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16.(j)(i)  Summary of "Fit to Go the Distance" by Susan K. Lewis, Editor of NOVA On-line

The Nova Marathon Challenge was conducted to find out if "almost anyone" could train and run a marathon if provide professional support and encouragement.

NOVA wanted to investigate these questions through "Marathon Challenge," and with the help of a dozen enthusiastic clinical recruits, including two who possess, Talk The Walk Motivational Skills, set out to see if "ordinary people" could transform themselves into "marathoners" in less than a year.  The results were extraordinary.

Click on definition of VO₂max.

We are all born with a genetic predisposition for a certain VO₂max range, and most of us, even if we work out daily, will never hit the marks of champions. Yet where we fall within our own ranges hinges on how often and how strenuously we exercise.  Exercise, like a wonder drug, can boost our physical and emotional well-being.  (Click on Endorphins and Adrenalines.)

So what innate physiological factors determined the NOVA runners' scores, how could training change them, and what impact could this have on their health?  For the answers, it helps to trace how oxygen moves from the air you breathe all the way to the mitochondria of your muscle cells, where it is ultimately consumed.

Given that VO₂max is a measure of oxygen consumption, you might think that lung capacity (volume of air a person can inhale) plays a major role in determining VO₂max scores.  Indeed, Lance Armstrong is renowned, among many more significant things, for having strikingly large lungs. However, lung size isn't a limiting factor; even people with smaller-than-average lung capacity breathe in far more oxygen than the rest of their bodies can process.

From the lungs, oxygen diffuses into the bloodstream.  For most of us, the rate at which the oxygen moves at this point is also insignificant. Only elite athletes might have their VO₂max scores hampered by the rate of diffusion, because their blood flows so rapidly that it might not have time to pick up all the oxygen it could carry. In any case, no amount of training will alter the lungs to make the oxygen flow from them any faster or make them healthier in general.

Exactly how much oxygen your blood can absorb and deliver to your muscles is critical to your VO₂max and your performance in endurance sports.  At the lungs, oxygen attaches to haemoglobin, a protein complex in red blood cells.  Oxygen-enriched, the blood turns bright red and remains this vivid colour until the oxygen is "dropped off" in all the various tissues of your body that need it—not just to power muscles, but to keep the heart, brain, and other vital organs functioning.

The sheer volume of blood in your body, the number of red blood cells it contains, and the quality of haemoglobin within these cells all affect the amount of oxygen your blood can shuttle to your muscles.  If you are anemic and your haemoglobin lacks iron, for instance, it is less able to bond with oxygen.  And cigarette smoking can dramatically compromise oxygen delivery, because tobacco smoke's carbon monoxide, rather than oxygen, holds onto haemoglobin.

With sweat and perseverance, all of us can strengthen our hearts.

"Born" runners may naturally generate high numbers of red blood cells that are particularly effective at transporting oxygen.  World-class athletes also frequently train at high altitudes, where their bodies make more red blood cells in response to "thin" (low-oxygen) air. And all too often, competitive athletes temporarily boost blood oxygen levels through illicit means, including blood transfusions and doping with EPO (Erythropoietin), a hormone that triggers red blood cell production.

Team NOVA, of course, never turned to such underhanded tactics.  Fortunately, legitimate training, even at sea level, could enhance the ability of their blood and vascular systems to carry more oxygen to hard-working muscles.

Regular and fairly intense training like the NOVA runners experienced spawns the growth of new capillaries, tiny blood vessels that supply oxygen and nutrients to skeletal muscles, the heart, the brain, and elsewhere. What's more, such exercise can make blood vessels throughout the body less stiff, improving blood flow and reducing risk of arteriosclerosis.  And by improving cholesterol levels, exercise also helps keep the vascular system, including vital coronary arteries, free of clogs.

Perhaps the greatest determiner of VO₂max scores is cardiac output, the amount of oxygen-rich blood your heart sends through your body in a single minute. Elite endurance athletes have extraordinarily powerful, and often unusually large, hearts. A typical jogger might pump over 15 quarts of blood per minute, while a frontrunner in the Boston Marathon is capable of pumping twice that.

Cardiac output is the product of heart rate (the number of beats per minute) times stroke volume (how much blood the heart ejects with each contraction).  For champions and recreational runners alike, even the most arduous training won't increase maximal heart rate, and this rate inevitably drops as we get older.

On the other hand, with sweat and perseverance, all of us can strengthen our hearts and increase stroke volume. Elite marathoners rack up thousands of training miles each year to extend the muscles of the heart and increase stroke volume.  Even Team NOVA's workouts—which eventually had the runners pounding pavement (and dirt) about 30 miles a week—could improve the efficiency of their hearts.

Elite distance runners may look almost waif-like, certainly not muscle-bound. Yet they have muscles that are exceptionally good at processing oxygen and propelling them through 26.2 miles—muscles that, despite maintaining nearly a five-minute-per-mile pace, don't seem to tire. How is it possible?

