The MacNeil/Lehrer Report; Running

ROBERT MacNEIL: Senator Strom Thurmond of South Carolina is seventy five years old, and he runs every day. So do more than ten million of his fellow Americans. Why are they running, and should they be? Good evening. Last Sunday nearly five thousand people took part in the New York marathon -- 26.2 grueling miles. Running has become such a popular sport that there are now no fewer than 166 marathons run in this country, and by next year there may be as many as 200. But whether in training for the marathon or just jogging around the block, millions of Americans have got the running fever. Tonight, a look at the running craze: is it good for the health, or dangerous? Jim?

JIM LEHRER: Robin, anyone in downtown Washington during the weekday noon hour knows about the running craze. They`re everywhere, these scantily clad people, making the rest of us feel guilty as they jog around the Lincoln Memorial, the White House and other national landmarks. The runners here, as elsewhere, come in all ages, shapes, sizes and sexes. They also wear all kinds of shoes and outfits, paid for with good money. For instance, these ten million or so runners nationally spend $500 million a year alone just on jogging shoes. The serious runner goes through five a year, at thirty dollars a shot. A high-quality acrylic warm-up suit goes for $150, the cheaper nylon outfits for twenty to thirty. They have their own clubs now, with group practice sessions and local marathons. There are also at least five national publications dealing solely with running. In short, by any measurement it`s become a very good deal. Robin?

MacNEIL: Three runners who competed last Sunday are with us tonight, three serious runners. Nina Kuscsic, who`s been in more than forty marathons, was running in the American Athletic Union women`s championship marathon in Minneapolis. She came third. Two contenders in the New York marathon were Jim Fixx, author of the recently published Complete Book of Running , and Dr. Richard Rabkin, an Associate Professor of Psychiatry at New York University. I would like to ask all three of you the same question first of all: why do you run? Nina?

NINA KUSCSIC: I run because it feels good, and it gives me energy for the rest of the day.

MacNEIL: Why do you run, Jim Fixx?

JAMES FIXX: I agree with what Nina says, but in my case there`s more. Ten years ago I weighed 220 pounds, I was editing a big magazine, every day I was going out to lunch and eating what I`d now regard as enough to keep me going for a whole day; and running has helped me lose something like -- goodness, sixty pounds, with practically no effort and just has completely changed my life.

MacNEIL: Why do you run, Dr. Rabkin?

Dr. RICHARD RABKIN: I run for the same reason that Nina runs - I like it. It makes me feel good. When I was in college I was very turned off by athletics, and I became very efficient at never exercising. So by the time I was about thirty-five or so I was a little concerned about it, so I started to try and do something. And I found, as I did when I was a kid, I liked running.

MacNEIL: You say you feel good. What do you feel when you`re running?

KUSCSIC: Well, the running is a present I give to myself every day. I feel a sense of completeness, just a sense of independence and something that I can carry with me that I`ve given to myself.

MacNEIL: What do you feel when you`re running?

FIXX: I think that when I first started I was thinking about the physical fitness of it. I wanted to know that my heart was working efficiently and that I could move like an animal. I think very quickly you go through that stage and you just accept the physical fitness. Now I think I run because running gives me a feeling of tranquillity and a feeling of being very much in control of my life. And it gives me a feeling of having a very sustained kind of energy all day long.

MacNEIL: Dr. Rabkin, you`re a psychiatrist as well as a runner. We hear a lot about this mental experience of running. What does it do to your mind?

RABKIN: Well, I`ll be concrete, as we say in psychiatry. When I first start I feel very lazy, because I have to say to myself, Well, you`ve got to get somewhere to run. Then when I begin I feel stiff. Then when I start to warm up, which is maybe in a mile or so, I begin to really feel good -- there`s something very nice about it. And I`ve spent many hours running trying to think about what I think about, and I can`t remember. Now, this makes me think that part of the fun of it is that my mind is off somewhere, so it`s a little hard for me to tell you precisely what happens except that I have a little vacation, I think, and I feel kind of high at the end -- and through it.

MacNEIL: I`d like to ask each of you one quick question: what do you believe it is doing for you physically?

RABKIN: Physically? I would say it`s making me physically feel better. I would approach it from a kind of wholistic point of view: I don`t have any beliefs about what it`s doing to my heart, although I notice my pulse rate is, like, fifty, which I`m impressed with. But from a wholistic point of view, just from all of me, I just really feel physically good.

MacNEIL: Jim Fixx, what is it doing for you physically?

