Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#17: Should you rest or stay active when you feel sick?
It used to be when you got sick, you were advised to "take it easy". But, does the evidence support this approach? And, it isn't just an academic question since, on average, we get 2-4 colds/year and many of us will have an episode of low back pain. And, how about COVID? Rest or stay active?
1. Low back pain: a key randomized clinical trial showed that prolonged bed rest did not do better than usual activities. Now we advise patients to continue activities.
2. Moderate exercise does not lessen (or worsen) cold symptoms. But, exercise may reduce the number of colds you get.
3. Sauna use doesn't make the cold go away faster but may reduce the number of infections that you experience.
4. COVID-it appears that exercise may reduce the likelihood of fatigue, anxiety, brain fog if you do get long COVID.
5. Multiple Sclerosis-previously it was feared that exercise might worsen the disease. Recent guidance is to be physically active.
Reach out to Dr. Bobby: www.DrBobbyLiveLongandWell.com
Hi, I'm Dr Bobby and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and figure that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome everyone.
Dr. Bobby Dubois:Today it's episode 16. Should you rest or stay active when you feel sick? Now you might think this is just an academic question that doesn't really matter in day-to-day life, but it really affects pretty much all of us every year. Why do I say that? Well, the average American adult gets about two to four colds a year, and each cold lasts oh I don't know three to seven days. So whether, when you have a cold, you should stay active or rest is an important issue. Well, most Americans will have an episode of back pain. Probably 13 to 15 percent of Americans will have two weeks of back pain in any given year. Again, should you stay active or should you rest? Most? All of us have had COVID, perhaps many times and again, for all of these, the question is should I rest or continue to be active? Well, I always like to begin these episodes with a bit of a personal story like why am I interested in this topic? And I'm actually quite interested in the topic, and let me explain why.
Dr. Bobby Dubois:In August, my brother and I did what's called the swim-run race in Casco Bay, which is outside of Portland Maine, and you, basically, as a team two-man team swim from island to island to island and then you run across each of the islands in between, and this goes on for a number of hours. It's fun and it's definitely something that us two brothers enjoy doing. Now, why am I telling you this? Well, tuesday of that week, with the race on Sunday, I wasn't feeling well. Actually, I hadn't been feeling well for a couple of days and I decided well, I guess I better check and see if I have COVID. Well, guess what? I tested positive. Now, at the time, tuesday, wednesday, I didn't have any fever, I did feel tired and I was congested and all those kinds of things. So here I am as a physician, as a triathlete, asking myself well, should I compete on Sunday? Is that a good idea or a really bad idea.
Dr. Bobby Dubois:Well before I had a chance to look at the evidence, which I did after the race, I was just sort of deciding I'm doing it out of stubbornness and that I would do the race. Now, of course, I thought carefully about am I going to infect anyone? And it turns out my brother didn't catch anything from me and I realized that we would be outdoors, we would be long distances from most of the other individuals in the race and then, other than perhaps I didn't feel normal, I shouldn't be hurting anybody else. And that turned out to be the case. So I did the race. I enjoyed the race. I was definitely not 100%. But then I went back and said well, what is the evidence? Because this isn't the only time this will come up, where I end up feeling sick and I ask whether I should continue my usual activities or whether I should race. I mean I should say that as a kid my grandmother would be like oh, you have a headache, go to bed. You have a cold, go to bed. I mean that was sort of the common answer back when I was eight or 10 years old. I wasn't looking at evidence, so who knew? But let's now delve into the evidence so you'll know what to do and how to handle your own life experiences when these types of things pop up.
Dr. Bobby Dubois:Well, let me give you a bit of background. If we go back 20, 30, 40 years, there was a general belief that rest is critical for healing, and one of the sort of classic examples I'll get to in a few minutes was for low back pain, and they thought you should go to bed for about a week to allow the inflammation to heal. It was felt that for chronic diseases like a multiple sclerosis, that activity might worsen the disease. And again, there was also feeling that even a simple cold exercising might be bad for you. So this belief has been around for a while and I'm going to try to talk through what the evidence tells us Now before I get too eager and excited about the fact you can continue to do what you might want to do. There are absolutely diseases where you have to be careful about extreme exercise. So hypertrophic cardiomyopathy is a problem in your heart If you had an aneurysm in your heart. Of course, if you have a serious illness, ask your doctor. I'm talking about sort of minor illnesses when you're otherwise a pretty healthy person. All right, let's go through some examples and begin to build a profile or a sense of what is safe and what is not, what is a good idea and perhaps what is not.
