Fast Physiology with Dr. Phil: When return to training after battling illness

Summary
In this episode, Dave and Dr. Phil discuss the healthy way to return to training after dealing with an illness. They emphasize the importance of understanding the stress that illness puts on the body and the need for proper recovery. They caution against jumping back into intense training too soon and recommend a conservative approach. They also discuss the cultural tendency to push through illness and the importance of being patient and not rushing the return to training. Overall, they stress the importance of stress management and listening to your body

Takeaways

• Illness is an extra stressor on the body and requires recovery time.
• Returning to training after illness should be done conservatively, gradually increasing intensity and volume.
• Listen to your body and be patient with the recovery process.
• Avoid the temptation to jump back into intense training too soon.
• Proper stress management is key to maintaining overall health and performance.

Find Phil at CriticalOxygen.com and follow him on Instagram. 

Find other episodes of #FastPhysiology on the Critical Oxygen Podcast

Transcript

Dave S (00:01.071)
Welcome back to the Training Bible Podcast. I'm your host Dave Schell and we are back for another Fast Physiology with Dr. Phil. Dr. Phil, thanks for coming back.

Phil Batterson (00:08.8)
Of course, Dave, always excited to talk with you, man.

Dave S (00:12.334)
So I'm excited about this one, even though I think a lot of athletes will hate it. So we were just talking offline and right now, I mean, I'll release this probably this week or next week, but looking in training peaks, like so many of my athletes at the moment are saying that they're sick and a lot of them, it ends up being COVID. And so regardless of what it is, whether it's the flu or whether it's the, you know, a cold or like,

there's always this tug of war with athletes where nobody wants to miss training and they want to push through it and stuff like that. And so today we are gonna kind of delve into what is the healthy way to return back to training once you've dealt with an illness, whatever that happens to be. And so yeah, I guess let's just start with that. What are your thoughts on that?

Phil Batterson (01:09.729)
Yeah, so where my mind always goes is kind of like, what are we dealing with right when we're getting sick? And being sick in itself is a form of an extra stressor on your body. And like we've talked about, Dave, numerous times is that you only have a certain amount of stress that you can deal with and adapt from on, you know, like a daily, weekly, monthly basis. So by getting sick,

you're essentially having some acute level of stress that's going on and your body is trying to deal with that. And you know, that's why you're tired all the time when you're sick, potentially. That's why, you know, you have a fever when you're sick. That's actually, you know, one of the stresses is that you're, you're, you just get hot because you know, your, your body is trying to produce enough energy to, you know, fight off whatever infection is going on. So

We have all these things going on when we're sick and then, you know, all of a sudden, you know, maybe, maybe you wake up one day and you're like, wow, I actually am not sick anymore. And, then I think we forget that we were just battling something that was a high stress for, you know, two, three, four, five days to a week. And we think that, you know, just because I'm not feeling that stress of being sick anymore, I can just jump right back on.

you know, get right back to where I left off. And if I don't know if you and I talked about this or Aaron Geiser and I were talking about this, but it was it was, you know, tracking, you know, sort of like the progression of exercise and how when you exercise, you actually decrease your performance after a pretty large stress load. And then what you need to do is you need to recover in order to get back up, you know, supercompensate as it were. So if we're thinking about just stress in general.

Dave S (02:48.617)
Right.

Phil Batterson (02:59.746)
You were just like, you know, you're you're exercising, exercising, exercising, hopefully recovering enough. Your performance is is up here and then you get sick and that's a massive stress, right? We just established that. So, you know, your performance is actually going to go down. And one thing that I think people don't also don't really remember is like, yeah, even though you're laying around doing nothing, because you have that fever, because you're trying to fight off that sickness, you're burning a lot of calories. And most likely, like I when I'm sick, I'm not.

eating that many calories. Like I might have like, you know, like a smoothie or some soda just because that makes me feel better. But even, you know, even chugging like a bunch of soda and stuff like that isn't going to replace all the calories that you're burning. So from that perspective, you're also probably depleting some substrate stores as well, you know, glycogen and those sort of things. So then when you go out and you know, you're now now like our performances up here, we got sick for seven days and our performance is down here. Now when we go out and we want to exercise again,

Dave S (03:27.689)
Right.

