Long distance running and coumadin

[ctyguy]

I've "officially" started training for a 1/2 marathon and am curious from those of you that are runners as to what the training did to your coumadin dosage. I've been running maybe 10 miles a week at best, honestly its been only one run a week since winter settled in. Im a bit of a tenderfoot and am not happy running in 20 degree weather or really windy conditions. So my coumadin has been pretty stable but now Im going to be running 20ish miles a week for the next 10 weeks. Im not a home tester, I go to the clinic once a month. Should I get tested every 2 weeks during the training ? I figure I will metabolize the coumadin faster and don't want to end up at the clinic and all of a sudden Im 1.5

[Karlynn]

I'm not a runner - but I would imagine that you'll be needing to increase your dose since your metabolism will probably speed up.

[kodi]

I am a runner but fortunately the only medication I'm on is a daily aspirin. I wish I could answer your question but I'm certain others out there will be offering suggestions.
As a distance runner I do have some training advice. Not knowing when your event is scheduled you need to start running more than once a week. Three or four days would be plenty to comfortably complete a half marathon. Be careful not to increase your mileage much more than 10% a week. I would really find a training plan (www.runnersworld.com) has plenty. My daughter used Hal Higdons and it worked great for her. When the weather is too cold try using a treadmill (which I never do, but I live in sunny AZ). The importance is consistency in training. You should also do some cross-training, that is, swimming, cycling, walking and possibly weight training.
As you progress in your training you should varying the distances, try to do a little speedwork, hill work and tempo runs. All this is more detailed in a comprehensive training program.
Let us know what event you are doing and when it is. Good luck in your training and don't be afraid to ask more questions.

[LucyLou]

I've "officially" started training for a 1/2 marathon and am curious from those of you that are runners as to what the training did to your coumadin dosage. I've been running maybe 10 miles a week at best, honestly its been only one run a week since winter settled in. Im a bit of a tenderfoot and am not happy running in 20 degree weather or really windy conditions. So my coumadin has been pretty stable but now Im going to be running 20ish miles a week for the next 10 weeks. Im not a home tester, I go to the clinic once a month. Should I get tested every 2 weeks during the training ? I figure I will metabolize the coumadin faster and don't want to end up at the clinic and all of a sudden Im 1.5

Scott, look into home testing, the peace of mind is priceless. When I was training for Army 10 miler, my dose was 40 mgs a week, still is today and I stay in range, 2-3. My INR did not drop below 2. The only time my INR went up was when I got sick, dehydrated, or had a couple more glasses of wine than I should have had.

We're starting to get nice weather here in TX, and we turn clocks ahead this weekend, meaning more daylight to squeeze in more running. :) Unfortunately, I am having issues with my right foot and will be seeing a podiatrist in 2 weeks. I had a morton's neuroma requiring surgery in '93, now they can inject alcohol to kill the nerve. I'm hoping that's all that is going on, could be some arthritis too. I shall see, maybe some orthotics is all I need.

Take care of your feet, you would not believe how important good running shoes are. :)

[spartangator]

Just wanted to say, "Good for you" for setting such a goal and to second kodi's advice. Not taking thinners myself, I can't otherwise be helpful, unfortunately, but we're excited to hear reports about your big run :).

[Philip B]

Hi Scott,

I'm not a runner, but do bicycle seriously (five Colorado century event rides in 2008). It's pretty normal to see changes in your metabolic rate when you engage in a regular exercise or training program. As metabolc rate increases, higher dosages of coumadin will probably be necessary to keep you in your INR zone. How much it takes varies from individual to individual.

Personally, I have to double my dosage when I'm into my serious training program and involved in events. Home monitoring really helps me adjust dosages to keep me where I need to be.

Good luck with pursuing your goals.

-Philip

[ctyguy]

I've pulled a training schedule off the net and it calls for running 5 times a week. Fortunately the runs are 3 miles a pop in the beginning. By the time I get to longer runs Im hoping we are in the 50s so running outside won't be such a burden.

