The clinic.

FOR MEMBERS ONLY PERSONALIZED SPORTS MEDICINE, TRAINING AND DIET ADVICE 255 CLINIC ADVISORS REPRESENTING MORE THAN 27 SPECIALITIES

ATRIAL FIBRILLATION: CAN I KEEP RUNNING?

I'm 53 years aid and have been running for 12 years. I have been diagnosed with atrial fibrillation and take Sotalol to control it, yet I've had five episodes over the last several months.

During these periods of atrial fibrillation I increase my medication and stop running. Overall though, I have kept running, but with some anxiety. Should I give it up?

Joseph R Grzesiak

Rome, NY

Atrial fibrillation is a common arrhythmia of the heart. Under normal circumstances, the electrical impulse that fires off before each contraction of the heart arises in the right upper chamber of the heart. The area from which the electrical impulse arises is called the sinoatrial node. During an episode of atrial fibrillation, the function of the sinoatrial node is overtaken and many electrical impulses, greater than 400 per minute, fire off from the upper chambers of the heart. Many, but not all, of the electrical impulses penetrate to the lower chambers of the heart, resulting in a rapid and irregular heartbeat. There are many medical conditions that are associated with atrial fibrillation and some authorities have even suggested that it is more common among runners. There is no evidence however that running causes atrial fibrillation.

In general, atrial fibrillation is more of a nuisance and is not a life-threatening arrhythmia. Periods of atrial fibrillation greater than 48 hours can increase the risk of stroke, which should be addressed with specific treatment and medication.

Symptoms of atrial fibrillation can range from unnoticeable in some people to nearly incapacitating in others. The most common symptom is palpitations, which is what you may notice as an awareness of irregular heartbeats. Other symptoms include lightheadedness, shortness of breath, or chest pain. In some people, atrial fibrillation has no impact on exercise performance, whereas in others, exercise performance can drastically decrease.

Sotalol is commonly used to help maintain a normal heart rhythm, and to lengthen the time between episodes, but it may not be 100% effective in all people. Even if it is not completely effective, it usually reduces the frequency and duration of atrial fibrillation episodes.

Here's the good news: I do not see any reason why you should give up running. There are many people who are in atrial fibrillation continuously and exercise on a regular basis. During episodes of atrial fibrillation, you may want to decrease the intensity of your workouts if you find it is more difficult than usual. From a practical standpoint, you might also want to avoid competitive running during episodes of atrial fibrillation. Otherwise, I do not see any reason why you should alter your running schedule.

Todd D. Millet; M.D.

Rochester. MN

LIFT THEN RUN?

If I do strength training and cardio on the same day, is it better to do one or the other first?

George Baird

Rensselaer, NY

Traditionally, strength and conditioning coaches recommend that you split up the two types of work-outs on separate days or at least by several hours. The logic is that either type of workout will subtract from the quality of the other. A hard run will leave your energy reserves depleted. Assuming that your strength training is intended to maximize gains, that won't occur if you are already fatigued. If your workouts must be back-to-back, do the one that's more important to your training goals first. If, for example, your strength training is basically an adjunct to your overall running program, run first, then lift. If you are interested in developing absolute strength to improve your running performance, try focusing on those goals during your off season.

Doug Lentz, C.S.C.S.

Chambersburg, PA

STRESS FRACTURES--HOW SHOULD I CHANGE MY TRAINING?

I am 30 years old and have been running seriously for four years. I was training an average of 50 miles per week at about an 8:45 minute pace. Over the past year I have suffered two tibial stress fractures resulting in long layoffs. After returning to running again I have gradually increased my mileage to about 35 miles per week and now I can feel trouble brewing at the location of my first stress fracture. I am 5'l" and 110 pounds. I take daily vitamins, drink milk, and wear prescription orthotics. How can I adjust my training so that I avoid these problems and the layoffs they cause?

Nicole Seferian

Woburn, MA

First, you should have a DEXA Scan to make sure you do not have osteoporosis, as well as a complete evaluation to rule out Female Athlete Triad. Small, slim women with high mileage training can be vulnerable to hormonal disturbances that can weaken bones and make you prone to stress fractures. Even if your hormonal status is normal, it is difficult to get enough calcium (1,500 mg a day) through diet alone and you may need to supplement. I would recommend a consultation with a registered dietitian to evaluate your diet and help make sure you are consuming adequate calories to meet your training and nutritional needs.

Given that you have a history of stress fractures, it is important that you make maximum use of crosstraining. It is my opinion that you should never run two days in a row. You might come up with a plan such as run Mondays, Wednesdays, and Fridays and choose crosstraining options other days such as NordicTrack, bike riding, stair machines, rowing, swimming, elliptical trainers, or water running. Don't assume that crosstraining to this extent will impair your running performance. Good use of crosstraining can improve your overall running performance. Replacing a significant portion of your mileage with crosstraining is certainly better for your running performance than long interruptions for injury and rehabilitation. When crosstraining, monitor your heart rate so that you train at about the same level of cardiovascular intensity as you would with running.

When you are able to return to running you must use caution. Start out with walking, then jogging, until you can comfortably run about 40% of your usual non-race preparation workout. Build up very slowly. Even the often-quoted 10% per week increase may be too much too soon. Continue to alternate with crosstraining options.

Larry D. Hull, M.D.

Centralia, WA

ROAD WEARY AFTER THREE MARATHONS

I just completed my third marathon in 14 months, with five months of training before that. I felt pretty worn out even before the race and I did not perform my best. I took a couple of days off, then added some light crosstraining for a few days then ran six miles about a week after the race. I feel totally wiped out and know I should be resting more, but I worry about losing fitness and getting lazy. For the last fifteen years I've worked out regularly, usually taking only one day off a week Must I lay off running completely for recovery?

Jane Newman

Marlton, NJ

Rest is often an overlooked element of training, but it is a must. Although many experts would consider it to be overly conservative, a general rule of thumb for race recovery is a day of rest for every mile of race--that's 26 days if you feel great and had a good race. It sounds as if you went into the race tired. so you probably need even more relative rest. Relative rest doesn't mean a total layoff It can mean scaling back, crosstraining, choosing light workouts, and resting. Don't worry about losing fitness or getting lazy. You will lose much more fitness by overtraining than by getting the rest you need. Overtraining also sets the stage for an injury that can force you out indefinitely. The principles of any type of training include overloading the body's systems. Improved fitness and training gains come only following rest to recover from the overload.

Since you are really rundown, consider giving yourself a full month without running to completely recover. When your energy improves start back with swimming, yoga, cycling--not running. Giving yourself time to recover fully will allow you to come back fully rested and motivated. and your crosstraining can help with new strength and flexibility.

Back off your racing goals for a while, to allow for a full recovery so that you feel fresh again when you return to racing. Build your base for at least four to six months before training for another marathon. The real key to endurance training for the long term is consistency with a very gradual build up. The body will adapt to the training stress, but only if you give it time. Incorporate recovery days and crosstraining into your training schedule. Rest and recovery are needed during training, not just after your races. Consider finding a coach or a training group that can help you with training schedules. Recognize that you may have a tendency to overtrain and that you must schedule rest and recovery along with your training runs.

Roger Moffat

Atlanta, GA

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 cannot 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.