Dr. Bobby Dubois:I mentioned low back pain. So 25% of Americans have back pain at any time and the teaching back in the 1970s 1980s was if you have an acute episode of back pain you were moving furniture, you said ouch and then you were in pain. You might be in pain for the next week or whatever the teaching was, you should go to bed, relax your back for a week. Now the mechanism made sense you have inflammation in your lower back. You may have torn a little muscle, a little ligament, something like that, and that rest should reduce the inflammation. Therefore, bed rest is a key part of how to handle it. Well, in 1986, there was a really, really important clinical trial, a randomized clinical trial, where they actually put this to the test and they said okay, one half of you are going to rest for a week, which was the standard, and one half of you were only going to take it easy for two days, and another group also had usual activity and bottom line is there was no difference. So staying active became the recommendation for people with low back pain. In fact, by going to bed with back pain you might make it worse, because the muscles back there not only do they tighten up, but they may gradually begin to weaken. So when you go back to doing your usual work a week or two later, all of a sudden you're in more risk of having a problem.
Dr. Bobby Dubois:Now there's a famous saying in medicine and it kind of applies here, but it applies in a lot of places which is the role of the doctor is to hold the patient's hand while nature runs its course. So much of what happens in medicine is probably going to resolve on its own. And now you may go to the doctor and you may say oh, that's because the doctor did X, y, z for me, but in this case the rest or the no rest made no real difference and so nature just ran its course. Okay, so back pain is very common. This is how we might think about that as well.
Dr. Bobby Dubois:Well, what about exercising and cold symptoms? Again, mechanistically, you could argue on both sides of this. Exercise might boost your immune system, white blood cells will increase, the cell immunity will increase. But then you can make the argument on the other side that maybe exercise would hinder your immune system. So of course I searched to find out are there any clinical trials of this? And it's a little hard to do because you never know when somebody's going to get a cold.
Dr. Bobby Dubois:So this sort of industrious clinical investigator did a randomized trial to ask the question whether exercise or no exercise affected cold symptoms. And well, here's the problem you never know when somebody's going to get a cold. So what they did is they inoculated these patients, these folks, with the rhinovirus. So in other words, they injected something up in their nose that would give them a cold. So they knew exactly when they were exposed and when they're likely to get a cold.
Dr. Bobby Dubois:And so exercise group did quite a bit of exercise. They were at 70% of their maximum heart rate for 40 minutes, and they did this every other day. And of course, the other group did no exercise. And they asked the folks in the trial to answer a questionnaire how they're feeling every 12 hours, so they could keep track of these two groups. And they followed them out for 10 days. What did they find? Well, it made no difference. Yes, the people got a cold, but it didn't really matter whether you were exercising or you didn't exercise. The length of symptoms was about the same and there's been a sort of a popular kind of recommendation among sort of the team exercise community, high school sports and others, and they called it the neck check approach, which means if you have no symptoms below your neck, you're fine to exercise.
Dr. Bobby Dubois:Now, of course, there was no evidence I could find that supports this neck check approach In the case of the cold symptoms. Yes, by and large they are above the neck, but I know when I get a cold I do feel tired all over. So anyhow, that didn't make a difference in that scenario. But here's one where it did make a difference and that is that exercise might reduce your risk of getting a cold. So there's actually been four clinical trials, about 300 people, and they asked the question whether people who regularly exercised at a moderate intensity whether they had fewer colds over the course of the time. They were observing them and they observed them for a few months. Well, it turned out that the exercise group that had three and a half fewer days with symptoms. So although it didn't look like exercise, made the cold go away faster. It might reduce the fact you got a cold in the first place. Of course I take it from the exercise one and whether the symptoms go away is well, you know, if I want exercise, it's certainly not going to make the cold worse.
Dr. Bobby Dubois:All right, here's another one. It's not exercise, but it's related. So what about taking a sauna when you have a cold? You know people think, oh, I'm just going to kind of burn it out of my system, I'm going to sweat it out of my system.
Dr. Bobby Dubois:And they basically did a randomized control trial. They took 157 patients that had a symptom of a cold. Some of them had a sauna, some of them didn't have a sauna. And what did they find? What they found was just like the exercise in the cold Didn't really make any difference. So if you feel like you want to take a sauna while you have a cold, there's absolutely no reason not to, and it might make you feel, at least temporarily, better. Some people say it opens up their sinuses and they just generally feel a little bit better. But when they did a more formal analysis, no, it didn't shorten the cold and it didn't make it obviously better. But, just like with exercise and having a cold, people who were regular sauna users, they had 25 sauna users, 25 controls and it reduced the rate of getting a cold by 50%. So in both of these situations, although exercise and sauna might not make the cold go away quickly, it actually might reduce the risk of you getting them in the first place or getting another one. So that's interesting and might be something you want to think about.
Dr. Bobby Dubois:Well, what if you have a fever so not just a simple cold, but now you have a fever, perhaps it's a flu, perhaps it's something else. Should you exercise when you have a fever? And people might argue oh, the virus might go to your heart and you'll get myocarditis. And if you already have a fever and you're hot, then if you need to exercise, you can't really tolerate the heat to burn off sweat or whatever else it is. So there's been a lot of theories out there.