FIXX: I`ve looked into a whole lot of studies in the course of doing this book, and I know that it`s made my heart more efficient, my lungs more efficient, my blood transport system more efficient. When I say I know that, I know it on the basis of the studies that I`ve read, and that

MacNEIL: And you assume it`s doing it to you.

FIXY: Yes.

MacNEIL: Nina Kuscsic, you`re a nurse. What do you think it`s doing for you physically?

KUSCSIC: Well, I like to go mostly by feel, and I feel super-efficient. I know the human body gets more efficient with use, and I think that science will find out exactly why we are more efficient, in about ten years or so.

MacNEIL: Okay. Three serious runners and three enthusiasts. Not everyone is so enthusiastic about the rage to run. Dr. Meyer Friedman of Mt. Zion Hospital in San Francisco is director of a new coronary prevention project underwritten by the government. He is also the co-author of the book Type A Behavior and Your Heart. I spoke with him yesterday in San Francisco.

MacNEIL: Dr. Friedman, is all this running that Americans are doing good for their health?

Dr. MEYER FRIEDMAN, Mt. Zion Hospital: I don`t really believe that the good that it`s doing equals the deaths that it`s causing.

MacNEIL: The deaths that it is causing?

FRIEDMAN: Yes, the deaths.

MacNEIL: What evidence do you have that running is causing deaths?

FRIEDMAN: Because so many are dying on the jogging paths in America, and on the streets -- at least one or two a week, I would suspect. So you can even say, given five or ten thousand people are running in a month on a five- mile jogging thing, maybe one out of five thousand will drop dead. As you know, in the San Francisco running match we had here -- jogging or running -- the twenty-three year-old fellow died; I think that`s one out of eight thousand who ran.

MacNEIL: What about the argument that running is actually good for developing and strengthening the heart, as well as other organs and muscle tone and so on?

FRIEDMAN: Well, I think running or jogging does strengthen heart muscle and lower the pulse rate, but that isn`t the problem in heart disease or coronary disease, and that`s what most adults are going to suffer from. Coronary disease is arterial disease, and there`s stone in that artery. And stones are not gotten rid of by exercise. And as far as I know, there`s no angiographic or hard evidence -- and there is a considerable amount of negative evidence -- that exercise prevents heart disease, coronary disease, or does anything to prevent a second heart attack.

MacNEIL: How does a person know whether running would be good for him or not good for him?

FRIEDMAN: One thing is if he doesn`t die it would probably be all right. Now, mind you, I think exercise -- moderate exercise in which the heart really doesn`t go over 130, let`s say -- is all right; and after a coronary, rehabilitation exercises, fine. But they have a defibrillator there, so in case there`s a fatal arrhythmia they can bring the person back to life.

MacNEIL: But if a person who believes that he`s healthy and in reasonably good condition comes to you and says, "Doctor, could you give me some tests so that I would know that I`d be all right," wouldn`t it then be all right for him to go and run?

FRIEDMAN: I don`t know of any test that I could give him that would guarantee his survival year after year except an angiogram. But that carries a risk in itself.

MacNEIL: An angiogram is what?

FRIEDMAN: That`s a visualization of the coronary arteries by putting a catheter in the artery and injecting a dye. The trouble now, unfortunately, in thirty to forty percent of cases does not show a significant obstruction of one or more of the three coronary arteries.

MacNEIL: Is there one type of individual who should not run more than another type?

FRIEDMAN: Oh, yes. A Type A individual, who`s fighting time -- that we`ve described in our book -or other people who easily get upset about trivia, he is the kind of person...

MacNEIL: A person under tension, you mean.

FRIEDMAN: Right. I would say he above all should eschew any kind of violent exercise that gets his heart rate consistently above 130.

MacNEIL: But a lot of people seem to feel, who lead very busy and tense lives, that running relaxes the tension in them. Wouldn`t there be a benefit from that?

FRIEDMAN: I don`t know of many Type B people who are relaxed who indulge in jogging or running. They think it`s kind of stupid. I think it`s some form, maybe, of slow mass murder.

MacNEIL: So your advice to Americans would be, stop running?

FRIEDMAN: I think people over thirty-five have other lovely ways of exercising except trying to look at their stopwatch attachment to see how much faster they can run every day and not see what`s around them as they run. It`s kind of mechanical, and I think it`s stupid.

MacNEIL: Dr. Friedman, thank you.

LEHRER: Let`s get a second medical opinion now from Dr. Herman Hellerstein, Professor of Medicine at Case Western University in Cleveland and director of the University`s National Exercise and Heart Disease Project. Well, Doctor, do you agree with Dr. Friedman as to how dangerous running can be?