Phil Batterson (03:55.555)
You know, like in response to that, we still have the lingering stress of the exercise that's going on. Plus now the stress of the exercise that we're doing. And that's where, you know, you were saying you're like, yeah, I went out for a really easy ride and I was, you know, way below the power outputs that I normally am at. And my heart rate was like 20 or 30 beats higher. And like, yeah, that's cause the stress of exercise now is compounding with the stress of the sickness.

So your body is just having to try to mitigate both of those at the same time.

Dave S (04:27.175)
Yeah. Yeah. And I, I always, I think you and I've talked about this before too, like talking about like productive stress and when we're, everybody kind of looks at like the training is the productive part, right? And it's actually not, it's the training is like providing the stress, the stimulus so that when we back it off, our body adapts to it. And so if you're either like training too much or like burning the candle at both ends and trying to feel every available minute,

Phil Batterson (04:35.588)
Mm -hmm.

Dave S (04:56.358)
with training, but then you're also going to work and like missing out on meals and missing out on sleep. It's like, it's probably not productive stress. And so I liked, I think you brought it up a minute ago. And I always think about this too is like, we have this, this bucket of resources to fight off things or to adapt to things. But if all of a sudden we're fighting off an illness and we're training hard, now we're splitting the resources. And so I always liken it to picking a scab.

Like if you keep picking it, it's just gonna take longer to heal, you know? And so it's like if you're trying to split your resources between training and also fighting off this thing, it's gonna take you longer to recover and you're not going to get faster.

Phil Batterson (05:38.406)
Yeah, no, I 100 % agree. And what, you know, that, that scab analogy, I think that kind of rings true because if, if somebody, for example, was training, training, training, then all of a sudden they got, you know, like an injury, like a broken foot where they actually couldn't exercise or something like that. You know, like they'd be like, okay, I need to take some time off, take a break, you know, whatever. But sickness is, is different for some reason where people are like, don't view it as.

you know, like, like a signal or a sign that your body needs to recover more. Like it's, it's different.

Dave S (06:10.66)
Well, I feel like it's a cultural thing too, right? It's like we, like as Americans, like we still show up to the office when we have, when we're sick and we work through it and like even rarely take the sick leave. And I think a lot of people maybe wear it as like a badge of courage or like, you know, like we celebrate that when people push through and like, you know, but it's like counterproductive a lot of times, I think.

Phil Batterson (06:14.598)
Yeah.

Phil Batterson (06:19.014)
Mm -hmm.

Phil Batterson (06:38.312)
absolutely. I think like, like, this is something that I say all the time. So I always take a conservative approach to training. Like if, if something, you know, if I have like a weird, you know, twinge in my, well, generally, and then I end up injuring myself just because I go too hard all the time wearing it as a badge of courage, right? But no, so, so with my athletes, I always take a conservative approach where it's like, yeah, you know, like I'm feeling kind of sore and achy today. Okay. Well, you were supposed to do a threshold run. Let's just make it easy one, like an easy run today because

Dave S (06:50.37)
Yeah

Phil Batterson (07:07.465)
I have never had a workout where I went too easy and was sad by that, but I've had workouts where I go too hard when my body is signaling to go easier. And then I'm out for two, three, four, six weeks. So I would rather go easy one day, lose a quote unquote day of intense training and then be able to just hit the intense training either the next day or the day after that, or just when it comes back up in the training cycle again.

Dave S (07:24.066)
Yeah.

Dave S (07:37.441)
Yeah.

Phil Batterson (07:37.641)
and continue to exercise rather than being like, you know, like, like my, my Achilles was kind of hurting today, but I had a threshold run on, you know, on the board. So I had to do it. And then all of a sudden you have a ruptured Achilles tendon, you know, speaking from experience. So it's, it's a similar thing with, with being sick. It's like, you know, the, all these people are like, is it safe to, is it safe to train if I have, you know, like, like, like

Dave S (07:52.449)
Yeah.

