An Open Letter to Masters Runners on Overall Health and Sport Longevity

In any conversation among masters runners, questions of overall health and sport longevity are quick to arise. Among my own peers, this is certainly the case.

First, some background. I ran competitively in high school and at a small NCAA Division III school in the U.S. Midwest. With the latter, I was lucky to be a part of a close-knit team of dedicated young men.

I have been even luckier that we have maintained that bond, now 25-plus years since we wore the same uniform. Even today, a large group of us gets together at least once a year to share some laughs, miles, and beers.

Today, my core alumni group is now well over age 40 and, as is commonplace, we’ve begun to have more frequent and compounding medical issues. They range from running-related aches and pains to major injury; and from persistent weight gain to more complex overall health issues. For many of us, this means we are no longer competing. And for some, we are no longer running at all.

Interestingly, among a group of 20 to 30 of us, I am the only licensed medical professional, as well as one specializing in orthopedics and performance. As such, during our last alumni event, the group asked many questions about how to treat and prevent injury, or how to optimize health when it feels increasingly difficult.

I gave the best professional and personal help and advice that I could. For indeed, I have experienced major health challenges — both orthopedic and holistic — yet today I gratefully have the best health I’ve experienced in years. In fact, in some areas, I’m healthier, stronger, and more vital than I’ve ever been.

Since that gathering, I began to think about what advice could help all of my cherished college teammates as well as masters runners of all kind. What resulted was this article, an open letter to masters runners on how to navigate the increasing challenges of staying strong, athletic, and energetic into middle age and beyond.

The to-do list in this article isn’t all-inclusive or exhaustive. Based on my experiences, these recommendations are listed in order of importance and, in most cases, easiest to more difficult.

As with athletic performance, I list a progression of change based on level of difficulty and commitment. Throwing it back to those high-school and collegiate teams, we name the levels of action:

• Varsity: A good starting point in making a positive change
• All-Conference: Advanced, intermediate change
• All-American: Peak optimization

An Open Letter to Masters Runners on Overall Health and Sport Longevity

Dear Masters Runners,

Running at all, let alone strong and fast, at our age, is increasingly difficult. Some issues we’re facing may seem daunting. As an orthopedic and performance physiotherapist and coach, and as a struggling masters athlete, I have gleaned some key strategies that can result in huge improvements in your life, in and out of the running shoes.

If you’re looking to run and feel better, consider the following:

1. Increase Protein Intake

There are few things more important for athletic health than optimizing protein intake.

Protein is best known for its role as the building block of muscle, the primary mechanical motor that powers our running. Strong, sustainable running requires strong, resilient muscles — tissues that take a beating with the impactful, repetitive nature of distance running.

However, protein plays many other important roles in overall health. It is the foundation of all connective tissue: the fascia, tendons, ligaments, and cartilage that cushion, connect, and transmit that propulsive energy of running. It also powers our nervous and immune systems, both building and repairing them, as well as playing a critical role in transmitting those electrical and chemical signals throughout the body.

While the other macronutrients — carbohydrates and fat — can be circumvented when in short supply (life-giving energy can be obtained from fat; and fat created from excess carbohydrates), many of the building blocks of protein cannot be synthesized outside the body. They must be consumed from dietary sources. And in substantial volumes, not just to survive but function at the highest levels.

We need protein. And a lot more than you think.

Recent evidence-based guidelines (1) suggest that even moderately active individuals over age 40 should aim for as much as one gram of protein per pound of body weight each day. For most of us, this requires between 160 and 190 grams of protein consumed per day.

In practice, this is a substantial amount of protein and far more than we’ve traditionally consumed. It often adds up to twice, or even three times, one’s current protein intake.

What This Looks Like

Personally, this requires that I (as per my preference) consume animal protein, via meat, with at least two meals per day. For references, a pound of lean chicken breast contains 140 grams of protein, while a pound of 80% lean ground beef contains less than 70 grams.

Plant protein is less dense, requiring higher volumes of consumption. However, soybeans provide the most protein (20% by weight) of any plant: a cup of cooked soybeans provides roughly 30 grams of protein.