Dr. HERMAN HELLERSTEIN:I think Mike Friedman has exaggerated the risk, but there`s some merit to what he says; namely, that if a person has silent heart disease and goes out without preliminary evaluation in an unsupervised area, if he or she develops a fatal arrhythmia, which can be reversed, then he`s going to die.

LEHRER: Fatal arrhythmia, meaning a heart attack, right?

HELLERSTEIN: No, it means a disturbance of the heartbeat. It`s like taking the ignition of a car and turning it off, and if you just turn it back on again you can restart the car. And there`s no question that people who are maybe over the age of thirty-five years, who have family characteristics of heart disease, whose blood pressure is elevated, who use the poison called tobacco, whose blood pressure is a bit up, et cetera, such a person for sure should not go into an exercise running program unless they`ve been thoroughly evaluated. I would disagree...

LEHRER: Dr. Friedman says that he couldn`t run a test that could evaluate that.

HELLERSTEIN: Well, that isn`t really true. Those of us that have not been thinking about it but have worked in this field know that if one has an individual perform a very high level of exercise one can pick up those people who have a predisposition to developing irregularities of the heartbeat, who develop changes of electrocardiogram which indicate that they would be more or less susceptible to unstable activity of the heart. But nevertheless the risk is real.

LEHRER: All right. What about the other central question here: whether or not running actually does anything in a preventative way in terms of heart disease. Does it?

HELLERSTEIN: That`s not the real question. The question is, does running -- and by the way, I don`t mean marathon running; I`m talking about moving the body against gravity -- does that do anything to health? And it certainly does, when it`s taken in moderation. We`ve measured this, not thought about it, in terms of the psychological parameters, the function of the heart, the change in the blood. The real question is, does it prolong life? And the answer is, there`s no single proof yet of a study that has taken a group of people, say middle aged, and put them into a training program to show that it prevents the development of hardening of the arteries. But what it does do, it reduces the symptoms as if arteries were known. You see, if we modified the symptoms of a disease without modifying the disease process itself.

LEHRER: In short, we don`t know at this point.

HELLERSTEIN: Well, we don`t know because there aren`t data available.

LEHRER: All right. What about the real basic point of Dr. Friedman, that dangers of killing you far outweigh any benefits? I think that`s a good summary of his message.

HELLERSTEIN: I would disagree, and I think the real thing is the danger of inactivity is far greater than danger of physical activity. The real question is how much. And this is the question. The mass craze of marathon running is exciting because it`s enhanced the idea of being physically active, but the real question is how much? Who says that it`s necessary to run 26-point-something miles or forty-two kilometers in three hours -- who said that`s any better than walking that same distance in eight hours?

LEHRER: What are you saying, that you think the marathon thing is not a good thing?

HELLERSTEIN: No, I think it`s good because it focuses people`s attention on the need for physical fitness, but like many things in America there are fashions and there are fads -- in fact, some people use the word "craze." What we need to do is develop habits of living which incorporate some of the fun -- and Dr. Friedman rightfully points out, the people who are running and their mind is turned off as if they`re in TM, they`ve missed the environment. It`d be much better to take a hike, to do some gardening, maybe do cross-country skiing, but not in such a big hurry. In fact, there`s evidence of what can enhance fitness without that intensive drive which is necessary in order to complete a marathon in three hours or four hours, or even two and a half hours.

LEHRER: All right. Let`s go back to the runners in New York and see what they have to say about what you said, Dr. Hellerstein, and what Dr. Friedman said. First of all, this point that it`s boring and it`s a TM exercise and why not enjoy the environment -- Mr. Fixx?

FIXX: I don`t find running boring at all. Most of the time when I go out and run I have the same attitude you would have if you went out to take a walk. I go out, I`m running at a comfortable pace, which for me is around eight minutes a mile. At eight minutes a mile I`m not putting any strain into it at all, and I can go out and do ten, twelve or fifteen miles, come back and feel refreshed and exhilarated and I just had a pleasant hour and a half or two hours.

LEHRER: Dr. Rabkin, let me ask you this point, that anybody, particularly over thirty-five, should go get a very good checkup if they can find a doctor -- and it`s in dispute about whether or not a proper check up can be had -- but they should have a medical checkup before they go out and start running. Would you agree with that?

RABKIN:I would agree with that. That would probably apply to any strenuous work too. It`s a generally accepted medical opinion today. It could apply to tennis, it could apply to anything.