Part of the answer lies in the type of muscle fibre that predominates in their bodies. Physiologists call it "slow-twitch" fibre (as opposed to bulkier "fast-twitch" fibre that helps sprinters and weightlifters with quick bursts of power).  Team NOVA's athletic muse, Uta Pippig, is likely graced with an abundance of slow-twitch fibre, while fast-twitch muscles probably contour NOVA runner Steve DeOssie, a former NFL linebacker.

It's possible that some of the positive change evident in Team NOVA's scores has little to do with red blood cells or mitochondria or any other physiological factor.

A person's tendency to develop either slow- or fast-twitch muscle is largely genetic, yet specific training techniques—long runs verses bench presses, for instance—practiced over many years may change the balance of fibre types slightly.  Endurance training can also alter the physiology of either muscle type, in essence making fast-twitch muscles perform more like slow-twitch, and making slow-twitch muscles do better at what they already do well, namely use oxygen for energy production.

The key is mitochondria, tiny structures that act as power plants within all cells. Mitochondria combine oxygen with glucose or other food fuels to make ATP (adenosine triphosphate), the so-called "universal energy molecule" that powers cellular work. In muscle cells, ATP is essential for muscle contraction. Slow-twitch fibre inherently contains more mitochondria than fast-twitch. But endurance training increases the number of mitochondria in both types of muscle. It also can make mitochondria larger and more metabolically active.

Bigger and more active mitochondria don't just produce extra energy to keep muscles moving, they also cut down on muscle fatigue.  Tired, sore muscles during exercise are linked to a build-up of lactic acid, and mitochondria can sweep up and consume lactic acid as a fuel source. Once again, champion athletes may have an innate edge; their mitochondria might be particularly well suited for this cellular housekeeping. But anyone can condition his or her muscles to be less crippled by lactic acid.

The members of Team NOVA conditioned their muscles over nine months of rigorous training, and they were capable of runs at the end that would have been excruciating for them at the start.  In the summer of 2006 some of them couldn't even make it through a single mile without cramping up and stopping.  By the spring of 2007, they were aiming to take on the gruelling 26.2 mile course of perhaps the world's most famous marathon, Heartbreak Hill and all.

Shortly before they made their way to the starting line on the outskirts of Boston, the runners on Team NOVA stepped onto a treadmill to have their VO₂max measured for the second time.  Below are the results, comparing how well they did prior to their nine-month training adventure with how they did post-training:

* Steve DeOssie was unable to take the test due to a weak Achilles tendon, which the high-intensity treadmill run could have severely injured.

** Betsey Powers-Sinclair's initial score was likely slightly lower than her true VO₂max. Her test was cut short when doctors picked up signals of possible heart distress.

*** Xenia Johnson had turned 40 by the time of her second test, putting her in a new category.

To understand these results, it helps to put them in the context of normal VO₂max scores for men and women of various ages:

Betsey Powers-Sinclair's standout gain—more than doubling her VO₂max—may be somewhat artificial, because her first test was stopped short due to concerns about her heart. But even had she scored slightly higher the first time, she still would have made a tremendous advance. By the time of her second test, she had dropped 45 pounds, largely due to changes she had made in her diet. Her final score is also a testament to her ability to rise nearly every morning at 5 a.m. to attend an exercise "boot camp," pushing herself far beyond even what Coach Megerle prescribed in his training regimen. Sama ElBannan also made a lifestyle change that may have boosted her VO₂max and certainly changed the entire outlook for her future health—she gave up smoking.

Power of positive thinking

It's possible that some of the positive change evident in Team NOVA's scores has little to do with red blood cells or mitochondria or any other physiological factor. Perhaps some psychological "X Factor" contributed to the improvement. VO₂max is, after all, oxygen consumption at "maximum" exertion, measured when people run on a treadmill as fast as they think they can. Did NOVA's runners, at the end of their adventure, have greater willpower and confidence to keep going on the treadmill at points where, nine months earlier, they might have felt they were too exhausted?

Whatever the answer, if the men and women of Team NOVA can retain some of the exercise practices and the mindset they gained through this experience, they likely will be not just fit to go the distance of future marathons, they will be better fit for life.  A mountain of medical studies has shown that regular exercise decreases risk of heart disease, high blood pressure, and Type II diabetes, helps people maintain a healthy body weight, and can ward off mild depression and possibly even Alzheimer's.

Do you have to train for a marathon to see such health benefits? Not at all. For Team NOVA, taking on the challenge served as an impetus to get some of them off the proverbial couch. However, as Tufts University physiologist and Team NOVA advisor Roger Fielding notes, even brisk walking five or six days a week for 30 to 40 minutes at a time can impart many of the same health benefits. And that's something almost all of us can do.

Back to Section 16(j).