The chief medical officer at British Athletics, Dr Noel Pollock, along with  Dr James Hull, Dr John Rogers, Dr Nathan Lewis and Dr James Brown offer guidance on exercise, immune functionality  and dealing with COVID-19.  

The coronavirus (COVID-19) is still spreading around the world and is the cause of a global pandemic with the UK currently in the top five nations for fatalities.

As it is overwhelming health care systems, it is paramount that limiting the speed of the spread of the virus is essential via social distancing and adhering to lockdowns.  

Physical activity plays an important part in all our lives and there is some information available about the role of physical activity at this time. This information and guidance is being updated constantly by the government and you should check gov.uk/coronavirus for the latest advice.

Regular physical activity enhances our immune system and makes us less likely to contract infectious diseases. That said, the focus should be on maintenance training at this time: to minimise the risk of injury and maintain a healthy immune system. If you are well you can and should continue to participate in light to moderate physical activity on a daily basis and this may  include strength training, stretching and coordination tasks in addition to running.

Everyone should be socially distancing. This means avoiding close contact (within 2 metres) with anyone outside your household. Therefore, at the current time in the UK, you should not be going for a run, training in groups or doing gymwork/circuits with anyone outside your household. Now it is time for runs on your own or with your family/housemates only. Take full advantage of the excellent online coaching resources, training tips and exercise classes bringing exercise to your front room. 

General measures to ensure you and your immune system are in the best shape possible during this time:

» Regular sleep, ideally of greater than 8 hours per night, is important to help the immune system keep healthy.

» High levels of stress and anxiety have a negative effect on immune function. This is a challenging time for all athletes, especially given your season’s goals or aims may now be uncertain. Seek support if needed and aim to re-plan and consider other ways of re-setting your targets.

» Other strategies to manage stress include continuing with training as regular exercise can help to manage stress and anxiety symptoms and can improve sleep. There are many useful meditation and mindfulness apps which can help you manage stress including Headspace, Calm and Insight Timer?.

» As always, it is important to eat a well-balanced diet and to avoid chronic low energy availability which can significantly impair your immune system.

» Stay well hydrated as saliva is an important part of your oral defence. Warm drinks may also help in this regard, but avoid caffeine in the afternoon/evening due to its negative impact on sleep quality.

» Aim for a high intake of fruit and vegetables ?(7+ portions per day). These contain polyphenols and flavonoids which have an essential role in respiratory immune function and have been shown to reduce the incidence of upper respiratory tract infections.

» Vitamin D supplementation may be particularly important at this time of the year to reduce your risk of respiratory tract infection. If you have not been supplementing through the winter, have not been exposed to sun through the winter months (or if you know your 25 OH vitamin d level is <75nmol/L) then it would be sensible to take over the counter vitamin D3 supplementation.

» Probiotics can be useful in reducing the incidence, severity and duration of upper respiratory tract infections. Work from University College London shows that liquid probiotics survive in the stomach much better than capsules.

» Vitamin C supplementation has been shown to be of benefit in the prevention and treatment of pneumonia. It has also been shown to reduce risk of the common cold in extreme physical stress (skiers and marathon runners) and to reduce the duration of the common cold in the general population. We would recommend taking Vitamin C 500mg daily and increasing this to 1000mg daily if you develop symptoms (persistent cough, fever, breathing problems). Zinc lozenges may also shorten the duration of colds.

» Fish oils contain essential fatty acids and are important in maintaining a healthy immune system. If you have no oily fish in your diet, then 1g of Omega 3 (DHA and EPA) daily may also be helpful.

» There is some evidence to suggest NSAID’s may complicate COVID-19 infection and until more information is available on this problem, we suggest that you discuss with your doctor and stop taking these medications unless absolutely necessary.

» If you have hay fever or asthma, then make sure you have a good supply of any prescribed medications and take this diligently.

» Finally, and one of the most crucial points is also the most simple – wash your hands properly for 20 seconds regularly and remember to avoid touching your face.

COVID-19

The main symptoms of COVID-19 are a fever, a new persistent dry cough, shortness of breath or loss of sense of smell.

