Inflammation is a major buzzword these days鈥攁nd not just in the context of sprained ankles or itchy insect bites. Much of the discussion instead surrounds the chronic low-grade inflammation that tends to increase throughout your body as you age. This phenomenon is thought to contribute to a wide range of ills, like heart disease, cancer, and chronic pain. It even has a catchy name: 鈥渋nflammaging.鈥� Whether exercise helps or hinders this process has long been a topic of debate.

It鈥檚 clear that exercise causes a short-term surge of inflammation. One of the earliest in sports science, in 1901, tested blood samples from four competitors in the Boston Marathon. The results showed a spectacular surge of inflammatory markers after the race, which was, at the time, interpreted as worrisome evidence that 鈥渢he exercise had gone far beyond physiological limits.鈥�

In the years since then, we鈥檝e come to a more nuanced view of the links between exercise and inflammation. Yes, exercise triggers acute inflammation. But the body responds by deploying its own anti-inflammatory molecules. One theory is that the body鈥檚 defenses against inflammation then get stronger over time, so regular exercise actually protects you from inflammaging. Evidence for this claim is mixed, though, so researchers in Spain recently pooled the available data to investigate the effect of decades of serious athletic training on inflammation.

What鈥檚 the Problem with Inflammation?

Inflammation is a double-edged sword. It鈥檚 part of the body鈥檚 emergency response to stressors like an infection or a twisted ankle, a biochemical cascade that often results in swelling or soreness, but also calls in key molecules that initiate the defense and repair process. That鈥檚 why sports doctors use anti-inflammatory drugs more sparingly than they used to, because shutting down inflammation might delay recovery. In this context, inflammation is good鈥攁s long as it turns off again once the danger is past.

Inflammation becomes a problem when it鈥檚 chronic (meaning that it doesn鈥檛 shut off once a threat has been successfully dealt with) and systemic (meaning that it鈥檚 everywhere in the body rather than just at the site of an injury). Chronic inflammation is a characteristic鈥斺�攐f heart disease, cancer, diabetes, and various other conditions. To put it bluntly, if you have high levels of various inflammatory markers when you鈥檙e at rest, you鈥檙e likely to than someone with lower levels.

There are various reasons that you might have chronic inflammation: a lingering infection, high levels of psychological or emotional stress, and so on. Your diet can contribute, although there鈥檚 plenty of debate about which foods help or hinder (fiber, fruit, and vegetables are ; sugar and trans fats, not so much).

The big factor, though, is aging. As you get older, baseline levels of various inflammatory markers creep inexorably upward. It鈥檚 not entirely clear why it happens. is that dead or damaged cells accumulate and keep triggering the immune system at a low level; is that it鈥檚 caused by gradual changes in your gut microbiome. Whatever the cause, it鈥檚 bad news.

How Being an Athlete Affects Inflammaging

The new study, , comes from a joint research team led by I帽igo P茅rez鈥慍astillo of Abbott Nutrition in Spain, along with medical staff from the Real Madrid soccer club and the Real Madrid Graduate School, a sports-focused unit of the European University of Madrid. (Yes, that鈥檚 a real thing. .)

Previous research has shown that if you train for a few months, your baseline levels of inflammation will go down鈥攂ut then if you stop training, the levels go back up. What P茅rez鈥慍astillo wanted to know was whether, if you train at a reasonable level and simply never stop, you can avoid inflammaging altogether. To find out, he and his colleagues pooled the results of 17 studies with 649 participants in total, comparing lifelong masters athletes鈥攑eople over the age of 35 who train and compete regularly in a sport鈥攚ith healthy but untrained people both young and old.

One challenge with studying inflammation is that there鈥檚 no simple measure of it. Instead, there鈥檚 a whole collection of molecules that respond to various types of stimulus in various ways that increase or decrease inflammation. Some do both. Interleukin-6, for example, surges sharply and temporarily after exercise in a way that fights inflammation, but at higher levels during rest can promote inflammation.

This means you have to look holistically at a bunch of markers to get a sense of overall inflammation levels. When you do this, a fairly convincing pattern emerges in the data. If you compare masters athletes with age-matched peers who don鈥檛 train, the athletes have consistently lower levels of baseline inflammation. But if you compare them to young people in their 20s who don鈥檛 train, the young people have even lower levels. Youth trumps training, in this case.

The data isn鈥檛 totally uniform. The strongest results show up in comparisons of C-reactive protein, which is associated with inflammation, and interleukin-10, which fights inflammation. Older athletes have less of the former and more of the latter. Training didn鈥檛 seem to make any difference for tumor necrosis factor alpha, another inflammatory molecule.

