Training When Sick

“I’m getting sick; what should I do?” 

We field this question daily. While the answer is obvious if you’re bedridden or can barely feed yourself (Do not work out), how you manage yourself from when you begin to feel symptoms to when you’re back to 100% will make a massive difference in your recovery speed.

What to avoid

Let’s state the obvious. You should avoid the following:

• Training (any kind): Your body won’t adapt, you’ll stay sick for longer, and you’ll just get other people sick. 
• Low-intensity training: Low-intensity training falls into the ‘no training of any kind bucket.’ Just because it ‘feels easy’ doesn’t mean it’s not compromising your ability to recover. 
• Compensating for low-energy or other symptoms with stimulants and other medications: We are not saying don’t take medications – typically, that’s the point: their primary objective is to manage symptoms long enough for you to get some rest. So, you should not use these to compensate and continue operating normally. They are tools to help you sleep better and recover faster, not return to your everyday life and act like everything is okay. 
• Anything that adds more stress: All stressors affect your capacity to recover from illness. Emotional and cognitive stress from work will significantly delay your recovery. 

What to do

1 – Act early

You don’t, and shouldn’t, wait to be bedridden to change your training strategy. Even if you can muster the willpower to get a good training session, you won’t adapt to training when sick; you will only delay the time until your body responds effectively. 

When you exercise, your body has a two-step immune response – an initial one to deal with the stress of the session and a long-term response to create adaptations to more effectively deal with the stressor in the future. This is how and why you get more fit if your training session is a strong enough stimulus. However, this requires your body and immune system to have the requisite resources to adapt to the training session. If you don’t, you won’t get more fit, even if it was a great session. 

A helpful analogy is to think of adaptation as a bank account. Training withdraws money out of your account. So does work and life stress. Sleep, adequate nutrition, and relaxing time with friends and loved ones are how you put money back in so you have a surplus to spend on getting fitter from the stress of your training sessions. 

If you’re in the red because your body is spending your excess funds on fighting off an illness, you don’t have any resources left to deal with the stress of a training session. And, if you go ahead and perform the session anyway, you’re putting yourself deeper into debt, and it will take longer for your body to get into the black again. 

This is a simplified model of the complex process and set of interactions in the body, but it holds in most cases. So, if you are experiencing any of the traditional signs like an elevated temperature, scratchy or sore throat, achy joints, running nose, or coughing, you should immediately cease training. 

Learning to differentiate between fatigue and illness

It can be hard to differentiate between the typical symptoms of accumulated fatigue over a periodized training program, the effects of a high-stress week or disrupted sleep schedule, and the beginning of an illness. But, there are some distinct differences you can learn to detect to help avoid continuing to push when you’re better served by backing off and focusing on recovering. 

The following symptoms fall outside the typical signs of accumulating fatigue from your training program and are indicators that you should stop training and focus on recovery: 

• HRV (heart rate variability) plummets: Sharp drops in heart rate variability typically precede sickness symptoms by a day or two. 
• Deep fatigue: If your body is extremely sluggish, motivation is low, and this doesn’t change as you get going with a training session, it’s best to shut it down.
  
• Elevated resting heart rate: If you use a wearable with continuous HR monitoring, a sudden increase in resting heart rate of 3 to 8+ bpm above baseline could indicate a developing illness. 
• Training heart rate is much higher than expected (8+ beats): If your heart rate is more than 8-10 beats per minute higher than it usually would be at the same pace.   
• RPE (rate of perceived exertion) feels 2-3 clicks higher than normal: Just like heart rate, if everything feels much harder than usual, stop the workout. 
• Grip strength, speed, jump height, etc., are diminished: Speed and power are the first capacities to drop off when your body is compromised. If you can’t move rapidly, you’re not improving your speed & power anyway, so you’re better off moving that session to another day, doing a lower-stress session (like aerobic capacity or recovery), and seeing if it’s just a temporary dip or the beginning of an illness. 
• More aches and pains than normal: If your joints feel more cranky than normal and aren’t getting back to baseline after your warm-up, or your muscles or other soft tissues feel twinges or tweaks like you’re going to pull a muscle or strain something, shut it down for the day. Some residual soreness or stiffness is normal, but if it doesn’t dissipate like normal as you get going, it’s a sign you’re either getting sick or can’t execute a high-intensity session without increased injury risk. Either way, it’s better to play it safe and replace the session with something lower in intensity and impact.  

If you recognize these symptoms and immediately shut down training and focus on recovering, you can avoid or significantly reduce the intensity and duration of your illness. 

2 – Focus on sleep, nutrition, and reducing stress 

Once you’re sick – whether in the early stages or bedridden – recovery should become your number one priority. To help support your body’s response to the illness and speed your recovery, focus on three primary areas: 

1. Get as much high-quality sleep as possible
2. Eat well & hydrate 
3. Take time off work and ask for help 

Let’s take a closer look at each. 