LEHRER: You`re a runner, you run a lot, you`re around a lot of runners. Do all of them do that or do they just start running?

RABKIN: Very few of the ones I know have done that, actually. But most of them have started running before they were thirty-five.

LEHRER: Ms. Kuscsic, what has been your experience? Have the people you run with gone through the exercise of getting a checkup before they do it?

KUSCSIC: No, and actually I feel I`ve been sort of out of the picture. Since I`ve been running for about ten years, I guess before the marathon craze, I guess I`m partly responsible because I broadcast how good it feels. And it`s true that not everyone has to run a marathon. But as far as people going to get checked before they run, I advise it for people who have not been involved in sports and they`re over thirty-five.

LEHRER: Let me ask all three of you a question. You heard Dr. Friedman say it`s not worth the risk, that one in five thousand, one in eight thousand die. Does that bother you at all? Mr. Fixx?

FIXX:I can`t argue this point on medical grounds, because I`m not a doctor and I have no medical training. But in the course of doing my book I became very, very interested in the psychological aspects of running. And the largest chapter in the book is on the psychological aspects. And I talk to numerous runners and I ask them all the same question, among other questions: I said, "If you were to discover that running is actually bad for you in some way, would you stop running?" And not a single one said they would. So that even if we were to grant, which I don`t, that there are physical drawbacks to running, it may well be that the mental benefits outweigh those enormously.

LEHRER: What do you think of the mental benefits, Dr. Hellerstein?

HELLERSTEIN: I think the mental benefits of being physically active are substantial because it increases a person`s self-esteem. But it doesn`t have to be running, that`s the point. This aura that`s being described by our colleagues in New York are personal wins for them; many people are not depressed, many people don`t need to be turned on, many people don`t require these things; in order to attain such comfort they don`t have to exert themselves to the same point.

LEHRER: What about Dr. Friedman`s point that somebody who is uptight, who is under tension, should definitely not go out and run?

HELLERSTEIN: I disagree thoroughly with Dr. Friedman because we have typified using his technique our people who are in an exercise program, whether it`s Type A or Type B. And indeed, to Dr. Friedman`s consternation, we find that people who are time-oriented, very busy, are able most likely to take the time to exercise one hour three times a week. If anything, they are the best participants.

LEHRER: I see. Dr. Rabkin, what is your view on the tension question? Do you find running, with yourself and with others, a tension-relieving device?

RABKIN: Yes. I think it`s very relaxing to run. I run maybe a nine mile pace...

LEHRER: You mean nine miles an hour?

RABKIN: Yes, nine miles an hour. And...

LEHRER: Compared, say, to the walking pace of four and a half to five miles an hour, is that right?

RABKIN: That`s right. And it`s both enjoyable, from many standpoints -- from what we`ve been calling on the show the TM point of view; it`s relaxing, the mind goes somewhere -- and sometimes you can run through very nice areas. I was running in Vermont recently, I ran through a state forest; I was just a gorgeous experience.

LEHRER: Doctor, let me ask you as a psychiatrist: if you were treating somebody professionally who was very uptight, had problems relaxing, would you recommend that as a way to get over that little problem? Is it that kind of thing?

RABKIN: Well, I think it`s more complicated than that, but I have recommended it, and other people have also recommended it. They`ve recommended it for people who are tense. There have been some studies that all strenuous exercise probably affects sleep; there`s more deeper sleep. So that runners will frequently say they weren`t expecting it but they`re sleeping much better.

LEHRER:Dr. Hellerstein, let me ask you one final question. Do you run yourself?

HELLERSTEIN: Yes, but not as faithfully, not as anxiously as our colleagues in New York.

LEHRER: How many days a week, for how long?

HELLERSTEIN: Maybe one or two days a week I will run a mile or so. Instead I prefer bicycling, which to me is more acceptable than running. I use the stairs, I like gardening, I like other parts of living, which...

LEHRER: For health reasons or for psychological reasons?

HELLERSTEIN: Well, I`m not that depressed, but I would certainly agree that any physical activity, not necessarily running, will enhance self-esteem.

LEHRER: (Laughing.) Okay. Robin?

MacNEIL: Would it be fair to conclude that the medical evidence on the central question that we started off discussing -- is it good for you in the long run or dangerous -- is not yet in? Is that true, Dr. Hellerstein?

HELLERSTEIN: Yes, that`s true. The evidence is not in, and we at the National Exercise and Heart Disease Project are trying to find out whether controlled exercise in people who`ve had a heart attack will actually change the quality of living as well as the quantity of living.

