The History and Health Benefits of Marathon Running: A Doctor's Perspective
Lately, as more and more people in Myanmar are embracing a healthy lifestyle, it is heartening to see that "Marathon Running" has become one of the most popular sports. Patients often ask me at the clinic, "Doctor... is running really good for our health?"
Before discussing these matters from a medical perspective, I would like to share an interesting piece of history about how the word "Marathon"—which we are all running around for today—first came to be.
The Historical Steps That Cost a Life (The Background History of the Marathon's Origin)
More than 2,500 years ago (around 490 BC), a major war broke out in Greece. In a coastal plain area called "Marathon," where the Greek army and the powerful Persian army clashed, the Greeks achieved a miraculous victory.
To deliver this invaluable news of victory as quickly as possible to the capital city of Athens, a Greek soldier named Pheidippides was dispatched as a messenger. Pheidippides ran nonstop from the Marathon battlefield to Athens—a distance of approximately 25 miles (about 40 kilometers)—crossing hills and mountains. As soon as he reached Athens, he shouted, "Rejoice, we conquer!" and collapsed and died on the spot due to extreme exhaustion.
(As a doctor, analyzing this, it is likely that due to a lack of adequate nutrition, hydration, and prior preparation/training, he pushed beyond his body's limits, leading to severe dehydration and sudden cardiac arrest.)
To honor his brave spirit and sacrifice, the "Marathon" race was officially included as an event in the very first modern Olympic Games held in Greece in 1896. Although it was originally around 40 kilometers, following a request by the British royal family at the 1908 London Olympics, the distance was measured precisely from Windsor Castle to the Royal Box inside the Olympic stadium. This established today's official standard of 26.2 miles (42.195 kilometers).
If you run systematically—without facing the life-threatening danger that Pheidippides did—marathon running can act like medicine for your body. From a medical perspective, I would like to share in detail how this sport, which spans over 40 kilometers (26.2 miles), benefits our bodies, and what preparations are needed regarding nutrition and injury prevention.
1. Strengthening Heart Muscles and Regulating Heart Rate
When you regularly perform aerobic exercises like a marathon, your heart muscles become stronger.
Increased Stroke Volume: A trained heart becomes capable of pumping out greater amounts of blood and oxygen to the body with every single beat.
Lower Resting Heart Rate: While an average person's resting heart rate is around 70–80 beats per minute, trained marathon runners typically have a resting rate of only 50–60 beats per minute. This shows that the heart does not have to work as hard, allowing it more rest and a more relaxed state.(https://asianheartinstitute.org/blog/marathon-running-heart-health-risk/)
(1) Widening Blood Vessels and Preventing Hypertension
When you run, blood circulation accelerates dramatically because the body requires more oxygen.
This regular and robust circulation makes blood vessel walls more pliable and encourages the formation of new capillaries.
Improved vascular elasticity significantly reduces the risk of developing hypertension (high blood pressure).
(2) Reducing Bad Cholesterol and Fats
The main culprit behind coronary artery disease is the buildup of fats in the blood stream.
Marathon training lowers the levels of LDL cholesterol (bad cholesterol) and triglycerides, which can clog blood vessels.
At the same time, it boosts HDL cholesterol (good cholesterol) levels, which cleanse blood vessels and protect the heart.
(3)Enhancing Blood Supply to the Heart (Collateral Circulation)
During endurance exercises like marathons, tiny blood vessels (collateral vessels) that supply the heart muscle develop more extensively. Therefore, if a main blood vessel encounters a problem for any reason, these smaller vessels can serve as a backup to continue supplying blood and oxygen, thus protecting against severe heart disease events.
2. Preventing Diabetes and Boosting Metabolism (Metabolism & Diabetes Prevention)
When meeting patients at the clinic, besides medical treatments for diabetes and weight management, I frequently have to advise on lifestyle modifications. From a medical perspective, I want to present in detail how long-distance sports like marathon running benefit the body's metabolism and help prevent Type 2 Diabetes.
Let's examine how this sport spanning over 40 kilometers (26.2 miles) affects our metabolic system:
(1) Improved Insulin Sensitivity
A primary cause of diabetes is that cells can no longer respond properly to the insulin hormone produced by the body (Insulin Resistance).
When running, muscles primarily use glucose or sugar in the blood as fuel.
During this utilization, muscle cells develop a heightened ability to directly absorb and use blood sugar even without insulin (Glucose Uptake).
Consequently, marathon trainees achieve exceptionally good insulin sensitivity, enabling superior control over blood sugar levels.
(2) Significantly Lowering the Risk of Type 2 Diabetes
Fluctuations in blood sugar and insulin deficiencies eventually lead to Type 2 Diabetes over time.
Regular marathon training revitalizes the body's metabolic system and keeps HbA1c—the 3-month average blood sugar level—in a normal state.
For those with a family history of diabetes, practicing endurance exercises like marathons systematically helps prevent the onset of diabetes.