Im already in the gym 4 times a week (at least) doing various cross training or weights. I just hate running on treadmills so over the winter I was running once a week for 3 or 4 miles. Last fall before the cold set in I'd run 3 or 4 miles on Wednesday and then run 5 or 6 on Saturday. My INR really was stable over the last few months but I figure the change to my exercise is going to mean a change to my dosage.

I've got to get in touch with my insurance to see if I can qualify for home testing. Its times like this where being able to test more frequently would be of great benefit and the Coumadin Clinic I belong to cost over $100 a visit.

Thanks for the suggestions and I will post my progress.

[tprice54]

Congratulations on setting such a lofty goal! Like Kodi, all I trake is an aspirin, but I second his running advice....4 days a week minimum, never up your mileage by more than 10%, an get in a progressively longer run every week, working up to 13 miles 3 weeks or so before your event. Keep us informed on your progress!
Oh, and think about joining us in upstate NY for the Wineglass marathon....not that far from you and many other heart patients will be there.

[tommy]

Ditto the congratulations and on the 10% rule.

I noticed that my INR dropped a little when I started exercising heavily. Dosage change was about 10%. I also found that variability's in diet have more impact than the exercise level. Consistency is the watchword.

Best wishes and keep us posted!

[SumoRunner]

I don't think it's ever had a major impact in the INR. I've been a distance runner for many years before and after AVR. Every winter I scale back my mileage and every spring ramp it back up again. The coumadin dosage has remained pretty stable throughout, whether I'm doing 10 or 20 or 30 miles a week, it's been pretty much the same year round.

Don't be alarmed by the burst blood vessels in your cheeks. When you go extra long or extra hard at short distances, you might see some red spots on the upper cheek. It goes away in a day or two - unless you really, really overdid it. Spouses tend to get all worked up over it.

Go buy some Bodyglide for chafing where the inner arms rub against the shirt and thighs rub on the shorts. Do NOT wear 100% cotton tee shirts. They chafe worst. Also bloody nipples are going to be a big deal when you get out past about 8 miles, trust me. There's a term for it, they call the big red spot a marathon badge. Take one bandaid, snip out the center pad and use the two sticky ends over the nips. It's a bit painful pulling it off later but forget to cover them up just once and you'll learn what real pain is the second you step into the shower.

[kodi]

Also bloody nipples are going to be a big deal when you get out past about 8 miles, trust me. There's a term for it, they call the big red spot a marathon badge. Take one bandaid, snip out the center pad and use the two sticky ends over the nips. It's a bit painful pulling it off later but forget to cover them up just once and you'll learn what real pain is the second you step into the shower.
Good warning but it doesn't happen to all of us. I've been running for 30 years; I get tender but never bleed.

[tprice54]

Jack is correct about the chafing! They also now sell nipple guards, special bandaids for just such an occasion! I have some really strange looking finisher photos with the blood showing on my t shirt!

[ChouDoufu]

if you want to shave around your nipples (most women won't need to do
this) you can use those round bandaids that should cover the sensative
part. if you sweat too much, they'll fall off.....but duct tape over the
bandaid should prevent that. no, i'm not kidding....duct tape.

usually i could get by with a thick dab of vaseline for marathons. carried
a small travel size tube, probably 20-30 gram size, in case it wore off.

[ctyguy]

I've experienced some nipple "issues" with cotton before. Boot camp first week was brutal and not a darn thing you were gonna do about it. :) All cotton tee-s 1000% soaked with sweat and mixed with that South Carolina red clay and sand. Ahh...the good ol days :)

But now Im a big ol tenderfoot and thought it wise to spend few $$ in the right type of clothing. Its just as important as the shoes in my opinion. I've got running shirts and I've done 6 and 8 mile runs without any nipple issues.

And if ANY of the people I know saw me putting on nipple guards or Duck Tape ! (that cracked me up ChouDoufu...your hardcore !) I'd never hear the end of it. Regardless of the fact that it actually is a serious consideration I would be tormented because all my true friends are still 13 years old mentally (according to their wives anyway).

I started my training program this week with 4 runs (3 3's and a 4 today). Going forward its 5 days a week. I go to the coumadin clinic on 3/11 to be tested so Im curious to see if my INR dips much. I've been in the 2.3 to 2.6 range for about 3 months now. I will keep you all posted.

