Running Addiction and Health: A Review of Relevant Cases and Research

In his opinionated but interesting book, Thinking in the Shadows of Feelings, Bar-Levav discusses the overuse of running as a coping skill, with the help of an excerpt from an article that appeared in a popular running magazine. The article describes how a doctor who used long-distance running to keep intense depression and mania at bay came down with an injury, had difficulty running as much as he used to, and later killed himself. He left a note saying something to the effect that, "For me, running was everything." I haven't found a link to that article yet, but here is another, similar story.

Such deaths are clearly very unfortunate, but the least we can do is to learn from them. These days, running, along with exercise in general, is heralded as a silver bullet for physical and mental ills, and much of this is justified. Compared to sitting on the couch, moving does wonders for body and mind alike. But we must also remember to think clearly about the addictive tendencies we all have to varying degrees, and the risk of putting all our eggs of anxiety in a single basket. If that coping-basket breaks, then all of our anxiety may break open at once. 

The addiction to running is still an addiction, but unique in being largely beneficial to most of those who have it, as long as their health, ankles, and schedules allow them to sustain it. It can also be a wonderful replacement for other, less kindly addictions, though it still has withdrawal effects.

But there is a possible second respect in which running addiction is unique, and it connects directly to the first. Insofar as runners correctly see running as a uniquely beneficial addiction, they may be even more likely than those with intrinsically destructive addictions to view their dependency as unconditionally healthy, even when it is not. That is, they may think running is healthy even if they are literally running away from problems they would be better off solving directly, or running as part of an eating disorder. In other words, it may keep them from the growth that would occur if they faced their problems and fears head-on.

Now, I am not anti-running by any means. I love to run, and think most people would benefit from doing more of it. But I also think Bar-Levav's concern is valid. Even something that is truly good for us can reach a point of excess. And what constitutes 'too much' may have more to do with the reasoning that leads us to engage in a given activity with a certain frequency and level of intensity than with the frequency and level of intensity itself.

Let's take someone who runs 1 mile a day because it is 'a godsend,' a way of skimming off excessive energy, and who is unable to cope without it. They may want to consider running more infrequently, perhaps every other day, and work on developing other coping mechanisms. Hopefully they will eventually reach the point that when they go back to running daily, days off are only a source of minor annoyance, rather than one of complete frustration.

On the other hand, consider someone who runs 3 miles a day, who finds it a pure joy to connect with their body and the world around them, in that steady succession of rhythmic motions and breaths. They often find days off a chance to enjoy the contemplativeness and relaxation of a bodily state that is less aroused, and have other, lower-intensity ways of releasing tension in their bodies when needed. As long as they are maintaining a healthy body weight and an adequate amount of body fat (and, in the case of pre-menopausal women, a key symptom of sufficient body fat is menstruating), such a person should undoubtedly continue as they are. For, they can enjoy running, enjoy not running, and remain healthy. This suggests they have other coping skills, and thus are more likely to retain their equilibrium even if injury strikes, and they cannot run for an extended period of time.

Still, there is such a thing as an extent of running that might be excessive in itself, even if days off are okay and the body is healthy, because the intensity of the experience is a thrill. And thrills, like all sensation-seeking, can make the rest of life seem more drab by comparison. Thrill-seekers have increased their tolerance to stimulation, and need more stimulation than daily life can reliably provide to feel pleasure. Therefore, post-race depression - which seems to have greater withdrawal effects than days off from a normal run - is not surprising. The intensity of the effort is greater than that which your body is used to, and the excitement (dopamine, adrenaline, endorphins, the whole shebang) is greater as well. If you deal with depression already, avoiding such intense workouts might not be a bad idea. This blog post in 'Runner's World' is a reflective, brief, personal take on the suicide of an ultra-marathoner, and mentions post-race depression as a possible issue.

Lastly, I would like to mention four interesting research-based findings related to running and high-intensity exercise in general. These may help to keep running in perspective. Running is a particularly effective tool in the toolbox of a balanced life when used moderately, but it is not a cure-all. Nor, as we have seen, is it without risks.

First, and perhaps surprisingly, the heart benefits from exercise based on distance, regardless of how fast you go (I wonder if this is true with swimming, too). Brisk walking is just as good for cardio health as running. This is not to say that brisk walking is superior to running in all ways, but this is at least one dimension of health where running is not clearly superior.

Second, as noted in Runner's World, "Last year, two large studies, including one in Copenhagen, found that running extends life expectancy by as much as six years. But there was a catch: People who ran 15 to 20 miles, or about two and half hours, per week enjoyed the added years. Those who ran 30 miles or more did not live longer." Research is being done to find out if normal longevity is par for the course for long-distance runners. It is possible that particular populations of runners, or runners with particular habits, can live longer despite running more than 30 miles weekly. However, the present research suggests that, for most people, running 15-20 miles per week is ideal.

Third, a recent, very small study showed that low intensity exercise provided the same 20% increase in energy levels as moderate intensity exercise over six weeks. Further, low-intensity exercise decreased fatigue by a whopping 65%, 16 percentage points more than moderate-intensity exercise.  Since it is conceivable that experience of fatigue is lower in low- and moderate-intensity exercisers than high-intensity exercisers, it is unfortunate the study did not include high-intensity exercise as a basis for comparison. The fact that many runners seem to have high energy levels may be a testament to their endorphins, but these same endorphins may also, conceivably, mask a deeper bodily or even psychological fatigue that returns on days off. I know of no research on this, but it would be worth looking at further. Regardless, the study indicates that low-intensity exercise certainly has significant short-term benefits.  For people who want an alternative to a daily run, low-intensity exercise still offers benefits.

Fourth, research also shows that walking is especially effective at inducing creativity, which comes in handy for solving problems real or perceived. Brisk walking gives us a chance to get out in the world, improve our heart health to the same extent as running, if we are going the same distance as we would when running, and think more creatively. For these reasons, walking may be a particularly good mode of exercise for runners who need to take a day off and think things through.

To sum up, running is a great thing. It can replace unhealthy addictions, help us feel wonderful, improve our physical health, and give us up to six more years of life. But it can also be a way of escaping from our problems, and become the only coping skill in the runner's toolkit. When that happens, withdrawal effects after running races or when taking days off seem to be able to bring about the return or worsening of depression.

Dedicated runners should make sure they have effective coping skills other than running, and can skip a day without excessive withdrawal effects. If their honest answer is that they do not have other effective coping skills, or cannot skip a day without intolerable withdrawal effects, they have three options. They can either gradually decrease their running mileage and substitute in lower-intensity exercises like walking instead; develop other coping skills in addition to running, but keep running the same amount; or, they can do nothing. The first two options will ensure that they will be prepared for the times when coping is needed and running is unavailable. The latter option will leave them just as unprepared as ever, and that lack of preparedness may, in some cases, be the difference between life and death. In this, Bar-Levav is correct.