Should you be rowing whilst ‘under the weather’?
Former international rower and current competitive cyclist, Dr Mathilde Pauls is back to discuss.
Hello! I am back! I actually quite enjoyed writing the last article – it made me research something properly, order my thoughts, and write something, rather than give up halfway through (in case you have ever done a personality test, evidence shows that I am not one who is able to complete tasks). I received some positive feedback so I thought I would have another go.
This article is still about sport and your health, except this one has nothing to do with bones. I am looking at training with an illness, which I believe has some interesting questions to ask.
So, last Saturday I went out and completed a 90-kilometer bike ride. I had woken up with a sore throat, snotty nose, and a slight cough. I’ve had this for a few weeks now; it gets better, then I pick up a new, slightly different bug, and it gets a bit worse again. I don’t feel awful, but definitely not 100%. So, was that a bad idea? Should I have stayed in bed, eaten superfoods and had tea all day? Should I have been training? It wasn’t as much as usual, but I never gave myself a break.
“Yes, you are making yourself ill. You should know better, you are a doctor.” Would be an answer that comes to mind.
But am I?
What is the evidence?
I don’t really know, and I don’t think anyone can give you a definite answer either.
So let’s have a look at what we do know.
Dr. Google, what are the symptoms of a viral infection? (There are also bacterial infections, but for the purposes of this article I focused primarily on viral.)
- Muscle aches
- Runny nose
(I had at least 5 of those, not that I needed confirmation of the presence of a virus!)
So I don’t think my best bike ride beckoned. But I wanted to go out on the ride together with my friends, stop for a coffee mid-way somewhere, and chat. So am I doing myself harm? What actually happens to our bodies with a virus?
The immune system, infection, and exercise
Your body has an immune system. It’s there to recognise and destroy intruders – viruses, bacteria, and fungi, to name a few. It does this with quite an intricate recognition and signaling system which sends off a variety of cells to destroy the enemy. Moderate exercise stimulates immune system function, but bouts of very intense, or very long training sessions lead to a temporary decrease in immune system function, rendering the athlete more susceptible to infections (1,2).
Infections, especially viruses, are a multi-system problem which often includes a degree of damage to your skeletal and cardiac muscle proteins. Exercise during this acute phase may promote complications, such as myocarditis. I have decided to look into the three main infection areas; the respiratory tract, skeletal muscles, and the heart muscle.
Upper Respiratory Tract Infections (URTI)
You may well have noticed that hard training leads to an increase in the number of slight colds you end up with. David Nieman postulated a J-shaped curve between exercise volume and the number of URTI’s sustained, i.e. a little bit or moderate amounts of exercise are good, but high loads and intensities lead to a higher risk of getting an URTI- the same as what has been observed for the immune system in general (3,4).
Nieman also suggests that this is not only due to reduced immune system function but also due to increased stress hormones, such as cortisol.
Animal studies confirm this observation: moderate intensity exercise reduced mortality associated with respiratory viruses, but intense exercise before or during viral infection increased morbidity or mortality(5). Observational studies in humans have found that exercise and URTI ‘levels’ correlate with the amount of a component of your immune system, Immunoglobulin A5.
Myositis is inflammation of the muscles – resulting in painful muscles, that don’t quite function properly. Mild myositis is very common (spot two in our symptom list above!) with influenza, some gastrointestinal viruses (and other forms of man and woman flu).
There also are much more rare, much more serious forms of infectious myositis that can be caused by a broad range of bugs (bacterial, fungal, parasitic, and viral agents). In these severe cases, pain and weakness are very marked, including the distal extremities, and can be seen with Influenza B infections, for example(6). Bacteria that can give you myositis including staphylococci and streptococci, fungal and parasitic, only tend to cause infection in an immunocompromised host in the former, or someone who has travelled to an exotic location in the latter (7).
The exact pathophysiology of infective myositis remains to be understood. It is thought it could be due to either the direct effects of the infective organism or the immune response. I suspect both have a role to play, with the systemic inflammatory response potentially playing a greater role in the much more common (benign) cases being part of the ‘general malaise’ that occurs with infections.