Thus, unless one is eating more than a pound of meat, or several cups of protein-dense plants, hitting that protein standard can be difficult.

The challenge is to consume lean protein: higher protein sources without necessarily increasing carbohydrate or fat intake. In doing so, the body gets the protein it needs for cellular repair and growth, without excess calories. In doing so, this shifts the dietary macro proportions toward higher protein, with relatively less carbs and fat.

For most, the key is supplementation. Currently there are many good options for protein supplementation, ranging from plant-based options such as soy and pea to various animal sources. Whey protein, derived from cow milk, is a traditional source. More recently, beef collagen — derived from various bovine tissues — has gained popularity as a viable protein source, especially because it is easiest to derive without added carbs and fat.

Personally, I obtain about two thirds of my 160-gram protein goal from a natural diet: I consume close to a pound of animal meats, and get another 30 grams or so of protein from plants. The rest, I supplement, by adding collagen protein powder to my coffee in the morning, in a “shake” after workouts, and in a nighttime hot beverage before bed — all 20-gram doses. Vital Proteins is my favorite, because of its nutrient quality and minimal carb and fat content.

For a terrific primer on the importance of dietary protein for runners, and various sources and options, check out this article.

Results

For my medical clients, those who increase protein intake report greater tolerance to consistent, high-intensity or higher=volume athletic activity, and faster recovery. They also tend to bounce back faster from injury, prevent small aches and pains from progressing, and report less frequent illness.

Besides improved resilience and decreased aches and pains, I have personally experienced increased lean muscle mass without working out harder. In fact, I’m more muscular now, in my mid-forties, than I ever was in my thirties or twenties.

Lastly, there are few serious consequences to excess protein intake, especially when lean. Excess protein — usually more than 50 to 60 grams in a meal — will usually be excreted without issue. And if in lean sources, high protein intake will have no negative effect on weight management.

In fact, adequate protein intake is crucial to maintain healthy metabolism and dietary satiation: the more protein you eat, the less hungry you will be for carbohydrates and fat.

Action Plan

• Varsity: Add 40 grams lean protein.
• All-Conference: Consume 0.75 grams of protein per pound of body weight.
• All-American: Consume 1 gram of protein per pound of body weight.

2. Reduce Alcohol Intake

This is both an easy and tough one. Tough because, for many of us, social alcohol consumption is way of life.

Even if we’re drinking quality beers, it’s a slippery slope to have a drink most days. One beer, then two beers. And before you know it, we are consuming 15-plus drinks per week.

What’s easy, however, is that, with growing evidence, alcohol has almost no physiological benefit and myriad negative health effects. Moreover, the negative effects increase as we age: affecting systemic inflammation, workout and illness recovery, weight management, and sleep quality.

As such, it’s time to cut it back. While zero may seem like both the greatest benefit yet least realistic goal, any decrease will be positive.

What This Looks Like

The first cut should be frequency. Because even small amounts of alcohol can disrupt sleep, stringing booze-free days can significantly improve sleep, recovery, and day-to-day function. This has a multi-pronged benefit for running: easier to get up and go for that early morning run, more energy to work out, faster recovery, and decreased potential for injury. Reserve alcohol for the end of the week.

Moreover, consider keeping alcohol out of the house. It’s too easy to enjoy a quick pour if you have it in the house. Reserve alcohol as a treat you get out in the world, and pair it with social and communal activities.

Personally, I have enjoyed non-alcoholic beers for that after-work, at-home refreshment during the week. Athletic Lite from the Athletic Brewing Company is among my favorites: it is low-calorie, refreshing, and closely resembles one of our historic brews out of Milwaukee, Wisconsin. This easily gets me through Sunday through Thursday nights without deprivation.

Lastly, look to cut back on volume. Personally, I typically drink two beers when out to eat or drink with friends. However, it is very rare to drink more than three. Three or more alcoholic beverages compound the physiological effects, making them more markedly perceptible: poorer sleep, more fatigue, and impaired motivation and focus. A sure-fire way to ruin a day is to have more than three beers the night before. But it’s also far more likely to impair my training and open the door for more aches and pains.

