Can I Run With a Cold?

Using the Above-the-Neck/Below-the-Neck Rule

Fatigued runner
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There is nothing more frustrating than developing a case of the sniffles in the middle of your training. You may have every desire to keep on schedule but are unsure whether doing so will make you stronger or make things worse.

There are a few simple rules that can help you decide.

Above-the-Neck and Below-the-Neck Rule

The above-the-neck/below-the-neck rule is one that runners use when deciding whether it is appropriate to train. It refers to the location of your symptoms at the time you are planning your run. According to the rules:

  • You can continue running if your symptoms are above the neck, including a runny nose, watery eyes, a sore throat, or sneezing. It doesn't mean that you should train at full tilt but rather proceed at a reasonable pace as long as the symptoms don't worsen.
  • Any symptom below the neck (such as chest congestion, coughing, body aches, vomiting, or diarrhea) is a clear indication that training will do more harm than good. You should stop immediately and rest for as long as it takes to beat the infection.

The rules are a common-sense approach for not only athletes but anyone wondering if they should go out or stay at home during an illness. What the rules do not take into account is the risk of infection if you are, in fact, contagious.

Exceptions to the Rule

Clearly, there are numerous exceptions to the rule. Among them, a fever of any sort should give you pause, even if it's relatively low-grade. While a fever may accompany a seasonal allergy, it is more often an indication of a developing infection. If in doubt, it is best to err on the side of caution and take it easy.

Similarly, dizziness should never be taken lightly. There could be any number of reasons why dizziness occurs, from a drop in blood pressure to a middle ear infection. Whatever the cause, it may not be safe to run if your balance is affected. Use your best judgment, and see a doctor if the symptoms do not improve.

There are also times when nasal congestion is bad enough that your respiration is significantly impaired. If you have a "nose cold" and find yourself breathing entirely through the mouth, you may want to think twice about running.

While a nasal decongestant may help, it is best to stop training if you find yourself gasping for air or feeling lightheaded. Until you are breathing freely again, you may want to limit yourself to walking or weight training.

Differentiating Illnesses

The above-the-neck rule suggests that symptoms limited to the head are inherently less severe. And, in large part, that's true given that above-the-neck symptoms are most commonly associated with allergies and colds.

Certainly, with an allergy, you can usually manage exercise without compromising your health. Even severe allergy symptoms can be treated without the risk of major complications.

The same cannot be said for the common cold. If not managed reasonably, the viral infection can worsen and lead to any number of complications, including strep throat, ear infections, bronchitis, or pneumonia.

For this reason, you need to be able to read the signs if experiencing above-the-neck symptoms. In some cases, what you assume is hay fever may actually be the early signs of a cold or flu. To tell the difference:

  • Allergies can cause fatigue with exertion. Colds and flu cause fatigue when at rest.
  • Allergies are generally not accompanied by fever. Colds and flu commonly are.
  • Allergies are often accompanied by rash and itchiness. Colds and flu aren't.
  • Allergies do not cause body aches. Colds and flu can.

How Exercise Affect Illness

Many people will force themselves to exercise at the first sign of illness, believing that it will "boost" their immune system. What researchers at the University of Illinois College of Medicine found was that there is a narrow line between the prevention and promotion of illness among people who exercise prior to and during a respiratory infection.

In plotting the risks, the researchers found that people who exercised moderately had fewer and less severe symptoms than those who did nothing at all. By contrast, prolonged or intense exercise translated to higher rates of severe illness than either of the other two groups. Within this scenario, no exercise was far healthier than doing too much.

According to the researchers, moderate exercise stimulates the production of a type of white blood cell known as helper T-cell 1 (Th1) which the body uses to neutralize viruses and bacteria.

Prolonged or intense exercise, by contrast, triggers an exaggerated Th1 response. When this happens, the immune system, suddenly on high alert, will flood the body with inflammatory cytokines that end up damaging respiratory tissues and accelerating the progression of the disease.

Making an Informed Decision

The "tipping point" between the prevention and promotion of illness can vary between one athlete and the next. While above-the-neck/below-the-neck rules can certainly help, common sense should always prevail.

As a general guideline:

  • If you develop symptoms above the neck, reduce the intensity and/or duration of your training by 50 percent.
  • If the symptoms are below the neck, stay at home and allow your immune system to fully recover. Always treat a cold or flu appropriately with plenty of rest and fluids.
  • Once you feel better, do not barrel back into training. Start at 75 percent and gradually increase to full intensity by the end of the week.

Finally, wherever your symptoms may be—above the neck or below the neck—be courteous to those around if there is any chance you're contagious. Wash your hands regularly and stay well away from others if you are coughing or sneezing.

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Article Sources

  • Martin, S.; Pence, B.; and Woods, J. Exercise and Respiratory Tract Viral Infections. 404 Exerc Sport Sci Rev. 2009;37(4):157-64. DOI: 10.1097/JES.0b013e3181b7b57b.