Phil Batterson (08:02.344)
stuffy nose or, you know, like, lungs or whatever. And there's, there's this weird rule that people have made up that anything above, above the neck is okay. And then anything below the neck is not okay to train with. And it's like, no, just take an easy day. You having a stuffy nose, if it's not allergies or something like that is an indication that your body is either not dealing with the stress of training or the stress of your life. And, you know, is having some immune response.

Dave S (08:17.184)
And I'll do it.

Phil Batterson (08:30.185)
Or it's just, yeah, it's an indication that you're potentially getting sick and the quicker you switch from stress mode to recovery mode, the faster you are going to get back from that. Right? Because exercise is a stress that you're just going to add more stress to your body. That's already gonna, you know, kind of be like the red sirens are flaring being like, shit, you know, like man, all battle stations. Cause we're getting sick.

Dave S (08:42.047)
and

Dave S (08:54.91)
Yeah, and so I use that same rule, but I think I'll kind of disagree with you or play the devil's advocate here. And it's not keep training, the rule is, and there's logic behind it, if it's above the neck, if it's a sore throat, if it's a little bit of congestion or like head or something like that, then you can keep training easy, like zone two, like less than two hours. If it's below the neck, meaning you've got

Phil Batterson (09:19.4)
Yeah, fair.

Dave S (09:22.749)
congestion in your lungs, you've got GI stuff going on, you've got a fever, then you just need complete rest because you're really dealing with something. And so that's kind of been my rule of thumb and it seems to work well and it's still pretty conservative, right? And now let's talk about like actually returning to training. So let's say, and this is something just to kind of go back to what you were saying. Like I used to be the same way and so I have this anecdotal or this anecdote where it's like,

this is what really changed my thinking on it is, God, it was probably in like 2015 or something, I got sick and I dealt with it for a few days, you know, and I was like, some lung stuff, some coughing, it kind of went away. And it like the first day that I felt mostly okay, I went out and did intervals, like really hard intervals. And then I was sick the next day and it took me like three weeks to get over it.

Like I couldn't breathe. Like when I would stand up, I'd get really dizzy. I was just like short of breath all the time. And it just like really showed me the risk with doing that and like returning to things too quickly. And so I kind of have a timeframe that I follow when somebody's sick. And so I'd like to get your thoughts. Like how do you view, how do you work with your athletes when they start saying they're ready to go to return to training?

Phil Batterson (10:42.859)
Yeah, well, first of all, so the above the neck below the chest sort of thing, like I think that's a good framework, right? To give people, you know, like, okay, you got to go eat easier or completely cut it out, right? It gives people a decision, a decision -making, you know, sort of, sort of route that, you know, they don't have to consult a coach or something like that. That's like, yep, this is the rule. Go easier or, you know, don't do anything at all. But when you're returning from being sick,

Dave S (10:54.491)
Yeah.

Phil Batterson (11:11.691)
There you know, there's a lot of you know general kind of like you like rules that people have followed and in the past I've done ones where it's like for every day that you're sick. It's like two days of easy before you come back So if you're sick for three days, then you're doing, you know, essentially six days of fairly easy work and We're testing the waters like we're not we're not trying to jump into the deep end and have you drown on the first day that you get back from training

Dave S (11:31.739)
And people hate that, right?

Yeah.

Phil Batterson (11:38.252)
we're trying to be like, okay, let's go to four feet today. Let's go to five feet. Let's go to six feet. And then when your heart rate and those sort of things are like start to come back down to what we would normally see, that's when it's like, okay, let's give it a go and then do something conservative in terms of like, you know, whatever sort of interval style training we're doing at the time, whether that's threshold or high intensity interval training or sprint interval training.

It's like, yep, we're going to do one or two and just see how your body responds to that. Cause again, like, you know, it's all stress mitigation and stress management. And, you know, it's easier to manage the stress at lower intensities. It's harder to manage the stress because it can be, it can run away real fast. You know, say for example, if you're already, you know, kind of, kind of red lining after, after two intervals, if you, if we had three or four on the schedule, you could essentially be doubling the amount of fatigue that you're accumulating.

