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? For the past year, I have been taking 25 mg of Atenolol and 12.5 mg of Hydrochlorothiazide to control my blood pressure. With the medications, my blood pressure is usually 120-130/65-75. I am currently training for a marathon and take these medications after my morning run. Is this the right time to take them? Or should I take them before I run?

Russ Slater, Pleasanton, CA

The most important issue concerning treatment of hypertension is whether or not you take the medication at all--which you are doing. All other issues, such as when you take the medication, are much less important.

That said, these medications are generally prescribed so that their maximal effectiveness occurs when a person's blood pressure is highest. As a result, most people take their blood pressure medication first thing in the morning so that the greatest effect will occur during daytime hours, when they are most active. In your case, it might make sense to take your medication an hour or so before you run since your blood pressure is likely to be higher during your training. However, my reasons for suggesting this are more theoretical than proven fact, so if taking your medication before your run would be inconvenient, I don't see any real reason to change.

Todd Miller, MD, Rochester, MN

It's important to have proper potassium and magnesium balance before you run, which can be reduced with the diuretic. Keep this in mind if you take it beforehand. In addition, it is important that you stay well-hydrated both during and after the run to avoid dehydration and low blood pressure.

The Atenolol has a long half-life and may provide blood pressure control for nearly 24 hours. If you don't take it before you run, you may get more out of training because your heart rate may be less "blocked" by the medication. However, this also may cause your blood pressure to be too high on your runs. Since you are training for a marathon, I would advise an exercise test to assess blood pressure control under aerobic stress.

Lloyd Lense, MD, Old Field, NY

ACE inhibitors may not adversely affect exercise performance at all or in the same way that a beta blocker like Atenolol does, which would allow you to take the medication without regard for your training. Perhaps you could revisit your doctor and see if a change in hypertension medicine is possible.

Mel Williams, PhD, Norfolk, VA


? I am a 66-year-old male who has been running three or four days for the past six years. I average 20 to 25 miles per week, with one 9-mile run always included. I have been told that running up to 90 minutes enhances your immune system, whereas any more than that degrades your immune system. Is this rule of thumb accurate?

Timothy D. McCollum, Bloomsburg, PA

Although I am personally not aware of the 90-minute rule you speak of, it is well documented that intense endurance exercise can temporarily impair the immune system. For example, several studies have shown that during the two weeks following a hard, long-distance race (i.e., 10K and up), 50 to 70% of runners may experience symptoms of upper respiratory tract infection (URTI). And, it seems that those who race faster and train longer and harder are more susceptible.

On the other hand, research shows that regular, moderate exercise at 60 to 80% of aerobic capacity, 45 minutes per session, four or more days per week does not increase the risk of URTI, and, in fact, may reduce the risk. Studies have also indicated that moderate exercisers have improved immune function compared to their sedentary counterparts.

I would describe your program as moderate, although you do one 9-mile run per week. If you are concerned about enhancing your immune system during training, you might try taking a replacement drink that provides carbohydrate and perhaps a little protein before, during and after your workouts, particularly the longer ones.

Tom LaFontaine, PhD, ACSM RCEP, FAACVPR, FACSM, Columbia, MO


? For the past two years, I have had iliotibial band (ITB) syndrome in my left knee. It originally occurred when I was training for my first marathon. After completing that marathon and one other, my knee pain went away after several weeks off from running. It reemerged six months later during training for my third marathon, even though I was very careful to increase my mileage slowly and methodically. Any time I ran longer than 10 miles, I had pain on the outside of my knee. I completed the marathon anyway and then another marathon a month later. Although I have now taken four months off from running, I still occasionally feel knee pain when walking considerable distances. I have followed various stretching and strengthening programs without success. I don't want to begin running until I am pain-free, but I am eager to get back out on the roads. Do you have any suggestions for treating this type of chronic injury? Would surgery be an option?

Doug Crews, Elkton, MD

Surgery is not something to consider for this type of problem. ITB syndrome can be chronic and annoying, but it is certainly something that can be managed. If you see a physical therapist, there are a variety of effective treatments that may help you. Cross-friction massage is a deep massage performed perpendicular to the fibers that are causing you trouble. It is painful, but very effective for treating ITB syndrome. Also effective for ITB syndrome are iontophoresis treatments, which use special equipment to electronically deliver dexamethasone into the skin at the point of inflammation. Another option is ultrasound treatment. With any of these treatments, you need to stretch regularly. Unfortunately, many runners only stretch on days they run, but they should really do so daily.

Ron Kleinman, PT, Akron, OH

I feel you need to look in another direction regarding your knee pain. You seem to have given the knee an appropriate amount of rest with minimal to no results. At this point, you need to make sure that you are not dealing with another condition, such as a chronic meniscal (cartilage) tear, a sprained lateral collateral ligament (LCL), or lateral chondromalacia (a softening of the cartilage). All of these conditions can be revealed through MRI. You also need to make sure that your running mechanics and foot posture are correct. A sports medicine podiatrist or physical therapist would be able to do an evaluation for you.

Brian A. Magna, MA, PT, Avon, CT

Please note that Clinic responses frequently appear as excerpts of longer answers, especially when the inclusion of two full answers would result in redundant information.


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 (301) 913-9520, or 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. Handwritten faxed letters cannot be accepted. All letters, even e-mail, must include your name, address and phone number. Receiving all responses can take up to three to four weeks.
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Title Annotation:exercises
Publication:Running & FitNews
Date:Mar 1, 2005
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