Dr. Kostrubala has found that running is emotionally or mentally therapeutic under certain conditions. First, you need to make sure that you are in _medically good condition_ to begin a therapeutic running program. It would be prudent to have a thorough physical and, if you are over forty, also a stress test. You need to do warm-up exercises, which any good book on running describes in detail, and then you need to build up your endurance--gradually and patiently--until you can run a _minimum_ of three times a week for an hour each time, without stopping, and {206} with a pulse rate of at least 75 percent of your maximum heart rate. (Your maximum heart rate is 220 beats per minute minus your age. If you are 40 years old, your maximum heart rate is 180. Seventy-five percent of 180 yields a pulse rate of 135 beats per minute. If you are 40, you would want to run for an hour so as to maintain a pulse rate of 135 beats per minute during your run. By way of encouragement, you may want to know that 75 percent of a person's maximum heart rate represents, for almost everyone, a slow, easy jog.) Second, you must have a _noncompetitive attitude_ toward running. Whether you're comparing yourself to others or just trying to beat your own running record, a competitive drive rivets your attention on a goal separate from yourself. This misplaced emphasis will undermine the therapeutic value of the activity. You also should either run alone or with someone who won't distract you by talking. Direct your attention within--to the rhythm of your pace, the regularity of your breathing, maintaining relaxation in your shoulders, back, and feet. To prevent distraction it is also important to run in an area or around a track that is familiar to you. For slow long-distance running to have a therapeutic effect, you cannot be a sightseer. The novelty of unfamiliar surroundings will distract you from being inner-directed, which is therapeutically important. Finally, be aware of the physical risks. If you begin to feel dizzy, stop running. In hot weather, dizziness is a first warning sign of heat exhaustion, which can lead to heatstroke. If you feel a snap in one of your running muscles, stop. An internal snapping or popping noise can mean that a muscle or tendon has torn, or a small bone has broken. Make sure you are all right before resuming. If you have a cramp-like pain in your side, which is very common, try slowing down, exhaling forcefully, giving a yell, or singing. You can often keep going, and the pain will subside. If it does not, or it gets worse, you'll need to stop to rest. WHAT RUNNING AS THERAPY FEELS LIKE The psychological effects of regular, slow long-distance running can be impressive if you follow the directions above.