Marathon training tips for people with cystic fibrosis

One of the most difficult parts about training for a marathon is maintaining your motivation. But keeping focused on your reason for running will help you stick to your training plan. You might be running to raise money for charity (perhaps for Cystic Fibrosis Trust!), or for health reasons.

Whatever your ‘why’ is, make sure you keep focused on it. You could write it down on a piece of paper and stick it somewhere you regularly pass by, like a mirror or the fridge. You could also think about building your local parkrun into your training. They’re a great way to meet other runners and keep motivated.

Finding a running buddy or local running group or club can also help to keep you accountable and motivated. There are running community apps you can join too – check out the Team CF Club on Strava.

Trainers

With so many different features choosing a pair of trainers can feel daunting. It’s worth getting advice from a running shop that offers a gait analysis. This will identify your running style and the kind of shoes that are best for you. Once you have your trainers make sure you leave at least a couple of weeks to break them in. Consider getting two pairs of trainers so you can rotate them to allow the shoe cushioning to ‘recover’ and avoid too much wear and tear.

Clothes and accessories

You’ll need a selection of comfortable, breathable running clothes for training in different types of weather. The TCS London Marathon has a good guide to choosing the right kit.

You will also need: 

• A water bottle. A basic one is fine but you might prefer one with special features that make them easier to carry or drink from when running.
• Sunscreen, it’s easy to get accidentally sunburnt on a long run.
• Reflective clothing and headtorch – so you can be seen at night.
• Fuel – energy gels, bars, chews or alternatives like bananas and dried fruit to provide you with energy during your long runs. Use your training runs to find what works for you. Check with your CF dietician what will be best for you, particularly if you have CF diabetes.
• Running belt, armband or rucksack – you’ll need somewhere to keep your phone, valuables, fuel and water, and any inhalers or treatments you need.
• Petroleum jelly or anti-chafe cream.
• There’s also a lot of non-essential technology and accessories aimed at making your training easier and more effective. Runner’s world has a guide to some of the options available.

It’s very important to follow a running plan which builds up your fitness week by week, and gets your body used to lots of running more gradually. This is the best way to avoid injuries and other health problems, and gives you the best chance to complete the marathon. 

Everyone’s training journey is different, and yours will depend on things like your current fitness and if you’re aiming to complete the course in a specific time. Because of this, it’s important to personalise your plan to your own needs.

Here are some of the different things you’ll want to include in your running plan.

• Easy runs – these let you build up the number of miles you run in a week. They can be shorter during the week, to fit around your own schedule.
• Long runs – to build endurance. It’s usually easier to do these at the weekend so you have enough time and daylight to complete these longer runs. These should eventually build up to several hours of running.
• Intervals (alternating fast and slow running), hills and faster runs – these build fitness and help you get faster. On these runs, try twenty seconds fast and two minutes slow – then increase the ‘fast’ time and reduce the ‘slow’ time as your training develops.
• Strength training – aim for at least two sessions a week to build up strength and help prevent injuries. You don’t need to lift really heavy weights – using bodyweight or weighted resistance bands builds good strength and endurance. 
• Cross-training – such as swimming or cycling. This keeps training interesting and allows muscles used during running to rest, and helps to prevent injury.
• Rest – crucial to recovery. This can include ‘passive’ complete rest, and ‘active’ rest like yoga or pilates, or short walks. 

There are plenty of online marathon training plans you can adapt to your needs, such as this Runner’s World training plans for different time goals. Your CF physio will also be able to help you develop a plan.

How long should your training plan be?

Marathon training plans are usually 16 to 20 weeks long. You should gradually increase the number of miles you run a week until you are running slightly less than the full marathon distance. If you’re a beginner or haven’t run much recently you should train over at least 20 weeks. 

Practicing for your marathon

You could enter other shorter events in the months before your marathon, such as 10K or a half-marathon. This will give you smaller goals to work towards and give you an idea of how your training is going. They can also be a useful way to find out what you need to do on race day, including how races are organised, what you’ll need to bring, and if the snacks and gels you’re planning to use will work for you. 

Planning a training route

When you’re planning your route you need to think about:

• how difficult the route will be (consider how hilly it is)
• if you have the right kit
• what will the weather be like
• sunrise and sunset times. 

Stay safe by making sure you’re aware of your surroundings, your phone is charged up, you’re wearing bright colours, and you’ve let someone know where you’re going and when you expect to be back. Choose a route with a well-lit path in an area you feel safe.

If you need to be near toilets or other facilities, plan a route that takes you on a lap around your house. You could also leave a drinks bottle outside the house to loop back if it is hot and you don’t want to carry it when you are running.

Consider an indoor session if the weather isn’t good or it’s too hot.

It’s impossible to train for a marathon without fueling your body properly. Remember, you will be exercising for many hours. You might also have extra nutritional needs because of your CF or CF diabetes. Your CF team dietitian can help you work out your specific needs. 

When you are training you ideally need to be consuming more calories than you are burning. A great way to monitor this is by recording what you eat on an app like the MyFitnessPal app. You will tend to eat more without trying as you are running more because your body will crave extra calories. 

Not taking on enough calories during marathon training can result in fatigue, increase your risk of injury, damage your muscles, and put unnecessary strain on your body. This could leave you vulnerable to lung infections and other health issues. So, it’s important to think about whether you are getting enough calories as your training progresses.

Finding a routine when you start training for a marathon is also important, for example, eating similar foods the night before each long run, or drinking extra fluids for a few days before a big run. 

Hydration and salt

Keeping hydrated is already an important part of living with CF. It can keep the mucus in your lungs thinner and less sticky, and your digestive system flowing smoothly. When you’re sweating a lot on training runs, hydration is even more important. 