For interleukin-6, the results were mixed. Training didn鈥檛 lower baseline levels by a statistically significant margin. But when you break out the data by sport, endurance training did have a significant benefit while resistance training didn鈥檛. That might be because endurance training has unique powers, or it might simply be that there haven鈥檛 been enough resistance training studies to see an effect. At this point, there鈥檚 no way of knowing.

If you were hoping for proof that running is the fountain of youth, you might see these results as a let-down. (I鈥檒l admit, I was hoping for better news.) It鈥檚 possible that we might eventually stop inflammaging entirely by pulling more levers: maybe it鈥檚 lifelong endurance training and eating some yet-to-be-determined mix of vegetables and fish and never raising your voice in anger. The more likely scenario, I suspect, is that nothing can halt the flow of time entirely. If that鈥檚 the case, then I鈥檒l take these results as a win.

***

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Everyone has a plan, Mike Tyson famously said, until they get punched in the face. The endurance athlete鈥檚 version of that dictum might be: everyone has a great VO2 max and an efficient running stride until they鈥檝e run 20 miles. How you fare in those final miles depends, in large part, on how steeply these factors have declined over the course of the race.

This is the fundamental premise of 鈥渇atigue resistance,鈥� an idea I first wrote about back in 2021 that is currently one of the hottest topics in endurance science. The old view was that you could run some lab tests to determine an athlete鈥檚 VO2 max, lactate threshold, and running economy (or an equivalent measure of efficiency for other sports) and calculate their predicted finishing time. The new insight is that these factors change as you fatigue鈥攁nd crucially, they change more in some people than others. Having good fatigue resistance, then, is the 鈥�fourth dimension鈥� of endurance.

So far, most of the research on fatigue resistance鈥攚hich is also called 鈥渄urability鈥� or 鈥減hysiological resilience鈥濃�攈as focused on demonstrating that it plays a role in determining who wins races. What we really want to know, of course, is how to improve it. That鈥檚 the question a pair of new papers tackles.

The Case for Strength Training

The first study, by Michele Zanini and his colleagues at Loughborough University in Britain, tests a twice-a-week strength training program in 28 well-trained runners with an average 10K best of 39 minutes. Half of them added the strength routine to their usual training for ten weeks, while the other half just carried on with their usual training.

The performance test was a 90-minute run at a pace near lactate threshold, followed by an all-out time-to-exhaustion test that lasted about five minutes. Every 15 minutes during the 90-minute run, they measured running economy, which quantifies how much energy you burn to sustain a given pace. They expected running economy to get worse as the runners fatigued, but wanted to find out whether strength training could counteract this deterioration.

The results were encouraging. Before strength training, running economy got 4.7 percent worse after 90 minutes of running; after strength training, it only declined by 2.1 percent over the same period of time. Here鈥檚 how running economy changed over the course of the run, with white circles showing the baseline test and black circles showing the post-strength-training test:

Note that a positive change (i.e. the line drifting upward) means that the runners were burning more energy to maintain the same pace as time went on. In the baseline test, running economy starts getting significantly worse after about an hour. After strength training, this drift is less pronounced.

The strength training program in the study consisted of a mix of heavy weights and explosive plyometrics. The resistance exercises were the back squat, single-leg press, and seated isometric calf raises, typically with around three sets of six reps. The plyometrics included vertical exercises (pogo jumps and drop jumps) and horizontal exercises (hops and bounding). It鈥檚 not clear from this study whether the heavy weights or the plyometrics provided the magic, though Zanini that both methods have produced similar results in previous studies of strength training and running economy.

Why does strength training improve fatigue resistance? Here we鈥檙e limited to speculation. It may have something to do with making fast-twitch muscle fibers more efficient, or making tendons stiffer and springer, or improving strength sufficiently to maintain good running form for longer.

Other Options for Boosting Fatigue Resistance

The other new paper is by Andy Jones of the University of Exeter in Britain and Brett Kirby of the Nike Sport Research Lab. Jones and Kirby played key roles in Nike鈥檚 Breaking2 Project in 2017, where they encountered what you might call the Zersenay Tadese Problem. Tadese had exceptional lab values, including the best running economy ever measured, but repeatedly struggled at the marathon distance, while his teammate Eliud Kipchoge had relatively modest lab values but turned out to be the dominant marathon runner of the decade. The difference, presumably, was that Kipchoge had better fatigue resistance.