Results

Clients and friends of mine who cut their social drinking from six to seven days down to two or three — and cut their drinks per week down to four to six — report noticeable improvement in sleep; notice better health and fitness metrics such as resting heart rate and heart rate variability; and experience training consistency without aches, pains, and injury interruption.

Stay social, maintain that pleasure, but make it special: save it for week’s end by going for quality over quantity.

Action Plan

• Varsity: Drink 4 days a week, and 10 total drinks or less.
• All-Conference: Drink 3 days a week, and 6 total drinks or less.
• All-American: Drink 2 or less days a week, and 4 total drinks or less.

3. Lift Weights

As we age, running gets harder. Through various mechanisms, running the same volume, frequency, and intensity gets increasingly difficult — and often more painful — as we age.

The medium- to higher-intensity running we commonly undertake via hard workouts and races is relatively high in both ground impact and internal physiological strain. Our tissues take a pounding, but so too, is the chemical stress high. As such, most of us — and the majority of my clinical clientele — over the age of 40 report both decreased tolerance and less health and weight management benefits from running.

In short, what used to be an all-in-one activity for strength, leanness, performance, and mental health begins to wane in effectiveness in all areas.

Just as individuals should increasingly diversify their financial assets with age — shifting from the more fun but more risky sources like stocks, toward safer but less exciting investments like index funds — so, too, should we masters-aged runners run less and cross train more.

My favorite is lifting weights.

Weightlifting has so many positive effects: increased functional strength and decreased injury (both in and out of the running shoes) are the most obvious and well-known. But consistent — even moderate-intensity, short-duration — weight training significantly increases lean muscle mass (2) and improves basal metabolic rate — the number of calories burned passively throughout the day. Conversely, running alone tends to provide limited increases in muscle mass. In short, time spent lifting weights does more for weight loss and management than the same amount of time spent running.

But the other benefit is metabolic. Medium- to high-intensity running required for both high performance and metabolic (fat-burning) benefit also comes with a significant amount of chemical stress: increased cytokines — immune system molecules — and cortisol — a key repair hormone — are both pro-inflammatory in nature. And while they endeavor to repair the physical damage incurred from exercise, their systemic effect can negatively impact whole-body health and function. Cortisol, in particular, breaks down tissue. While this is useful when repairing damaged tissue, too much cortisol throughout the body becomes a major tissue stressor.

If running creates a relatively high pro-inflammatory chemical response, weightlifting — if done right — can actually produce the opposite effect. Moderate-intensity weightlifting, even if done on consecutive days, has a markedly lower inflammatory effect on the body. Without the high-impact and high-metabolic strain, both cytokine and cortisol levels post-weight session are far lower than running. Instead, anabolic hormones — namely testosterone and growth hormones — are naturally secreted in response to weight training. They promote healthy tissue growth and repair, not just for the focal muscles used, but throughout the body.

What This Looks Like

To begin, I recommend to my clients they lift weights three times a week, but only for short durations. Like beginning runners, most weightlifters do better with higher frequency and lower intensity. This helps the body adjust to the novel loads with minimal soreness and low injury risk.

For most of us, we avoided weightlifting during our prime competitive years because it made us feel too heavy and slow. However, high-frequency, moderate-intensity, and low-volume strength training tends to minimally impede running.

As such, I recommend weightlifting three to four days per week in only 20- to 30-minute sessions of moderate intensity. If lifting in an alternating circuit — performing, say, a lower body exercise, then without rest, shifting to an upper body exercise — one can easily perform three to five sets of four to six different exercises of eight to 15 repetitions each. It goes fast and, at moderate intensity, feels similar in work to an easy run. It also gets you in and out of the weight room in well under a half hour.

Results

Clients, particularly runners, who shift to weightlifting report improved running (race pace, sprint, and hill) strength and performance, as well as increased flexibility and decreased injury incidence. Even better, they feel a lot better. Without the repetitive pounding of seven-days-a-week running, they get their fitness fix without the physical pounding and chemical erosion. They leave the gym feeling good and feel better throughout the day.

But the most fun? Across the board, they’re leaner. They look better. And their energy out in the world — at work, at home, and with the family — is better.