MacNEIL: I see. How long will it take? Will we have to go through a whole generation of watching people like the Fixxes and the Rabkins and the Kuscsics here and then possibly even doing post-mortems on them when they die to find out what actually did happen to them?

HELLERSTEIN: No, I think we`ll have an answer by 1980 as to what effects it has on this controlled national exercise and heart disease population. But for normal people it`s going to take 50,000, 100,000 people to be studied prospectively to answer this big question, not, is activity physically worthwhile, but, how much activity? And that`s the bone of contention.

MacNEIL: Could we hear from the runners now? Presuming that there are people who are watching who have got attracted by watching these marathons on television, and apparently the number who go in for them every year increases -- as I said at the beginning, there are more marathons -- how do you recommend beginning running? If you don`t do it now, how do you recommend beginning? What do you start with?

KUSCSIC: First, common sense is the keyword. You have to look over what your exercise program is at that time.

MacNEIL: Suppose it`s nothing.

KUSCSIC: If it`s nothing...

MacNEIL: Supposing you`re an overweight middle-aged man who doesn`t do much exercise and just suddenly feels, "Hey, I should do something."

KUSCSIC: I would recommend he go for a walk and then he take a walk to the doctor and be checked out and have a stress test if he thinks he`s going to go into some kind of exercise program. And then there are any number of books -- we have Jim Fixx`s book now -- that can show you how to start very gradually with a walk program and then eventually go into a jogging program.

MacNEIL: What`s the difference between jogging and running?

FIXX: I think it`s mainly a semantic difference. Some people have said that it`s running if you`re going faster than eight minutes a mile and jogging if you`re going slower. I sort of think it`s jogging if you`re doing it for your health and it`s running if you`re doing it for fun, and I think we all do it for fun. Can I make a brief comment on something that`s been said here? That is on the marathon question. I would give as a piece of advice to anybody starting out in running, forget marathons for a long, long time. The marathon has somehow become the glamour event, but it`s a terribly long distance.

MacNEIL: Very few people can run that far.

FIXX: Very few people, and very few people should. I mean, it`s something to do when you`ve got to the point where you can run ten miles, where you can race ten miles and not feel destroyed by it. Then you can start thinking about a marathon. But certainly not until you`ve been running for two, two and a half years. It takes that long to restructure your body so you can handle that distance.

MacNEIL: What were you going to say about beginning running?

RABKIN: I was going to say about jogging. Jogging is what someone else does, and running is what you do.

(Laughter.)

MacNEIL: I see. "Restructuring your body" to run that distance. What does that mean?

FIXX: Well, your body goes through a lot of changes. One fairly obvious one is that your heart rate diminishes, and that takes time; that doesn`t happen -- mine was up in the seventies when I started running, and it`s now down in the forties.

MacNEIL: Your regular, normal heartbeat when you`re at rest.

FIXX: Yes.

MacNEIL: And what is yours now?

RABKIN: About fifty.

MacNEIL: And what is yours?

KUSCSIC: Fifty.

MacNEIL: And what else do you have to do to restructure your body?

FIXX: Well, when people first start running they usually have a lot of injuries. Minor injuries. I don`t think I`ve ever had an injury that made me stop running, but I`ve had injuries that made me cut down. And for example, if you`re a woman and you`re accustomed to wearing high heels, your Achilles tendon, that cord at the back of your ankle, is likely to be short -- shortened by wearing the high heels -- and so that has to be stretched until it`s the proper length. And then your whole cardiovascular system is affected by running, and that doesn`t happen instantly. Much of it happens very fast, during, let`s say, the first six or eight months of running. But then, since you continue to improve for years, even if you start in middle age, it`s evident that much of that happens slowly too.

MacNEIL: I just want to, in the final less-than-a-minute, ask Dr. Hellerstein: what is your advice, Doctor, to people contemplating running because they`ve been charmed by the marathons and things?

HELLERSTEIN: First thing, put both hands on the table before you finish the meal and push yourself away and get rid of that flab. Secondly, take the effort and put out any cigarette that you might have around. Thirdly, start walking slowly and more rapidly, get to a doctor, get evaluated. And if you`re an old man, like an old rat, recognize that uncontrolled exercise is harmful. Rats exercised in older age die prematurely. But don`t be in a hurry to attain a high level of fitness.

MacNEIL: Thank you very much, Dr. Hellerstein, and good night, Jim. And thank you all here, and good running. Jim Lehrer and I will be back on Monday evening. I`m Robert MacNeil. Good night.