A Triathlete's Guide to Cold and Flu Season

So how sick is too sick to train? The American Medical Society for Sports Medicine answers just that and many other questions.

By Daryl Rosenbaum, MD
Member AMSSM

Cold and flu season is here! The average adult suffers from two to four colds per year. Depressing, but don’t cancel your workout just yet. There are ways to train sensibly and feel better. Virus infections are usually the culprit.

 

Treating Infections
Public enemy number one is the common cold. Symptoms include nasal congestion and drainage, scratchy throat, cough, and headache. These symptoms usually start to improve after five to seven days and resolve within two weeks. An oral decongestant such as pseudoephedrine can be helpful but watch out for increased heart rate, blood pressure, and nervousness. To avoid your body getting dependent on the medicine, nasal spray decongestants should never be used for more than three to five days. Beware of drowsiness and impaired coordination when taking an alcohol-based liquid cold remedy, especially if you plan to ride your bike that day. Zinc nasal gel started within the first twenty-four hours can shorten the duration of a cold by a few days but vitamin C is not helpful for this acute phase. Remember this is a virus; so antibiotics are not helpful as they are for bacterial infections.

As the cold symptoms become more prolonged, sometimes the nasal congestion can lead to growth of bacteria in the sinuses. Sinusitis symptoms are similar to a cold and can include focal pain in the cheeks or forehead (where the sinuses reside). An antibiotic prescription from your doctor may be needed for this bacterial infection. The nasal drainage can be thick and yellow in both sinus(bacteria) infections and cold(viral) infections.

The symptom of a sore throat can also be caused by a bacterial infection, but, is usually associated with a fever and swollen, tender lymph nodes in the neck area without the nasal drainage and cough common in colds. When you see your physician, they may do a test for a specific type of bacteria, “strep” (streptococcal bacteria). If you have ‘strep throat’, antibiotics are given. Salt water gargles, medicated sprays, and lozenges are all safe, simple ways to try and soothe throat discomfort.

The strong cough and congestion of ‘chest colds’, or bronchitis, is usually caused by a virus, so treatment should focus on the cough. Over the counter cough remedies are not all that effective but an inhaler prescribed by your physician may offer some relief. If you have wheezing, shortness of breath, or a fever, see your physician as a bacterial infection may have developed during the course of your symptoms.

Lastly, a visit to your physician may also be helpful if you are ill from the influenza virus: all-over body aching, high fever, chills, muscle aches, and malaise are present. You may be prescribed medication that when given in the first 48 hours of symptoms can limit the symptoms and course of this viral infection.

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Exercise and The Common Cold
There is some evidence noting that light physical activity such as walking offers protection from getting sick. However, the physical stress of heavy training can make an athlete more vulnerable. For example, in one study runners averaging more than 96km/wk were twice as likely to suffer from colds as those running less than 32 km/wk. Poor nutrition and psychological stress that can occur with over-training also can weaken immunity.

So how sick is too sick to train? A good rule of thumb is that if symptoms are confined to the neck or above, it is probably fine to work out but at a reduced level initially and then advance the intensity and duration as tolerated. On the other hand, if symptoms occur below the neck, one should rest until the problem resolves. A fever means the body’s temperature regulation center already has its hands full and may not be able to tolerate additional physical stress of training. Exercising with a fever can also be a recipe for dehydration. Muscle aches, diarrhea, and difficulty breathing all indicate that an infection is more serious and that the body needs rest in order to heal.

Prevention
There are a few strategies than can be helpful to prevent getting ill. Avoid over training to keep antibody levels and immune system in top condition. While not proven to help prevent colds in the general population, there is evidence that at least 200 mg of vitamin C daily helps those studied who exercised in cool weather: they cut their risk of getting a cold in half. Echinacea has not proven to be helpful. Frequent hand washing and cleaning of exercise equipment is highly recommended. Inhaling chlorine gas can cause lung inflammation, so make sure your indoor pool facility has adequate ventilation. And finally, a flu shot can help in some of the viral illnesses present during Fall and Winter. This is meant as a guideline; don’t ever hesitate to contact your physician with questions about your health.

 

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The information, prepared by a member of the American Medical Society for Sports Medicine, is not medical advice and should be used for informational purposes only. Please consult your own physician or health care provider about any opinions or recommendations with respect to your symptoms or medical condition.