Personally, I lift weights five to six mornings per week, but at moderate intensity, alternating muscle groups (upper and lower body; push-type exercises versus pull), and for only short durations. This preceded by my mobility routine is a setup for a productive, happy day; and a stronger, more enjoyable midday or evening run!

Action Plan

• Varsity: Lift weights 2 days a week, for 20 or more minutes per session.
• All-Conference: Lift 3 to 4 days a week, for 25-plus minutes.
• All-American: Lift 5 to 6 days a week, for 30-plus minutes.

4. Adopt a Morning Mobility Routine

Remember the days when we could wake up (usually after a night of partying) and knock out a run — even a long, fast session — without batting an eye? Ha, those were the days!

A daily mobility routine may be the most important thing we do to not only feel better for the ensuing run, but to maintain overall functional mobility day to day (and year over year), decrease overall aches and pains, and keep us feeling and looking young.

Performing a routine in the morning is most beneficial because it helps jump start that natural mobility rebound as early as possible, so we can end today as mobile as we ended the day (a week, month, and year) before. But a morning routine also helps hydrate tissues — a key not only for tissue flexibility, but overall strength, resilience, and health.

What This Looks Like

A pre-work, pre-family obligation, and short-duration routine that can be done in 10 minutes or less. Wake up, use the bathroom, brew the coffee, then get on the floor.

If dynamic stretching like yoga isn’t your thing, even some time spent on a foam roller is a great start.

Results

Clients who are physically active relatively early (3) in the day report less running injury incidence and better training and racing consistency than those who wait until midday or later to move their body. They also report less non-running aches and pains such as neck or back pain.

Action Plan

• Varsity: Do mobility 3 to 4 mornings per week, for 5 minutes.
• All-Conference: Do mobility 5 mornings per week, for 10 minutes.
• All-American: Do mobility 7 mornings per week, for 10 to 15 minutes.

5. Begin a Yoga Practice

Second only to weightlifting, if a person could choose only one physical activity they could perform in a day, I would recommend yoga (4).

Yoga has so many benefits. Mobility and strength are obvious, but yoga also provides benefits difficult to obtain elsewhere, including:

• Increased bodily awareness: Attuning to and feeling the whole body, checking in, and comparing the left side and right, and then attending to those sensations and imbalances that stand out.
• Increased breathing quality: Runners often have remarkably poor breathing mechanics, failing to breathe with the whole cylinder of the rib cage and belly. Yoga promotes deep and complete breathing, which helps optimize both whole body mobility and stability, as well as down-regulating over-active nervous systems, as deep breathing activates our parasympathetic (resting) nervous system.
• Improved nervous system mobility: Yoga is one of the few exercise modalities that can safely and effectively mobilize the nervous system — facilitating the mechanical slide-and-glide capacity that all our nerves require for optimal function, mobility, and pain prevention.

What This Looks Like

For starters, even a 10-minute routine such as this one is a terrific start. Most yoga flows (movement patterns and routines) mimic what we do in running, so even a very short, self-guided mini-practice can provide great benefits.

The next step is a weekly in-person practice. Most of us, me included, do a lot better with coaching and guidance. A skilled yoga instructor provides a coherent, safe, and balanced movement routine. And the class structure supplies the accountability we were accustomed to as members of a team.

And like running, once a client or runner has developed some skill and autonomy, doing a solo practice — or finding almost limitless options of online video classes — can provide the flexibility to perform yoga around the clock.

Results

Clients — and I — who perform a consistent yoga practice report not only less aches, pains, and injury, as well as more flexibility, but they also run more efficiently. More than any other cross-training activity, yoga helps identify and correct movement imbalances that cause top-speed and endurance leaks in our running. Thus, identifying and addressing those imbalances not only helps runners stay ahead of impending injury, but keeps them running faster at all distances, with less strain, and faster recovery.

Action Plan

• Varsity: Perform 1 yoga session per week, for 20 to 30 or more minutes.
• All-Conference: Perform 1 to 2 yoga sessions per week, for 30 to 60-plus minutes.
• All-American: Perform 2 to 3 yoga sessions per week, for 60-plus minutes.

