Running in our COVID-19 Public Health Crisis

At this writing, we’re in a national state of emergency.  The “15 Days to Slow the Spread” guidelines indicate limiting gatherings to fewer than 10 people, while local mandates may provide different limits.  (For example, at this writing, the New York State Department of Health says, “all non-essential gatherings of individuals of any size for any reason are temporarily banned.”)

Here in Tucson, all of our local hospitals are ready to respond to this emergency.   Our friends at Tucson Medical Center are providing regular updates on their www.tmcaz.com site.  In addition, their mobile health app is very helpful — you can stay at home and get 24/7 care with TMC Now . Access virtual visits with Arizona licensed physicians so that you can communicate with a doc via phone, video, or mobile app. The current fee for the app is $20 when you use the code SPRING20. You can also follow TMC’s Twitter feed to receive TMC updates here.

Across the country, the running  community is struggling with how to handle this situation.  As physician and RRCA instructor Dr. Bobby Gessler based in Maryland says, “”It is extremely important to protect oneself and other people.  This needs to be a community effort with family, extended family and neighbors all doing their part.”  Whether running alone or in small appropriately-spaced groups, continue to take all precautions and be a good health steward.  Assuming that you will follow the overarching CDC advice, the RRCA recommends some basic do’s and don’t’s:

• Don’t show up if you are feeling ill or have flu-like symptoms.
• Don’t share fluids. Carry your own fluids to avoid contact with others on course.
• Don’t share towels, food, gels, or any other item that runners normally share freely.
• Do wash your hands or use hand sanitizer after using the port-a-john.
• Do not spit or “nose rocket” your nose in public – bring along tissues or a small towel or a good old-fashioned hanky if you need to get rid of some snot during the race.
• Do practice social distancing – ensure appropriate spacing between runners; the current recommendation is at least six feet of separation.
• Do run single-file not abreast of each other (unless there is ample public room)
• Do avoid close-group selfies.

WHAT EXPERTS SAY ABOUT EXERCISE AND IMMUNE HEALTH

To help us think about how to stay safe during this public health crisis, we looked at a few academic articles in the field of immune health and exercise.  As with all fields, there are competing viewpoints, but we’ve leaned on these sources for the following information and we are grateful for the private communication with some of these authors:

• “Should, and how can, exercise be done during a coronavirus outbreak? An interview with Dr. Jeffrey A. Woods.”  Journal of Sport Health Science. Retrieved March 17: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031769/
• “Can exercise affect immune function to increase susceptibility to infection?”  Exercise Immunology Review.  Simpson, Campbell, Gleeson, Kruger, Nieman, Turner, Pyne, and Walsh.  Retrieved March 17: https://www.researchgate.net/publication/339775058_Can_exercise_affect_immune_function_to_increase_susceptibility_to_infection?)
• “Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan.”  Frontiers in Immunology. Campbell and Turner.  Retrieved March 15: https://www.frontiersin.org/articles/10.3389/fimmu.2018.00648/full
• “Recommendations to maintain immune health in athletes.” European Journal of Sport Science. Neil P. Walsh. Retrieved March 17: https://www.tandfonline.com/doi/full/10.1080/17461391.2018.1449895
•  

Takeways In Support of Exercise:

• From the Simpson, Campbell, Gleeson et al article:  There is agreement that “Regular bouts of moderate to vigorous intensity exercise are beneficial for the normal functioning of the immune system and likely help lower the risk of respiratory infection/illness and some cancers. The frequent exchange of immune cells between the blood and the tissues with each bout of moderate to vigorous intensity exercise likely contributes to enhanced immune surveillance, improved health and a lower risk of illness.”
• From Woods: “It is safe to exercise during the coronavirus outbreak. One should not limit the multitude of health benefits that exercise provides us on a daily basis just because there is a new virus in our environment. However, there may be some additional precautions to reduce your risk of infection.”
• From Campbell and Turner: “evidence from epidemiological studies shows that leading a physically active lifestyle reduces the incidence of communicable (e.g., bacterial and viral infections) and non- communicable diseases (e.g., cancer), implying that immune competency is enhanced by regular exercise bouts . . . exercise should be encouraged, particularly for older adults who are at greatest risk of infections and who may obtain the greatest exercise-induced benefits to immune competency.”  “leading an active lifestyle is likely to be beneficial, rather than detrimental, to immune function . . . “

Opposing Viewpoint: According to the Simpson, Campbell, Gleeson et al article, there is a viewpoint that “illness risk may be elevated during periods of heavy exertion that go beyond recommended physical activity guidelines, especially when other stressors are present.”

