The Clinic.

INLINE SKATIN6 AND ORTHOTICS 

I'm planning to try inline skating for crosstraining. I use custom-made orthotics in my running shoes and wonder if I should use them for skating as well. Clearly it would impact fitting and buying my skates. Any advice?

Craig Barbehenn

Stevensville, MI

If you need orthotics for biomechanical reasons then you will need them in your skates. Four-wheel recreational skates can easily accommodate orthotics just as your running shoes. Five-wheel racing skates are often custom molded and won't accommodate your orthotics.

If you're interested in instruction, contact the International Inline Skating Association at www.iisa.org to find an instructor near you and for other good information on skating. Always wear a helmet and wrist guards and skate in control. This is a terrific, non-impact crosstraining method.

Jon Scarlet, D.P.M.

Boston, MA

I would recommend that you buy inline skates that have the room to accommodate your orthotics. Try skating without your orthotics first and you may find that a proper fitting inline skate will hold your foot and ankle securely enough that orthotics won't be necessary.

Bruce Wilk, P.T., O.C.S.

Kendall, FL

RETURN TO MARATHONS AFTER 20 YEARS

Twenty years ago, at the age of 47, I ran three marathons with times clustering around four hours. Over the next two decades, life and work intervened and sadly I didn't run, gained 65 pounds, developed high blood pressure and high cholesterol and now take Avapro and Lipitor to control these problems. I have recently retired and returned to exercise by regularly walk/running 30 to 60 minutes on the treadmill, and do strength training. I'd love to run another marathon but need some help to get there. Is it a reasonable goal for me? Will my medications hold me back? I've lost half the weight gained over the years, but am having a hard time getting rid of the rest.

Bob Walker

Harrisburg, PA

It is a very realistic goal to run another marathon. Your age and the fact that you have been away from running do not preclude this. You are, however, at risk for heart disease because of your age, high blood pressure, and high cholesterol. Be sure you see a physician and discuss an exercise treadmill test to make sure your running program is safe. Also, you need to rule out underlying problems such as anemia and thyroid disorders since you aren't progressing despite training.

Your medication is unlikely to have much of an adverse effect on your exercise ability. Lipitor can have an effect on muscle, but this usually appears as muscle pain and weakness. Have a discussion with your doctor about possible side effects of all the drugs you are taking.

Age-related running performance has been studied. In general, a 5% to 10% increase in marathon time occurs with each decade above 40. The effect on shorter distances is even greater. You should look for other causes of slow progress such as training errors. Aerobic exercise should be done at least five days per week, but not necessarily walking or running every time. Cycling and swimming are excellent cardiovascular workouts and allow the running muscles to recover. Stretching to maintain flexibility and strength training should also help.

Restricting your calorie intake too severely will affect your exercise performance. Make sure you consume enough calories. One pound of body fat contains 3,500 calories so a daily deficit of 500 calories should produce a safe loss of one pound per week. I would highly recommend you consult a registered dietitian to help you plan a healthy diet. Along with a solid training plan, you should be able to reduce your weight and regain a level of fitness necessary for marathon training. Don't give up; instead work with your physician and a dietitian to get you on a progressive track.

Jeffery M. Hubbard, M.D.

Clovis, CA

ULTRA TRAINING

I need some help in training for my first 100-miler. Although I'm an experienced 57-year-old marathoner and have run one 50-mile race, this will be my first 100-mile effort. I currently train about 70 miles per week with a pace of 7:15 to 10:30 depending on the distance and conditions. A typical week includes eight miles slow, eight miles hard, six miles easy, rest, 25 to 30 miles slow, 16 to 20 miles slow, and another day off. I'd love a weekly training schedule that will get me through the event in one piece.

Carl Grupert

San Diego, CA

I suggest some "patterned running" for your long runs. The "pattern" is an individually determined, preset pattern of walking and running beginning at the start of your run rather than when you are already fatigued. The scheduled walks of three to five minutes alternating with 25 to 30 minutes of running give your muscles time to recover and give you time to eat and drink in order to maintain fuel and fluid levels for the long haul.