The new paper sums up their thoughts on fatigue resistance, including some speculation on how to improve it. Strength training, they note, is one option鈥攖hough they point out that few of the East African runners who currently dominate international marathoning do structured strength training.

Overall, their view seems to be that the best ways of improving fatigue resistance are mostly the things that endurance athletes already do to get better: high mileage, especially accumulated over many years; long runs, including some sections at close to race pace; intense interval sessions; following a pyramidal training distribution. There may also be some more subtle effects from, for example, doing some fasted training or living at high altitude. None of these are uniquely targeted at fatigue resistance.

Jones and Kirby do mention one other possibility: put on some supershoes. There鈥檚 likely an instant effect, since the heavy cushioning reduces muscle damage and enables you to keep striding smoothly through the later stages of a marathon. And there may also be a chronic effect: the cushioning allows you to absorb and recover from higher levels of training, enabling you to safely rack up higher mileage and thus improving your fatigue resistance over time.

The overall impression, then, is more evolution than revolution. All these years, we鈥檝e been training to maximize VO2 max, running economy, and threshold. Now we鈥檝e got a new target鈥攆atigue resistance鈥攂ut so far the best ways of improving seem to be mostly the things we鈥檙e already doing. Even Zanini鈥檚 strength-training routine is the kind of thing coaches and scientists already recommend. But if you have the sense that fatigue resistance is one of your weaknesses, you now have extra motivation to move strength training and plyometrics from the 鈥淚 should do this鈥� column to 鈥淚鈥檓 doing it.鈥�

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I have never run a marathon.

I have no intention of running a marathon. It isn鈥檛 on my bucket list. I don鈥檛 get a tinge of envy when I see the 26.2 bumper sticker proudly emblazoning the back of the car in front of me at a stoplight. I鈥檓, personally, good. That said, I do love staggering feats of human endurance when other people accomplish them.

Thus, I was fascinated when a friend sent me a of two women arriving at the 2024 Chicago Marathon with鈥攁s the text overlaid on the video explains鈥斺�渘o training, no breakfast, no sleep, no headphones, no battery, and no sense.鈥�

I sat rapt for over five minutes, watching Jaryn Garner and Paula Hughes check in mile after mile, their legs flagging but somehow still smiling, laughing, and cracking jokes deep聽into the back half of the marathon.

my legs are still humming #@Jaryn Garner

The major聽headline of this year鈥檚 Chicago Marathon was Ruth Chepngetich鈥檚 dizzyingly fast new women鈥檚 record of 2:09:56. The TikTok is pretty good, too, though,聽and I found myself wanting to know more about why it was created.

I reached out to Garner, one of the masterminds behind the video (in it, she鈥檚 the one holding the phone camera and wearing the beanie), to learn more about the backstory and to ask the ever-present internet question: Is what you claim in the video true? And if it is true, what did it feel like after the fact?

This Is What a Marathon on Minimal Training Looks Like

OUTSIDE: What did it actually feel like to run one of the country’s most famous marathons totally unprepared? How did it come to be, and what was the lead-up like?
GARNER: There was no real inspiration. The company I work for (, a lifestyle brand founded by professional athletes Alex Morgan, Chloe Kim, Simone Manuel, and Sue Bird) had four bib entries for the Chicago Marathon and asked if anybody was interested about six weeks before it. Nobody jumped at the thought of the idea, so Paula [Hughes, the other woman you can see running in the video] reached out to me and said, “So, are we running the marathon?” 鈥� I truly felt it was a joke until we got to a month away, and I just kept thinking, wow, we’re really doing this.

We started to get all the information emails, and Nike began to send us stuff for the marathon, and that’s when it really got real. In the lead up, we had a Nike coach give us a few pointers (that we tried our best to attempt), and we started running like once or twice a week, but it was nothing that exceeded two to three miles. So, not enough at all.

Your baseline fitness seems… high! You don’t strike me as just popping off your couch and running a marathon. What’s your workout schedule look like, marathon training aside? Are you into distance running? Walk me through a little of your backstory.
Neither of us are runners in the slightest. We are both former D1 athletes. Paula rowed crew at Syracuse University, and I played basketball at the University of Virginia and finished my career at St. Joseph’s University. With that being said, we both hate distance running, so although we aren’t true couch potatoes, the thought of even running a mile is laughable to the two of us.