TRAINING ADVICE FOR RUNNERS

Given that there is significant uncertainty about the implications of the coronavirus and COVID-19, the following advice is given recognizing that caution should join the uncertainty.

Summary: Keep Moving: While cities and states throughout the country are asking people to stay home, to avoid unnecessary travel, and to keep social distance, there is compelling evidence that moderate exercise keeps you physically and emotionally healthy.

While following all the guidelines by the CDC and local authorities, if you can get outside for a run, that’s great.  If you’re worried about exercising near others, try getting out early in the morning or at dusk during standard dinner time.

We’re advocating moderate effort, while reducing the physical and mental stress of holding yourself to a focused training cycle.  However, if you continue to train, consider managing your effort spikes and planning a recovery or adaptation week every second or third week.

Evidence indicates that this is a time to incorporate a bout of moderate effort followed by a recovery period – NOT what is commonly called cumulative fatigue, where you are in constant low-level stress in order to build building the ability to handle constant fatigue.

That is, give yourself a gentle spike of effort followed by enough rest to recover – as opposed to doing consistent bouts of effort that leave you fatigued on an ongoing basis.

Remember: in contrast to training for peak performance, the goal in this phase is to be moderate.  In this public health crisis, you want to provide time for rest and recovery so that you are not feeling lethargic.

Go Back to Base

As races and event cancel, you may lose your motivation to train.  Remember, though, this is a great time to cycle into a phase of Base Training.  Easy conversational pace running has proven mental health benefits and proven cardiorespiratory benefit, so spend this time doing easy running at a low heart rate.

Depending on fitness, a base program of 1-2 runs of 25-40 minutes, 1-2 runs of an hour or so, and a longer run of 90-120 minutes will get you in excellent aerobic shape.  (More running for those who run more and less for those who run less . . .)

Add in a 10-20 minute protocol of standard body-weight strength work and any of the standard flexibility/mobility exercises.  A few months of this gentle running and you’ll be in excellent shape.

Sprinkle in Some Effort

On the other hand, the good news is that you can also continue with high intensity training.   As Dr. Jeff Messer, an exercise physiologist and 2017 US Girls High School Coach of the Year writes in an email, “Two (2) such vigorous sessions per week, for example, interspersed with multiple recovery sessions might be highly conducive to both a progressive enhancement of aerobic fitness and a corresponding enhancement of immunocompetency.”

Thus you may feel comfortable adding in 20 minutes of Lactate Threshold Tempo Run or 1-3 miles total of Track Tuesday-style vigorous sessions.

Dr. Messer writes that this sort of training, “presupposes, of course, that an individual has no physician-imposed limitations to aerobic exercise / training and no substantially or potentially limiting health issues (such as a prior myocardial infarction, for instance).”

In sum, Dr. Messer indicates that consistent mild-to-moderate intensity interspersed with periodic vigorous intensity bouts “can collectively yield improved immunological health.”

Run-Specific Cross Training and Indoor Exercise

We love activities that mimic the running motion and increase our ability to bring in and process oxygen.  Due to many of the community restrictions, this is a great time to include run-specific cross training activities in a training regimen, such as walking, hiking, elliptical, elliptigo, stair-stepper, cross-country skiing, snow-shoeing, bike riding, and swimming.

Once again, in private and public settings, be sure to follow all local and national public health guidelines.

Swimming is, of course, an excellent form of exercise.  While many beaches and public swimming facilities are currently closed, swimming may continue to provide mental and physical health benefits to those who can access water.

