I have posted several times in the past about Couch to 5k and the fact that I am now training for a half marathon. Throughout those threads, I have received several requests to put together a complete guide to running for those of us starting out as obese. If you are reading this, I am going to assume that you are a.) interested in running and b.) have been or currently are obese. There are a lot of things that heavier people need to take into consideration when they begin running and, while programs like Couch to 5k are great for inactive people, they aren't necessarily targeted at people who are carrying around an extra 80, 100, or more pounds. So I will try to break this post up into logical and manageable chunks and I hope it proves useful to any of you who are aspiring runners.

My History

Like most people on this site, I have struggled with my weight my entire life. And while I had dieted and lost a little weight here and there in the past, my most successful pre-WLS attempt began in Nov. 2009 after the death of my sister-in-law. She died from a pulmonary embolism, most likely due to her obesity, and it really motivated me to try to get my butt in gear to spare my family another major loss. At the time I was 270 pounds. I ultimately managed to lose 90 pounds over the course of a year, thanks in part to a lot of exercise, including Couch to 5k.

I had never been a runner, but always watched marathons and triathlons on TV in awe of people who ran. My dad was a runner when I was little and I always loved going to races and cheering him on. But I had never managed to even run a full mile in my entire life. My first attempts at running ended abruptly when I developed Patellofemoral Pain Syndrome, better known as "runner's knee" in both knees. Turns out, I had been walking and carrying my weight incorrectly my whole life. I ended up going to physical therapy, learning the proper way to walk and stand, learning some great stretches and strength training exercises, and learning about proper equipment. I will share my findings with you in the sections below.

After losing the 90 pounds, relearning how to walk and run, and participating in several 5k races in the summer of 2011, I decided to have plastic surgery. Complications from my tummy tuck caused soft tissue swelling in my lower back that rendered me pretty much immobile for months. Needless to say, I fell off the fitness bandwagon. Once I was recovered, I redid Couch to 5k and participated in another 5k race in July of 2012. Then it was off and on the fitness train over and over as I gained and lost and gained and lost weight all the way up until the time I had my VSG in Sept, 2014.

Once I was recovered from my VSG and cleared for intense exercise, I completed Couch to 5k yet again and participated in several 5k races last summer. Now I am training for a half marathon on April 24th. I plan to participate in several 10K races this summer and finish out the running season with another half marathon on September 18.

Equipment

As I mentioned in the previous section, I have learned some valuable lessons through my attempts at running over the past 6 years. It might be tempting to throw on your cotton socks and your Payless tennis shoes and try to run. That's what I did when I started! I quickly learned the error of my ways in the form of blisters and injuries. So let me save you the trouble and offer a little advice. You can learn from my mistakes!

• Shoes - Obviously this is a critical area. I don't know why I didn't realize how big a deal it would be to wear terrible shoes, but if you do, you are looking at blisters, arch pain, knee injuries, hip injuries, etc. DO NOT SKIMP on your shoes. Ideally you should go to a store that specializes in running and be properly fitted for proper running shoes. Make sure the sales assistant knows that you will be both walking and running in these shoes, because some shoes are made for just walking, some for just running, and some for both. As a beginner, you aren't going to need the super light-weight shoes designed for speed and distance running. You will want something a little heavier that offers proper arch support and cushioning. Be prepared to spend upward of $100 for a good pair of shoes. It might seem like a lot, but it will save you so much trouble down the road that it will be well worth it.
  
• Inserts - Turns out that the factory installed inserts are just flimsy pieces of cheap foam. Even if you buy those expensive $100+ running shoes. They aren't meant to actually be used. They are just place-holders for the REAL inserts that you need to buy separately. When I learned about this, it was from my physical therapist and she recommended SuperFeet inserts. I used them for a while, but ultimately switched to Dr. Scholl's Active Series and they have worked just fine for me, even through this half marathon training where I'm running 10+ miles at a time. Note: you should replace your inserts every six months.
  
