Public Health and Wellbeing in the context of a marathon coaching business

This is an essay I wrote for my Master’s, Professional Practice in Sport. I’m sharing this in the hope of helping people understand more about the importance of strength and nutrition for marathon running. This achieved a mark of 78/Distinction.

Introduction 

Public health is a constant topic of research and debate, with ever-changing factors creating changes in behaviours, attitudes, policy and strategies to combat the negative consequences that poor health and wellbeing can create.

Our understanding of the words health and wellbeing has evolved since the definition of health was popularised by the World Health Organisation in 1948. More recently, health has begun to encompass characteristics outside of individual factors, to include both subjective and objective viewpoints from the individual, related to their environment and expectations, creating an overlap with wellbeing which is arguably why the two words are often used simultaneously and interchangeably. The specific health and wellbeing challenges of a given society, the populations and individuals within that population, can vary greatly. 

The educational context that is the focal point of this essay is a running coaching business referred to by the trading name “Runstoppable” located in semi-rural South Norfolk. Runstoppable’s clients are predominantly men aged 30-59, working in managerial positions or self-employment. Most clients are in relationships and have children varying from those under ten years old to being in their early thirties. Client goals centre around marathon running, with many people looking to run faster times. Although performance focused, a recurring theme related to health and wellbeing is reducing the risk of injury, a key concept since 50% of runners are injured every year; (Kakouris et al., 2021), and Li, X. et al. (2026) found marathon runners experiencing 46.5% injury rates in a 6-month training period. Strength training and nutrition can reduce this risk. The goal of Runstoppable is to ensure clients achieve their marathon goals, but not at the cost of long term health or wellbeing.

The evidence provided throughout this essay will show that strength training and appropriate nutrition changes can promote and support the long term health, wellbeing and performance of Runstoppable’s marathon running clients. We will outline strategies for health and wellbeing improvement, as well as identifying issues with potential strategies, and the methods of measuring the impact of the proposed strategies. 

Theoretical framework

To design effective strategies, it is helpful to understand the wider context of health behaviour change. We will start by assessing the socio-ecological model introduced as a concept by Bronfenbrenner (1979). This model describes five levels of influence on an individual’s behaviours. Appendix 1 illustrates a physical activity focused variation of this model, and the commonly accepted factors involved. McLeroy et al. (1988) created a health focused variation, identifying five levels of influence on health behaviours: intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy factors.

Within this model, public policy factors and community factors could be viewed as beyond the scope of practice and influence of a coach such as Runstoppable, especially considering that clients predominantly live in the South Norfolk area, which Norfolk County Council (2025) shows has no areas of deprivation. This means that common determinants of health, such as the cost of healthy food, exercise equipment and transportation or access more broadly, are rarely an issue for Runstoppable’s clients, which is reflected in the health behaviours of these individuals. Runstoppable’s clients do have obstacles to overcome however. Typically obstacles relate to the time necessary to train appropriately for their performance-related health goals, combined with familial time constraints and the potential for longer working hours and higher stress levels when working in upper management roles and self-employment, as identified by Souitaris et al. (2026). A lack of time was also found to be a factor in health behaviour choices by both Luckin et al. (2017) and Iversen et al. (2021).

The “Type 1” coding described by Eriksson et al. (2025) who expanded upon the socio-ecological model, would accurately describe the health behaviour views and actions of the majority of Runstoppable’s clients. These people face barriers but prioritise their health, and typically require less support regarding health behaviours or interventions. Regardless of the amount of support needed, Runstoppable is arguably explicitly responsible for helping to shape the interpersonal processes and intrapersonal factors, with strength training and nutrition being allocated to the latter category. It could be seen that the methods for health and wellbeing improvement employed by Runstoppable constitute institutional factors as these are external to the client however this could be argued since the changes would be optional for clients. There does remain a question of which methods coaches should employ to assist clients with their health and wellbeing. Evidence from numerous studies shows that in some circumstances, multilevel interventions do not yield significantly superior results compared to a single level health intervention (Schölmerich and Kawachi, 2016), (Maloney et al., 2025). The interventions that will be proposed will include intrapersonal level changes by the client, as well as interpersonal level changes by Runstoppable, making the overall strategy multilevel. Client needs must be balanced with time pressures, service packages, scope of practice and the wellbeing of the coach, which may dictate the extent of support offered.

