Work Hard, Recover Harder: Part Two

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It's been three weeks since Ironman 70.3 Coeur d'Alene and I am a couple of weeks into marathon training.  If you are new to endurance training (or you are my husband) you may roll your eyes and think, "this biish is crazy."  Truly, I never thought I would be the person to finish a race of any kind let alone be hopping from one to the next. But they are addicting.  I'm not even close to NYC Marathon and I am already thinking of what will be my next marathon or Ironman.   That being said, recovery between races is SO important.

After my first marathon, I heard from other runners that you should take ~30 days off after you race and let your body recover.  I didn't do much research, but that sounded good.  I was so sore the first week and I also missed cross training, so it wasn't that difficult to hold off on running and fill my time with my favorite group fitness classes.  A handful of races later, I am actually interested in understanding why recovery is important and how to recover appropriately.  Reminder every human and race is different.  This is meant to provider more details and look at what evidence if any is out there.  Always feel free to share your perspective below or email us!
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When Should I Start Running Again?

There are lots of opinions and recovery plans out there.  As a clinical pharmacist, I have access to scholarly literature searches (Pubmed and UpToDate), which I used to help delve into some of the later details on this topic.  However, I decided to start my search like many of you would, by surfing the web to see what comes up when you type in "marathon recovery plan."

If you have ever looked up running plans, then chances are you have come across a Hal Higdon plan.  Hal Higdon is a runner and a best-selling author. He has developed training plans for everyone from novice to advanced runners, half marathons and full marathons, and even has a week by week guide for the month post marathon.  He refers to the time frame post marathon as, "Mile 27" in his book.  I will be the first to admit that I have not purchased any of these plans, so  I cannot vouch from personal experience, but I do think they create a great framework.  My spark notes summary of his recovery program for advanced runners is below:

1. Week One: Take it easy
2. First 3 days, do nothing + massage
3. Day 4, go for a run (2 miles)
4. Day 5, cross training
5. Day 6, easy 3 miler
6. Day 7, 60 min run
7. Week Two: Don’t run hard even if you have another race
8. Speed work Tuesday or Thursday
9. Take a day off after speed work, then add a tempo run
10. Go a bit longer on Sunday, 60-75 min
11. Week Three: Glycogen replenishment should be progressing
12. Carbs should still be main part of nutrition
13. Uptick in training duration slightly, longer tempo run (35 min) and long run (75-90 min)
14. Week Four: Approaching mid-week training that was pre-marathon
15. Have two 5-milers with speed work the following day
16. Add back strength training

I wanted to compare the Hal Higdon post-marathon recovery plan to other internet plans.   My next web search brought up and article from Runner's World.   Pleasantly, Runner's World broke down the recovery post marathon week by week as well.  They didn't provide as much detail on when to run or incorporate speed work, but encouraged adding on to intensity and duration as week's progressed.  

1. Week One:
2. ​Rest and cross training was the main advice
3. Short, easy 30 minute run at the end of the week
4. ​Week Two:
5. If you are still hurting with running, continue to cross train with what feels good
6. If you run, keep it easy and short (30-60 minutes)
7. Week Three:
8. Add more intensity and longer runs as you feel better
9. Week Four:
10. If you are feeling good, you can return to pre-marathon schedule

At this point, I want to look into the science behind the recovery.  Most plans are recommending a similar amount of time to recover, but why?  What is going on in your body after a marathon?

In a study by Tsai and colleagues, massive aerobic exercise i.e. running 26.2 miles led to un-repaired DNA base oxidation.  "This oxidative DNA damage correlated significantly with plasma levels of creatinine kinase and lipid peroxidation metabolites, and lasted for more than 1 week following the race."  WHOA...what does that actually mean??  Creatine kinase is a muscle enzyme that lives within your mitochondria and is usually elevated in response to muscular damage, which in turn is a marker of the degree of muscle injury.  It is also involved the storage and transfer of energy.  In elite athletes or in marathoners the concentration of this particular enzyme increases within skeletal muscle and is usually in response to regenerating muscle fibers.  

So basically, running a marathon = elevated creatine kinase for ~1 week = wait a couple weeks to resume vigorous aerobic exercise.  