Sleep

Sleep is when our body heals and adapts to the stimulus from the day. So, when we are sick, our recovery needs are amplified, and the importance of restful sleep increases. 

Thinking of sleep the same way you think of nutrition can be helpful. 

If you eat a bucket of Haagen Dazs and two Big Macs daily for dinner, you’re not surprised when you start to gain body fat. On the flip side, if you fasted all day, you’d feel terrible and wouldn’t expect to hit a PR. 

Two easy metrics for measuring sleep are quantity and quality. Just like with the food we eat, both variables are important. 

How much you sleep matters. No matter what you tell yourself, you’re not performing as well on six hours of sleep as you would on eight. The research is unequivocally clear: how much sleep you get impacts your rate of performance improvement.  

Just like nutrition, more isn’t necessarily better. Once you’re getting enough sleep, the second sleep factor comes into play: quality.  

Returning to our nutrition analogy, what you’re eating matters as much as how much you eat. Three thousand calories of Swedish Fish won’t lead to deadlift PRs. Sleep quality is the same. Not all sleep is equally restorative. How well you sleep impacts how quickly your body recovers and your mind learns. 

Sleep fundamentals:

Shoot for 8+ hours of uninterrupted sleep. Getting an extra hour of sleep or adding some naps throughout the day is helpful, but continuous sleep at night is more important than total sleep broken up throughout 24 hours. 

Deep, restful sleep requires a solid sleep environment and a consistent sleep schedule – even when sick. This does not mean avoiding extra sleep or naps during the day but don’t stay up late binging on TV and sleeping late. This will further disrupt your circadian rhythm and your sleep quality. Stick to your routines: 

• Evening routine
  1. Be consistent – Go to bed around the same time. 
  2. Screen time – Dim your screens in the evening and break away from all screens in the last hour before sleep.
  3. Relaxing activities – Read a book, meditate, listen to music, do mobility exercises, foam roll, or anything that helps increase your parasympathetic (rest and relax) system activity. This will help you ease into sleep. 
  4. Clear your mind – having a system to clear your mind before trying to go to sleep is essential for easing into sleep consistently. Journaling, a “brain dump” exercise, or updating your schedule for tomorrow can all be helpful. 
  5. Supplements/medications –  Often, sleep is disrupted when we are sick due to symptoms such as body aches, runny nose, coughing, etc. Consult your doctor for recommendations on over-the-counter medications that can help manage symptoms and allow you to sleep. Listen to episode 77 of our podcast with Dr. Allison Brager for advice on sleep supplements and a deeper understanding of sleep science. 

• Morning routine 
  1. Get up around the same time, even when sick. A little extra sleep is okay, but unless you’re very ill, getting moving and taking a nap later tends to maintain higher quality sleep as you recover. 
  2. Get direct sunlight exposure first thing in the morning, outdoors with no sunglasses on.

Create an ideal sleep environment. This means making your bedroom:

1. Cool
   • Your body prefers a cool environment for sleeping. Turn down the temps and use a heavy blanket for deeper, more restful sleep. 
2. Dark
   • Light is the primary method through which your brain synchronizes your circadian rhythm. Try to reduce light exposure in the 1-2 hours before bedtime. 
   • Turn off all lights in your bedroom (even tiny lights like alarm clock screens and LED lights on electronics) and use blackout curtains. A sleep mask can accomplish the same if this isn’t possible. 
3. Quiet
   • Intermittent noise (like a car horn or a dog flopping around) disrupts deep sleep cycles. If you can’t eliminate these noises, use earplugs. 

Nutrition

Eating well is simple but not easy. It’s not about exotic foods and ultra-precise macro timing. It’s about consistently doing the basic stuff well under a wide range of conditions. The most common sticking point with nutrition is bridging the behavioral gap, where we have to turn what we know into what we consistently do. Doing the basics day in and day out even when we’re tired, stressed, or traveling is a lot harder than it sounds. 

Nutrition fundamentals – eating enough vegetables, protein, a variety of fats, and high-quality carbohydrates is all that most people in most situations need to worry about – including when you’re sick. 

Nutrition basics

Here are the fundamentals you want to focus on:

• Protein – 1g per pound of bodyweight each day / around 50-70g each meal / 2 palms worth each meal
• Fats – .5g per pound of bodyweight each day / around 20-30g each meal / 2 thumbs worth each meal
• Carbohydrates – 1-1.5g per pound of bodyweight each day / around 50-80g each meal / 2-3 cupped handfuls worth each meal
• Vegetables & Fruits – 8+ cups per day with a 2:1 ratio of veg/fruit / 2 fists worth each meal

Being sick isn’t the time to stop eating (starving a cold doesn’t work) or feed yourself like a child. Your body needs nutrients to support your immune system and help you recover. 