[ChouDoufu]

Boot camp first week was brutal and not a darn thing you were gonna do about it. :) All cotton tee-s 1000% soaked with sweat and mixed with that South Carolina red clay and sand. Ahh...the good ol days :)

fort jackson?

[ctyguy]

Ft Jackson....arrive July 1, just in time for a lovely summer of 8 billion degree heat.

[tommy]

I used the same little round bandaids for nipples that I use for my finger stick INR checks. Then I switched to body glide (for the nipples).

[SumoRunner]

I used the same little round bandaids for nipples that I use for my finger stick INR checks. Then I switched to body glide (for the nipples).


Vaseline is only good for about 6 miles and Body Glide will only get me through 8 or 10. If I'm going 11 or more then I need the bandaids. When I head out on a nice Saturday morning in summer or fall I don't always know how far I'm going to go until I'm several miles out.

I'm much too hairy for the round ones. There isn't that much clear skin surface to get them properly seated, so they always end up falling off because they never stuck well in the first place.

[jpattillo]

Wow, this thread got way off-topic!

[Bill B]

I'm not a runner - but I would imagine that you'll be needing to increase your dose since your metabolism will probably speed up.

Back on topic....

This is FALSE. Burning more calories in your skeletal muscles and increasing blood flow to your skeletal muscles does not affect metabolism of drugs like warfarin or metabolism of clotting factors. Warfarin and many other drugs are metabolized in the liver by an ezyme system known as cytochrome P450. Even heavy exercise programs have no effect in cytochrome P450 content or activity. Also changes in blood flow to the liver do not affect metabolic rates of most drugs. There are some drugs whose liver meabolism is blood flow dependent, but warfain is not one of them. People seem to commonly confuses burning calories with drug metabolism. I spent a lot of time studying this in pharmacy school and during my career, and I feel an obligation to correct this misunderstanding when I come across it here, even years later, like today.

[SumoRunner]

Yes, forum threads do drift over time.

Bill is right. I've been everywhere from months of total inactivity to running 40+ miles a week and that has no effect on the INR. What does change it is what you consume, leafy greens, etc..

[yotphix]

No argument with Bill B's scientific statement that Warfarin metabolism is not accelerated by exercise. I can, however, offer the same anecdotal evidence from my experience, that when I went from walking/running at a leisurely pace about 10 miles per week, to a much more intense (not crazy, just 8 minute miles or less) 15-20 per week, I needed to increase my dosage too. I keep a log of activity, and of diet and when I was finding my INR consistently low for a couple of weeks (I home test) after it had been stable for a year, the only coincident difference was the increase in activity. To be fair, I don't record the precise quantities of food that I eat, nor do I have any way of precisely measuring 'K' content. What I can also offer, is that when I recently stopped exercising rather suddenly (8 day road trip) my INR shot up, despite it having been stable for another year since my activities and my dose increased. My increase, coincidentally, was also 10%, from 10mg/day, to 11.

I don't wish to get into an argument with Bill over whether there is a relationship between the two things or not, but it seems very relevant to anyone increasing their activity levels that I and others have experienced this. The answer to the original question should be: if you aren't in a position to start self testing, it's probably a good idea to visit the lab more frequently during the course of any dramatic lifestyle changes.

[MarkU]

Too many variables here to assign any absolute conclusions regarding the relationship between exercise & INR.

My experience is similar to Jack's: In my triathlon and half marathon training over the past 11-1/2 years I've seen no correlation between exercise and my INR.

Then again, my INR has been remarkably stable over that period. So much so that I'm only on a six week test cycle. The only times I've gotten out of theraputic range is when I did Lovenox bridges for colonoscopies or other envasive medical procedures. I consider myself lucky that I've been so stable.

I try to be consistent in my diet, but am not obsessive about it. Even then, when I splurge (most often with alcohol), it seldom has any significant effect on my INR.

Again, this is just anecdotal evidence based on a N=1 sample size, but just gives credence the fact that everyone is different. Individuals are going to react differently and I would strongly encourage everyone to determine their own sensitivity and make decisions appropriate to their specific situation.

Mark