When Mark Cucuzzella talks about running, savvy runners listen. Cucuzzella is a medical doctor, professor, coach, and the owner-operator of a shoe store that specializes in "minimalist footwear" to promote a more natural running form. He's also an elite athlete who has completed more than 100 marathons, the fastest in 2:24, and he holds a record for the longest active streak (30 years!) of sub-3 hour marathons. As he geared up for the release of his illuminating book Run For Your Life (Knopf), Cucuzzella took a break from his work and his running to answer questions from the National's Charlie Gofen.

Q: Your book is a lot more than a typical running guide. It’s a clarion call from a medical doctor to combat obesity and physical inactivity. To what extent is our sedentary lifestyle a public health crisis in the United States? 

A: Our current burden of chronic disease is unsustainable for the economy of the nation. Just this week the CDC obesity charts came out and we are still losing ground despite more public awareness. So my book calls for a bold approach which includes policy change at the food level especially. We cannot allow children to drink sugary drinks and eat junk food freely (this would be processed packaged foods). The dose makes the toxin, and children and adults now are at a toxic dose. Yes, physical activity is critical also, and we are building small trails here in my region so kids can just go outside and move like humans are designed to. This does not take anything extreme.

Q: Along similar lines, you write about the dangers of sitting for prolonged periods, as many of us do at desk jobs.

A: In the book, there is a chapter on sitting that focuses on the mechanical changes that occur in the hip flexors, the neck, lower back, as well as bone health. There are other signals to the body’s mitochondria and metabolism that turn off and turn on as we change positions, especially sitting to standing. Our bodies need gravity for health. Sitting and lying down all day creates what is called “zero-G” physiology, and none of it is good.

Q: A question about the other extreme. Some studies have shown a U-shaped curve relating exercise to heart health. Moderate exercise is better than no exercise for virtually everyone, but extreme exercise may actually be harmful. Is too much running bad for you?

A: That’s a great question, and yes, my book describes how over-exercise—especially over-exercising at high intensity zones—stresses the heart, especially the right heart, in a way that it is not designed for. We are designed for aerobic activity, which is exercise at a conversational pace interspersed with short sprints, strength work, and episodes of high intensity in the context of a normal active life. The modern zoo human is the opposite of this.

Q: When writing about an optimal running style, you note, “Start by imitating kids.” Please explain what you mean with that advice.

A: My running career started by being an active kid and lining up in some races. And then I started running too much as a single sport in modern shoes and got hurt. If you look at the best runners around the world, almost all of them had a very active childhood, especially in distance running. When you look at the East Africans, they ran to and from school barefoot and were never habituated to modern running shoes. This has assisted them in developing a natural movement pattern which is springy and does not include overstriding and high impact peaks when they land. Just watch the video of Eliud Kipchoge, who just set the world record in the marathon this past Sunday in Berlin. He is wearing shoes now, but he developed this perfect movement as a child in his daily run to and from school and while playing. So the simple strategies for families are (1) get kids outside and play like we did as children—climb things and run around and chase things—and (2) get them in as little shoe as possible for the needs of the activity so they develop a strong and springy foundation for movement.

Q: Speaking of “as little shoe as possible,” you suggest that many runners could benefit by switching from conventional running shoes (featuring elevated heels and heavy cushioning) to “minimalist” running shoes. How would you recommend that a runner make this transition?

 A: Like all answers, this depends on the runner and their goals. It does take some patience and slowing down. In our store as well as in the book, we have assessments on mobility and strength that can help define who is ready to run in a minimal shoe. There are some runners with foot structure problems for whom I would not recommend it, but the majority of people can gradually reduce the support in their shoe as their feet get stronger.

 Q: You have the world’s longest active streak for consecutive years running marathons in under three hours. You must have had races, and years, that proved especially challenging along the way. What’s the secret of sustaining motivation and a high level of performance over such a long time?

A: Actually, the streak came upon me by chance and just being out there running every year. It has not really been much of a struggle to finish under 3 hours until this year’s Boston Marathon, with the extreme weather conditions, where I was happy with a 3:04. I will give it a go again in a few weeks at the Marine Corps Marathon, hopefully without a 40-mile-an-hour headwind, freezing temperatures, and driving rain. I do not run for streaks, so if it continues fine, and if not, no big deal – I’ll still be out there running for my life.

Q: You write, “In order to reliably increase performance, a runner needs to slow down.” Please explain.

A: Like any sport, you must master the skill of moving well at an easy speed, and then you have earned the right to go faster. For example, a golfer would go to the range and swing easy with a 7-iron, preferably the old blade style, before pulling out the Big Bertha. I encourage people to learn the art of running ridiculously slow, well, and effortlessly.

Q: One of my running partners runs in place at red lights to stay loose and burn additional calories. I think neither reason outweighs how silly this looks. Who’s right?

A: For one, running is not for burning calories. I would suggest doing some jumping jacks or light plyometrics at the stoplight to help the foot spring. But no kidding, the best thing would be to do burpees or mountain climbers. You will get the last laugh by being strong and springy for life.

Q: What are your top recommendations for cross-training for runners? If you’re unable to run for an extended period, what’s the best way to stay in strong cardiovascular shape?

A: I think just like with running, it needs to be fun and it’s good to add diversity into your life—not just with physical activity, but with everything you do. That being said, go with the seasons and ski in the winter, swim and bike in the summer, just whatever you do, keep moving. And best to be outside in nature.

Q: What are your favorite two or three books on running?

A: One of the original books that changed the world was Bill Bowerman’s Jogging. Early books by Arthur Lydiard, who influenced Bowerman, are also enlightening for his insight into what modern coaching is today. For the medical provider, coach, or runner wanting to know all the details of the body human as related to running, Jay Dicharry’s Anatomy for Runners is timeless. The book that is coming out soon which I am anxiously anticipating is the sixth edition of Dr. Tim Noakes‘ Lore of Running. He is a preeminent sports scientist, and this will be the completion of his life’s work.

Charlie Gofen runs regularly and has an active 53-year streak of not having run a sub 3 hour marathon.