(3) Boosting Fat Burning and Elevating Metabolic Rate
When training for a marathon, the body shifts to using stored fats alongside carbohydrates as primary fuel.
Running such long distances elevates the body's Basal Metabolic Rate (BMR), increasing calorie-burning capacity even while resting.
By naturally eliminating visceral fat and obesity, it fundamentally prevents metabolic syndrome.
(4) Building Muscle Mass for Long-Term Metabolic Health
Running primarily engages the lower body and leg muscles. Regularly putting these muscles to work improves muscle mass and density.
The more muscle you have, the more calories and sugar your body consumes even while at rest.
This creates a healthy metabolic system that constantly converts sugars and fats into energy rather than storing them.
3. Strengthening Bones and Joints (Bone & Joint Health)
At the clinic, patients often worry and ask, "Doctor... I've heard that running long distances causes knee pain and damages joints. Is that really true?" Most people assume that running wears down and damages joints.
However, medical and scientific research shows that systematic running does not weaken or damage bones and joints; rather, by applying correct mechanical stress, it makes them stronger. Let's look at the positive impacts of marathon running on our skeletal and joint systems:
(1) Increasing Bone Density and Preventing Osteoporosis
Bones need weight-bearing exercises where the body supports its own weight to grow stronger.
When running a marathon, with every single step, the ground reaction force and body weight pressure are transmitted to the bones.
This mechanical stress stimulates the bone remodeling process, which encourages the formation of new bone cells.
Therefore, marathon runners have higher bone density, offering the best defense against osteoporosis in later life.
(2) Enhancing Lubrication and Nutrient Delivery for Joints
Many people think that running wears away the cartilage between knee joints. Surprisingly, according to research:
The cartilage inside joints contains no direct blood vessels. They absorb required nutrients and oxygen from a lubricant called "Synovial Fluid" inside the joint capsule.
Regular running moves the joints in a natural range of motion, circulating this fluid and delivering more nutrients to the cartilage. This is a natural support system that keeps joints healthy and youthful.
(3) Strengthening Surrounding Muscles to Support Joints
Marathon running directly impacts the knees, ankles, and hip joints.
To support these joints, surrounding muscles, tendons, and ligaments become stronger.
As muscles strengthen, the impacts of body weight and movement are absorbed by the muscles rather than directly hitting the joints, protecting them from injury.
(4) Lowering the Risk of Osteoarthritis
The notion that "running causes osteoarthritis" is popular but contradicts reality.
Studies show that extremely overweight individuals and sedentary people have a higher incidence of joint pain.
Systematic runners and marathon runners actually have a lower incidence of osteoarthritis compared to sedentary individuals. (However, caution is needed for those with previous severe injuries or those running excessively with incorrect techniques.)
(https://pmc.ncbi.nlm.nih.gov/articles/PMC7377236/)
4. Boosting Mental Health (Mental Health & Runner’s High)
In clinical practice, alongside physical health, I frequently encounter patients suffering from high stress, anxiety, and depression. Lifestyle modifications are crucial for mental health alongside medical treatments. Here is how endurance exercises like marathon running provide unique psychological benefits alongside physical ones:
(1)"Runner’s High" and the Release of Happiness Hormones
Engaging in long-distance exercise prompts the brain to release a multitude of chemical substances:
Endorphins: Hormones that relieve pain and induce happiness and euphoria.
Serotonin and Dopamine: Neurotransmitters that stabilize mood and generate feelings of satisfaction and achievement. The combined state of these chemicals is known in medicine and sports as a "Runner’s High." It naturally relieves stress and refreshes the mind.
(2) Reducing Stress and Anxiety
Daily work stress and problems often crowd the mind with overwhelming thoughts.
During prolonged marathon running, the brain shifts its focus elsewhere.
Because you must concentrate on your pacing and breathing control, anxious thoughts are temporarily forgotten, allowing the mind to rest.
Post-exercise, levels of cortisol (the stress hormone) drop, bringing mental calm and peace.
(3) Improving Sleep Quality
People under high stress often experience insomnia or frequent night awakenings.
Marathon training normalizes the body's circadian rhythm.
Tired muscles and brains from a day's workout signal a natural need for rest at night, leading to deeper, sounder sleep (Deep Sleep).
(4) Building Self-Confidence and Mental Resilience
Running a marathon is a journey that thoroughly tests mental resilience alongside physical strength.
Crossing the finish line after miles of grueling effort produces an overwhelming sense of achievement: "I can do this."
This mindset increases your resilience when facing difficult problems in daily life without easily giving up.
When running long distances, the brain releases happiness hormones like Endorphins, Serotonin, and Dopamine. This process is medically termed a "Runner's High," which naturally treats stress, anxiety, and depression.(https://www.mqmentalhealth.org/mental-health-is-a-marathon-why-exercise-helps-mental-well-being/)
5. Boosting the Immune System (Immunity Boost)
A healthy immune system requires a nutritious diet, adequate sleep, and regular physical activity. Systematically performing endurance exercises like marathon running significantly supports the body's immune defense. Let's see how this sport impacts our immune system:
(1) Faster Circulation of Immune Cells via Improved Blood Flow
When running, heart rate increases and blood circulation operates systematically.
