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Preventing and Training With Illness

"Upper respiratory tract infections are the most frequently reported disability among all athletes and are the cause of more lost training days than all other infections put together.” -Midgley A. (Research Study at University of Hull)

The following are strategies to prevent illness, how to manage illness when we are unlucky enough to get sick, and how to comeback into training without a relapse.


Hard training sessions suppress your immune system for a period of 3 to 72 hours. This period of impaired immunity is known as the “open window.” Being hyper-vigilant with prevention techniques during this “open window” period is advised. In other words, avoid going to big department stores or babysitting your runny-nosed nieces after a long hard workout.

Guidelines for prevention of illness for endurance athletes:

  • Execute your recovery post-training to minimize exercise-induced immune suppression. (Eating within 30 minute of training ending. Rehydration, foam roll, stretch, ice bath or compression. Ending with a good nights sleep.)

  • Maintain optimal nutrition to enhance general health and maintain vitamin and mineral stores, particularly Vitamin D status.

  • Avoid crash diets and rapid weight loss.

  • Minimize contact with sick people, especially during your “open window”. Minimize time spent in public places with large crowds, especially during your “open window”.

  • Keep a distance from people coughing and sneezing. If possible, ask them to wear a mask.

  • Wash your hands before eating.

  • Carry hand sanitizer to use when hand washing is inconvenient.

  • Avoid touching your mouth, nose and eyes with your hands.

  • Use clean, disposable tissues to wipe your mouth or blow your nose, and put soiled tissues in the trash immediately.

  • Do not share food or drink with anybody, especially cute children with runny noses!

  • Use a face mask to protect your respiratory membranes from being directly exposed to very cold and dry air during strenuous exercise.

  • Wear appropriate clothing to avoid getting overly cold and wet.

  • Consistently get at least seven-eight hours of sleep per night.

  • Keep life stress to a minimum.

Follow immunonutritional support guidelines (see below) to minimize training-induced immune suppression, and to bolster immunity.

Immunonutritional Support:

Several nutritional supplements and strategies have been shown to bolster immunity.

First and foremost, make sure your vitamin D and C are up to par. Vitamin D is produced naturally in your body when your skin is in direct contact with sun light. In the winter months (especially in the Midwest), this doesn’t happen enough because of clothing covering the skin, and cloud cover. Supplementation is recommend during the winter.

Quercetin supplementation of 1,000 mg/day reduces illness rates in exercise-stressed athletes. Combining quercetin supplementation with green tea extract and fish oil can further augment immune function and reduce the incidence of upper respiratory tract infections in athletes. Quercetin can also be found in the following foods, which is probably better then a supplement but not always as assessable.

  • Peppers.

  • Dark cherries and berries (blueberries, bilberries, blackberries and others)

  • Tomatoes.

  • Cruciferous veggies, including broccoli, cabbage and sprouts.

  • Leafy green veggies, including spinach, kale.

  • Citrus fruits.

Increase Antioxidants:

In short antioxidants fight off the “bad guys” in your body. They are going to help you get back or normal and more stable faster. But should part of your daily diet not just when sick. If you feel your not getting enough in you daily diet here are real foods as well as a few supplements I’ve found to help.

  • #1 antioxidant to have on board is Astaxanthin. This is found in most dark red seafood. ( sockeye salmon, red trout, red seabream, lobster, shrimp, crawfish, crabs, salmon roe, krill, and algae.) I supplement this because of how well it works, and how hard it is to eat dark red fish everyday. (This is the brand I use (Click Me)

  • #2 Spirulina isn’t technically a antioxidant, it’s a algae, but it works like one and contains antioxidants. (Most likely you’ll need to buy this in supplement powered form. (This is the brand I use (Click Me) You can easily add it to a smoothie or shake, or food.

  • Spirulina also includes protein, vitamins B-1(thiamine), B-2 (riboflavin), B-3(nicotinamide), B-6 (pyridoxine), B-9 (folic acid), vitamin C, vitamin D, vitamin A and vitamin E, potassium, calcium, chromium, copper, iron, magnesium, manganese, phosphorus, selenium, sodium and zinc.

  • Research on Spirulina has show the following for endurance training:

  • Time to fatigue after the 2-h run was significantly longer after spirulina supplementation (2.05 +/- 0.68 vs 2.70 +/- 0.79 min). Ingestion of spirulina significantly decreased carbohydrate oxidation rate by 10.3% and increased fat oxidation rate by 10.9% during the 2-h run compared with the placebo trial


Lactobacillus probiotics can augment some aspects of immune function and reduce illness rates in exercise-stressed athletes.

Recovering from an Illness

The bugs are out there and, despite your best prevention efforts, you may still fall sick. Most endurance athletes are tough as nails and would rather train through almost any illness than rest and get off-plan. That is a bad idea! Training through a viral infection can have serious negative outcomes, including mononucleosis, pneumonia, or myocarditis, an infection of the heart caused by common cold viruses. It is better to back off for a few days rather than blow up your common cold into one of these serious conditions. Remind yourself that you can’t build fitness on a sick body.

Furthermore, a study done by Thomas Weidner (Chairperson of the School of Kinesiology at Ball State, and Professor of Athletic Training), found conclusive results on the effects of running when sick caused by an upper reparatory illness.


They identified significant differences in mean changes between the ILL and CRL group stride lengths (p <.01), stride frequencies (p <.05), and ankle maximum angle displacement (p <.01). Mean changes in stride length (p <.03) and in stride frequency (p <.04) were larger for ILL subjects who felt feverish.


Alterations in running gait during a rhinovirus-caused upper respiratory illness, and possibly increases in injury incidence, may be associated with feeling feverish. Gait alterations may increase injury incidence or decrease athletic performance, or both.

To put plainly, your not going to gain fitness, and your risking injury when you train sick, period.

Just how sick do you have to be before holding off on training becomes the correct decision? Any illness symptoms are reason enough to avoid training hard. I am okay with my clients completing a recovery-paced training session, keeping heart rate in zone 1, if all symptoms are above the neck. These include a mild sore throat, stuffy nose and headaches. Light exercise may be helpful in this instance.

Stop training and take a day off from all activity other than gentle stretching if you have any below-the-neck symptoms. These include a very sore throat, fever, fluid in your lungs, coughing, body chills and aches, exhaustion, diarrhea or vomiting.

While you are sick, rest, drink plenty of hot fluids, and seek comfort from over-the-counter cold remedies. The vast majority of colds derive from a virus, so taking antibiotics is rarely helpful. Antibiotics will weaken your immune system further by destroying bacteria—both good and bad—in your gut, where a portion of your immune system resides. If your illness symptoms deteriorate rapidly or continue for more than three days, consult your physician.

Returning to Training Following an Illness

Here are some guidelines for getting back on track after being sick:

  • Wait one day after below-the-neck symptoms have resolved before resuming any training.

  • After that, resume training with a day consisting of one recovery-paced session.

  • Continue training at a recovery pace until all above-the-neck symptoms disappear.

  • Stop training and return to rest if any below-the-neck symptoms return.

  • If you were sick for three days or less, resume your training plan after your one “wait day” plus one recovery day.

  • If you were sick for more than three days, resume training with one “wait day” and two or more recovery days. After two or more successful recovery days, gradually ramp up your duration first, then intensity, to full training loads over the course of four to seven days.

  • Use a face mask to protect respiratory mucous membranes if exercising in very cold temperatures following a respiratory infection.

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