Overall needs assessment

Having explored factors influencing the health behaviours of Runstoppable’s clients, we will now perform a needs assessment, which will be expanded upon within the priority health issues sections. As Runstoppable’s clients often differ greatly from the general population, few comparisons will be drawn between these two groups. Instead, we will discuss the ideal needs of marathon runners, common deficits compared to the ideal actions, and how these can be improved. The common areas for health and wellbeing improvement Runstoppable proposes to address are strength training, and nutrition.

Due to the individual nature of Runstoppable’s coaching, we will focus on what could be described as a menu of interventions that clients can choose to engage with. Choice is key to health and wellbeing interventions with autonomy regularly highlighted as a predictor of self-efficacy and adherence, particularly as it relates to exercise (Walsh, A., 2012) . This is of great importance in Runstoppable’s context, where clients are selecting to work with the coach and pushing them too far may result in disengagement or cessation of the coaching relationship, thus removing the opportunity for health and wellbeing improvement.

Priority health issue 1 – a lack of strength training

Needs assessment for strength training

Sarcopenia, the process of age-related muscle mass and strength loss begins around forty years of age, accelerating and becoming more pronounced when a person reaches their fifties and beyond (Pereira et al., 2025), increasing mortality and morbidity rates (Beenakker et al., 2010). This would be concerning for the health and wellbeing of non-runners of any age, but when considering the activity levels and age of Runstoppable’s clients, it becomes even more relevant, especially with the findings of Piercy et al., (2018) which showed just 20% of adults met the minimum requirement of two strength training sessions per week for health.

Bone stress injuries are another health consideration for Runstoppable’s clients, often in their forties and fifties. Although musculoskeletal injury rates of 50% per year for runners (Kakouris et al., 2021) predominantly relate to muscles, ligaments and tendons, this also includes bone injuries such as stress fractures. High impact activities such as running have been linked to increased risks of bone stress injuries (Sirls et al., 2026) as has high Body Mass Index or BMI (Lindman et al., 2025). Strength training can assist runners to reduce this risk by reversing the bone density loss that accelerates beyond forty years of age (Demontiero et al., 2012), and allowing better control of running movement and force management, common issues for runners who experience bone stress injuries (Sirls et al., 2026).

The evidence would strongly imply that the inclusion and/or improvement of strength training could help to reduce the risks of bone stress injuries and sarcopenia in Runstoppable’s clients, improving their health, wellbeing and performance.

Strength training interventions

Time is listed as a common barrier to completing strength training (Luckin et al., 2017), (Iversen et al., 2021), alongside a lack of knowledge and facilities.

To address the lack of knowledge and facilities, a possible intervention would be encouraging clients to opt for additional one-to-one coaching sessions every one to four weeks. In-person strength training supervision has been shown to result in improved maximal strength, greater feelings of wellbeing, higher rates of adherence to training, with higher attendance rates, and lower drop-out rates when compared to app-based and PDF/document based training (Gavanda et al., 2025). Whilst non-supervised training can be effective for simple, single-joint exercises, in-person training may also be more appropriate for complex movement patterns (Gavanda et al., 2025) including the strength training exercises suited to running. 

Not all clients will be in a position to engage in this way, therefore the provision of a document created by Runstoppable would be included. This document (see Appendix 2) is a tool written to allow clients to self-identify the barriers they face, strategies to overcome them, without the need to pay for additional services or travel to Runstoppable’s facility. Runstoppable also has online video resources for running-specific exercises that clients can access to learn exercises to reduce the knowledge barrier identified by Luckin et al. (2017). To increase the current low uptake of this resource, and improve the health and wellbeing outcomes of clients, Runstoppable could sign up on their behalf and supply the details, removing a potential time-related barrier to engaging with strength training.

Evaluation of strength training strategy

Whether clients are able to engage in regular in-person sessions or not, we could assess their strength. Commonly used maximal strength testing requires three to five days of reduced training, which would be self-defeating for the primary goals of Runstoppable’s clients. Instead, clients would track their strength training using the Google Sheet used for all other training. Firstly, this would act as a way to monitor adherence and counter the reduced training intensity identified as a potential weakness of non-supervised strength training (Gavanda et al., 2025), by allowing Runstoppable to suggest regular increases to training variables. Secondly, the logged data could be analysed at regular intervals of approximately four weeks, with the expectation that there would be increases in strength (Del Vecchio et al., 2019) seen in most or all exercises, seen as an increase in the weight used or the number of sets or repetitions performed.