If you become unwell you should take advice if needed from your local health care system and online resources (in the UK: gov.uk/coronavirus).

For many people with COVID-19 infection it appears that the illness usually improves over the course of a week. It can however get worse at that time and thus we recommend taking at least 10 days of complete rest from strenuous exercise (and rest for at least 7 days from when your symptoms stop).

This is important and although we still don’t have all the answers to questions of how COVID-19 affects us, it appears that the heart muscle and the lungs can be involved and cause problems even after a week. In some cases this can be very serious and require hospitalisation and high levels of medical support.

If you return to exercise too soon, there is a real risk that you could increase your risk of heart and/or lung complications.

Athletes with chronic medical conditions (for example, asthma) are likely to be at greater risk and in many countries will now be advised to be completely ‘shielded’ and not leave the home.

In some cases, people appear to cope very well with exposure to COVID-19 and may have almost no symptoms (such as only a mild loss of smell and muscle aches). If you develop (even mild) symptoms, then remember that your risk of transmission to others is very high. It is all of our responsibility to keep a safe distance from others and socially isolate. 

The COVID-19 outbreak presents significant challenges for athletes of all abilities. Work hard to keep safe, take moderate exercise, focus on staying healthy and take time to relax and re-plan.

Many thanks from the contributers to this article
Dr Noel Pollock – Consultant in sport & exercise medicine, chief medical officer at British Athletics @DrNoelPollock  
Dr James Hull – Consultant in respiratory medicine, The Royal Brompton Hospital Trust @Breathe_to_win                     
Dr John Rogers – Consultant in sport & exercise medicine, Manchester Foundation Trust and Manchester Institute of Health and Performance @jpmrogers 

Nathan Lewis PhD – lead performance nutrition scientist at the English Institute of Sport, clinical and sports nutrition scientist at Orreco @DrNathanALewis @ORRECO1
Dr James Brown – Sports medicine physician, British Athletics National Performance Institute @sportsdocjb

Athletics Weekly  

References for further reading:

1. Neil P. Walsh (2018) Recommendations to maintain immune health in athletes. European Journal of Sport Science, 18:6, 820-831. DOI: 10.1080/17461391.2018.1449895
2. Campbell JP and Turner JE  (2018) Debunking the Myth of Exercise-Induced Immune Suppression : Redefining the Impact of Exercise on Immunological Health Across the Lifespan. Frontiers in Immunology 9:648. DOI: 10.3389/fimmu.2018.00648
3. Mountjoy M et al (2014) The IOC consensus statement: beyond the Female Athlete Triad. Relative Energy Deficiency in Sport (RED-S). Br J Sports Med Apr;48(7):491-7. DOI: 10.1136/bjsports-2014-093502.
4. Walker Matthew (2017) Why we sleep: The New Science of Sleep and Dreams. ISBN: 9780141983769
5. Sommerville VS et al (2016) Effect of Flavonoids on Upper Respiratory Tract Infections and Immune Function: A Systematic Review and Meta-Analysis. American Society for Nutrition. Adv Nutr 2016;7:488–97. DOI:10.3945/an.115.010538.
6. Bergman P, Lindh A°U, Bjorkhem-Bergman L, Lindh JD (2013) Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 8(6): e65835. DOI:10.1371/journal.pone.0065835
7. Hao Q, Dong BR, Wu T. (2015) Probiotics for preventing acute upper respiratory tract infections. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD006895. DOI: 10.1002/14651858.CD006895.pub3.
8. Das JK, Bilal H, Salam RA, Bhutta ZA. (2018) Vitamin C supplementation for prevention and treatment of pneumonia. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD013134. DOI: 10.1002/14651858.CD013134.
9. Hemila H. (2017) Vitamin C and Infections. Nutrients 2017, 9, 339. DOI:10.3390/nu9040339.
10. Hemila H. (2017) Zinc lozenges and the common cold: a meta-analysis comparing zinc acetate and zinc gluconate, and the role of zinc dosage. Journal of the Royal Society of Medicine Open; 8(5) 1–7. DOI: 10.1177/2054270417694291