The Clinic.

Q: Flu Shots Good or Bad

I have heard that annual flu vaccines can suppress the immune system and actually increase your chances of contracting the flu. Is this true?

Erin Irwin

Detroit, MI

A: Any vaccination stimulates rather than suppresses the body's immune response to the particular agent. The vaccine exposes the immune system to small amounts of either killed, weakened, or modified viruses. The body is stimulated to produce antibodies against the virus and will respond aggressively if exposed to the disease itself. Although you may feel achy and a bit lousy for a couple of days, the flu vaccine will not cause the particular illness if given according to guidelines. Any respiratory illness that occurs after the vaccine is coincidental and not related to the vaccination.

Annual flu vaccines are highly recommended for certain groups of people including those over 65, those with chronic upper respiratory diseases, and individuals who are immunologically compromised, like AIDS patients. More recently, flu vaccines have been recommended for healthy adults as well since the economic cost of days missed from work exceeds the costs of any risks associated with the vaccine.

Sometimes, however, flu season can arrive with a particular strain of virus that was not predicted, and therefore not covered by the vaccine. No protection can be achieved for an unexpected influenza strain.

Unless you have egg allergies, there are many good reasons for runners to enjoy the benefits of flu vaccines, including no lost training time for a two-week bout with the flu. Some runners, especially those who compete in marathons or ultras, may suffer overtraining syndrome and resulting lowered immunity. Flu vaccines could help those runners outdistance the flu viruses. Discuss the pros and cons for vaccination with your doctor.

Mark Elderbrock, MD.

Ashland, OH

Q: Safe Way to Measure Heart Rate

I am a fitness instructor with many years of training and teaching experience. I have always encouraged students to find their heart rate by taking their pulse at the carotid artery in the neck or the radial artery at the wrist. Recently I heard a story about permanent blindness caused by checking the pulse at the carotid artery during exercise. The explanation was given that a carotid plaque was dislodged and blocked an artery supplying the nerves of the eye. Do you think the explanation was accurate? Are athletes at risk with this simple procedure?

Pat McDonnell

Oak Hill, VA

A: Although I've never heard of a person causing a stroke this way, it may be a possibility in a person with advanced atherosclerosis. Of course that same person is at high risk of suffering a stroke at some other point whether associated with exercise or not.

Taking the pulse at the carotid artery, however, does have potential drawbacks. First, if you have any trouble finding the pulse, a deeper probe can stimulate the nearby parasympathetic nerves in the neck causing an artificial slowing of the heart rate And exercisers often have trouble finding the pulse this way. I recommend teaching your clients how to use the temporal artery to monitor their pulse. The temporal pulse is found on the side of the head, just in front of the ear. Use the index finger and press gently upwards. Another good technique is to use the radial pulse on the palm side of the wrist.

A far better way to gauge exercise intensity is by how you actually feel, using the Borg Ratings of Perceived Exertion Scale. This scale ranges from six or seven for sitting in a chair to 20 for maximum exertion (such as sprinting up a steep incline at maximum effort). Exercising at a level of 11 (light) to 14 (vigorous) would be the normal range for moderate exercise intensity. Above 15, you enter the anaerobic stage where the body is outperforming its oxygen supply, and you become breathless. This is more like lactate threshold training, which you may want to do to improve performance. If you run just for health, use the "talk test" to reach levels 11 to 14. These two methods really make pulse taking unnecessary.

John D. McPhail, C.R.C., L.PC.

Okemos, MI

Q: Stride or Turnover for Speed

I am a 57-year-old male and have been running for 15 years. I average about 25 to 35 miles per week. I have run 12 marathons with a personal best of 4:17. My most recent 10K was 52:45.

What is the best way to improve speed? Is it stride length or strides per minute that should improve? I make approximately 180 strides per minute, which according to Jack Daniels, Ph.D., is standard. I have read that stride length is natural to each person and a runner shouldn't over-stride. So, how do I get faster? Increase frequency? Or, length of stride? What flexibility and strength exercises should I do to improve, and what speed training should I do?