Improved accessibility to the video resources, provision of the document addressing barriers, and in-person coaching could vastly benefit the health and wellbeing of clients by limiting the obstacles they face and increasing the quality of their strength training. This in turn would reduce the risks of bone stress injuries and sarcopenia.

Priority health issue and strategy 2 – insufficient nutrition

Needs assessment for nutrition

The findings of Grunert et al., (2010) suggest that higher income individuals and those interested in health, such as the clients of Runstoppable, are more likely to examine food labels. Possessing a greater level of interest does not, however, mean that their nutrition needs for health and wellbeing as runners are being met by their actions. A gap may exist between the nutrition habits of Runstoppable’s clients and the ideal nutrition for performance and health during training periods (Bauhaus et al., 2023), especially in the days leading up to a marathon, during the event and afterwards. 

A study by Chen et al. (2025) showed only 57.2% of marathon runners performed carbohydrate loading pre-race which would have allowed for sustained performance (Lanpir et al., (2025). For those in the Lanpir et al. (2025) study who did plan and execute carbohydrate loading and marathon nutrition strategies only 42.1% hit the minimum recommendations for carbohydrates pre-race, and a mere 5.3% fuelled appropriately during the race. Older male runners, similar to Runstoppable’s clients, were less likely to adhere to the correct timing or quantities of pre-race nutrition (Chen et al., 2025), highlighting a need for nutritional education strategies.

Concurrent studies by Rozmiarek, M. (2025a) and Rozmiarek, M. (2025b) examined nutrition behaviours during international marathons, finding that achieving adequate hydration, carbohydrate and protein intake was a challenge. This was attributed to limited access to appropriate nutrition sources in the unfamiliar environment of another country, combined with high stress levels before competition,  which Lanpir et al. (2025) showed has further negative impacts on carbohydrate intake prior to marathon running. With an increasing number of people participating in marathons internationally (Rozmiarek, M. 2025b), including Runstoppable’s clients, this appears to be an area that is of great importance for guidance to support health and wellbeing as it relates to marathon running.

Post-race recovery and health is also important. Methenitis et al. (2021) found that masters marathon runners ate insufficient protein, causing lean body mass reduction following the tapering, racing and recovery period. This is particularly relevant since the runners in the study were fifty-eight years old on average and had completed an average of six marathons, representing a demographic overlap with Runstoppable’s clients and further justifying nutritional guidance for them. Repeating this cycle of insufficient protein and reduced strength training may cause muscle mass loss which will compound with successive marathons, further increasing muscle loss and the health related issues that come with it (Pereira et al., 2025).

Considering the evidence that suggests few runners plan marathon nutrition, and many of those who do plan still do not achieve adequate nutrition, it is likely that nutrition interventions from Runstoppable may help clients to achieve better health, wellbeing and performance outcomes.

Nutrition interventions

Few of Runstoppable’s clients pay close attention to their nutrition, and many follow the pattern found by Chen et al. (2025) by not planning what could be considered basic nutrition strategies around their race, including carbohydrate-loading.

Aiming to balance the health and wellbeing needs of clients, Runstoppable could provide easier access to the eBook titled “Nutrition for marathon runners”. This is currently available as a downloadable file on Runstoppable’s website however, improving access by sending this to clients instead, may improve nutrition literacy and engagement with nutrition strategies appropriate for improving health and wellbeing as runners. Whilst Eriksson et al. (2025) suggest that because of the interdependent nature of health behaviours, improving knowledge and access alone is unlikely to change health behaviours, Lanpir et al. (2025) found that higher knowledge scores can influence hydration behaviours for marathon runners. This impact may also be seen in nutrition related to food choices.

Runstoppable could also increase client uptake of individual sessions to discuss their nutrition, making it a mandatory session rather than this being an optional extra session. This would not be without risks however, as Raffoul and Kirkpatrick (2026) found unintended consequences can arise from weight-related behavior change interventions due to the stigma and fears associated with weight and nutrition. This may make it a difficult topic for Runstoppable and clients alike, which could create barriers to discussing important topics related to nutrition for health, wellbeing and performance.