6. Minimize Dietary Inflammation

This is an interesting one. In my professional and personal experience, our bodies become increasingly sensitive to dietary stress as we age. In other words, certain foods (in both type and quality) that were well-tolerated when we were young, begin to cause problems later on.

Food sensitivities — defined as subtle but significant negative effects caused by the foods we eat — can loom large in many aspects of health. First, the effects tend to be mild and, at times, difficult to identify. Overt gastrointestinal symptoms are both easy to sense and connect to foods we eat. Acid reflux, bloating, gas, diarrhea, constipation, and other abdominal symptoms experienced shortly after eating are easy to identify and thus avoid, simply by steering clear of those offending foods.

But what about more vague and general symptoms? Persistent fatigue, sleep disturbance, brain fog, depression, skin issues, headaches, joint pain, nerve pain, stubborn weight gain, and a general inflamed look can all be caused by subtle food sensitivities.

The other challenge to food sensitivities: they often arise from healthy foods. Even high quality, organic meats, eggs, and vegetables of all kinds can cause an internal inflammatory response in a system with specific sensitivities.

Why certain people develop specific sensitivities isn’t well known. The primary theory is our individual gut microbiome — the specific microorganisms that naturally live in our gut and play a huge role in digestion — can become dysfunctional. Based on many factors, the balance of organisms can be disrupted. What was once a “good neighborhood” — populated by micro-critters that appreciate and transform quality meats, vegetables, grains, and legumes into valuable nutrients — can turn “bad” and react poorly to these objectively healthy fuels to create metabolites that are irritating and pro-inflammatory throughout the body.

Assessing for, let alone treating, food sensitivities isn’t easy. But it’s incredibly important if you suffer from any of the issues above, and other medical strategies have failed to help. Moreover, if you have any of those symptoms and seem to be playing “whack-a-mole” with running aches and pains, and/or have persistent weight gain, despite being disciplined in the rest of your life, dietary inflammation may be the cause.

What This Looks Like

Personally, I have struggled with gut issues and food sensitivities for at least a decade. For various reasons my gut was impaired even at the height of my competitive ultramarathon running career, but it cratered when I contracted giardiasis after drinking untreated stream water in early 2017. That infection — and subsequent aggressive pharmaceutical intervention used to eradicate it — wrecked my gut microbiome.

Rebuilding it has been a multi-year process and included identifying and addressing food sensitivities. Today I am the healthiest I have been in over a decade, but still have to mind several mild sensitivities — avoiding certain foods in order to prevent an inflammatory response. My symptoms include itchy skin, impaired sleep, brain fog, fatigue, and poor running tolerance. There’s almost no food worth those consequences!

Assessing for food sensitivities can be tricky. There are myriad “medical tests” available, but many lack depth and specificity and thus often lack accuracy or test-retest reliability (crucial to know if any measures you take actually improve your sensitivities!)

Through working with my friend and terrific registered dietician Cara Marrs, we used mediator release testing — a technique that measures the degree of inflammatory response of certain foods in our own blood. This requires a blood draw and medical laboratory analysis. From there I obtained a quantified measure of what foods were currently inflammatory to my body, and how severe.

Again, the results are surprising: certain healthy foods for almost everyone were, for me, inflammatory. This included many vegetables and fruits that I enjoyed and ate because I thought they were good for me.

The goal of food sensitivity treatment isn’t necessarily to avoid them. Rather, to cut back entirely, at first, then gradually introduce small doses. This is especially the case for universally healthy, high quality foods like meats and vegetables.

Eventually, eating small doses of a large variety of foods helped my gut microbiome rebalance and do its job of helping my gut process those foods into beneficial, low inflammatory nutrients.

But few of you need to go this far. Instead, look at your diet for what we now consider to be more commonly inflammatory foods. Examples of common foods with a potential inflammatory effect include wheat, corn, and dairy. For some, these are healthy and well-tolerated. But for many, these can cause inflammatory responses, even if below the threshold of “Celiac” or dairy allergy diagnosis.

Universally inflammatory foods — those things we need with little nutritional value and known poor health effects — include things like sugar and other sweeteners, processed foods of all kinds, and alcohol.