Summary and Conclusion
So, If you feel generally shoddy, there’s immune police action happening, and it’s killing some of your cells that are hosting Mr & Mrs. Virus in your mucus membranes, lungs, muscles etc. That, and all the chemicals in your immune system that float around with that are responsible for the man-flu-feeling.
Most of the time that is probably the main extent of the problem if you’ve just got ‘a bit of a cold’. The problem is, that you can’t tell for sure which virus (or other infection) you currently have, and if it’ll be one of the rare cases that may cause a more serious infection is probably not something we know how to distinguish. You will probably be more ill with those already, but there is no such thing as certainty here.
That’s why your doctor will if in doubt, tell you something like the following (I have borrowed this from Friman and Wesslen, from their Special Feature for the Olympics in 2000 (2):
“Strenuous exercise during ongoing infection and fever may be hazardous and should always be avoided. In addition, early symptoms of infection warrant caution until the nature and severity of the infection become apparent. Because myocarditis may or may not be accompanied by fever, malaise or catarrhal symptoms, athletes should be informed about the symptoms suggestive of this disease. Although sudden unexpected death resulting from myocarditis is rare, exercise should be avoided whenever myocarditis is suspected.”
And I think that is the right thing to do. Because there is no way to be 100% certain they have to give you very cautious advice They are there to advise you / guide you / help you. But what you do with that advice (and your health) is your own responsibility.
Will I follow this advice? If I feel really bad, then yes. (Being me, I have tried to do the opposite and felt generally so crap even just trying, that only on one occasion can I think of where it was either definitely worth it, or usually the ‘mission’ was abandoned before being able to cause much damage to the heart or other muscles. Probably a sign from the gods…) And if I don’t feel so bad like on that Saturday? It won’t be a flat out three-hour session, but I probably will head out again. But that is my choice, aware of the fact that I might make myself worse, giving my immune system a bit more of a beating as I go along. But then one of my teammates did say ‘Do as she says, and not as she does.’ …
What you do is up to you.
Just don’t blame anyone else for the consequences.
About the author: Dr Mathilde Pauls
Dr Mathilde Pauls is a Berlin-born anglophile who has always been active in sport. She played handball at county-level as a child in Germany. Mathilde subsequently took up rowing and represented Germany at the U23 World Championships in 2005 (winning the LW2x) and as a senior in 2006.
Sophie Hosking, Laura Greenhalgh, Mathilde Pauls and Jane Hall of Great Britain celebrate winning silver in the LW4x at the Rowing World Championship 2007
In 2007 she represented Great Britain in the LW4x, winning gold at World Cup 3 in Lucerne and silver at the World Championships in 2007 with Sophie Hosking, Laura Greenhalgh and Jane Hall. In 2008 she competed at Rowing World Cup events and the World Rowing Championships in the LW1x. The same year she made the final of the inaugural Princess Royal Challenge Cup at Henley Royal Regatta. Mathilde has also competed at a high level in duathlon/triathlon and is currently part of the Sigma Sport Women’s Cycling Team.
After studying medicine at Cambridge and Imperial College, Mathilde is now a trainee neurology doctor. She is a qualified doctor and has an MSc in Sports and Exercise Medicine and a BA in Zoology and Physiology.
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- Friman G, Wesslén L. Infections and exercise in high-performance athletes. Immunol. Cell Biol. 2000;78:510–522.
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- Gibson S, Majersik J, Smith Ag, Bromberg M. Three cases of acute myositis in adults following influenza-like illness during the H1N1 pandemic. J. Neurosci. Rural Pract. 2013;4:51.
- Crum-Cianflone NF. Bacterial, fungal, parasitic, and viral myositis. Clin. Microbiol. Rev. 2008;21:473–494.
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- Karjalainen J, Heikkilä J. Incidence of three presentations of acute myocarditis in young men in military service. A 20-year experience. Eur. Heart J. 1999;20:1120–1125.
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- Hjelm E, Wesslén L, Gnarpe H, Gnarpe J, Nyström-Rosander C, Rolf C, et al. Antibodies to Chlamydia pneumoniae in young Swedish orienteers. Scand. J. Infect. Dis. 2001;33:589–592.