to exercise or not: the cold virus conundrum

Ah, winter time. The special time of year where we get to cozy in close with family and friends and share all of our germs with each other. Cold and flu seem to spread through families and work offices as swiftly as a yawn. In terms of its purely annoying features, having a cold is right up there with people who tailgate you and awkwardly autocorrected texts (sitting on the toilet only to discover you have no TP also comes to mind).  Upper respiratory infections or URIs are quite the pain in the butt.

While not causing too much mortality (besides flu, which we'll hit later), colds top the ranking in terms of short-term disability, just ahead of gastrointestinal illness and skin infections. URIs cost the US billions per year thanks to truancy from work/school, physician expenses, and over-the-counter medicines. Oddly enough, a typically obsessed collective of people seem to continue their normal activities: the athlete. As an athlete or someone who is physically active, you already have a leg up on your immune system. Evidence shows that a lifestyle that is active diminishes the risk of contracting these annoying communicable diseases, including bacteria or virus.  But should you continue that cross-fit class with the coughing-sniffles?


Many articles I've seen just note the"should and should not"approach to colds. So I dug a bit deeper. I wanted to know if exercising would prolong my symptoms. Would exercise actually enhance my healing? What about overall performance? Is there a risk of muscle or performance atrophy while taking days off? Sheesh, so much to unravel. So, pop some DayQuil and lets roll!

UPPER RESPIRATORY INFECTIONS VS. LOWER RESPIRATORY INFECTIONS

Anatomically, the upper respiratory tract includes the mouth, nose, sinus, throat, and trachea. The lower respiratory tract includes the bronchial tubes and lungs.

The general rule that you'll read on fitness and health blogs and from experts is if your symptoms are above the neck, you're clear to exercise or as I like to tell my patients: "Above the neck... hit those pecs;  In the chest...rest is best".

To clarify these statements, runny nose, cough, congestion, sore throat--OK. Wheezing, horrible body aches, shortness of breath, fever--no go. You probably aren't going to want to try and squat with pneumonia anyway. Even further, you should probably be seeing a medical professional with those types of symptoms. One pesky little bastard is the flu.

The 1979 Cotton Bowl Classic was an icebox of a football match for a usually mild-wintered state like Texas. The young QB for Notre Dame had come down with the flu prior to the game and Notre Dame went into the locker room behind at half-time. At the start of the 3rd Quarter, the influenza-stricken QB didn't come back out to the sub-zero temperatures with his teammates. As the team went down 34-12 to the University of Houston in the fourth quarter,  the sickly Fighting Irish QB was fed some chicken-noodle soup to help bring some warmth back. With less than 8 minutes left in the game and belly full of chicken-noodle soup, the starting QB emerged from the tunnel. After an initial turnover by the offense and a couple great defensive stands, the Irish put together enough scoring drives to find themselves with the ball and two seconds left in the game. Rolling out to the right, the QB hoists the ball into the right corner of the end zone where the TV cameras pick up a blur of jerseys. Agonizing seconds pass until the referee raises two hands in the air to indicate a score and thus Joe Montana starts his legacy as the comeback kid from Notre Dame.

Influenza is actually an upper respiratory infection that causes systemic symptoms like body aches, fever, and sometimes vomiting and diarrhea. We end up keeping that one out of the URI category because of the body-wide manifestations. Generally speaking, you probably shouldn't pull a Joe Montana if you have the flu. I'm guessing our chicken soup isn't the voodoo magic soup that restored Joe's vigor. I will say though, people think they have the flu when they feel a little worn down with a runny nose. That’s not flu.

PROLONGING THE SNIFFLES

If you are reading this and are already physically fit, you already have the upper hand on URIs. Plenty of studies show that when you exercise regularly, you reduce the risk of catching a cold, amongst other risk reductions, i.e. heart disease, diabetes, etc. This study showed over 40% reduction in days with URI symptoms in active adults! Throw this into the overflowing bag of "reasons to exercise".

When lying on the couch with a cold, tissue promptly dangling out of your nose, going to the gym is probably not high on the priority list. Most athletes and exercise enthusiasts have the desire to train and will continue to, with maybe a decrease in intensity or volume. Some may worry that if training when sick their body will shift away from "healing the cold" to "healing the muscles" and make the whole illness worse.

Lucky for us, Ball State researchers decided to literally drop the cold virus into trained individuals to test this theory. They had half the participants completely stop exercising and the other half complete 40 minutes of moderate exercise every other day. A severity score survey was filled out every 12 hours for the duration of the study. For some disgusting reason, they even kept track of their used tissues and weighed them as another "severity" factor. Gross. However, what they found was that the severity and duration of the illness were the same between the two groups.

Even further, a few years later, they did a similar test with people who never worked out and they still had the same results: no worsened severity or duration of the cold.

With these studies, you shouldn't be worried about making the cold worse by exercising moderately. Just don't try some crazy, David Goggins type workout (look the dude up if you don't know him).

Not many studies like this have been done in that infecting someone purposefully with a virus is a bit of an ethical conflict. What we are left with is a lot of anecdotal evidence. Many active people say exercising helps them feel more energy, relieves congestion, and enhances recovery. I seem to agree. Sometimes the mental aspect of getting a little sweat on can provide a boost.

