By June Spence

In May of 2009, artist Lisa Oakley went out to dinner with a group of friends. “My friend Julie said, ‘Are you up for a big adventure?’ I must have been; I said yes first, then asked, ‘What is it?’”

Julie proposed that the friends take part in the Avon Walk for Breast Cancer in Charlotte that October, a two-day, 39-mile walk to raise funds for research and treatment. Oakley’s work as a glass artist is more physically demanding than the average office job, but regular exercise “went away with little kids,” she says. Still, she was game. “I figured I probably couldn’t run a marathon, but walking that distance felt like something I could do.”

In the past, extreme endurance sports such as marathons, triathlons, and long-distance cycling and hiking events were the purview of pure athletes -- fund-raising, cause-centered events used to be primarily 5K or 10K walks and “fun runs.”

But in recent years cause-related athletics have ventured into the realm of extreme sports, such as the Avon and Susan G. Komen foundations’ breast cancer walks (39 and 60 miles, respectively) and Team in Training events, which raise money through marathons, half-marathons, triathlons, 100-mile bike rides, and hiking adventures to support blood cancer research and patient services.

This trend significantly ups the physical ante for amateur participants who are dedicated to supporting their cause. David Berkoff, MD, who specializes in emergency medicine and sports medicine at Duke, says such events can really coax people off their couches. “I think it’s great. I’m seeing a lot of people that I would never have picked out of a lineup who are going to run a marathon.”

However Berkoff, himself a triathlete and distance cyclist, cautions newcomers to be aware of the rigors and risks of training and competing. “People are suddenly doing huge amounts of miles, and they may not be ready. You’d think these folks would slow down or stop when they get hurt, but they’re as committed to the cause as some athletes are to the race.”

Proper Planning for Peak Performance

Duke sports medicine experts David Berkoff, Priscilla Tu, and Andre Grant offer training tips that endure.Long distance runners, walkers, and cyclists face risk of injury to their bones, joints, and muscles from both accidents and chronic overuse. “Competition adds intensity,” says Duke family and sports medicine physician Priscilla Tu, DO. “There’s a much greater chance of injury -- your adrenaline’s kicking in, and you may not listen to your body.”

“I see a lot of knee injuries in my practice,” says Duke orthopaedic surgeon Andre Grant, MD, noting that different bodies are prone to injury in different areas. “Calf and hamstring problems are more common in men, whereas women experience more hip and pelvis problems.”

Ignoring pain or not giving the body enough recovery time can have long-term consequences. “We see patients who had an injury but kept pushing through the pain, and now they have a chronic problem,” says Berkoff. “They got a massage rather than seeing a doctor, when maybe we could have turned things around six months ago.”

“Let pain be your guide,” adds Grant. “If something doesn’t feel right, take time out, have it evaluated, and allow it to heal.”

Thoughtful training is key to preventing injuries. “The preparation has to be done over an extended period of time,” says Grant. “Don’t get off the couch a month before the race and expect to avoid injury. Probably the main reason people get injured is they increase their distances too quickly.”

And the greater the distance, says Grant, the more mindful you should become. “We’ve seen in the sports medicine literature that the risk of injury increases significantly once you’re logging over 40 miles a week.”

Oakley and her friends trained from May to October for the two-day, 39-mile walk, according to guidelines provided by the event’s organizers. Still, she admits, “we didn’t train for the long distances as much as we needed to. It was a huge time commitment -- our husbands weren’t always willing or able to give us all day Saturday and Sunday.”

The farthest distance they had reached before race day was 20 miles, but day one of the event was a 26-mile trek. “Around 21 miles was a near-breaking point for everyone,” she recalls. “I was having some foot pain. I probably should have stopped, but I had raised almost $2,700, I had told people I was going to walk 39 miles--I was going to walk. I was thinking about the women who went through chemo; they couldn’t stop just because they got tired!”

She completed the 26 miles and then spent about three hours in the medical tent, “nauseated and freezing cold. Then the next day I went on out and walked the last 13 a mile at a time.”

Endurance Events: Tips for Beginners

• Check with your doctor: Before you start intense training, your doctor should make sure your heart is healthy and that your program won’t worsen existing conditions, like asthma or previous injuries.
• Follow a training program: Many cause-affiliated events provide support and instruction to help participants prepare safely. A good rule of thumb for training safely is to increase your mileage no more than 10 percent each week.
• Cross-train: Integrating different aerobic activities and a strength- training routine into your weekly workouts will engage different muscle groups and is a great way to ward off overuse injuries--and improve overall conditioning, as well.
• Gear up: “The right gear and clothing are important considerations,” says sports medicine physician Priscilla Tu. “You need to get shoes with proper shock absorption and proper foot support, or you can really damage your feet and lower extremities.” Understanding the type of surface you’re walking or running on is also important. “Someone older who may already have bone loss could risk a stress fracture walking or running on concrete or asphalt, for example.”
• Check the weather conditions: “Especially if you’re predisposed to heat illness, you need to understand how to properly hydrate yourself,” says Tu. And exercising in frigid weather requires warm, breathable layers of clothing to prevent hypothermia or frostbite.
• Don’t go it alone: Extreme walker Lisa Oakley says she could never have gone the distance without her friends urging her along. “It’s a big bonding thing.”