• Socks - So it turns out cotton is not your friend when it comes to running. This goes for bras, shirts, pants, and ESPECIALLY socks. I began running in my white cotton socks and quickly developed blisters on my heels. What you need are some sports socks. They don't have to be anything fancy. I bought a 6-pack of Danskin Now socks from Walmart at first and I still have some of them 6 years and thousands of miles later. I've had to supplement with some newer packs, but they last a good long time. I recommend something low cut and with extra elastic around the arch, like these Fruit of the Loom socks.
  
• Bras - This one is for the ladies. If you are obese and just starting out running, you will likely struggle mightily with the issues of bouncing and chafing in the boob department. For me, the easiest solution has been to double up on cheap, seamless sports bras. I have invested in a couple more expensive bras from Moving Comfort and Under Armor, but honestly, for my shorter runs I will wear one of these cotton Fruit of the Loom bras on bottom with one of these seamless Danskin Now bras on top. This strategy doesn't seem to work as well for my long runs during my half marathon training where the chafing potential of cotton is realized, so for those I've just been doubling up on the seamless Danskin Now bras and putting band-aids over my nipples.
  
• Underwear - For my short runs, I wear my usual cotton underwear. But for biking and long runs, chafing has been rearing it's ugly head again, so I recently discovered Saucony's Runderpants and I love them. But they are pricey, so I only bought a couple pairs and wear them only on my long runs and bike rides. They only go up to an extra large, though, so might not be an option for women starting at a higher weight.
  
• Compression Wear - Let's face it, large people have jiggly bits. And as we lose weight, we have loose skin. The best way to keep everything tight and tucked and to avoid chafing is to wear compression wear, like Under Armor. This is an area where you are really going to have to find what works best for you. If you are running on a treadmill in the comfort of your home, like I do most of the time, you can probably get by with just wearing some compression leggings and sports bras. But if you are at the gym or running outside, you are going to have to layer. So a tight compression legging or short with a looser running short over in might be a bit more modest. And sports bras with a compression t-shirt over them and then a loose t-shirt or tank over that? You'll have to figure out what you can tolerate and what you really need to control your own unique jiggly bits.
  
• Moleskin - In the event that you do develop some blisters or calluses, I highly recommend moleskin as way to cover them and keep on going with little to no down time for healing. If you get a blister on your heel or toe, slap a square of moleskin on it, leave it there for a few days, and continue running as normal. It's pretty awesome, but it does mean no excuses to skip runs.... PS: Don't get the foam kind. It might sound nice, but it doesn't stay in place well. Get just the thin, fabric-y kind.
  
• Tape - If you are like me and have issues with your arches and plantar fasciitis once you start running, watch this video on how to tape up your feet before a run. It helped me SOOOOOO much back when I had trouble with my arches. Luckily they got better as I lost weight and I no longer have to tape my feet up like this for every run.

Proper Form

As I began running, I almost immediately started experiencing issues with my knees. Obviously running while carrying around so much extra weight is going to put a lot of strain on the knees. But there are several things you can do to lessen that, including carrying yourself with proper posture. Not just while running, but while walking and standing as well. Turns out that for the first 30 years of my life, I was walking wrong. I carried myself with too much Anterior Pelvic Tilt, which basically means I walked with my butt stuck out and my knees hyper extended. I learned that I needed to pull my butt under me and keep my knees slightly bent. That was easier said than done. For a couple of months I had to consciously think about every step I took and I had sore muscles where I didn't even know I had muscles, but I eventually got the hang of it and it's just second nature to me. If you think you might be walking improperly or start experiencing any lingering knee pain once you begin running, I highly recommend seeing your PCP for a referral to a physical therapist who can evaluate your posture and stride and recommend ways of correcting the issues.

Speaking of stride, another important factor in running is the way your foot strikes the ground. I am a heavy heel-striker, which is ultimately bad for my heels, knees, and hips. It causes more impact than is actually necessary for running. So as I began doing Couch to 5K I started to mentally focus on trying to land on the balls of my feet more. Ideally you want to be landing on your toes almost, that's what those stupid toe shoes some runners wear are for. I never really mastered it that much. But I have gotten better at at least landing more on the middle to front of my foot while running. Still terrible about it while walking though! One thing that kind of helped me mentally while running was to imagine I'm falling forward and kind of catching myself with the front of my foot.

