Marathon Sniffles – avoidable or an inevitable outcome?

lemsipIt’s that time of the year again. Dark cold evenings, rain, snow and the distinct noise of coughs, sneezes, the occasional gag from every corner of the office.  Well it’s all that, but it’s also marathon training time!  This uneasy combination of endurance aspirations and fending off germs from sick people often brings down the most committed marathon apprentice during their training period.  Personally, it always seems to get me in the week before my marathon, leaving me sipping cold ‘Lemsip’ (Paracetamol) on the start line as part of my pre-race prep.   I decided to look into it a bit more and see if it was something I could prevent this time round.

You’re at the peak of your training or you just completed a marathon, when suddenly you have a sore throat, runny nose, and fits of sneezing. According to various surveys and studies it happens to many marathon runners, with many developing colds and other upper-respiratory infections (a.k.a. the “marathon sniffles”) in the weeks prior or the two weeks following a race.

But isn’t running supposed to make us healthy?  After all, the University of South Carolina reports that people who exercise have 20% fewer colds than their non-active peers.   Experts advise that while 30 to 45 minutes of moderate daily exercise does stimulate the immune system, however, the rigors of running longer distances temporarily weakens it. During the strain of a hard run, the body churns out the stress hormone cortisol, which suppresses the immune function in large amounts. The more intense the run, the higher the cortisol level.

Illness and running don’t always mix. But, we runners are a stubborn bunch and sometimes it takes near death type symptoms before we’ll crack and back down from a planned training run. I’ve always adhered to the “neck rule” put forward by David Nieman, Ph.D. the guru on this subject;

“Symptoms below the neck (chest cold, bronchial infection, body ache) require time off, while symptoms above the neck (runny nose, stuffiness, sneezing) don’t pose a risk to runners continuing workouts.”

Marc Bloom reviewed research by Dr Nieman, who heads the Human Performance Laboratory at Appalachian State University…….

Dr David Nieman

Dr David Nieman

Dr Nieman has run 58 marathons and ultras, and has researched extensively on the effects of exercise on the immune system.  Nieman’s view is supported by research done at Ball State University by Tom Weidner, Ph.D., director of athletic training research. In one study, Weidner took two groups of 30 runners each and inoculated them with the common cold. One group ran 30 to 40 minutes every day for a week. The other group was sedentary. According to Weidner, “the two groups didn’t differ in the length or severity of their colds.” In another study, he found that running with a cold didn’t compromise performance. He concluded that running with a head cold–as long as you don’t push beyond accustomed workouts–is beneficial in maintaining fitness and psychological well-being.But, doctors say, you still walk, or run, a fine line. Take extra caution when training with anything worse than a minor cold because it can escalate into more serious conditions affecting the lower respiratory tract and lungs. Sinus infection, or sinusitis, is an inflammation of the sinus:  symptoms include runny nose, cough, headache, and facial pressure. With a full-blown sinus infection, you rarely feel like running. But if you do, consider the 72-hour rule of Jeffrey Hall Dobken, M.D., allergist/immunologist and ultramarathoner: “No running for three days,” Even without the presence of a fever, says Dr. Dobken, some sinus infections, when stressed by exercise, can lead to pneumonia or, in extreme cases, respiratory failure.

Not surprisingly, winter weather increases risk of sinusitis. In dry air, the nasal passages and mouth lose moisture, causing irritation. “The sinuses need time to recover,” says Dr. Dobken, “just like a knee or foot.” So Dr. Dobken recommends including treadmill running in your winter training regime.

If your body is running a temperature (above 37 degrees C), the advice is to skip your run. “Some people think that they can ‘sweat out’ a fever by running,” says Nieman. “That’s wrong. Running won’t help your immune system fight the fever.”

flu“Running with a fever makes the fever and flu-like symptoms worse,” says Nieman, “and it can lead to other complications.” During exercise, your heart pumps a large amount of blood from your muscles to your skin, dissipating the heat your body generates. If you have a fever, your temperature will rise even higher, and your heart will be put under greater strain to keep your temperature from soaring. In some cases, this can produce an irregular heartbeat. Also, a virus can cause your muscles to feel sore and achy; exercising when your muscles are already compromised could lead to injury.