Dr. Bobby Dubois:Problem is I couldn't find anything other than anecdotes of people who might've exercised, they might've had a flu and something bad might've happened. Exercise, they might have had a flu and something bad might have happened. But I did not find any strict clinical evidence. So I don't know whether you should treat a flu the same as a cold. Probably because, as I say, I'm pretty stubborn I would probably continue just because I feel like it. But of course, if I'm feeling really tired and I often, with even a cold, feel weak as a kitten, then I certainly will climb into bed and not do a lot of exercise.
Dr. Bobby Dubois:So again, we don't know All right, what about COVID and exercise. Should you rest or should you exercise with COVID? Now we don't have the definitive answer here. It's kind of sad that, given all the people that had COVID over the last number of years, that we don't really know the answer to this one, or at least I couldn't find it. Well, this was a study of about 800 young women and basically they divided or stratified the group into those that had a low amount of exercise, a moderate amount of exercise or a high amount of exercise or physical activity, and they looked at 50 different symptoms and they really were starting to figure out okay, so exercise with COVID. So these are people that exercised while they had COVID and after they had COVID and, interestingly, although they didn't have any sort of general differences in symptoms for people who developed long COVID and again, that's a small number relatively of people who have COVID the people that exercised had fewer mental or neurologic symptoms during the long COVID phase, like fatigue or anxiety or trouble concentrating, and there was some suggestion that maybe it reduced the risk of reinfection. So exercise with COVID again doesn't seem to cause a problem and in fact for long COVID might make it even better. So something to keep in mind.
Dr. Bobby Dubois:So up until now we've talked about acute illnesses or injuries, so the low back pain and colds and flus and the like. But what about chronic illness? Now, every illness may be different and of course you should talk to your doctor about it. As I said in the beginning, it used to be that for multiple sclerosis the theory and the fear was that if you exercise it might cause a flare-up of your symptoms, which could be visual. So patients will feel better and then all of a sudden they'll have a relapse and then they'll feel better again, they'll have another relapse and for some of these people, each time they have a relapse they don't actually return to their baseline of health. They gradually get worse and worse. So at the time, 10, 20, 30 years ago, it was felt that rest for these folks was better because exercise might cause a flare-up. Well, that's all changed and the Multiple Sclerosis Society now recommends exercise is good. They're recommending 150 minutes a week, which is very similar to what all of us should get. So this is just an example of one chronic illness.
Dr. Bobby Dubois:If you have something that you're not sure about, ask your doctor or let me know and maybe I can take a look into it as well. So we've talked about, for the acute illness, whether rest or whether continue your usual activities is a good idea. Rest or whether continue your usual activities is a good idea One of the things that keeps people wanting to exercise. Because they'll say to me, dr Bobby, I've worked so hard to be in good shape and now I've got this cold and it typically lasts a week or two and if I don't exercise I'll lose my fitness and then I'll have to start all over again and that's horrible. Well, to be clear, generally speaking, if you have a cold or something like that, you may not feel up to doing much of anything for a few days. Well, it turns out a few days is not going to do anything to your fitness.
Dr. Bobby Dubois:And studies have been done. They've looked at strength training. So you know, going to the gym lifting weights probably takes about three weeks for whatever strength you might begin to lose to happen. Now, this was a study in young athletes, so you never know whether young or middle age would be different. But they basically asked the people to not train for three weeks and they compared that to the group that continued to train and they basically found no difference in strength. So for a week or two I wouldn't worry about it, don't think about it. Just if you feel like you need to rest, you rest, and if you don't, you don't.
Dr. Bobby Dubois:Well, what about aerobic fitness? You know there's always felt that, oh, I'll get detrained and I won't be able to run and I'll have to again start all over again, which is the fear. But when you've looked, when folks have looked at this issue of loss of aerobic fitness, maybe after about 12 days or so you might begin to see what's called detraining. But by and large, if it's going to be a week and if you're not an Olympic athlete, it won't make much difference. I've got my 70.3 Ironman race in Waco, texas. That'll be a few days after this hits the airways. So it's coming up for me and I'm in a tapering phase Now. For me it'll be about a seven-hour experience and race. So I take a couple of weeks and start to take it quite easy over time so that when I get to race day, I feel full of energy, vim and vigor and excitement. So how does this all net out?
Dr. Bobby Dubois:So, when we think back, where were we as a medical profession 30 or 40 years ago, with rest being often the common thing? To where we are today, I believe, for most illnesses, moving and exercising is a good thing. There's some evidence that exercise might reduce the number of colds that you might get, and it also seems fine. If you exercise or do a sauna or whatever that might stress your body, it's probably fine to continue to do that if you're feeling a bit under the weather. Obviously, if you're feeling awful, then you should take it easy.
Dr. Bobby Dubois:Do what feels right. Is your body telling you that you really can work out? Fine, the science supports that. Does your body say you don't feel good and you really don't want to do much of anything? The science can support that too. So I guess I made the right choice at my swim run with my brother in terms of having COVID and doing a race. But the science is still not perfect on any of this. Until next time, I hope you all stay healthy, but if you get a cold, rest or continue, it's up to you. It's up to you. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobbilivelongandwellcom. That's, doctor, as in D-R Bobby. Live long and wellcom.