Eating when sick can be more difficult due to symptoms, reduced hunger signals, GI distress, etc., so this isn’t a comprehensive guide on managing nutrition for all illnesses. However, the more nutrients you can eat and metabolize, the more resources your body has to fuel recovery. 

Our bodies are generally resilient and very good at managing different stressors if we tune into the signals they provide. If you’re sick with food poisoning or a gastrointestinal illness, you may not have an appetite for a while. That’s fine. When your appetite returns, focus on easily digestible, nutrient-dense foods, and stay well hydrated if you’re unable to eat. 

Hydrate

Fevers make dehydration more likely. GI disturbances and increased mucus production further increase the likelihood of dehydration. Dehydration is a significant stressor to your body and will inhibit your ability to recover. So, ensure that you’re getting enough fluids. 

You should aim for 3-4 liters daily (at minimum). 

The best way to do this is to ensure you have a liter first thing in the morning, one liter mid-morning, one liter with lunch, and one liter with dinner. 

The easiest way to assess hydration status is via a urine-color chart. See below: 

• If you’re sliding into the fair to dehydrated zone, immediately drink 8-16 ounces of water. 
• If you’re in the very to severe hydration zone, immediately drink 1 liter of water and continue to hydrate if thirsty. 

Electrolytes (sodium, potassium, chloride, magnesium, calcium) are all lost via sweat, which is likely to occur when you have a fever. Adding an electrolyte solution to one of your drinks throughout the day will ensure you’re replacing these vital nutrients. That’s especially important if you’re unable to eat for a while because you won’t have your usual dietary sources of electrolytes. 

Take time off work

All stressors matter. If possible, take some time off work & ask for help. 

You’re not helping anyone by showing up at work, performing poorly, getting others sick, and delaying the time it takes to return to normal. The same is true at home. Don’t power through – ask for help and focus on recovering. 

Of course, some obligations can’t be set aside or delayed. But, if possible, give yourself some space to recover and ask for help. If you’re reading this, you’re probably the type of person who is not a liability but an asset to your family, friends, and coworkers. Asking for support once in a while isn’t a sign of weakness, but that you trust these people enough to have your back. The purpose of a community is to support each other to make the whole stronger. Working yourself to the bone or continuing to push through when you’re compromised isn’t helping them or you in the long run. 

3 – If you’re on the mend, let symptoms guide you.

As you start feeling better, jumping back into hard training sessions can be tempting. This mistake is a great way to extend your recovery time significantly. Or, if you push hard enough, revert to being entirely ill again. 

The Golden Rule of Exercise when Recovering: You should feel better after your workout. Your goal is to stimulate recovery, not delay it.

You should feel better immediately and the day after training, not worse. If you start to feel worse during a workout, shut it down. Full stop. 

Sometimes, you’ll feel a bit better after your session, but take a nosedive later or the following day. Or, you might feel worse after your training session but return to your previous baseline by the next day. Both are signs you did too much and need more rest before resuming your training. 

If you experience an elevated heart rate, lower energy, or any return of sickness-related symptoms (these will vary based on your illness), then you did too much. Back off or take a complete rest day and then ease back into things.

4 – Perform aerobic and movement training for your first few sessions. 

Aerobic training

Not all training stressors are the same. All recovery is aerobic, so light aerobic exercise can stimulate and speed your recovery. These sessions are also lower in intensity, creating a lower recovery demand, which makes them the ideal choice for easing back into exercise. 

Guidelines: 

• Stick to heart rate zone 1 or 2, nasal breathing only, or an RPE (rate of perceived exertion) in the 3-5 zone.
• Keep sessions shorter than you think they should be. A good rule is to start with 15 minutes for your first sessions and add 10-15 minutes per session.  
• Being outdoors has other health benefits that can also stimulate recovery. So, if possible, go for a walk, hike, bike ride, etc., and stay out of the gym. 

Movement circuits 

Light movement work paired with breathing cues stimulates the aerobic and parasympathetic nervous systems. It’s also a nice way to get full body movement without picking up heavy objects or even going to the gym. These sessions are also concise and require no equipment. If you’re in our training app, you’ll have quite a few circuits of these kinds of movements available in the on-demand section.

Here are some examples:

5 – Return to strength training and other high-intensity sessions slowly. 

If you’ve performed a few days of aerobic exercise and movement circuits and consistently feel better the following days and feel like you’re returning to normal (see the checklist below), you can start easing into strength training by managing intensity & volume.

Checklist for training to strength and other high-intensity training sessions: 

• No fever, nausea, GI issues, runny nose, or other symptoms.
• HRV, resting heart rate, and RPE during low-intensity training are returning to baseline.
• Energy levels throughout the day are returning to normal. 
• Sleep quality is high and continuous (not disrupted due to coughing, runny nose, aches and pains, etc.).
• You feel better the day after each training session (you’re not delaying recovery). 