Stretching
My time in physical therapy really taught me the value of proper stretching, which I really had NO CLUE about before. When you are doing any kind of cardio, you need to start with a warm-up, NOT stretching. Stretching is for AFTER you work out and your muscles are already warm. Cold muscles need to be warmed up and the easiest way to do that is by doing a slower or simpler version of the main workout. So in the case of running, simply walking is the best way to warm up. I always start any run with a 5-minute warm-up walk. I try to walk at a comfortably brisk pace, pushing a little faster than my normal leisurely walk (imagine the pace at which you walk from your car into a store from the parking lot), but not so fast that I am uncomfortable in my stride.

Similarly, you want to cool-down with a walk as well. I usually do about 5 minutes at the same pace as my warm-up and then 2-3 minutes even slower than that... like really slow... as slow as I can be and still be "walking".

Immediately after that cool-down walk I do a series of stretches that I learned from my physical therapist.

• Standing Quad Stretch - Okay, this one you have probably seen people do a lot. One thing my physical therapist advised is that you should hold your ankle with your OPPOSITE hand. If you use the hand on the same side of your body, you are more prone to twist you hip out to the side and not get a proper stretch. If you are like me when I started, you are too fat to actually do this stretch. The trick there is to use a strap or a resistance band or something and wrap that around your foot and lift the end of it up, instead of actually grabbing your foot/ankle with your hand. Also, I still to this day have to hold onto something while I do this, because my balance sucks. I hold this stretch for 5 seconds each leg and repeat 5 times.
• Calf Stretch - Okay, this is likely one you've seen before too. My physical therapist has me do it this traditional way first, but then bend my back knee at about a 45 degree angle and hold that as well, which really stretches out the ankle. So I hold this the normal way for 30 seconds, then down into the second bent-knee position for 30 seconds. I do that on each side then repeat again for 30 seconds in each position on each side.
• IT Band Stretch - During one of my forays into running I developed pain on the outside of my left knee. It turned out to be IT Band Syndrome, which is inflammation of the tendon that connects the outside of your knee and hip. This stretch helped alleviate that. I hold for 30 seconds on each side.
• Sumo Squat - This one is pretty self explanatory. I hold this for 30 seconds total.

That's it! Those are the only stretches I do and I have honed them after various injuries and random pain. After I am all done with those, I change into my pajamas and I elevate and ice my knees for 15-20 minutes. I don't know if I really NEED to ice my knees at this point. I haven't been struggling with any knee pain lately. But I figure it can't hurt! And there was definitely a time when I needed to ice my knees after every run to stave off inflammation.

You will, of course, have to hone your own stretching routine once aches and pains start to develop and focus on your specific problem areas, but this will at least give you a baseline. And I would recommend going ahead and getting into the habit of elevating and icing your knees as well.

Strength Training

Running shouldn't be your only method of strengthening your legs. If you do regular lower body strength training on your cardio rest days, you can strengthen your muscles and tendons and ultimately make running easier. I do lower body strength training twice a week. For a little while, when I was in physical therapy, I did it every day! But 2-3 times a week should be sufficient if you aren't already injured. Here's my routine:

• Balance on One Leg - This is exactly what it sounds like. My physical therapist had me start by just balancing on one leg for 10 seconds at a time. She then had me start balancing on one leg with my eyes closed. She THEN had me start balancing on one leg with my eyes closed while standing on a pillow! I'm now to the point where I balance one leg, with my eyes closed, standing on a pillow for 30 seconds. I do this twice for each leg.
• Single Leg Squats - These are very shallow "squats". I don't get all the way down into a squat position. Just more of a "dip" really. I do 10 of these on each side with my free foot sliding out in front of me, then 10 on each side with my free foot sliding out to the side. I am even to the point where I now do these while balancing on a pillow! My physical therapist says you can always make balancing exercises harder by standing on a pillow. She's right!
• Single Leg Raises - These are pretty straight forward. Lay on your back with one knee bent and one knee straight (physical therapist said this is the only time allowed to fully extend my knee). Lift your straight leg up off the ground as high as you can and then lower it back down. I do two sets of 15 of these on each side.
• Lying Abduction - I like to think of these next two exercises as my "Jane Fonda Workout". They are straight out of an 80's fitness video. But they still work! You lie on your side and raise the top leg up to a 45 degree or greater angle and lower it back down. I do two sets of 15 reps of these on each side.
• Lying Adduction - Just like the last one, straight out of the 80's. This time you have to bend the knee of your top leg and brace yourself on the floor with your foot, then raise and lower your bottom leg. Two sets of 15 on each side here as well.
• Bridges - This one is super sexy. Made even sexier by the fact that my physical therapist told me to hold a pillow in between my knees while I do them! For this one I hold the bridge position at the top for a 5-count, then lower my butt back down. I do two sets of 15 of these as well.
• Stretching - I usually do a shortened version of my post-run stretching after my strength training.

