Posts Tagged ‘sick’

Galen Rupp’s revenge: allergies in marathon runners

December 1st, 2011

It’s pretty well established that heavy training — the type you might do to prepare for a marathon — can reduce immune function a bit, leaving you more susceptible to colds. Same thing with the race itself, which can trigger a temporary lowering of immune function: it’s well documented that runners have an elevated risk of catching an upper respiratory tract infection (URTI) in the week or so after a marathon.

Except… are those symptoms (e.g. congestion, cough, watery eyes, sneezing, “nasal discharge”) really the result of URTIs? In a new paper in Medicine & Science in Sports & Exercise, a group of mostly British researchers suggest an alternate explanation: allergies. And they provide some intriguing data to support this claim. They studied 208 runners who ran the 2010 London marathon. Before the race, the runners completed an allergy questionnaire and did a blood test to look for reactions to common inhaled allergens (like pollen). After the race, they filled out questionnaires daily for 15 days describing any possible URTI/allergy symptoms. The key results:

  • 47% of the runners suffered from the symptoms of an apparent URTI after the marathon (i.e. they reported symptoms on at least two days in a three-day period during the 15-day follow-up).
  • The researchers also surveyed non-runners who were living with the runners in the study; only 19% of the non-runners reported URTI symptoms during the period, which (the researchers say) argues against the symptoms being due to an infectious disease like cold or flu.
  • 40% of the runners had some form of allergy, based on either the questionnaire or blood test — and the allergy questionnaire was a “significant predictor” of the whether the runner would suffer URTI symptoms after the race.

So what’s going on here? According to the researchers:

The shifting of breathing during exercise from nose to combined mouth and nasal breathing results in a greater deposition of airborne allergens, and unconditioned air, to the lower airways.

They go on to note that these symptoms may be associated with asthma, but that, “worryingly,” few of the runners were being treated pharmacologically for asthma — which they attribute to the fact that asthma meds are restricted by the World Anti-Doping Association. Given that the average finishing time of their subjects was slower than five hours, I find this an extremely strange argument to make! They go on to recommend that recreational runners should be screened for allergies and consider treatment.

I think this is a really interesting topic. It’s been known for a long time that endurance athletes (particularly winter athletes) are far more likely to suffer from conditions like exercise-induced brochoconstriction (basically exercise-induced asthma symptoms) than the general population. Why is this happening? What makes athletes’ airways more sensitive? Is it the airways being dried out by large volumes of air passing through? Is it particulate matter being inhaled and damaging airways? Or is it allergens that are causing inflammation due to all the deep breathing? It would be great to see more research looking into these questions.

That being said, I think this study has some pretty important limitations. I found the presentation of the data to be a bit lacking — it’s very hard to get a precise sense of just how different the allergy and non-allergy groups were, to see how strong the data really is. But the more fundamental issue is simple: selection bias. The subjects “were recruited randomly during the 4-day registration exhibition before competing in the 2010 London Marathon.” So which people would be more likely to agree to fill out a questionnaire about allergies and give a blood sample for allergy testing? Probably people who have, or believe they have, allergies. So when the results tell us that a very high proportion of runners have some indication of allergies, that doesn’t necessarily hold true for all runners!

Still, a thought-provoking paper: maybe the famous “post-marathon cold” isn’t quite what we thought.

The more stressed you are, the more exercise keeps you healthy

February 7th, 2011

The standard picture of how exercise affects your immune system is sometimes called the “J-curve hypothesis“: your immune system is strongest at some “moderate” level of physical activity, and gets weaker if you exercise too little or too much. Stress, on the other hand, has a simpler curve: the more stressed you are, the more susceptible to infection. A new study in this month’s Medicine & Science in Sports & Exercise takes a look at how these two factors interact, with some interesting results.

The study, from the Karolinska Institute in Sweden, followed 1,509 adults for four months, recording self-reported levels of stress, physical activity, and upper respiratory tract infections (e.g. cold and flu). They saw the following (the top graph is everyone, middle is men, and bottom is women):

The key point: for men in particular, the more stressed you are, the more exercise helps to keep you healthy. Why is this not the case for women?

The ‘‘fight-or-flight’’ response to stress, although present in both men and women, is proposed to be stronger in men and a ‘‘tend-and-befriend’’ response more common in women in response to stress (35). These response differences could explain why men might benefit more from physical activity while under stress than women.

The researchers also note that the J-curve response isn’t very pronounced in their data, likely because very few of the respondents were exercising at anywhere near the intensity and duration of a marathon runner: “A participant classified as having a high physical activity (>55 MET*h/d) in our study would for example be someone with a sedentary job that goes jogging or to the gym for an hour each day and is moderately active the rest of the day.”

Why fatigue and illness aren’t the same as “overtraining”

April 3rd, 2009
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Got an interesting e-mail about overtraining from a Jockology reader named Nathan:

I used to train frequently and at a high exertion level, as a result I […] was often fatigued and sick. It also appeared that other athletes arround me who exercised frequently for sport specific activities (e.g., triathlons, distance running, cycling, etc.) were also sick frequently.

This is a pretty common observation — if exercise is a miracle drug, I guess this is the fine print. Nathan goes on to frame the question in terms of a hypothetical graph of health benefits versus amount of exercise. As activity increases, health improves — but at a certain point, it begins to plateau, and eventually more exercise actually makes you less healthy.

There’s an element of truth to this, but it’s not the full story. Read more…


Exercising when you’re sick

March 4th, 2009
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Blah. I have a sore throat, a bit of congestion, and I’ve been feeling crappy for a couple of days. So should I exercise or not? Nobody really knows. A few months ago, Gina Kolata wrote an interesting article in the New York Times on this question. A couple of studies done a decade ago suggest that a head cold won’t hurt your capacity to exercise (though you may feel more tired), and exercise won’t speed up or slow down your recovery (though it may make you feel better). Other than that, we’re all just guessing.

Me, I took yesterday off and hoped that would be enough. Then I went for a short jog this morning, but cut it short when I felt worse than I expected. Cliche though it is, listening to your body is probably the best we can do for now. If you start feeling better as you get into it, that’s great; if you feel worse, cut your losses.