Runner's Connect is another great blog with a wealth of information, including a post on overtraining.  In this post, the recommendation is to wait 2-3 weeks post marathon to allow ample time for recovery of both creatine kinase and myoglobin (myoglobin acts as oxygen storage for mitochondria).  Based on my research, there are limited studies and data on the physiologic changes that occur after prolonged aerobic exercise; however, it appears that at least 2 weeks of light or minimal exercise is recommended before the athlete resumes rigorous training.  One of the other topics that intrigued me was nutrition after the race.  We all have heard of carbo crams before aerobic sporting events, but what about replenishing our glycogen stores after crossing the finish line?  
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Carbo-loading Post-Race: Glycogen Replenishment Facts

Disclaimer, the pic above is part of the dinner my husband an I enjoyed before my Ironman 70.3.  It has absolutely nothing to do with building back glycogen stores after the race.   I wanted to share this pic to spark some intrigue --everyone's pre-race rituals and nutrition vary.  That is normal and I don't encourage you to suddenly change your diet the day before a race to reflect what works for me.  However, a part of training involves using the months prior to race day to figure out what food fuels YOU best.  I don't change my nutrition drastically the days leading up to my race.  I don't eat pasta often in my regular life because it makes me feel heavy so you probs won't see me eating pasta the day before a marathon.  I do love sushi and fries.  So you can bet my pre-race meal always includes sweet potato fries and either sushi or an alternative lean protein source (baked fish is great if the city doesn't have great sushi).  I also drink one, no more than two glasses of wine or a margarita in my normal week.  PAUSE.  Yes, you read that right.  I am an athlete who enjoys fries and alcohol.   Pre-race jitters would be so much worse if I also forbid myself from enjoying the foods and draaanks I love.  Again, I don't binge drink while training so I definitely don't binge the day prior to the main event but a glass of wine is the perfect way to unwind.   But  enough about pre-race carbs, let's chat about what comes after.

Massive aerobic training does not just impact your muscle fibers and enzymes, it also depletes your glycogen stores.  But what is glycogen?   An article in The Sport Journal, titled "Glycogen Replenishment After Exhaustive Exercise," delved into awesome detail on this topic.  

Glycogen is made up of long chain polymers of glucose molecules which are stored in liver and muscle and used by the body during exercise .  At higher exercise intensities, glycogen becomes the main fuel utilized.  When liver glycogen is depleted it can reduce blood glucose levels which results in volitional exhaustion.   The concentration of muscle and liver glycogen prior to exercise plays an important role in endurance exercise capacity.  It is actually typical for glycogen to be more depleted in the liver than muscle following intensive training, 85-95% versus 65-85%, respectively.  Although you did a stellar job building up your glycogen stores before the race, now you have used all that energy and need to refuel.  

Think about it, your body is like a race car.  You fueled it with premium fuel leading up to race day and you won because you competed and completed by crossing that finish line.  Now I don't know about you, but my bodice is even more of a temple after that race and I definitely want it running smooth quickly after.  So fuel up!  The two hour window immediately after exercise cessation is optimal for carbohydrate (carb) ingestion.  Your glycogen resynthesizes at a rate of 2% per hour after this two hour window, but this rate rises to 5% when 50 grams of carbs are consumed.  Another lit search led me to a great read titled, "Fundamentals of Glycogen Metabolism for coaches and Athletes," which states that 1-1.2 g carbs per kg of body weight per hour  should be consumed to take advantage of the improved glycogen synthesis that can occur immediately post massive aerobic exercise.  The overall goal is to ingest 10 g of carbs per kg of body weight in the first 24 hours.

For example, I weigh 63 kg (or ~140 lbs) so my goal is 630 grams of carbs post marathon and I should ideally try to eat 60-75 g of carb per hour.  Let me put that in perspective, a banana has ~30 g of carbs and a slice of bread has ~15 g of carbs.  So it takes WERK to eat all those carbs.  Work smarter, not harder people!  Help your bod recover by capitalizing on improved glycogen synthesis occurring immediately after the race and start ingesting those carb dense foods shortly after crossing the finish line.  

​Below are some examples of carb-rich foods from that article:

• Baked potato with skin (36 g)
• 1 cup rinsed black beans (40 g)
• 1 cup wheat bran cereal with raisins (46 g)
• 1 cup enriched penne pasta (33 g)
• 1 slice whole wheat bread (14 g) ...make a PB & J and increase those carbs closer too 40 g

P.s. you can bet I looked up grams of carbs in my two fave foods (because research duh)... a side of sweet potato fries at a restaurant is ~50 g and the average sushi roll is anywhere between 50-60 g.  Unfortunately, a pour of wine is only 4 g of carbs.  Soo I guess I will stick to eating my carbs ;).  

OKURRR... I know I hit you guys with a lot of science and knowledge bombs, but hopefully this helps you understand the importance of recovering the right way after your next big race.  I know I have personally failed at glycogen replenishment in the past and feel fatigued the evening and day following the race.  I will definitely be making some big changes to nutrition after NYC Marathon and am hoping this helps with energy.  I also need to SLOW DOWN after races and allow more than 5 days before revisiting vigorous physical activity.  Guilty of starting back up again too quickly!  I promise to be more patient after the next race and respect my body if you all do, k?  

XX,

Ives