NEW YORK—October 30, 2008 

Most runners will tell you that the physical challenges of running a marathon are tough, but the psychological strain can be even more demanding. Training for the mental endurance can be just as important as practice runs, stretching and carbo loading.

The more than 90,000 participants in the year's ING New York City Marathon will need to be in top physical and mental shape to conquer the streets of New York. This marathon attracts elite and amateur runners from around the world and is one of the most demanding as well as prestigious races of the year.

"Physical training for this type of major sporting event is grueling," says Jenny Susser, Ph.D., sports psychologist at the Women's Sports Medicine Center at Hospital for Special Surgery in Manhattan. "The impact of months, if not years, of training all leading up to one day can be psychologically and emotionally draining for even the toughest of athletes. Preparing yourself mentally can dramatically improve your overall performance and experience." According to Dr. Susser, every athlete should consider the following tips to maintain and improve his or her mental game:

• Be Physically Prepared: Being prepared physically is the first step to mental toughness. "If you step on to that starting line knowing that you have done the work to reach your goal, it makes an enormous difference," says Dr. Susser.
  
• Simulate Challenges: Create physical and mental challenges in training that you might encounter during competition. For example, do not avoid bad weather during training since it might rain the day of the race. Remember to train on similar surfaces to the marathon course (i.e., hills, pavement, sidewalk). Find ways to put some social pressure on yourself during training as well because the line of on-lookers will certainly add a dimension to the race, both negative and positive, that you will not normally find in training runs.
  
• Create a Practice Game Plan: "Even if this is your first marathon and your only goal is to finish, make sure to have a plan to help you get there. Also, give yourself mini-milestones to focus on throughout the race," says Dr. Susser. Try going out "too fast" on a few training runs and see how your body handles it so you will know how to overcome that feeling if it happens during the race.
  
• Monitor Anxiety and Remember to Breath: Practice how you want to run that first mile so that you do not over-stress your body and your mind with 25 more miles to go. Try a 10-step breathing exercise (count 1-2-3 while you inhale, hold your breath for 4-5-6, and exhale while you count 7-8-9-10). Practice this routine throughout the day when you encounter stress and try to make it a habit. You can also try tying a string on your finger to remind you to breathe if you are worried you will forget during the race.
  
• Stay Focused: "It is a long race and your mind will jump all over the place, but do not let that worry you – prepare for it. Try a positive 'mantra,' just make it believable, or mental distraction. For example, count backwards from 100 by threes," says Dr. Susser.
  
• Confidence: Unfortunately, confidence is "evidence-based" and getting that first bit of evidence can be challenging. "Keep some positive thoughts and imagery ready to turn to when your mind starts worrying and your legs start to ache. Even repeating something as simple as 'I got this far, I bet I can go a little more' can help you get to the finish line," says Dr. Susser.

After the race, even if you ran it perfectly and shattered your goal time, be prepared for a "let down" period. "You put a tremendous amount of energy, time, emotion and even money into your preparation, so do not discount the importance of what you have accomplished," says Dr. Susser. "It will feel like the week after final exams – both physically and mentally exhausting."

Depending on how tough it was to prepare for and run the marathon, some people even feel a little depressed afterwards. "All of this is normal and typically passes quickly, so just grab the tissue and let it all hang out," counsels Dr. Susser. "Talk to your peers if you need some support, they are going through the same thing. But most of all, celebrate what you have accomplished!"

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics and No. 4 in rheumatology by U.S. News & World Report (2008), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In 2008 and 2007, HSS was a recipient of the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Cornell Medical College. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.