In terms of swimming in pools, the CDC writes, “There is no evidence that COVID-19 can be spread to humans through the use of pools and hot tubs.  Proper operation, maintenance, and disinfection (e.g., with chlorine and bromine) of pools and hot tubs should remove or inactivate the virus that causes COVID-19” (retrieved March 14, 2020 from https://www.cdc.gov/coronavirus/2019-ncov/php/water.html).

If you can’t leave your house, there are still multiple ways to exercise:

• do body-weight exercises for muscle strength
• stretch for flexibility and mobility
• do core workouts for stability
• do modified cardiorespiratory workouts such as walking up and down flights of stairs
• set up a cross-fit style exercise course in your home, household items as weights

True story: we once watched a middle-aged man do a whole fitness routine on a California beach using nothing but an empty green garbage can and the low concrete wall alongside the walking path.  All you’re trying to do is get your heart rate up and have a bit of fun, so be creative and enjoy the pleasure of moving.

While many public facilities are closed around the country, if you are running on an indoor track, or in a treadmill studio a gym setting:

• Don’t go to the gym if you are feeling ill.
• Don’t wipe your eyes, nose, or mouth while running. (It should go without saying that you should not spit or nose rocket indoors.)
• Do thoroughly wipe down the handrails and monitor before you use the treadmill.
• Do thoroughly wipe down the handrails and monitor after you finish your workout.
• Do create space for yourself by trying to use a treadmill at least 6′ from other treadmills being used
• Do wash your own hands when you’re done.
• NOTE: All of these suggestions apply to ALL standard gym equipment, including elliptical machines, stair-stepping machines, rowing machines, and the like.

To keep yourself healthy, experts suggest that we all try to sleep well, eat well and reduce our outside stress as much as possible (which sure seems a difficult task these days).

EAT WELL & STAY MOTIVATED

EAT WELL

Be mindful of your diet and continue to eat healthy food.  It is easy to stockpile processed foods (crackers, chips, cereals, canned soups, and so forth), but you can also stockpile healthier foods, whether frozen, in a jar, or in a can.

Frozen fruits, peas, broccoli, brussel sprouts will add variety and nutrients, while canned beets, carrots, and other root foods will add texture and color to your meals. Tofu, nuts, and nut-butters can offer protein and healthy fats.

Of course, you can also reach out to registered dieticians to get professional advice to share with your athletes.  The Walsh article cited above offers general advice that may be useful for many runners in their efforts to maintain immune health:

• Match energy intake to expenditure
• Avoid crash dieting
• Eat a well-balanced diet
• Consume >50% daily energy intake as carbohydrate
• Ensure adequate protein intake (1.2−1.6 g/kg body mass/day)
• Consider including 1000 IU/day of vitamin D3
• At the onset of a cold take zinc acetate lozenges (75 mg/day)
• Consider probiotics (≥ 1010 live bacteria/day) for illness prone/travelling athlete

As always, we stress that you reach out to professionals in the nutritional health field with any questions about specific dietary needs.

As an athlete, understand your own body, be mindful of your intake and understand that stress is normal . . . allow yourself the gift of comforting yourself in a healthy manner.

STAYING MOTIVATED

Just because your next race got cancelled doesn’t mean that your fitness got cancelled.  You’re still in shape — it’s just a question of how you can use that fitness.  Here are some possibilities — and remember, please always follow national and local health advisories.