The caption on the video (鈥渕y legs are still humming鈥�) indicates some post-race pain. Can you describe what the day and week after the race were like for your body?
The moment we crossed the finish line, we went back to a tent Nike provided to celebrate and recover for about 20 minutes and took pictures. After standing up, walking out of the tent, and heading out to get picked up, I experienced probably some of the worst pain I’ve ever felt in my lower body. Moving at a snail’s pace, every step hurt from my feet all the way up to my hips. I definitely had never experienced that. The very next day I struggled to walk and actually crawled a bit to move around.

The worst part for me was my feet. I didn’t get to 100-percent pain-free walking until nine days later, and my legs came back to 100 percent about five days later.

Seriously, Though, You Need to Train Before Your Marathon

As fun as my conversation with Garner was, I鈥檇 be remiss if I didn鈥檛 talk through the very real dangers of running 26 miles without training that builds up circulatory, respiratory, muscular, and mental fitness over time.

If you read the comments on the viral video, you鈥檒l see lots of upvoted commenters pointing out the danger of rhabdomyolysis, a condition in which muscle tissue enters the bloodstream following overexertion, among other health concerns. (You can read a longer explanation of the .)

For some perspective on the issue, I also reached out to my friend Kaylyn Christopher, a former NCAA All-American distance runner for West Virginia University, Boston Marathon qualifier, and the current men鈥檚 and women鈥檚 cross-country coach at Fairmont State University, for her perspective. She had already seen the video and said she thought 鈥渋t was a brave undertaking!鈥�

But, Christopher notes, marathons typically require intentional preparation. In addition to getting miles under your belt to make sure your body is physically ready, there are other factors to consider, like nutrition and hydration. Most marathon runners spend a lot of time honing their system during training runs.

鈥淒o you carry a handheld bottle? Is it filled simply with water or perhaps electrolytes? Or do you practice grabbing cups from water stations? Do you carry salt tabs? What about gels? Do they cooperate with your digestive system?鈥� says Christopher. 鈥淭hese are things that marathon runners seek to answer through trial and error during training.鈥�

With her own athletes, she says, under-training leads to higher occurrences of things like IT band issues and shin splints.

Garner herself noted the same in our conversation. I asked her what she would say to folks inspired to mimic her feat. She told me that she does want to be conscious of health concerns. At the same time, she says that commenters pointed out how 鈥渨e helped make them feel better about their upcoming marathon, inspired them to sign up for a marathon, or just to start working out, and that has probably been more rewarding than getting that medal at the end.鈥�

Watch the video. Run the marathon. Just spend some time training beforehand.

This interview has been edited for brevity and clarity.

Despite her feelings about marathons, Ryleigh Nucilli actually did run college track and cross-country at Washington and Lee University in Lexington, Virginia. When she鈥檚 not writing, walking dogs, or wrangling a toddler, she鈥檚 lucky to get in a few miles a week.

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The diabetes drug Ozempic and similar prescription weight management drugs, like Wegovy, are getting a lot of buzz, from millions of mentions on social media to rumors that celebrities are taking them to dramatically slim down. And that buzz means more people are taking them off-label, potentially solely to lose weight, whether they need to or not.

That focus on weight loss can be problematic for people with eating disorders or who feel pressure about their weight, a population that includes a high percentage of athletes. The drugs have brought a renewed emphasis on being thin, potentially undoing progress of the anti-diet and body acceptance movements in the last few years, and that can be triggering for those susceptible to worrying about their weight, says Evelyn Tribole, a registered dietitian with a private practice in Newport Beach, California.

鈥淚鈥檝e seen the rhetoric about how diets don鈥檛 work and therefore use these drugs, so these drugs have co-opted that rhetoric,鈥� Tribole says. 鈥淚f you鈥檙e really interested in health, why would you be taking something that can really injure your health in the long run?鈥�

The injectable drugs work by mimicking the action of the hormone GLP-1, which produces insulin but also makes your body feel less hungry by slowing down your GI tract. People who take the drugs say they barely feel hungry and cannot finish big meals.

The chatter around the drugs has caused a shortage of them for people who actually need them鈥揳 huge concern, especially for people with diabetes. And they can be very pricey鈥搈ore than $1,000 a month.

Side Effects of Ozempic

The drugs can have strong side effects, from nausea and vomiting to severe inflammation that can lead to hospitalization. But there are additional considerations that athletes should take before starting the drugs, says Dr. Abisola Olulade, a family medicine doctor at Sharp HealthCare in San Diego.

Because drugs like Wegovy are meant for weight management for individuals with body composition-related health complications. She says anyone considering the drugs should check with their own doctors.

