When Rico Fiore ran his first Long Island Marathon in 1978, the longtime Southampton resident remembers a few bystanders looked at him midrace and said in astonishment, "But he's an old man!"

Fiore was 48 years old then. Now he's 81, and he's still running the Long Island Marathon, easily the oldest finisher in last year's race. And he'll be there again on Sunday, certain to get a chuckle out of the many young faces surrounding him at the starting line.

That's the moment in the race, he said, when he's always reminded that one's will is more telling than one's age. "You realize how much you can do with yourself," he said, "if you don't let the idea of being old take over."

A radiologist at Stony Brook University Hospital who was born in Italy and moved to New York in 1958, Fiore began running in his late 40s because he was tired of the long drive to find an indoor place to play tennis or swim during the winter. Running was more convenient, and he hasn't stopped since.

Fiore thinks he's completed more than 40 marathons, with most of them taking place on Long Island, though he admittedly has lost count over the years.

"I'll keep doing it until I can't," he said before a recent workout at Positive Energy gym in Southampton. And when you hear what he's overcome over the years, it's very easy to believe him.

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For starters he didn't stop running after undergoing surgery to remove a benign tumor from his right thigh in the early 1990s, even ignoring his surgeon's advice to sit out the New York City Marathon six weeks later. Fiore still remembers the surgeon saying, "You're crazy! You're going to rip the stitches."

"But I ran it fine," he said, "no problems."

Fiore also once tore his left Achilles tendon during a race and said he refused to have surgery to repair it, instead choosing to build the muscles back up the old-fashioned way -- by continuing to run.

Then there was the time last year when he said he was riding a bicycle on a Southampton street and was hit by a car coming out of a parking lot.

"They forced me to go to the hospital," he said. "I didn't want to go." He left with a bandage on his forehead, but when he got home he took it off and ran a race the next day.

In 2004 he was diagnosed with non-Hodgkin's lymphoma and had to go through several rounds of chemotherapy. But he said he still ran almost every day, just as he has done for the last 30 years. The chemotherapy sapped him of some lung capacity, he said, but his will to keep running remained strong.

"What kills me," he said, "is inactivity."

One time he said he was running around Southampton, passing through a cemetery, when he fell and cracked some ribs. He didn't know the extent of the injury at the time, of course, only that he felt intense pain in his side. He said he sat there and thought he only had one choice. To continue running. So he did.

"I actually had a good run, too," he said.

His best marathon time, he said, was 3 hours, 3 minutes. He's slowed considerably since his chemo seven years ago, finishing last year in 5 hours, 52 minutes. But he's still pushing.

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And, yes, there have been times when he's questioned himself, and whether he should continue running. He remembers a Long Island Marathon in the early 1990s when he stopped and sat on the side of the road, pondering the purpose before restarting. Another time in the Boston Marathon he thought about quitting before continuing.

All these years later, he's glad he's stuck with it.

"It's a healthy thing," he said. "People don't understand, they think a workout is a punishment. It's not. It's a delightful thing to do. It's to be alive. If you move, you're alive."