• Get outside.  Running in the open air and the scenery will do wonders for your spirit.  According to a 2019 study in Mental Health and Prevention, “Numerous studies found green exercise to have positive health effects, in particular, green exercise was found to reduce anxiety and stress, and to improve mood, self-esteem, attention, concentration and physical health.”
• Get Virtual. Use your social media accounts to communicate with your local and at-a-distance community – share photos, share tips, share stories. Be supportive, but also be willing to ask for advice.
• Create a calm space to exercise. In the 2019 Mental Health and Prevention study, “Optimizing Mental Health Benefits of Exercise” (Klepeski, Koch, Hewell, Shempp, and Muller), the authors conclude that “in order to reduce stress levels by engaging in exercise, it might not be crucial to engage in green exercise but to engage in exercise in an (indoor or outdoor) environment which is being perceived as calming.” The takeaway? Find what is calming for you and build it into your daily life.
• Organize a mini track meet.  If you’re in shape and not displaying any cold or flu symptoms, head to your local track and set up a timed mile and see what you’ve got for the classic mile distance.  Give yourself props for leg speed but be mindful of regulating your effort – perhaps don’t go at 100%.
• Pick a course that simulates your goal race and go run fast.  Consider the standard negative split workout — run the first portion at a reasonable pace, then shift gears and run the rest of the route with a low level of intensity.
• Pretend you’re an Olympian.  Olympic athletes take the long view — and you can too.  You’ve built up your fitness, now cycle down and build it up again.
• If you have the resources, consider purchasing a membership in a company like Peloton or Mirror that provides virtual fitness classes.  (You will want to be careful of overtraining in this environment, as it is easy to get caught up in the excitement and do more than your body can handle.)

COMMUNITY LEADERSHIP AND COACHING

Some running communities have cancelled all group runs, while others are continuing to hold small group social workouts.  Regardless of what you personally want, be sure to check the CDC material and local health advisories so that you understand the overall conditions affecting your athlete.

• Do not pressure your athletes to run, either in a group or alone. People need to make their own choices about joining a small group run during these uncertain times.
• Do communicate with your athletes — if you coach groups, be sure to share with them your group protocols that follow local health advisories.
• If you coach individuals, be sure to reach out to each athlete and discuss their individual situation.
• Do support your athletes as they navigate their personal obligations.
• Do consider teaming up with others in your local running and endurance community to form a cohesive community-based plan.
• Do practice social distancing – ensure six feet of separation between runners if you host small group runs.
• Consider checking with the community leaders in road cycling, mountain biking, swimming, outdoor boot camps, and others.

FINANCIAL ISSUES AND EVENT CANCELLATION

THANKS TO THE ROAD RUNNERS CLUB OF AMERICA FOR THE FOLLOWING MATERIAL:

A hard truth is that the current public health crisis is going to impact the endurance sport community in negative ways.  If you are thinking about cancelling your event, we recommend you err on the side of caution and cancel or postpone your event for a later date, especially if your event is between now and June. Many events are moving to virtual options. There are a variety of resources available for hosting virtual events. RunSignUp, FitRankings and others offer virtual event platforms. If you elect to move to a virtual option, DO NOT hold a packet pick-up where people can come to collect shirts and medals. This defeats the purpose of limiting interaction with people. Inform participants that a plan will be devised for distribution of shirts/medals by mail or in person as soon as it is safer to congregate.

Keep in mind that cancelled and postponed races impact everyone, from the local organizer to the race participant to the local barricade company to the charity partners and so on. In sum, all of us in the running community will be affected, so here are some quick strategies for managing this difficult time:

• For event directors, communicate, communicate, communicate, with health officials, participants, vendors, charity partners, and more.
• For event directors, be mindful of contract language, now is a good time to review all agreements and check with your local experts.
• Check with your online registration platform for the status on what is commonly called a “holdback” to ensure that you can manage your cash flow.
• Make sure you balance your cash flow needs with legal and ethical commitments.
• If you are producing a race or a group event, decide if you want to postpone, cancel, or move to virtual. As you make this decision, outline a plan for all of the operational, financial, and ethical implications.
• Determine your refund plan and communicate clearly with your clients and participants.
• For runners, it is important to be kind to event organizers:
  • Remember, everyone is in a tough position.
  • Respect the no refund policy if that is what you agreed to during registration.
  • You love the sport, so take a long-term view of your role in ensuring the financial survival of your community-owned events.
  • DO NOT harm your race of choice by doing charge backs or demanding a refund if the race has a no refund policy. This hurts the long-term survival of an event you hope to run one day.
  • Keep in mind local events are just like small businesses in your community, and your support will be critical to their survival.