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Can I Exercise When I Am Sick?

DrSugar: Can I Exercise With a Cold?

DrSugar is in the house! And she's answering your health related questions.

I was wondering how to determine whether it is OK to work out if I have a cold. I have heard of the "neck up" rule but sometimes find that it's not easy to tell whether the cold is localized in my head or not. For example, I have a cough and head congestion now but am not sure if I have chest congestion or not. I hate to break up my routine but also do not want to make myself worse. Any suggestions? Thanks so much!
— Sniffles

This is a great question I received this week from one of DrSugar’s readers! I think it is a fantastic subject to discuss, as I’m sure that most of you have encountered this very situation and perhaps did not know what to do! To learn my advice on the matter, keep on reading.

First, I’d like to commend you on your exercise routine and provide you with this very interesting fact: people who exercise on a regular basis report fewer colds than their inactive peers! Also, other research has shown that during moderate exercise, several positive changes occur in the immune system. Once the exercise is over, the immune system returns to pre-exercise levels. But, each exercise session provides a boost that appears to reduce the risk of infection over the long term. This is great news for all of our active readers and should be a motivator for anyone to exercise!


According to the American College of Sports Medicine, there is some evidence that elite athletes (marathon runners, Olympians) who participate in heavy, prolonged training have reduced resistance to colds. The researchers have studied the immune systems of marathon runners before and after running for 2-3 hours. A steep drop in immune function occurs after running that lasts for 6-9 hours; that can be a time where the body is more susceptible to infection.

The Mayo Clinic and the American College of Sports Medicine both endorse the "neck up" rule and state that you can proceed with your workout if your signs and symptoms are "above the neck," such as runny nose, nasal congestion, sneezing, or sore throat. It should be noted that if you have the "above the neck" symptoms, you should not engage in exercise if you also have a fever. One should employ some common sense as well and not engage in exercise if one has severe "above the neck" symptoms. Waiting until the symptoms resolve, if severe, is the smart thing to do. Also, according to a CNN medical expert, people with colds should begin working out at 50 percent intensity. If symptoms improve in the first five to ten minutes, you can gradually increase the length and effort up to about 80 percent of your normal workouts. On the other hand, if your symptoms do not improve, you should only engage in mild-to-moderate exercise such as brisk walking. And remember, overdoing it with heavy and intense exercise may actually reduce your immune system function and prevent you from getting better!

If your symptoms are "below the neck" — such as chest congestion, hacking cough, upset stomach or consist of systemic symptoms such as fever, extreme fatigue, severe muscle aches or swollen lymph nodes — you should rest and not participate in intensive exercise for at least two to four weeks. The American College of Sports Medicine also recommends a gradual progression back to normal training after a systemic (widespread) illness. You should be evaluated by a medical professional if you develop severe above the neck or any below the neck symptoms, in order to determine the cause of the symptoms.
There are a few precautions to keep in mind if you have above-the-neck symptoms and proceed with exercise. The first is to keep very well hydrated! The nasal drainage associated with colds can speed up dehydration and some over-the-counter remedies can dry you out further. Illness can predispose you to dehydration (especially if you have a fever), so no matter what type of symptoms you have it is very important to drink plenty of fluids. Second, if you work out in a public gym, be extra vigilant about cleaning equipment before and after you use it and try to use machines away from other people to avoid spreading your illness (or catching another bug that someone else might have)!

Hopefully this review will give you the information necessary to determine your symptoms and whether or not you should engage in exercise. As I always say, if you have any concerns whatsoever, you should contact your primary care provider for an evaluation. And to all DrSugar readers, always live strong, keep healthy, and stay active!

Have a question for DrSugar? You can send to me via private message here, and I will forward it to the good doctor.

DrSugar's posts are for informational purposes only and should not be considered medical advice, diagnosis, or treatment recommendations. Click here for more details.

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