Can I Run With a Cold?

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 your training schedule on track but you might be unsure about how running with a cold might impact your long-term goals and short-term health.

Scientific studies have investigated the role of exercise on illness—specifically colds and respiratory infections. Based on the evidence, there are a few simple rules that can help you decide whether to run or stay home.

When You Should (and Shouldn't) Run With a Cold

Medical experts advise that you use a basic rule to determine whether you should or shouldn't run with a cold. The rule is based on the location of your symptoms. In short, assess how you feel and determine whether your symptoms are above or below the neck.

The Neck Rule

The above-the-neck/below-the-neck rule is a tried and true test that you can use when deciding whether it is appropriate to train.

Above the Neck Symptoms

  • Headache

  • Runny or stuffy nose

  • Sore throat

  • Sneezing

  • Watery eyes

Below the Neck Symptoms

  • Chest congestion

  • Coughing

  • Body aches

  • Fever

  • Fatigue

According to the rules, you can continue running if your symptoms are manageable and "above the neck," including a headache, runny nose, watery eyes, sore throat, or sneezing, which suggests that you have a run of the mill cold. Any symptom "below the neck," however, such as chest congestion, coughing, body aches, vomiting, or diarrhea is a sign of more serious illness that likely requires some rest. Training may do more harm than good.

Of course, just because your symptoms are "above the neck" doesn't mean you should train. If you do decide to run, take it easy and stop if your symptoms get worse or become unmanageable.

Exceptions to the Rule

As with most rules, there are important exceptions to the neck rule. "Full body" symptoms like a fever should give you pause, even if it's relatively low-grade. While a fever may accompany seasonal allergies, 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.

Cold Symptoms vs. Allergy Symptoms

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.

The Difference Between Allergies & Cold/Flu

  • 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 Affects 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.

A review of studies conducted by Cochrane researchers concluded that based on current evidence, they could not determine "whether exercise is effective at altering the occurrence, severity, or duration of acute respiratory infections." While some studies found exercise to be helpful in reducing symptoms and the days of illness per episode, the researchers noted that the quality of studies was poor.

Should You Run With a Cold?

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

  • If you develop symptoms above the neck, reduce the intensity and/or duration of your training by 50%.
  • 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, don't barrel back into training. Start at 75% 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

  1. Exercising with respiratory infections. Harvard's Men's Health Watch. Harvard Medical School

  2. Silva D, Moreira A. The role of sports and exercise in allergic disease: drawbacks and benefits. Expert Rev Clin Immunol. 2015;11(9):993-1003. doi:10.1586/1744666X.2015.1058158

  3. Martin SA, Pence BD, Woods JA. Exercise and respiratory tract viral infections. Exerc Sport Sci Rev. 2009;37(4):157-64. doi:10.1097/JES.0b013e3181b7b57b

  4. Grande AJ, Keogh J, Hoffmann TC, Beller EM, Del mar CB. Exercise versus no exercise for the occurrence, severity and duration of acute respiratory infections. Cochrane Database Syst Rev. 2015;(6):CD010596. doi:10.1002/14651858.CD010596.pub2.

Additional Reading

  • Exercising with respiratory infections. Harvard Men's Health Watch. Harvard Health. February 2012

  • Grande A, Keogh J, Hoffmann TC, Beller EM, Del Mar CB. Exercise versus no exercise for the occurrence, severity and duration of acute respiratory infections. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD010596. DOI: 10.1002/14651858.CD010596.pub2

  • 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.

  • Martin, S. A., Pence, B. D., & Woods, J. A. (2009). Exercise and respiratory tract viral infections. Exercise and sport sciences reviews37(4), 157–164. doi:10.1097/JES.0b013e3181b7b57b