If you have mild-but-stubborn health issues and suspect the cause could be dietary, consider an elimination diet. This includes identifying one food type or category — such as wheat or dairy — and fully eliminating that for several days. Gauge the physical and mental effects of that elimination. Then add in again. Major symptom changes in either direction indicate a potential food sensitivity.

For moderate or more severe issues, I recommend consulting with a medical professional that specializes in gut health and performing a more thorough food sensitivity testing.

Results

Clients and athlete friends who have eliminated offending foods have noticed significant changes to energy, weight, sleep quality, mental focus, aches and pains, and skin health.

Finding the diet that’s right for you can be one of the most powerful things you can do to not only improve your running, but optimize your health, daily function, and quality of life.

Action Plan

• Varsity: Eliminate 1 or more universal inflammatory foods (added sugar/corn syrup, processed foods/chemicals, alcohol).
• All-Conference: Try your own elimination diet to avoid specific triggers (wheat, corn, dairy, or others).
• All-American: Work with a medical professional to identify and treat any complex food sensitivities.

7. Be A Teammate Again

If there’s anything I’ve learned from both being a masters runner and treating them, it’s this: we can no longer out-run (or out-work) certain dysfunctions, both training and orthopedic factors, and lifestyle.

The above recommendations will take you far in righting your body to both tolerate and enjoy running again. But for us — mostly married with children, and with thriving careers — the time, energy, and motivation to keep running far and fast is at a premium. We often need outside motivators to do the things we want and need and, in some respects, our family, friends, and careers benefit from.

Become a teammate again. Run with and for others. If you, your spouse, family, coworkers, clients, and community all agree that you are a better person when you run — it’s time to run for them, not just for yourself.

What This Looks Like

In high school and college, we ran with someone at least 90 percent of the time. Practice was five or six days a week, and there was always one of us around, wanting to hop into a long run, shakeout, or speed session.

With age, family, and work commitments, those obligations to team have disappeared for most of us.

Get it back.

Find a running friend — a training partner. Agree to meet regularly. Two people with similar goals will maintain focus on those goals, primarily, because they show up for that other person. Alone, it’s all too easy to snooze the alarm at 6 a.m. and skip the cold, dark morning run. But you won’t stand up a friend.

Become a teammate to one person and help them do the work. They’ll do the same for you. And if possible, grow that pairing into a group. Meet consistently, have shared goals, and push one another to go the distance, hit the paces, and push the envelope of excellence.

If that’s not possible, expand your “why” — the motivations for your running — by including your relationships and community contributions, and how they are improved when you are a strong, healthy runner. Set the alarm and get out the door, solo, knowing you “show up” better for them after you’ve done that personal work.

Results

The clients and friends I know with a consistent physical fitness routine are usually the healthiest, highest-performing people with the strongest family and community relationships. Indeed, for most of my orthopedic and coaching clients, running is less about the time and distance goals than the value running brings to their lives. The process of training and racing creates an outcome of wellness.

Action Plan

• Varsity: Run and exercise consistently to be a better spouse, parent, friend, coworker, and community member. Run for yourself by running for others.
• All-Conference: Train with a friend or two at least once a week toward mutual goals. Show up and support each other.
• All-American: Run with — or form — a training group. Mentor younger, less experienced runners and be mentored and inspired by your elders. Never stop growing or supporting others.

Final Thoughts

I hope this advice is helpful, and I have faith in the potential that these small things have in making a huge difference in your lives. I see it every day and, in some ways, I’m living it.

Long may we all run,

Joe

Call for Comments

• Are you a masters runner? If so, what new challenges have you experienced that you didn’t when you were younger?
• Did you find the above helpful?

Notes

1. Obtained from the literature reviews from performance and longevity practitioners, including Peter Attia and Andrew Huberman MD — who also personally embody the ideals and strategies they professionally promote.
2. When coupled with adequate protein intake.
3. The exception: those runners who run extremely early in the morning. Those who run before 6 a.m. anecdotally report less sleep volume and less pre-run mobility and prep-work than the 7 a.m. or later cohort.
4. While yoga may be more holistically beneficial with its physical and mental benefits, I clinically find those who engage in strength training to have higher levels of function and less injury incidence than yoga alone.