I. Problems & Solutions Need Action

Problem
“The federal government now spends $952 billion a year on Social Security, Medicare and other beneits for the elderly, which come to a record $27,289 per senior citizen, up 25% since 2000. About 35% of the federal budget is now spent on seniors.”
Source: THE WEEK, Feb. 29, 2008

Solutions
“Increased Fitness Associated with a 50% to 70% Reduction in all Causes of Mortality.”
This was one of the largest studies ever to link exercise capacity to all causes of mortality. Physicians should be motivated to pay as much attention to exercise capacity as they to do major risk factors.
Source: Circulation 2008 and DOI:10.161 Kokkinos et al. “Exercise Capacity in Black and White Men”

An 11-year study of more than 25,000 men and women ages 45 to 79 years of age found that healthy lifestyle behaviors equated to a longer life. By eating lots of fruits and vegetables, exercising, drinking alcohol if desired (but not too much), and not smoking individuals may live an additional 14 years.
Source: PLoS Medicine, Jan. 8, 2008

This is not to imply that other modalities are not appropriate because in specific instances they are needed. It would seem however, that if exercise were only half as good as reported, it would still be better than everything else!

Conclusion
Very simply put, when done properly, there is no other form of treatment, pill, medication or intervention as cost-effective as exercise.

II. Medical Benefits of Exercise
i.e. slow-twitch vs. quick-twitch muscle fibers*

Contrasted with their sedentary counterparts, those who exercise a minimum of 1 hour, 3 times a week (burning 2200-3300 cal.), experience the following diseases/problems less frequently (usually by a magnitude of more than 30%).

1. Hypertension
2. ASHD (arteriosclerotic heart disease)
3. Stroke
4. MyocardialInfarction (Heart Attack)
5. Acute Sudden Death (ventricular fibrillation)
6. Peripherovascular disease
7. Diabetes (especially Adult Onset Type II)
8. Esophagitis
9. Hiatal Hernia
10. Gastric Ulcer
11. Appendicitis
12. Duodenal Ulcer
13. Diverticulitis
14. Cholecystitis (Gall Bladder Disease)
15. Varicose Veins
16. Hemorrhoids
17. Osteoporosis
18. Estrogen Dependant Cancer
19. -Breast (recurrent breast Cancer 50%)
20. -Uterine
21. -Ovarian
22. Colon Cancer
23. Prostate Cancer
24. Premature Labor/Low Birth Weight
25. Teen Pregnancy
26. Failure to Complete Education
27. Substance Abuse
28. Depression
29. Alzheimer’s
30. Cataracts
31. Migraine Headaches

These are the most common medical, problematic and surgical conditions in the United States today, and regular exercise is the best “medicine/cure!” Clearly, it’s never too late to get started, but as in any other form of medical therapy, the sooner the better!

*There are two types of muscle fibers, slow-twitch and quick-twitch. Quick-twitch muscle fibers help with quick bursts of energy. Slow-twitch muscle fibers, which are for endurance training, i.e. 1 hour running/walking 3 times a week, dramatically reduce the above mentioned problems.
Important: 30 minutes of exercise 6 times a week does not give the same disease fighting benefit as 1 continuous hour, 3 times a week.

III. LIFE CHOICES CAN SAVE YOUR LIFE!

If an individual dies prematurely (before age 65), 85% of the time it is due to “lifestyle” related causes consisting of:

1. Hypertension
2. Cigarette smoking
3. Lack of exercise

With the exception of #1, choices #2 and #3 are clearly personal.

Proper endurance exercises modify many other diseases as well. Further, there are no credible reports in the medical literature to support that runners have more low-back pain, cervical discogenic disease, or any form of arthritis as compared to their sedentary counterparts. There are no studies suggesting that running stunts growth or damages epiphiseal plates in children at any age. Running is child’s play! (Running is the strongest natural stimulus of growth hormone there is).

Jack H. Scaff, Jr., M.D., FACSM
President, Hawaii Sports Foundation
Director, Honolulu Marathon Clinic

This fitness brochure was prepared in its entirety by the Hawaii Sports Foundation as a public service. Supported in part by an Educational Grant from Pacific Cardiology,(SM) LLC. Visit www.pacificcardiology.com. 

You may make copies of this pamphlet but please give the Hawaii Sports Foundation credit. Rev 4/08

IV. Honolulu Marathon Clinic Welcomes Beginning Runners

The Honolulu Marathon Clinic is all about being healthy and having fun. If you finish a marathon, wonderful. If not, the training is great anyway. The Honolulu Marathon Clinic is one of the most successful running programs in Honolulu … in Hawaii … in the world. Moreover, it’s free!