Guidelines for returning to high-intensity training: 

• Start with 50% of your previous volume: If your workout calls for five sets of five reps cut it to two or three sets of five reps. 
• Reduce intensity by 20-25%: If you’d normally use 200 pounds for five reps, use 150-160 pounds. 
• Add 10% more volume and 5% intensity each workout until you’re back to normal: 
  • Day 1-3: 50% volume, reduce intensity by 20-25%
  • Day 4-6: Increase volume by 10% and intensity by 5ish% each day and return to full intensity as long as you’re still feeling better/more normal each day
  • Week 2: Back to normal 

This is a general formula, not a rigid set of guidelines. Depending on how sick you were and how long you have been out of action, you may need to slow down this progression. Detraining occurs quickly, so losing some fitness is normal if you are out of action for a week or more. These losses are temporary; you’ll return to your previous baseline within a few weeks. The worst thing you can do is rush back into training and expect to hit the same weights or pacing immediately – this is a good way to injure yourself or delay your recovery. You’ll be training for a lifetime, so think long-term. 

As you ease into full-intensity training, monitor your resting heart rate, HRV (if you use it), and other objective & subjective data points like heart rate and RPE during sessions. If you see a rapid change in any of these (as outlined in step 1), back off and let your body recover. 

6 – Figure out why you got sick.

Once you’re back to normal, it’s a good time to figure out why you got sick in the first place. Ask yourself: 

Was this preventable or just a normal part of life?

Everyone gets sick sometimes, especially those of you with young children, working in health care, or amid unavoidably high-stress life phases. However, an imbalance between stress and recovery is the primary reason for most illnesses. In other words, this situation may have been preventable, and there were undoubtedly components of it that you had control over. 

If we take the time to reflect on the variables that led to our immune system being so worn down that it was compromised, we can helpt to avoid this situation or reduce its likelihood of recurrence. 

Adaptability, or your ability to effectively adapt to training without negative health consequences, is primarily affected by nutrition, sleep, and stress. 

Your body is always adapting. Everything that you do places some form of stressor on your body, and it responds accordingly.

People generally tend to fall into one of these two camps:

Net Positive Adaptation Process: the body has a surplus of resources created by balancing recovery and training stressors, so the body utilizes these resources to adapt to the training you’re doing (gain muscle, more mitochondria, new or stronger neural connections in the brain, etc). 

Net Negative Adaptation Process: the body adapts to your training stimulus, but by doing so, you become vulnerable to other problems because of stress’s cumulative and progressive nature. Do this for long enough, and you can get injured, burned out, sick, hormonally imbalanced, etc.

If you train hard, your body will adapt, but adaptation costs vary. Both processes utilize resources to create an adaptation, but one comes at the expense of health, while the other maintains it and improves resilience.

When training correctly, you apply enough stress (local and systemic) to elicit the desired adaptation response without flattening the readiness curve (always training, never improving) or adapting at the cost of another physiological system.

Over time, you want to stress the system enough to create a significant specific adaptation response and then allow the body to recover. More is not necessarily better – you need enough stress to induce an adaptation response, but not so much that you overwhelm the body or never back off and allow the body to adapt to the training response.

The graph below illustrates the process of stress accumulation, recovery, and improved fitness over time when you manage stress effectively.

When you apply too much stress, recover too little, or some combination thereof for long enough, something breaks. It could be in the form of soft tissue injuries, illness, and/or mental performance falling off a cliff. 

The human body is incredibly resilient. It takes a considerable deficit before things start breaking down. 

You have excess hormones and less damage from years of hard training when you’re young. This buys you wiggle room. As you age, your hormone production naturally declines (very incrementally if you are healthy), your tissues become less pliable, and you accumulate minor wear and tear in all body systems. This tends to coincide with a greater awareness of other people and increased responsibilities in every aspect of your life. 

None of this is free. Even purely mental tasks like managing relationships and thinking about how your actions impact others increase your systemic stress (even when well-managed). 

This is why you don’t get away with the same things as you get older than you did when you were younger. No matter how smart you are about caring for yourself, you must be more conscientious about recovery as you age. 

If you’re falling into the negative adaptation pattern and constantly getting sick, it’s worth asking yourself where you’re going astray: 

1. Too much stress? Areas of stress include: 
   • Physical training: how much/what are you doing for exercise
   • Life and work demands: all cognitive, emotional, and physical demands outside training. 
2. Not enough recovery?
   • Sleep quality and quantity
   • Nutrition quality and quantity

Ask yourself, do you have too much stress, not enough recovery, or a combination of both? 

Whatever the answer is, identify the root of the problem so you can address it instead of constantly battling against symptoms.