Evaluation of nutrition strategy

Whilst dietary assessment tools can be important in nutrition monitoring, the ideal method depends on several variables, each of which has limitations (Bailey et al., 2021). Tracking nutrition intake via apps could be a possible option to monitor and plan more effectively. Whilst nutrition tracking has been shown to be more effective in a group setting Meng et al. (2017), in this educational context, that would likely not be feasible or desired. Tracking food with Runstoppable’s support instead, could allow for more personalised guidance on top of the beneficial increase in levels of awareness and improved food choices that nutrition tracking can bring, leading to better outcomes related to health, wellbeing and performance (Medical University of South Carolina, 2024). 

Clients who do not wish to engage in nutrition tracking could instead complete a weekly or monthly survey as a way to encourage more consideration of nutrition choices (see Appendix 3). Runstoppable could employ a simple rating system combined with optional text blocks to allow clients to offer more in depth self-analysis, which could change behaviours, as well as allowing Runstoppable to gauge their wellbeing and health. Experience has shown Runstoppable that clients who do not wish to use food diaries may still be interested in monitoring nutrition more closely around their marathon. This would be advisable to address the insufficient carbohydrate and protein intakes identified in this period by Lanpir et al. (2025 ) and Methenitis et al. (2021), potentially reducing the risks of bone injuries and muscle loss.

Whether using a food tracking app, survey or other method a client might propose, Runstoppable would be looking for improvements from that clients’ baseline. Nutrition tracking may result in weight loss as a whole with body fat as the focus (Medical University of South Carolina (2024). Less technical food diaries may show changes as simple as consuming more portions of high protein foods, or increased carbohydrate intake around training, while we could directly monitor the grams of carbohydrate and protein consumed if the client used a nutrition tracking app.

Evaluation plan overview

Health behaviours in some populations appear to improve comparably whether one or two interventions are utilised (Maloney et al., 2025). Outcomes such as a reduction in body fat and promotion of muscle mass that would be desirable for many of Runstoppable’s clients, however, are more effectively achieved when exercise and dietary interventions are combined (Schwingshackl et al., 2014). Of great importance for clients who do engage in nutrition tracking and strength training monitoring is overall health and wellbeing. Whilst this combination has the potential to yield greater results, Anderberg et al. (2025) found that exercise and nutrition tracking in tandem posed a higher risk of disordered eating, although this was lessened when people stated health related goals as would predominantly be the case for Runstoppable’s clients. Runstoppable would therefore encourage clients to select the interventions they engage with to simultaneously reduce the risk of harm and boost self-efficacy and adherence (Walsh, A., 2012).

Although many measurement methods have numerous limitations (Yin et al., 2024), a combination of body weight, body composition, anthropometric measures and photographs could be monitored, focusing on the waist and lower body predominantly. This would facilitate the monitoring of strength training changes and/or nutrition behaviours. The exact expectations would vary for each client, therefore clear goals would need to be set individually. In general, we would anticipate seeing weight loss from a reduction in body fat, coupled with reduced anthropometric measures at the waist (Hendryx et al., 2025), potentially in combination with visibly improved muscle tone around the abdomen if photographs were utilised. Anthropometric measurements at the upper and lower leg may increase as muscle is gained, or could reduce whilst maintaining the same muscle mass. This may be measured with highly accessible bio-electrical impedance scales, or skin fold calipers (Yin et al., 2024). 

The combination and inference of data would be key, considering the client’s recent training. Comparing expected outcomes to the actual outcomes would allow for open conversations around the client’s health behaviours. For instance, a client wanting only to monitor strength training could be encouraged to consider monitoring their nutrition more closely if results showed unexpected weight loss that does not appear to be body fat related based on photographs and measurements. 

Conclusion

Whilst Runstatopable’s clients do not appear to face many of the challenges set out by Bronfenbrenner’s socio-ecological model and subsequent variations, considering the typical age of Runstoppable’s clients, intrapersonal and interpersonal health behaviour interventions could focus on strength training and nutrition to reduce the risks of bone stress injuries and sarcopenia, improving the health and wellbeing of this population.

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