, then by all means go. I just worry sometimes that getting a doctor’s “permission” to run keeps a lot of people from ever starting. So besides those who don’t know their basic health information, who should see a doctor before starting a running program? The National Heart, Lung, and Blood Institute has issued the following guidelines, and they seem reasonable to me. If one of these statements applies to you, discuss your desire to start a running program with a doctor, preferably one who is used to treating active patients.
  • You’re over the age of 60 and aren’t used to regular exercise.
  • You have family members who have had coronary artery disease before the age of 55.
  • You frequently have pain or feel pressure in the left or mid chest area, the left side of your neck, the left shoulder, or left arm during or immediately after exercise.
  • You often feel faint, dizzy, or unaccountably out of breath after mild exertion.
  • You have high blood pressure that isn’t under control.
  • You’ve had heart trouble, a heart murmur, or a heart attack.
  • You have arthritis.
  • You have a medical condition that might need special attention once you start exercising, such as diabetes.
If none of these statements applies to you, you can proceed to learning how to get going.

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