Ron Marianetti

Novi, MI

A: Factors that affect your ability to run fast are heredity, stride length, and stride frequency. Forget the first ingredient- nothing to be done about that. Stride frequency can be improved somewhat, but for the most part your turnover rate has a lot to do with the first ingredient-genetics. What many runners can improve (without over-striding) is their functional flexibility. Do you stretch now? If not, regular static stretching, progressing to a dynamic flexibility program, can increase your stride length involuntarily A good source for information on stretching is Sport Stretch by Michael Alter (Human Kinetics, Champaign, IL, 1998, second edition, available at a discount to American Running members by calling 1-800-776-2732. American Running also has a new brochure on stretching, which is free to members.) Regular stretching, combined with functional progressive resistance exercises, should enable you to run faster with less energy expended. I strongly advocate multi-joint free weight exercise (with dumb bells and barbells) for runners. Exercises such as lunges (multidirectional), squats (one leg, two legs, front, back) and dead lifts, train more than one muscle group at the same time. These exercises will not only improve stride length and muscular strength and endurance, they will also aid your proprioception and balance.

If you are not well-versed in resistance training, consult with a certified strength and conditioning specialist in your area. You can certainly improve your own personal best, even if you can't improve your genetics.

Douglas B. Lentz, C.S.C.S.

Chambersburg, PA

A. You might benefit a good deal from an extended phase of repetition training. Two sessions a week of "rep work," which should include a comfortable warm up and stretching session followed by about one and a half miles-worth of 200- and 400-meter repetitions. For example, a routine could consist of two 200s at 55 seconds each, and one 400 at 1:50. Repeat this three times for a total of six 200s and three 400s. Take a complete rest between all the 200s and 400s (probably about two minutes between the 200s and four to five minutes after the 400s).

Jack Daniels, Ph.D.

Cortland, NY

Q. Sixty-Five and Climbing

I would like to do the Ascent (13.2 miles) of the Pikes Peak Marathon next August to celebrate turning 65 and I wonder if you have some tips on how to train for it. I know I will be walking much of the race, which is fine. I ran in the San Francisco Half Marathon about eight years ago in 1:46 and was the second woman in my age group to finish. I also did the Napa Marathon in 3:26 in 1982 (a long time ago!). I trained very hard for those times. But now I am working full time and have limited hours to train. I have been running consistently, however, and completed the New York Marathon (4:15) to celebrate my 60th birthday.

I've been running about five miles a day on flat terrain for five days, then one day I go 40 minutes on the stair machine and one day 40 minutes on the elliptical trainer. Two days a week I do upper and lower body weight work. This keeps me fit (last year I did a 42 minute 8K race), happy, and injury free. Any tips?

Joyce A Hanna, MA, MS.

Palo Alto, CA

A. Your 65th birthday celebration is going to be a great accomplishment. With your discipline, intelligence, and perseverance you will take the day!

To prepare for the Pikes Peak ascent, over 70% of your training should consist of running up hills and stair climbing, and the remaining 20% should be long runs of over ten miles. You'll need to build up to this level of training, being careful not to increase either intensity or duration by more than 10% per week. Your weekly training should consist of two days of climbing and two days of long runs. Put a day of rest between each workout to keep you injury free. In addition, keep up your strength training to improve muscular endurance, especially of the upper body, which has a tendency to fatigue early when traversing uphill.

Fritz G. Huber, Ed.D., C.S.C.S.

Tulsa, OK

A. Here are some tips for dealing with your training and preparation for the altitude. Avoiding altitude sickness would go a long way toward making your ascent as well as your birthday celebration a success.

Try to arrive at Colorado Springs two weeks prior to the event. Fourteen days allows for most of the physiological adaptations to occur. Each day attempt to run the Barr Trail from increasing heights for three to four miles each time for 11 to 12 days, spending two days at each level. Find entry points to the trail about 2,000 feet higher every other day to do your run. Then finally, drive to the top and run down 2,000 feet and back up a couple of times. Train for only 30 to 40 minutes the first couple of days and the build up to 75 to 90 minutes over the next nine to ten days. Ease up on days 10 and 11 and take days 12 and 13 off. You can stay loose with some walking or swimming.

Eat lots of complex carbohydrates and adequate protein to assure optimal day to day recovery. Drink lots of fluids--dehydration is very common.

See a physician about acetazolamide or dexamethasone. These may help prevent altitude illness but they do have some side effects.

Make sure your iron intake is sufficient to meet the increased iron demand due to increased red cell formation. Vitamin C enhances iron absorption; caffeine decreases it.

Be alert for the symptoms of acute mountain sickness (AMS): headache, nausea, vomiting, decreased appetite, lethargy weakness, sleep disturbances, and labored breathing, if you experience AMS and it is severe or it doesn't resolve within a few days, the only cure is descent. However, oxygen and diuretics may help.

Tom LaFontaine, Ph.D.

Columbia, MO

Ed. If you can't devote two weeks to acclimate yourself, a compromise could be to come one day prior to race, use medication, and do your best.

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