With enhanced circulation, immune cells—particularly white blood cells and antibodies that fight pathogens—circulate more rapidly to the extremities of the body.
This improves the immune system's ability to timely detect and rapidly fight off invading bacteria or viruses.
(2) Preventing Common Colds and Routine Illnesses
Research shows that individuals who exercise moderately and systematically have better resistance to common colds compared to sedentary individuals.
Regular marathon training enhances the body's anti-inflammatory response.
Consequently, it provides greater defense against environmental stressors that easily cause physical illness.
6. Eliminating Body Toxins
From a medical standpoint, intense and prolonged endurance exercises like marathon running boost the body's natural detoxification systems.
(1) Eliminating Toxins Through Sweating
As body temperature rises during a run, sweat glands produce copious amounts of sweat to regulate temperature.
This sweating not only releases water and salts but also assists in clearing trace minerals and certain toxins from the body via the skin.
Heavy sweating opens up skin pores and naturally cleanses trapped impurities.
(2) Eliminating Carbon Dioxide and Waste via the Lungs
Due to high oxygen demands during a marathon, breathing rate and depth multiply rapidly.
This respiratory activity allows unwanted carbon dioxide and other gaseous waste accumulated in the lungs to be expelled outside the body as quickly and efficiently as possible.
This revitalizes lung function and cleanses air passages.
(3) Cleansing via Kidneys and the Circulatory System
During a run, blood circulation speeds up drastically, allowing the kidneys to filter impurities present in the blood much faster.
Kidneys remove excess salts, urea, and other waste products through urine.
Good blood circulation delivers more blood and oxygen to internal organs, optimizing cellular function.
Essential Nutrition and Hydration for Marathon Runners
Just as a car needs a full tank of gas for a long journey, nutrition is vital for marathon runners.
Carbohydrate Loading: During a run, the body primarily uses glycogen as fuel. Therefore, 2–3 days prior to running, you should consume more carbohydrate-rich foods such as rice, noodles, sweet potatoes, and potatoes (Carb-loading).
Rebuilding with Protein: After running, protein is essential to rebuild torn muscle fibers. You should consume eggs, meat, fish, beans, and milk within 2 hours post-run.
Hydration and Electrolytes: Heavy sweating causes a loss of water as well as electrolytes like sodium and potassium. To prevent muscle cramps, besides drinking water, you should consume sports drinks, bananas, and energy gels roughly every hour during the run.
Common Injuries and Prevention for Runners
While marathon running has benefits, exercising without proper system discipline can lead to injuries. The most common injuries seen in runners at the clinic include Runner's Knee, Shin Splints, Plantar Fasciitis, and Achilles Tendinitis. To prevent these injuries, make sure to follow these rules:
Follow the 10% Rule: A primary cause of injury is doing "too much, too soon." When increasing weekly running distance, do not exceed a 10% increase over the previous week's total distance (e.g., if you ran 10 miles this week, do not run more than 11 miles next week).
Warm-up and Cool-down: Before running, perform dynamic stretches (e.g., high knees, walking lunges) to prepare your muscles. After running, do not stop abruptly; instead, walk slowly and perform static stretches to minimize next-day muscle soreness.
Proper Footwear: Choose authentic running shoes that match your foot type (flat foot, high arch, etc.). A pair of shoes loses its cushioning properties after running 300 to 500 miles and should be replaced. Continuing to wear old shoes places stress on the knees and back.
Strength Training: Running alone is not enough. To support your knees and joints while running, your leg muscles, glutes, and core muscles need to be strong. Go to the gym or do bodyweight exercises like squats, lunges, and planks at home about 2 days a week.
Listen to Your Body: Pain is a warning bell from your body. If you experience sharp pain or swelling rather than normal fatigue, stop running immediately. Rest when needed, and do not hesitate to apply ice and consult an orthopedic or sports medicine doctor.
Medical Caveat
Running a marathon is not a sport you can simply wake up and start doing tomorrow.
Train Systematically: Start from 5K, 10K, Half-Marathon, and gradually increase distance over several months.
Consult a Doctor: Individuals over 40, those with chronic underlying diseases like heart disease, diabetes, or hypertension, or those with a family history of sudden cardiac death should consult their doctor before starting a marathon and undergo necessary cardiac evaluations (ECG, Echocardiogram) if needed.
Recovery: Just like exercising, adequate sleep and rest are crucial for muscle recovery.
"A marathon is not a competition against others, but a journey to conquer yourself and test your perseverance."
May you run safely and systematically, listening closely to your body's signals and nourishing it with the necessary nutrition.
May everyone be healthy and happy in body and mind.
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