It is staffed by experienced volunteer runners who started out as beginners (some even smoked!) but graduated as marathoners.

Honolulu Marathon Clinic

1. Beginners are always treated as new friends.
2. The 9-month training begins the 2nd Sunday in March at 7:30 a.m. at Kapiolani Park on Paki St., in Honolulu. The clinic meets every Sunday thru December, (except 3-day holidays) rain or shine!
3. It starts ON TIME (always has, since ’74, and always will)!
4. Each clinic begins with a short expert talk on some aspect of running, health or the latest research.
5. Participants then break up into ability groups for a run or walk. Experienced, caring volunteers are with you all the way.

Join us to learn the elements of recreational long-distance running (and getting healthy along the way). Even experienced and world-class runners show up. Like the motto of the San Francisco Dolphin South End Runners, we “start out slow and taper off.”

The Honolulu Marathon Clinic was founded in 1974 by Jack H. Scaff, Jr., a physician who was also the Founder and the 1st President of the Honolulu Marathon Association, Co-founder of the Great Aloha Run, and Race Director of the 1997 H-3 Run.

QUERY:

A reader and marathon clinic participant writes, “Hey Doc, last year when I joined the Honolulu Marathon Clinic, I developed shin splints.  Fortunately they went away and I completed my first marathon.   Now I’m beginning to run again and I don’t want them back.

RESPONSE:

This is a good news bad news situation.  The good news is shin splints are usually a “first year” phenomenon and when individuals train properly, shin splints rarely return in the second year of training. 

CAVEAT:

Unless of course that individual becomes over enthused or suddenly increases to prodigious mileage and/or speed.   On the other hand because shin splints develop in the first year of training and as noted are a sign of overuse, while the probability of return is small, it is not negated.  

ETIOLOGY:

Exactly what are shin splints?  Shin splints represent the result of the body trying to remodel itself to a new task.  And yes, the body is capable of making tremendous adaptions depending on the various workloads that are imposed.  One only as to look at the habitus of the long-distance runner versus the sprinter or weightlifter to realize how much body remodeling can occur in response to a challenge. 

The lower legs are no different.  The anterior flexor compartment muscles (those on the front) obtain their support by attaching to the fascia on the anterior surface of the tibia (shin).

To get a better picture, when visiting the supermarket, look at ribs, particularly lean one’s (vegetarians you can do this too because you’re only looking).  You will note that the intercostal muscles (the muscles between the ribs) attach along the entire length of the rib in a fibrous latticed fashion in order to facilitate breathing.  The lower leg muscles attach to the shin in the same fashion.  When these muscles are introduced to a new activity, such as recreational long-distance running with its repetitive 5000 stop steps an hour, an attempt is made to reconstruct to this new activity. 

Shin splints are results of the terrible 2s.    i.e. 2 much, 2 soon, 2 often and 2 fast which then becomes “2 bad 4 me’. 

Generally shin splints progress in intervals of several weeks from initial pain (indicating the fiber is beginning to stretch) to tenderness to touch, to induration and swelling (a depression occurring over the tender area of the shin if one applies pressure) and then finally death or tear of tissue.   But just as a broken bone is always stronger after the fracture has healed (with its protective callus as seen on x-ray), the muscle (if it survives) likewise become stronger and not weakened by this process. 

In advanced shin splints, if one did an MRI or similar sophisticated investigative technique, one would note that the fibers along the shin are actually tearing off and reattaching up and down the shin remodeling in order to better facilitate running style.  In essence then, the shin splint is the beginning of a fatigue fracture and indeed it can progress to that.

TREATMENT:

Clearly because the shin splints did not exist before your running program, if running had not occurred, they would not have appeared. The treatment is simple.  The body is telling the individual that too much is occurring too soon and to back off.

The bottom line is that when symptoms appear, one needs to learn to back off by either running slower or less frequently.  Additionally, ice helps decrease the inflammation whereas heat and massage make it worse.  Anti-inflammatories such as nonsteroidals, (ibuprofen, Motrin, etc.,) are helpful, but if one uses them to cover the injury (by hiding inflammation and pain) training when the injury resurfaces, it will be worse than before.   Therefore, use nonsteroidals only when you are not running; do not take them on the days prior to your run.

Shin splints can take as long as 6 to 8 weeks to heal and if one fails to make progress, one should contact a sports minded physician knowledgeable in this area.  A major stress fracture resulting from shin splints might require casting, which virtually predicates that that leg may never be as strong again as it was before, something to assiduously avoid. 

When starting over again, do your running more slowly, less often and once you can run very slowly for a month at 1 hour 3 times per week (20% slower than your former training base), return to your former running schedule.