The Art and Science of fitness | Returning back safely to running and exercise

Exercise and sports are good for you, but how do you return safely to them after a break because of injury or sickness? Here's the best way:

I had my tryst with Covid-19 in May 2020. I was down and out for a couple of weeks with the viral infection, followed by two more weeks of recovering from weakness. This experience made me realise that getting up to go to the bathroom felt like running an ultra marathon.

Exercise and sports are good for you, but how do you return safely to them after a break because of injury or sickness? Here's the best way: (PTI)

I made my first attempt to go out and run in October, exactly two years ago, when a lot of people were succumbing to Covid-19. So it was more a psychological challenge than a physical one. I would struggle to run even a single kilometre in one go. To put it in perspective, I was running 30-40 km every Sunday before the lockdown was imposed. I then had to practise what I had been preaching to everyone else: Focus on each breath and each step and learn to let go, rather than stiffen up. It felt like I was back in my nascent stages of running.

It was my first-hand experience of the challenges that novices face when they begin exercising. Even though I had access to a lot of theory, putting it into practice is where I struggled. I would plan each night for the next morning's run, but would then come up with excuses. Covid-19 made me nervous like never before.

Around the same time, several reports said that people who had recovered from Covid-19 were getting myocarditis, ie inflammation of the heart muscles, which put them at a high risk of having a heart attack, more so while exercising, playing or running post-Covid-19.

From my own experience and what we know about Covid-19 — which still isn’t enough — my advice to sportspeople and runners has been to err on the side of caution. If you’ve ever had a mild episode of Covid-19, don’t rush into getting back to an active lifestyle. Don’t start where you left off. Listen to your body about how much you can push yourself without straining too much. If in doubt, just take it easy for the next few weeks, gradually building back. For a month, don’t bother with increasing the intensity.

Learning to move slowly, for me, was a blessing in disguise.

It took me two months before I got to running a full 10 km. It was important for me to run, not just because running has physical benefits, but because running is my passion and love — always there for me, never judging me.

In recent months, we have heard of unusual deaths during running events or in gyms. Due to fears induced by Covid-19, there has been a lot of talk in the medical fraternity about screening everyone who wants to run, go to the gym, or play sports to identify those who are at a higher risk of sudden death. When an individual collapsed and died at the Delhi Half Marathon, he was one of the 11,000-plus participants at the event who were running 10 and 21 km. Imagine if every person at the event had to be screened!

The 11th edition of the American College of Sports Medicine (ACSM)'s Guidelines for Exercise Testing and Prescription acknowledges that the value of routine medical screening procedures like physician evaluation and exercise testing in low-risk asymptomatic people is not proven. There is insufficient evidence even for routine cardiovascular screening to prevent the most common cause of sudden death in young asymptomatic sports enthusiasts.

One thing that we are taught in medical colleges is that we should be treating the patient, and reports alone don't determine the full picture. Doctors who deal with athletes and sports people need to understand them and the activity they are involved in, more than just going through their reports. A classic example is an idea of “maximum heart rates” to determine how hard someone can and should push. It’s often quoted as “220 minus your age”, further giving reference to the American Heart Association. There is a basic flaw with this formula because there is an assumption that all people of a certain age have hearts that are equally healthy and can tolerate the same amount of physical work. And that’s why your sense of exertion becomes an important feedback mechanism to how much you should push yourself. This formula might work for the sick, but definitely not for the active.

So, if we all don’t need to line up for screening tests, then needs to be done? The onus lies on us.

It is important to also acknowledge that common things occur commonly. A lot of people have picked up running and other forms of exercise during the lockdown. Many of them didn’t have a sporting background or restarted after a long break. They enjoy exercising, more so with simple movements like running because, perhaps, like me, they find it meditative.

ACSM’s Guidelines for Exercise Testing and Prescription states, “Vigorous physical activity, particularly when unaccustomed and performed by inactive and unfit individuals, can acutely increase the risk of sudden cardiac death and/or Acute Myocardial Infarction in persons with known or occult cardiovascular disease.”

While this seems like common sense, the problem is that we falter at pacing ourselves. We get started too quickly, rapidly increasing the mileage and speed, and entering too many events — a classic recipe for disaster.

At the Delhi Half Marathon, more than 44% of participants running 21 km were running the last 6 km at 8 minutes per kilometre, and over half the participants ran the last 5 km at a pace (minutes per km) more than a minute slower than they ran the first 5 km. That's lower than a brisk pace for anyone who goes out walking regularly. They started way too quickly, not knowing how to pace themselves and then started to pay for it later, exposing themselves to serious medical conditions. Had they planned their pacing better and had they trained well, more important than finishing quicker, they would have also enjoyed the last half or quarter of the run. Just think about those who started off running so quickly that they were taking 4 minutes less for each kilometre by the time they were crawling to the finish line.

Then there are some who push too much right in the beginning, who have the desire to run faster than they are capable of on race day, it could be because they were forced to take a break because of injury or illness, or those who just never had the fitness and training to perform at that level. This might surprise you that these are the folks who are more likely to get themselves into trouble than the slower ones who are literally walking in the park for the last or quarter of the distance of the race.

When you put yourselves in such awful situations, no amount of tests and investigations, no amount of planning by the race organisers, and no amount of competency by the medical support team can do anything. You need to plan and train accordingly.

So the first tip is: If you have been inactive, don’t have any known chronic disease and want to start running, don’t start with running. Start with walking. Even if you have been very inactive, start with a slow pace of 12-15 minutes per kilometre, gradually building up time on foot. You could start with 15-30 minutes. Give yourself 6 months to progressively build up your time on your feet and pace, rather than signing up for a running event. Add strength training and breathing exercises to your routine as well. At the end of the day, breathing will keep you alive and muscle strength will get you moving comfortably. And at all times, smile. That will help you relax your muscles, rather than strain.

I have, in previous columns, covered how heat, humidity and overhydration play a major role in things going wrong and play their part in serious incidents happening in athletes. People who haven’t done these distances and then are taking long, need to be consuming energy too. That needs to be thought through too. As for water, don’t drink gallons of water at each aid station as this can backfire, since, during running events, overhydration is far more fatal than dehydration.

Rather than blaming the event organisers and management, and expecting doctors to pull a miracle out of the hat, we need to train smart first, rather than train hard to begin with. Of course, organisers mustn’t have on-spot registrations as most people don’t appreciate how wrong things could go if they suddenly attempt these distances.

At the end of it all, we must remember that what the world faces today is not that we should be wary of moving. It's simply that we don’t move enough.

Keep miling and smiling.

Dr Rajat Chauhan is the author of MoveMint Medicine: Your Journey to Peak Health and La Ultra: cOuch to 5, 11 & 22 kms in 100 days

He writes a weekly column, exclusively for HT Premium readers, that breaks down the science of movement and exercise.

The views expressed are personal