Nieman recommends that runners with a fever or the flu hold off until the day after the symptoms disappear–and then go for a short, easy run. Runners should wait one to two weeks before resuming their pre-illness intensity and mileage. Otherwise, you risk a relapse, he says.

Above all, obey your body and the thermometer–not your training program.

How far is too far?

Post Marathon no runner should be surprised if they feel a cold coming on in the days that follow. Nieman conducted the largest study ever done on this question by examining 2,300 runners who competed in the 1987 Los Angeles Marathon –  his conclusion:   Marathoners are six times more likely to get sick during the week after a race compared to those who didn’t trash their immune systems. The illnesses were of the upper respiratory tract, including sinus infections.

Nieman’s research has found that the immune cells are temporarily impaired after heavy exertion that lasts longer than 75 to 90 minutes. The dividing line seems to be 60 miles a week – those who ran 60 miles a week or more doubled their chance of getting sick. He’s also used himself as a test case: When Nieman trained up to 90 miles a week, he constantly battled sore throats. When he dropped his weekly mileage below 60, the symptoms stopped.

So while moderate exercise has been shown to have a protective effect, something as intense as a 26.2-mile marathon may create an open window of “immune dysfunction” that can last between 3 and 72 hours, he said. During this time, viruses and bacteria can gain a foothold, increasing the risk of coming down with a sore throat or runny nose.

Instead of “wasting your money” on vitamin and mineral supplements that haven’t been shown to work, Nieman suggests you get plenty of sleep and rest, wash your hands and eat fruits and vegetables. “The nutrient mix in fruits and vegetables is optimal for normal immune system function,” he said.

Also, try to minimize mental stress. “Marital discord, work stress, and financial worries in and of themselves cause a downturn in immunity,” said Nieman. “This combined with the physiologic stress of the marathon race is a one-two punch that can put you down.”

Unfortunately, many runners deal with stress by running. But the general rule of thumb is to rest one day for every mile in the race you’ve just finished.

Twenty six days of rest?

Nieman says there’s no evidence to support taking one day off for every mile run in a race.

“I recommend slowly getting back into the routine, ramping up over a 10-day period,” he said. “Getting sore and stiff muscles moving promotes repair better than rest. The issue is moderation for several days, not avoidance of exercise.”

Runners World’s advice to cope with the open window of “immune dysfunction” and avoid exposure to germs is a little more dramatic:

  1. Bring alcohol-based sanitizer to the race and use it before and after you run; avoid touching your mouth, nose, and eyes.
  2. Celebratory hugs are okay; high-fives, handshakes, and kisses are not.
  3. Continue to eat well, stay hydrated, and get plenty of sleep.
  4. Get a massage,which has been shown to increase the number of infection-fighting white blood cells in circulation.
  5. Avoid germ centers like the shopping malls and kids’ parties.
  6. If you start to feel the sniffles, try a saline nasal rinse or drape a towel over your head and lean over a bowl of steaming water for 10 minutes.

So, can you change an inevitable outcome?

Regular deployment of hand sanitizers having touched germ infested office appliances and keyboards while avoiding handshakes and kisses may make colleagues feel you are obsessive and maybe a little ‘nuts’, but to other equally dedicated distance runners they seem like sensible precautions.  Having endured the pain of running many hundreds of miles in training I am happy to be seen as obsessive for just a few weeks.  I had one colleague who even put himself in virtual self-isolation in the office, preferring to undertake meetings via a conference call from the room next door in his attempt to avoid catching a lurgi.  Now that really did make him appear nuts!

