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Ask the Doctor – with Michael Ross

By Michael Ross, MD

Dear Doc;
I was recently diagnosed with pneumonia. I was pretty ill for a several days, including a 102-degree temperature, general aches and pains, a pulse of 80 (versus my normal resting pulse in the high 40’s/low 50’s) and some nasty stuff to hack up.A few days of antibiotics and a methylprednisolone [steroid]dose-pack have me on the mend.Given my schedule, my usual training session is short but intense. Now, I’m concerned with when and how hard I should resume training. Any advice would be helpful, Doc.
Hacking up phlegm in CTDear Hacker;
In general, when you are sick, you should perform a “neck check” before returning to activity. If your symptoms are limited to above the neck (nasal congestion, sore throat, ear ache), you may return to activity whenever you are ready. You should start out slow and increase your intensity every 15 minutes. If you feel worse, decrease the intensity or go home.If you have any symptoms below the neck, including systemic symptoms, including fever or swollen glands, you should not resume activity until your symptoms are resolved. When you start exercising again, I recommendthat you go easy two days for every day that you were sick.

If any of your symptoms return, or get worse with exercise, stop. Ifyou are having trouble breathing when you resume exercise, you need moretime off.

In the long run, resting more may be preferable to exercise, especiallyfollowing an illness that required antibiotics. Depending upon where youare in your training plan, you may find that more rest will be more usefulthan easy exercise, which will have very little fitness benefit. The cellsof your immune system require glucose for fuel just as your muscles doand long, easy exercise will be stealing the fuel from your immune system.

As with preventing over-training, if there is a stress to your body outsideof your training plan (emotional or physical) you will likely need morerecovery time.

Incidentally, I hope that you are not planning on participating in anysanctioned competition where you may be drug tested. Steroids are not permittedunder IOC or USADA rules and could prevent you from competing for upwardsof a year if you test positive. Your physician might not be aware of whatis legal and what isn’t, so you should check with the U.S. Anti-dopingagency (www.usantidoping.org)before taking any prescription or over the counter medications.

Don’t overdo it,

Taking it easy
Dear Doc;
I am a Cat.3 masters racer on the road. I feel that I have been traininghard, but continuously feel tired when juggling family, job, and training.I have lightened my training schedule, but the feeling of fatigue persists.Any advice?

Dear JL;
Fatigue can be caused by a number of factors. Sleep deprivation, poornutrition, depression and other medical issues can cause fatigue aloneor contribute to over-training, which itself is perhaps one of the mostavoidable causes for fatigue.

The over-training syndrome is marked by a decrease in performance despitetraining. Symptoms can include sleep disturbances, increased frequencyof infection and a general feeling of “staleness.” However, not all ofthese symptoms need to be present to diagnose over-training.

You can also look for these signs of over-training in your performance:earlier exhaustion during a constant velocity, decreased power during amaximal effort, and increased time over a given distance at a constantheart rate. Other signs can include increased muscle fatigue or increasedheart rate for a similar perception of exertion. A variation in restingpulse, either up or down from your baseline, can also be a sign of over-trainingand should be measured frequently. Each of these factors represents harderwork with less to show for your effort.

Athletic performance improves after the body is stressed and allowedto recover, a principle known as “over-reaching.” If there is inadequaterecovery time, or the stressors to the body are overwhelming, over-reachingcan very easily lead to over-training.

Any given training stimulus needs a certain amount of recovery time.Natural life events, such as sleep deprivation, illness or job stress mayrequire a longer recovery for the same workout done without these otherstressors. It is therefore possible to be over-trained without actuallytraining more than usual.

Unfortunately, many training plans do not take into account illness,emotional issues or job stress. Once the decline in performance is noted,the instinct is to train harder, not rest. This can quickly lead to a downwardspiral. If there are a lot of physical or emotional stressors, take a restday (or three!).

One of the worst mistakes that you can make is training too hard.The difference between training hard and training too hard lies not inthe workouts, but in the recovery. The response to two identical trainingweeks can be increased fitness or over-training. The direction that yourbody takes usually lies not in the training, but in the other areas ofyour life outside of your training.

The difference between over-reaching and over-training can most oftenbe achieved with a three day rest period, although up to two weeks maybe required.

Prevention of over-training is easy. To start, adopt a periodized trainingplan that increases intensity while decreasing the amount of volume. Gettingenough sleep and focusing on nutrition can hasten recovery from a combinationof training and lifestyle-induced stressors. It’s important to make sureyou have adequate glucose during training and adequate amounts glucoseand protein after exercise. If you recognize that you cannot take thesepreventative steps, then your training volume and intensity should be lightened.

After three days off (and I mean completely off, a.k.a. couchtime) if you still feel this way, you should visit with your physician.Your doctor should get a complete blood count and serum electrolytes measurements. Liver and thyroid function tests can also be useful. Further tests may include serum cortisol, testosterone, erythrocyte sedimentation rate, C-reactive protein and iron tests. These tests help determine if your body is building up (anabolism) or breaking down (catabolism).Unfortunately for many, one of the most common ways to avoid over-training is to actually become over-trained and then learn from your mistakes. Hopefully, watching for these signs and symptoms can help you avoid the problem in the first place.Take care of yourself and good luck,

Michael Ross, MD is an emergency room physician and author of “Maximum Performance: Sports Medicine for Endurance Athletes” by VeloPress books.Please send questions or issues to “Ask the Doctor” in care of WebLetters@7Dogs.com.Dr. Michael Ross, will be hosting a book signing and Question-and-Answer session prior to this year’s USPRO championship in Philadelphia on Friday, June 6, at 7 p.m. at race headquarters at Philadelphia’s Wyndam Hotel in Salon Room 4.Important Notice:
The information provided in the ASK THE DOCTOR column does notconstitute formal medical advice. The information provided on this public web site is provided solely for general interest of the visitors to the site. The information contained in this column applies to general medical practice and may not reflect current medical developments or be interpreted as medical advice. Understand that reading the information contained in this column does not mean that you have established a doctor-patient relationship with any of the physicians responsible for this column Readers of this column should not act upon any information contained in the web site without first seeking medical advice from their personal physician.

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