You will need to experiment during your training runs to determine your particular pattern to maximize recovery and minimize fatigue. During a 100-mile event, these scheduled recoveries to rest, refuel and drink can make a huge difference in your performance and ability to finish "in one piece."

You should also take some time to calculate your energy needs and experiment with food, energy gels, and sports drinks during your training runs. A 163-pound male running at roughly nine minutes per mile will burn about 14.3 kilocalories per minute; at a pace of 11:30 it would be about 10 kilocalories per minute. The stakes are too high to resort to guesswork when it comes to the energy demands of ultra distances.

Roger Moffat

Alexandria, VA

One thing you might experiment with is combining your long runs. Because you are training for a 100-mile event it might be better to cover 40 to 50 miles in a long run rather than two shorter runs. Try a modified schedule of six miles, eight miles, eight plus miles hard, six miles, day off, 30 plus working up to the combined distance of 40 to 50 miles. Also, begin to increase your midweek eight-mile hard run.

In addition to the specificity of one longer run, the back-to-back long runs in your current schedule aren't giving you enough recovery time. Better to plan one long run and one moderate run.

Take your last and longest run three to four weeks prior to your event to insure adequate recovery. Give lots of attention to your recovery diet.

Lee Fidler, Ed.S.

Stone Mountain, GA

Given that you are already an experienced marathoner, I'm sure you are using sports drinks for fluid replacement. However, even that may not be adequate for sodium replacement. In order to avoid hyponatremia, a potentially dangerous dilution of your blood supply, choose a sports drink with the highest amount of sodium available and increase the amount of salt in your diet as long as you are not sodium sensitive or hypertensive. It won't hurt to include a salty food like pretzels for some of your energy needs during runs that exceed four hours.

CAN I RUN WITH OSTEOARTHRITIS OF THE HIP?

I have been diagnosed with osteoarthritis of the hip. The damage to the joint is not severe and I have little pain at this point I have been crosstraining on a bike, an elliptical trainer and with strength training. Is my running career over or can I include some running in my workouts?

Jacob Poleyeff

Teaneck, NJ

Your question is straightforward but the answer isn't. Most authorities believe that osteoarthritis isn't exacerbated by weight-bearing exercise unless weight is excessive or biomechanics of the joint are abnormal. The fact that you have osteoarthritis of the hip suggests that you may have some abnormality of the joint caused by an injury or by heredity. You don't mention how old you are, but the younger you are with osteoarthritis, the more likely that progression will occur with continued stress.

I recommend a thorough evaluation by a sports-minded physician with a referral to a physical therapist that works with runners. This could identify any biomechanical abnormalities, which could then be corrected with orthotics, a change of shoe style, or running form. Even if there are no underlying problems and your weight is optimal, it is still difficult to predict the potential progression of the osteoarthritic hip joint with or without running.

If you do decide to try to include running in your fitness program, consider alternating running with non-weight bearing options such as swimming or deep-water running, change your shoes twice as often as you normally would, and run on a forgiving surface such as well-maintained trails or grass. Most important, re-introduce running very gradually--try 10-minute runs on a treadmill every other day and monitor your hip closely for pain. If you find symptoms increasing, you have your answer about whether you can safely run.

William M Simpson, M.D.

Charleston, SC

Osteoarthritis of the hip is evidence of a biomechanical abnormality. Running stress can aggravate those conditions. Pain is evidence that the joint is responding poorly to the stress. See a sports-minded orthopedist for guidance regarding appropriate exercise (which may not include running) and referral to a physical therapist.

Marvin Bloom, M.D.

Burlingame, CA

ARE YOU BOTHERED BY AN INJURY? DO YOU HAVE A TRAINING OR DIET QUESTION?

Ask The Clinic, in care of The American Running Association. 4405 East West Highway. Suite 405. Bethesda. MD 20814. FAX [phone]. or e-mail at [e-mail]. Write a letter Including as much relevant information as possible about you (age, weight. etc.) and your injury (type and location of pain), training schedule (typical weekly workouts, pace, surface). athletic and medical history sole wear, recent changes in training, etc. Type or print your letters. Hand-written FAXed letters can not be accepted. All letters, even e-mail, must include your name, address and phone number. Responses usually take three to four weeks, but can take as long as five.