In an article on Runners World, Jayme Moye, points to a more practical perspective and identifies 4 key areas that we runners can address and that may help us in avoiding the inevitable on-set of colds and viruses.…

Tweak your training Long, slow runs (90 minutes or more) use slow-twitch muscle fibers, which feed on simple sugars, the same fuel as the immune system, says Michael Ross, M.D., medical director of The Performance Lab in Cherry Hill, New Jersey. “It sets up a resource battle between the exercising muscles and the immune system, with the immune system losing out,” he says. While you probably don’t want to give up all your long runs, you can scale back on mileage by replacing a medium-distance day with a high-intensity interval training (HIIT): Instead of a slower run over 1.5 hours, for example, do a series of eight intervals where you’re running at 80 to 85 percent of your max for four or five minutes, with two minutes of recovery in between. Also, avoid increasing both intensity and volume at the same time, says Dr. Ross, a sports physician. After upping your mileage, give yourself a two-week buffer before adding a tempo workout. A good prerace taper also helps your immune system recover.

Manage Stress The body recognizes vigorous exercise as a stress factor: Hard workout or bad day at the office, it all looks the same to your internal fight-or-flight response. Add to that the mental angst that often goes along with race preparation, and it’s no wonder runners are prone to colds. All the more reason to work on your mental balance.

Sleep In After strenuous workouts, sleep plays a critical role in restoring the body, he says. And research shows that repeated lack of sleep (six hours or less per night) lowers your immunity protection by up to 50 percent. In fact, a study of German athletes found that risk of upper-respiratory infections was highest in those who reported sleep deprivation and stress. If you’re having trouble getting to sleep—or staying asleep—in the days leading up to your race, you may need to back off your training. Insomnia can be a symptom of overtraining. Top tips…..  Make sure you’re going to bed and waking up at the same time every day, jot down any worries before going to bed – or have a pen and paper at hand if you wake with ‘to do’s’ on your mind.  Start winding down 30 minutes before bedtime.

Eat Well Eating right matters most when endurance athletes reach the peak of their training. Include plenty of anti-inflammatory, antioxidant-rich food sources in your daily meals and snacks. This includes fruits, vegetables, whole grains, beans and legumes, seafood, healthy fats (nuts, seeds, avocados, olive and canola oil), whole soy foods, cooked Asian mushrooms, herbs and spices, and tea, as well as red wine (in moderation – good news!). Drink a carbohydrate beverage during a hard run and  a carbohydrate and protein mix/drink in the first hour after a workout or race to aid recovery. Carbohydrates slow the release of stress hormones; protein stimulates white blood cell counts, which shield against upper-respiratory problems.

Help in a Bottle?

And how about the commonly held view that an ample and regular dose of vitamin supplements can stave off the onset of sniffles?  Jayme Moye’s conclusion is that there is little concrete research to help guide runners interested in using supplements such as glutamine, beta-glucan, and vitamins C or D to prevent a cold. The article highlighted that a number of respected immunologists pointed to the fact that they’ve seen no compelling, peer-reviewed study results that lead them to recommend anything other than a well-balanced, antioxidant-rich diet.

So in conclusion…. earlier to bed!

I’m well into the spring marathon training schedule, deep in to my long runs and feeling the normal round of niggles and sniffles.   The physio looks after the niggles – I need to do a better job of adopting the advice on avoiding the sniffles.  Some of it I can cope with – avoiding shopping malls and kids, training tweaks, diet and a moderation of red wine.  While other recommendations seem easy to adopt, the pressures of family life, work and others mean that I need to get a better job and get a grip on my sleep patterns and stress management.  Training hard on less than 6hrs sleep a night for the past several years inevitably takes its toll and I’m sure is a major contributor to my situation.    I won’t neglect the array of vitamins that sit on my desk and provide an element of possible false comfort but clearly I need to do more.

I will still be packing my Lemsip in my race pack just in case!

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