Dave S (12:08.091)
Yeah.

Phil Batterson (12:32.749)
or stress and then like you had happen, open up your body for even worse infections that then take even longer to come back from. So it's again, it's a conservative approach for me. It's like, go easy for multiple days, test the waters a little bit, test the waters again, test the waters again. And then once we start to see those physiological responses come back to where we were seeing it before you were sick, then we can say, okay, we're probably back to normal.

Dave S (13:02.715)
Yeah, I really like the idea of using heart rate and something like power or paste together to kind of see what were you at before, where are you at now, and when do you return to that baseline. And I haven't done that, but maybe I'll start doing that. Typically, I just have it in my head that once somebody starts telling me, I'm ready, I'm ready to go, it's like, I want three days of pretty moderate training, easy to moderate. And if...

things continue to trend up or don't get worse, then we might start to introduce a little bit into that low heavy domain, if I'm gonna use that, but tempo. So we're getting into a little bit above zone two, breathing is a little bit elevated, stuff like that, but we're not doing super stressful stuff. And then that might be the next week where we're just kind of doing some tempo workouts and seeing how that feels. And then if you're still good after that week, then I'll generally jump back into not exactly where we were.

but close to where we were. Because I think that's the other thing too, is people want to just pick up where they left off.

Phil Batterson (14:06.989)
Yeah, yeah, everyone, everyone wants training to be this like beautiful linear sort of thing. And you know, like the way we talk about it is like, progression all the time, right? It kind of infers some linearity to training. But like, training is anything but that maybe in like, if you zoom out and like get a macro lens of it, like, yeah, it's probably pretty flat trending upwards, but

Dave S (14:11.355)
Exactly.

Dave S (14:18.683)
Yeah.

Phil Batterson (14:28.141)
I always tell people it's like the stock market. The stock market is going up, it's going down, it's going up, it's going down. But the general trend is that it is positive. When you start to introduce extra stresses, I guess this is where I'm going today. Sickness is just an extra stress. And we don't know, especially with things like COVID. I've coached individuals who have long COVID.

Dave S (14:53.147)
Right.

Phil Batterson (14:55.341)
We still, I mean, we know more now, but it is amazing just the changes that the body undergoes after being sick, especially with some of these crazy pulmonary diseases and other things like that where you can potentially.

completely change your ability to, you know, say like oxidize like fats versus carbohydrates. And then, you know, then you're running into issues with that. It's, it's really, really wild, you know, all of like the different things and it's, it's different per person. So that's another big thing is like, you don't want to continue to compound on the stress, especially with something like, like COVID or something along those lines, because you could then induce something like long COVID and trust me, you don't want to be there.

Like it is, it is awful. Like the, the people that I like, I, the people that I've coached and helped like with this sort of stuff, it was like, like they were, went from running marathons to like, you know, heart rates of like one 60 for a three mile easy run. Well, well, well below, you know, marathon pace to the point where it's just like, we just need to walk and just like, make sure that your heart rate isn't just like completely runaway freight train here because it's, it's crazy.

Dave S (15:44.219)
Right.

Dave S (16:11.227)
Yeah.

Yeah, and I was just looking at that because like I mentioned, I've got several athletes that are like all of a sudden sick, I'm sick. And yeah, like essentially the recommendations are seven to 10 days after your symptoms stop, then you can return to 50 % intensity.

Phil Batterson (16:33.644)
Wow, so over the course of seven to 10 days, you're building back up to 50 % like intensity and volume.

Dave S (16:34.075)
15 to 30 minutes.

Dave S (16:39.308)
Yeah, it says you can return to your 50 % of pre -illness intensity for 15 to 30 minutes or something like that. I personally won't go that drastic, but it just shows that the temptation is to jump back to intervals, and I definitely need to fight that.

Phil Batterson (16:51.628)
Yeah.