I've spoken to few physicians here locally and they have an interesting theory on the benefits of exercising while sick: vasodilation (or in layman's terms, the dilation of your blood cells). I can’t find any evidence to back this up, but some of these guys are elite athletes as well as great doctors. They swear that staying active helps them recover faster because when those blood vessels open up nicely to pump oxygen to the muscles, the immune cells also get the same permeating aftermath and viola! Cold be gone!

IMMUNE SYSTEM BOOST

Here's where there seems to be some conflicting data. A lot of studies were performed measuring various immune cells before and after serious exercise. Results showed a reduction in the measurement of immune cells IgA and lymphocytes after various activities such as a two-hour workout. Now the key word there is "measurement" of these cells because just because they weren't measured, doesn't mean they aren't there. Let me elaborate.

A new theory has come forward as to what happened to the reduced cells and its called "immune surveillance".This theorized that the cells are not reduced but actually distributed throughout the body in an attempt to sort of deploy-the-troops, so to speak. Theoretically, it makes sense. Why else would active individuals have stronger, more "alert" immune systems? We already know they get sick less.

Another interesting take on exercise immunosuppression is marathon runners and their increase in illness after the race. Some evidence points to immune suppression. Other data points to the exposure risk of large crowds since there is a measured increase of URIs with airplane travel and the Muslim pilgrimage, Hajj. Some believe that marathon runners have increased URI-type symptoms such as congestion or a runny nose from non-infectious causes like allergies.

IS THIS GONNA AFFECT MY PERFORMANCE?

More than likely yes. Although pulmonary function tests weren't changed when compared to a control group in this study from 1997, most people will say anecdotally that their performance decreases with a cold. I tend to agree, especially since there is a broad spectrum of severity when it comes to these URIs. Whether from the"I can't breath through by nose", the "my throat is so sore I can't swallow", or the classic "I can't stop coughing", your performance probably won't be 100%.

After numerous athlete's bodies and performances were plagued with URIs in the Olympics of the early 1990s, a very cool study was done on the kinematic changes that may occur during a URI caused by Rhinovirus, the most common cold virus. The subjects had naturally occurring URIs and were asked to complete a slowly increasing five-minute run. Runs were recorded and the subjects heart rates were tracked via an EKG done every 30 seconds.

Three weeks later, the now asymptomatic subjects were asked to complete the same running protocol. When analyzed with software, they measured significant alterations on stride length and stride frequency. The researchers believed the changes in kinetics possibly from altered muscle glycogen utilization. They postulated that these alterations could mean potential injury risk. This study has many limitations but it is intriguing they found true bio-mechanical alterations with a cold.

The variable that seems to be altered by most seems to be energy levels. The fatigue from a viral URI really drags you down. Unfortunately, you can even expect this draining sensation to last a week or more. The nice thing is usually your most annoying symptoms and feeling like hell may only last 3-4 days before they start their fade. Taking a day or two off won't create any muscle atrophy or performance hindrances in the long run. Just keep those nutrient-packed meals coming. Keep feeding the beast.

THE RUNDOWN

  • You are an athlete. Great news! You already have the advantage and should be getting sick less than the average person.

  • "Above the neck... hit those pecs; In the chest... rest is best". As long as there are no systemic symptoms, you can do activity as tolerated. But, please don't be reckless. If you're short of breath, vomiting, or any other "below the neck" symptoms, take it easy and maybe let your doctor take a look at you.

  • So you're "above the neck" and you've decided to get a pump on. Great! Just know that more than likely you aren't prolonging your symptoms by exercising, and because you are getting that blood moving, you might even feel better sooner.

  • Keep the exercise to a moderate level. Some evidence shows that intense or prolonged exercise could lower your immune system and keep you from healing.

  • So you decided to take it easy for one or two days. No problem! Feed your body with heavily nutritious meals to make keep the immune system as optimal as possible. Get your Vitamin C in. As simple as it seems, it may actually reduce symptom time.

  • This miserable sickness will last anywhere from 3-14 days total. Thankfully, the worst symptoms usually only stick around a few days. Remember! These illnesses are usually caused by a virus so antibiotics will not help you. Even worse, taking antibiotics when not warranted can be harmful.

  • Keeping up with your ordinary physical activities may be difficult. Performance will more than likely drop. If you're feeling bad about a couple of lousy gym days, focus on other areas sometimes neglected like flexibility. I foam-roll like crazy when I've got a cold.

  • Keep your body a cold-fighting machine by getting 7-9 hours of sleep (more important than you'd think), keeping stress low, and supporting it with superior nutrient-rich fuel.

  • Extra tip: When at the gym, please clean your machines, cover your cough, etc! Keep in mind, you got this cold from someone too. So, do your best not to share the misery.

 ____________________________________________________________

Brock Reichert is a practicing emergency medicine PA from Fort Collins, CO. Being an adventurer stuck in a football player’s body, he enjoys hitting the slopes as much as hitting the weights. After doing collegiate sports and fitness competitions, the travel bug bit him hard. He now runs a travel and fitness blog, BuffandAbroad.org. You can follow him on social media @buffandabroad

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