What to do when a cold threatens your big race

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I'm running my first marathon this weekend, and I've come down with a cold. Can I run with it? Is it safe to take a cold medication if it’s bothering me on race day?

This is an important issue for runners, especially for those racing longer distances. And it is very timely with the start of the autumn racing season, which is when viral illnesses seem come out of hibernation.

There is very little data regarding outcomes for runners who choose to compete when they are ill or recovering from a recent illness. Many of us involved in marathon medicine have observed that recent illness seems to be related to exertional heat stroke both on hot and cool days, but this has not been formally studied.

There is data coming out of South Africa presented at scientific meetings (but not yet published) suggesting runners who have been recently ill have a lesser chance of finishing the race. This seems especially true for those who have been systemically ill with fever, muscle aches or diarrhoea.

In sports-medicine circles, we commonly use the “neck check” to advise patients regarding participation, but this is based on expert opinion and not on outcomes data. The neck check suggests that symptoms above the neck - like a runny nose - are probably safe for participation. However, symptoms at and below the neck are probably not safe. If you are experiencing a fever, chills, and muscle aches, I'd advise you not to train or race.

As for medication, if you need medication to participate because you do not feel well, you probably shouldn't attempt to start the race. I generally don't recommend over-the-counter cold medications, since time will usually do the job. Medications that “dry up” the nasal passages may affect other systems and may not be safe during exercise, especially if you haven't used the medication during training.

A first marathon is a physical and mental challenge. It may be prudent not to run ill when you have no point of reference to your well-being along the course. If you are systemically ill, you also risk passing your illness on to the other competitors and the volunteers who are giving their time to make your race safe and enjoyable.

Here are a few tips for running a healthy marathon:

  • Respect the virus: Don’t run ill.
  • Respect hot conditions: Don’t start if you are not acclimated to the conditions.
  • Know your fluid needs: Don’t drink too much, and if you don’t know your sweat rate for fluid replacement, drink to thirst.
  • Use tried equipment and strategies: Don’t wear new shoes or try new foods, fluids, or medications.
  • Keep your pace: Don’t get caught up in the excitement and go out too fast.
  • Listen to your body: Don’t ignore symptoms like chest pain or excessive fatigue.