1. Low Blood Sugar Levels

First of all, Olulade says, the drugs actually mimic what exercising already does to the body. When you train, it increases GLP-1, which in turn increases insulin release, leading to lower blood sugar levels.聽

鈥淔or someone who exercises regularly, you would have less resistance to GLP, so you could get hypoglycemic from that,鈥� she says. 鈥淭he medication has a similar effect, so when you鈥檙e taking Ozempic and you鈥檙e running, then you could have this exaggerated hypoglycemia. So you could have a worsening of that lower blood sugar effect, which could potentially be dangerous.鈥�

2. Limited Hunger Cues and Dehydration

Another impact, she says, is that you don鈥檛 experience hunger cues on the medication, which could mean you aren鈥檛 getting enough fuel before or after your workouts.

鈥淵ou have a decreased appetite, so you may not be fueling adequately with food, and hydration status also is a risk,鈥� she says. 鈥淪o you could get dehydrated, and that would be another risk that we can see with this.鈥�

3. Kidney and Pancreatic Issues

Beyond the direct effects of the medicine, there are side effects to consider, including the potential for acute kidney injury and pancreatitis, which get worse with dehydration.

4. Stomach Pain

鈥淭hen the stomach pain, the diarrhea that you can get with it, that could also get worse,鈥� Olulade says. 鈥淪o if you鈥檙e not hydrated and you鈥檙e having loose stools, then you can get really dehydrated, which could be a problem as well.鈥�

Those issues could lead to electrolyte imbalances and a potential increase in heart rate, she added.

What Do Experts Have to Say About Athletes Using Ozempic?

A spokeswoman for Novo Nordisk, the Danish company that makes Ozempic and Wegovy, says the company does not 鈥減romote, suggest, or encourage off-label use of our medicines.鈥�

鈥淲e trust that healthcare providers are evaluating a patient鈥檚 individual needs and determining which medicine is right for that particular patient,鈥� Allison Schneider wrote in a statement.

She added that the drugs have demonstrated long-term safety in clinical trials, with common side effects including nausea, diarrhea, vomiting, constipation, stomach pain, headache, tiredness, upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, and heartburn.

Olulade says with advice from their doctors, athletes can take drugs like Ozempic if they鈥檙e needed.

鈥淵ou do still want to take precautions, which is making sure that you鈥檙e hydrated, making sure you鈥檙e eating, making sure that you are aware that even though you don鈥檛 have hunger cues, you should still have a sense of how much you鈥檙e eating,鈥� she says. 鈥淪o that it鈥檚 enough to fuel your exercise, depending on what you鈥檙e going to be doing.鈥�

Be sure to let your doctor know that you鈥檙e an athlete if you鈥檙e talking about taking Ozempic or Wegovy, because the doctor may prescribe a lower dose, Olulade says.

鈥淵ou could potentially try a lower dose first, see how you react to that,鈥� she says.

Tribole, who also qualified for the first-ever women鈥檚 U.S. Olympic Trials Marathon in 1984, says she would not advise runners to take the drugs for weight loss.聽

鈥淚f you鈥檙e taking it for intentional weight loss, I think it鈥檚 really problematic, not enough is known,鈥� she says. 鈥淚f you鈥檙e a diabetic and you鈥檙e a runner and that鈥檚 going to help your blood sugar, then, yeah, absolutely, I don鈥檛 have an issue with that. If it鈥檚 taking it for the intention of weight loss, that I think is really problematic.鈥�

Tribole says running already masks hunger cues, at least for a few hours, so combining that with Ozempic could be especially problematic by causing injury due to a lack of nutrition. And for women runners, conditions such as relative energy deficiency syndrome.

鈥淲hen you鈥檙e training intensely, that already temporarily blunts your hunger, and so now you鈥檙e adding something else on top of that,鈥� she says.聽

She worries that the buzz around the drugs and how they鈥檒l make you thin could also lead to more eating disorders, and convince runners who don鈥檛 need to lose weight to try them.

Despite these concerns, Olulade says these drugs will likely only continue to grow in popularity, and as they get more attention through celebrities and social media, more people ask their doctors about them.鈥淲e have people that call every single day requesting them and asking about them,鈥� she says. 鈥淎nd so we obviously need to be better about educating people on this and also reminding people that nutrition is also important.鈥�

She says these drugs are meant to be taken in conjunction with changes in diet and exercise.鈥淭hey are authorized to be used in conjunction with nutrition and exercise as a whole,鈥� she says. 鈥淭hey鈥檙e not supposed to be used just in isolation. They鈥檙e supposed to be something that is a multi-targeted approach.鈥�

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