Feeling sick but still want to exercise? Let the ‘neck rule’ be your guide

Be careful about exercising when you're ill.
(Tom Merton / Getty Images/OJO Images RF)

It’s that time of year again — the time for sore throats and sniffles, body aches and fevers.

It’s also the time for throat lozenges, hot tea with lemon, chicken soup and long naps.

But what about sweating it out? What’s a fitness fanatic to do when the gym emits its siren call? Will some perspiration banish the virus that’s otherwise dragging the body back down toward the pillows?


If you’re sick, experts say, tone it down.

If you’re really dragging, just rest.

In fact, if there’s one phrase David Nieman hates, it’s “sweat it out.” The idea that a virus is best vanquished by a tough workout “is crazy,” said the Appalachian State University professor. “It’s a myth, and it’s dangerous.”


Nieman should know. Not only is he a seasoned marathoner and ultra-marathoner, he’s also the author of multiple studies on the effect of exercise on health. The evidence, he said, is in, and it does not support workouts as a remedy for the sniffles.

That doesn’t mean everyone with a sore throat needs to take to bed. Experts like to quote the neck rule: If the symptoms remain above the neck, go forth and work out, in moderation.

“The workout is OK if you can comfortably hold a conversation while doing it,” said Cedric X. Bryant, chief science officer for the American Council on Exercise.

As to whether the exercise will be beneficial, there’s some disagreement.

“It’s not going to help,” Nieman said, “but it’s not going to hurt.”

Bryant, though, sees some benefit. “That level of exercise gives us a little boost in our immune system function,” he said.

Jennifer Holmberg, 39, a social worker in West Los Angeles, would agree. A regular runner, she’s loath to change her routine just because of a stuffy nose. “I often don’t want to go,” she said, “but when I do get out the door, it’s awesome.” But, she allowed, “if I’m not feeling great, I take it easy.”

So a light to moderate head cold gets a green light for exercise.

The flu is a different story.

If the symptoms are below the neck — chills, body ache, fever or nausea — for heaven’s sake, experts urge, get some rest.

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Working out with the flu “is going to set you back rather than help you recover more quickly,” Bryant said.

Dan Stone, a Cedars-Sinai internist, knows this phenomenon well. Each year, Stone said, he has eight to 10 patients who stay sick with a cold or the flu for pretty much the entire season. And it’s not, he added, because these patients have compromised immune systems, though they nearly always ask if that’s the issue. Usually, they just refused to slow down.

“Once you get nailed by the first one, and you don’t let yourself get enough sleep and rest, then you’re at risk of getting one thing after another,” he said.

He advises his patients to think of exercise as a form of stress. When your body is healthy, putting it through stress can make it stronger. But when you’re ill and you decide to go for, say, a long run, “you are adding stress to a system that’s already stressed,” Stone said. “Why do that?”



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