Deciding whether to train while sick is a choice every athlete faces at some point.

We all know the feeling . . . that dreaded tickle in your throat.  The headache that won’t go away. A little sneeze or sniffle that starts to happen again and again.  A stomach that is just a little off, but is getting worse. You start with denial, then you move to anger, and maybe you even engage in some good old fashioned self-hatred (If I only would have slept more, eaten more veggies, remembered to take my immune support vitamins…).   

But eventually, you must come to terms with your fate.   Yes, it’s a cold. Or even worse, the flu. Or any one of the hundreds of nasty viruses that seem to be everywhere this time of year. 

So what next?  Whether you are in the middle of a major training block or exercise to maintain your physical or mental health, illness just plain sucks.  Sleep it off? Starve a cold, feed a fever (or is it feed a fever, starve a…who even remembers that advice anyway?

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Full disclosure: we’re not your personal physician and aren’t in the business of providing medical advice, so talk to your doctor if you have specific questions.

The COVID Update: All Bets Are Off

When it comes to COVID, none of the traditional advice about training through illness applies.  If you’ve got COVID, read this section and ignore everything else in this blog.  Seriously.  

Experts are learning more and more every day about numerous direct and indirect effects of COVID, including on the heart.  

What does COVID mean for athletes? 

First, no training during COVID, symptoms or not.  As explained in this August 2020 article in Bicycling Magazine by Selene Yeager, intense activity during COVID may cause the virus to replicate at a faster rate.  The increased viral load may increase your risk of cardiac harm in the form of myocarditis (inflammation around the heart), arrhythmias (irregular heart rhythm), and even heart failure.

Second, when returning to exercise after COVID, go sloooooow. 

According to a May 2020 article published by the American College of Cardiology (“Exercise and Athletics in the COVID-19 Pandemic Era”), here are some guidelines based on activity level: 

The recreational exerciser who had only mild to moderate symptoms should be able to resume activity slowly and gradually once fully recovered, watching for any clinical change or new cardiovascular symptoms.  Patients with pre-existing conditions or who had COVID complications may require additional testing and assessment prior to a return to exercise. 

Competitive athletes and highly active people may need a 2 week period of rest and recovery after symptom resolution.  After the 2-week rest period, they should have testing and evaluation by a medical professional, including possibly extensive biomarker testing to assess for residual inflammation, echocardiography, stress testing, and rhythm monitoring.  Short version:  don’t return to training or play without getting cleared by your physician. 

Can Vitamin D Reduce Covid-19 Risk for Athletes is another topic we’ve covered along with should I train while sick? Dr. A’nna Sewall gives her take here.

Train in moderation through a cold, rest through the flu

Most coaches and medical professionals today agree that what you do depends on what you have.  But hang tight- the advice gets better. As noted in an oldie-but-goodie (2008) New York Times article, studies have found that exercising with a cold doesn’t impair performance, symptoms, or recovery.  Although people report feeling fatigued, they also assessed their symptoms as being helped by exercise.  Based on this information, some exercise physiologists have revised their recommendations, encouraging people to exercise if they have colds that produce symptoms like runny noses and sneezing, but to exercise more caution with illnesses that produce fevers or symptoms below the neck, like chest congestion, or worse, something like the flu.

What experts say on training while sick

Coaches in the endurance sports world agree with the “above-the-neck vs. below-the-neck” distinction.  In “The Well Built Triathlete” Matt Dixon (exercise physiologist, elite coach extraordinaire, and founder of Purple Patch Fitness), explains that “[i]f you have symptoms that include only a  runny nose, sniffles, or a sore throat, you can likely maintain exercise but avoid all intervals or high intensity. . . . keep the duration of training relatively short.”  If instead, your “symptoms are systemic in nature, or you feel the sickness in your body (fever, chills), or you have a chest infection, then complete rest is necessary.” In typical and refreshing Dixon-like fashion, he also reminds us to focus on the big picture which is to “limit the time you are burdened by sickness.”  Sleep, rest, fluids, nutrition, and patience.

Not so easy in practice, is it?

Douglas Wisoff (physical therapist, injury and form healer, and founder of Radiant Running) counsels an approach that similarly encourages a bit of zen.  Wisoff explains healing as a process that engages the entire person, physically, mentally, and emotionally.  

He notes that while the typical mental, physical, and emotional response to illness is to “fold, shrink, rest, and medicate,” this “has a tendency to invite the sickness in, and give it a temporary home. “ By contrast, the better, whole-being approach to this is totally opposite:  “training can be a healing agent.” It allows you to “mentally affirm your strength and health, consciously and deeply breathe the air, hold yourself in a strong posture, and even enjoy the process of pushing through.” Ultimately, Wisoff explains, if you can think of the sickness as something that is just “moving through,” and “not bad or out of the ordinary,” you can get through it stronger (and even faster)—it just takes “a little faith, a little dedication, and a belief in the ability of your immune system.”

Trust your instinct – train through sickness if it feels right to you

Feeling better about the cold and flu season yet?  No? Well, we hope that this article has at least given you a few tips that might help you ease the pain just a bit.  Ultimately, you know you’ll get through it. And in the process, we’re cheering for you.

Should I train while sick? Was written by several ABT staff members

Should I train while sick? was Reviewed by Dr. Garret Rock