Training Programs & Strategies

As I've already mentioned about 15 times, I'm a fan of Couch to 5k and have completed it several times. Because of my excess weight and my terrible level of conditioning, I had to make some modifications in order to make the program feasible. Here are a few tips that might make the program more manageable for you:

• Don't start with Week 1 - The first workout of Week 1 has you running for 1 minute, followed by 90 seconds of walking. If you are like me, starting out with 100+ excess pounds and NO physical conditioning, this will be too much. When I started out, I would run for 1 minute and then walk for FOUR minutes. I repeated that 5-minute cycle 5 or 6 times. Once I was comfortable with that, I finally officially started C25k. The point here is, if you need to ramp up to Week 1 Day 1, then ramp up to it. There's no shame in that. It's better to take it slow and work your way up to it than to get injured right away and stop altogether.
• Repeat workouts as needed - Couch to 5K is structured to take 9 weeks. Each "week" has three workouts. If you are struggling with completing a workout, then don't just advance to the next workout. Repeat the current workout until you have it down, or even revert to the previous workout if necessary. While part of the beauty of Couch to 5K is that it pushes you to do things you didn't think you were capable of, it can also push you TOO far. So, listen to your body. It's good to test your limits and push yourself that little bit further. But again, an injury is only going to set you back.
• Stretch Weeks 5 & 6 into two full weeks each - If you look at the schedule for C25K, you will see that in Weeks 5 & 6, each day is a different workout with one "long" run on the final day of the week. For me this was just TOO MUCH. So what I did was repeat Week 5, Day 1 three times (making it it's own whole week). Then I repeated Week 5, Day 2 three times. THEN I did the Week 5 long run once. Then I advanced to Week 6 where I did the same thing. Week 6, Day 1 became it's own whole week. Then Week 6, Day 2 three times. THEN finally the long run of Week 6. After that it's all just progressively longer runs.

Most running programs are only going to have you running 3 days a week. You should use the remaining days for cross training and/or strength training. It is VERY important to give your muscles a chance to rest. So don't try to do the same exercise multiple days in a row. Cross training will give you a chance to continue burning calories on your non-running days. Strength training will allow you to build muscle which will burn calories all day long. My current plan is:

Sunday: strength training/cardio rest day

Monday: run

Tuesday: bike

Wednesday: run

Thursday: strength training/cardio rest

Friday: bike

Saturday: long run

In the past I have incorporated some chunk of strength training on cardio days and taken true rest days. Like Monday might be running AND upper body strength training. Tuesday might be bike and core... Wednesday run and lower body... you get the idea. For me, with my current schedule, it's easiest for me to do ALL of my strength training together on my cardio rest days. Which, unfortunately means I don't get any true REST days from working out. Oh well!

If you are crazy like me and want to work on training for longer distances once you have completed Couch to 5K, here is the training program I'm currently using for my half marathon: http://www.walkjogrun.net/training/half-marathon/training-plan.cfm?planId=half-beg-rw

Conclusion

Whew! That got long! I hope this proves useful to some of you. Feel free to ask me any questions you might have about anything here or anything I might have left out. Happy running!

Yes let's hear it for the Bariatric Pal website !

Best wishes to all

Amen to that! I don't know how I would have gotten through all this without this site and the people on it!

I don't know if somebody mentioned that book before (sorry, 7 pages of posts) but I found "Ready to Run" pretty helpful, especially when it comes to stuff like plantar fasciitis and mobility stuff.

I think you should design a new app. Couch to 5k for the obese!


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