Try to drink around 500ml in the two hours before a run, plus 150ml just before you run. This could be water, a sports drink or diluted fruit juice. During and after a training run, let your body tell you how thirsty you are, and keep an eye on the colour of your urine (wee). Avoid too many caffeinated or alcoholic drinks as this can increase the amount of liquid you urinate (wee out). 

If it’s hot and you feel like you’re sweating even more than normal while training, think about adding some extra salt to your drinks or diet too. Salt tablets can also be very helpful for people with CF. 

Be careful when drinking isotonic sports drinks (for example, Lucozade or Powerade), as these can be very high in sugar. Drinking too much too quickly could cause your blood sugar to rise too quickly and then crash. This is especially a problem for people with CF diabetes. Drink little sips frequently instead of big gulps.

Our bodies repair themselves during sleep, and your body will need a lot of time to repair during marathon training. Get in the habit of going to bed and getting up at similar times – routine helps the body heal better. During your training plan you should try to get at least 8 hours of sleep per night. 

You can use apps to help you train more efficiently by tailoring your training to the changing energy levels during the menstrual cycle. 

If you notice your period becomes significantly lighter or stops during marathon training, this could be a sign that your body is using more energy than you’re giving it. If this happens increase the calories you’re taking on and reduce your training, and get advice from a doctor. 

Balancing your treatments

The clearer your lungs are, the easier exercise will feel. And exercise can be a great way to move up any sputum that is deeper in your lungs. 

Try doing your ‘mucolytic’ treatments, which break down sputum (like DNase, mannitol, saline), before a training run. During the run add in regular huffs to clear any sputum. Then take any antibiotic nebulisers afterwards, as these can then get further into your lungs.

CF diabetes

Keeping your blood sugar stable can be challenging during marathon training, but it is possible. Make sure you fuel your body properly with meals and snacks at regular intervals. Make sure you also take all of your diabetes treatments and closely monitor your blood sugar, especially before and after your runs or other training. Keep glucose tablets or other rescue sugar sources like sports gels with you on every run.

Our muscles need more energy (sugar) if we’re running faster, so interval-style training at high intensity may cause blood sugar levels to change more than other runs. It might be better to do intervals at lower intensity or cut them out of your training plan if you need to. 

If you have CF diabetes and don’t have a wearable blood sugar monitoring device (such as a Freestyle Libre), ask your CF team if you can have one. This could make monitoring your blood sugar much easier.

Lung infections and IVs

If you feel unwell and need to have antibiotics or a hospital stay, prioritise your recovery. Your health is far more important than a marathon. Let your CF team know that you’re training for a marathon and they can work with you to make a plan or help to readjust your goal.

Injuries 

Injuries can happen to anyone — they might not be related to your CF. Even if it feels like you’ve done everything right, the unexpected can happen. Get advice from a physio as injuries can happen because part of your body is not functioning properly, and that may need treatment. You can sometimes self-refer to an NHS musculoskeletal (MSK) physio, or your GP or CF team physios can refer you. Remember that it’s crucial to give yourself the time to fully recover from the injury before starting training again, or you could risk more serious damage. 

What if I can no longer run the marathon or can’t finish it?

Sometimes, with all our best intentions and planning, things can still go wrong. It can be disappointing, even devastating, but remember – it’s out of your control. It is ok not to run or complete the marathon. If you’ve had people sponsor you, they won’t blame you for needing to pull out. Most, if not all, will want their donations to go to charity anyway. You’ll have helped to raise awareness of a great cause. If you’re feeling disappointed about not being able to run the marathon it can help to look at other events or fundraising you could take part in. You could:

• Ask to defer your place to the following year.
• Find an alternative running event you can take part in when you’re feeling better, like the Great North Run. 
• Find a different kind of fundraising event like a walk, skydive, or baking competition.

Take a look at the Cystic Fibrosis Trust’s fundraising events.

The week before

The final week before your marathon is an important time to rest and prepare yourself for race day. Give yourself the chance to do your best by:

• Reducing the amount of exercise you do and getting plenty of rest.
• Fueling and hydrating yourself well.
• Prioritising your CF treatments to help you feel your best.
• Focusing on your ‘why’.
• Relaxing – you’ve already done most of the hard work. You could use relaxation techniques like meditation and breathwork.
• Planning how you’ll get to the start line and how much time you’ll need.

On the day 

• Eat a breakfast that you have tried before during training and gives you enough energy. 
• Hydrate well.
• Warm up well.
• Check you have all your kit and other essentials to take to the start line – remember loo roll and warm clothing that you can bin if needed. A black bin bag can be useful to sit on or keep yourself dry if it’s raining on the day.
• Go to the loo before you start.

During the run

• Run your own race. Stick to your plan and don’t overthink the run. Don’t be tempted to run at the same speed as others. 
• Keep an eye on your blood sugar if you need to, and remember to fuel regularly.
• Drink regularly, before you are thirsty. There will be lots of water stations on the marathon route.
• Listen to your body. If you need to slow down, walk, or even stop, that is ok. You can only try your best on the day.
• Soak up the atmosphere. If you are running the London Marathon the Cystic Fibrosis Trust have cheer crews along the whole route, so watch out for us cheering you on.

After the run:

• Keep moving gently and stretch. 
• Keep fuelling and drinking afterwards. 
• Take a few weeks to recover properly. Keep gently moving, walking and stretching, but avoid heavy training for at least two weeks. 
• Wear your medal with pride. Tag us in your social media posts.

Cross-infection

There could be other people with CF at any of our outdoor events (including the London Marathon).

It’s a good idea to keep a safe distance from anyone in Cystic Fibrosis Trust branded clothing unless you’re sure they don’t also have CF. Take a look at our information on cross-infection at events. If you’re worried, you can contact our Helpline.