Table 24.3.

Guidelines for exercise during episodes of URTI in athletes

Day of illness	Recommendations
1st	No strenuous exercise or competitions when experiencing URTI symptoms like sore throat, coughing, runny or congested nose No exercise when experiencing symptoms like muscle/joint pain and headache, fever, generalized feeling of malaise, diarrhea or vomiting Drink plenty of fluids, keep from getting wet and cold, and minimize life-stress Consider use of topical therapy with nasal drainage, decongestants and analgesics if feverish Report illness to team physician or health care personnel and keep away from other athletes if you are part of a team training or travelling together
2nd	If fever is >37.5–38 °C, or coughing increases as well as diarrhea or vomiting: no training If no fever or malaise and no worsening of “above the neck” symptoms: light exercise (pulse <120 bpm) for 30–45 min, indoor during winter and by yourself
3rd	If fever and URTI or gastrointestinal infections (GI) symptoms are still present: consult your physician. Quinolones should be avoided whenever possible because of an increased risk of tendinopathy If no fever or malaise and no worsening of initial symptoms: moderate exercise (<150 bpm) for 45–60 min, preferably indoor and by yourself
4th	If no symptom relief: do not to exercise but make an office visit to your doctor If first day of improved condition, follow the guideline below

Adapted from Walsh NP, Gleeson M, Pyne DB, Nieman DC, Dhabhar FS, Shephard RJ, Oliver SJ, Bermon S, Kajeniene A: Position statement. Part two: Maintaining immune health. Exerc Immunol Rev 2011, 17:64–103, with kind permission of Dr. Hinnak Northoff