Phil Batterson (16:59.501)
No, no, and we've, we've talked about it too, right? You know, like the, the statue analogy where like high intensity interval training is kind of like, you know, knocking massive blocks of marble off of your marble statue. The problem with being sick though, is that now your marble is a lot more fragile. So if you're knocking massive blocks off of your marble, then you run the risk of completely fracturing it and you know, like, yeah, yeah, exactly. So, so that, that's the, that's the big analogy and that's like kind of the big takeaway.

Dave S (17:15.056)
Yeah.

Dave S (17:21.296)
having to start over.

Phil Batterson (17:28.3)
you know, from me at least is that, you know, be conservative with this sort of stuff. Like you don't want to, it's much more worth it to take an easy day. Don't let your ego kind of get in the way of things. Back off. And then if you end up getting sick, because you know, there's almost an inevitability of getting sick with just like the exposures to people and other things like that. It's just that it is what it is. But you can be smart about how you come back. Yeah.

Dave S (17:51.6)
Yeah. When we're training, we're breaking down our immune system, you know, over time. And so it's like you open yourself up to being more susceptible to infections and viruses. And so, yeah, I agree. And I like, I would say my takeaway, and this is a quote that I stole from Alan Cousins, and I'm not sure if he's the originator of it, or he stole it from somebody else, but it's be patient, not a patient. And I...

I love that because I think it sums it up perfectly, you know.

Phil Batterson (18:21.964)
Yeah. Yeah. Cause that's, that's what's going to happen if you, you know, if you don't have the patients when you're trying to come back from, you know, being, being sick is that you're just going to go through that revolving door at the waiting room, you know, at your doctor's office. And, you know, I, I've also had individuals in the past who do have, you know, kind of like issues with like chronically being sick. And then we start to run into, you know, like, well, that's probably a stress management sort of thing. Like they were trying to work 60 hours a week and train.

Dave S (18:33.552)
Yeah.

Phil Batterson (18:50.412)
20 hours a week and it was just like, well, this isn't working. Like the recovery isn't there. So if that is you, if you are somebody who like has a tendency to get sick like regularly, then you need to start to think about, you know, the overall stress that you're placing upon your body during, not only during training, but just like in general. And then you probably need to back it off just a little bit. And I know again, it's like everybody's like posting on their Strava and they're posting, you know, how much like

how many miles they're running per week or how fast they're running or like all these other things. And I think a lot of us would be a lot better off if we weren't trying to compare ourselves to others because I've tried to play that game in the past. And, you know, to be honest, like now, like, you know, even though like my, my endurance performance probably isn't as high as it used to be.

Like all my physiological markers are still very, very good, like we were talking about, Dave.

So this is just like, you know, it's my way of saying it's okay to kind of back off and be a little bit more conservative. I think people have more of a tendency to go too hard too often rather than going too easy.

Dave S (20:04.56)
Yeah, and I'll finish this by saying, like, this has always been my philosophy, at least for as long, I think for as long as I've been coaching, but it's, it's a diminishing returns. Is that if you can get 98 % of the performance for 85 % of the work, is that last 2 % really worth all the risks that comes with it? And usually it's not unless you're like Olympians, right? Like,

Phil Batterson (20:28.684)
I mean, unless you're a elite level athlete, yeah.

Dave S (20:32.811)
But it's like for most people, it's not worth riding that edge all the time. And I'd rather like allow a little bit of buffer. And like I always tell people, I'd rather have somebody like a little under trained, but like motivated and healthy and excited than over trained and burned out and you know, all the things that come along with it. So didn't mean to end on that note, but anyway, where can people find you?

Phil Batterson (20:58.7)
Yeah, you guys can always find me if you have more questions on Critical O2 on Instagram. That's typically where I field questions, answer questions. I also have a website called criticaloxygen .com where you can find some of the courses that I'm doing as well as some more information on how I approach things. So you guys can find me basically on Instagram. Reach out if you have questions.

Dave S (21:21.45)
Perfect. Thanks again for your time. I always enjoy doing this and can't wait till the next one.

Phil Batterson (21:27.02)
Thanks Dave.