Rest is best way to fight flu, even for fitness buffs
By Jeannine Stein
Published: Saturday, Sept. 26, 2009
Far be it for die-hard fitness buffs to let a little fever stop them from doing their regular workout — or for pint-sized football players to miss a practice. But it's not good idea for an illness such as the H1N1 virus.
"The best information we have says complete bed rest is best," says David Nieman, director of the human performance lab at Appalachian State University in Boone, N.C. And forget the idea you can sweat out the flu through intense exercise: "That's a myth," he says. "A big myth."
Working out, especially at a vigorous pace for a long stretch, may do more harm than good.
"We know that heavy exertion causes a transient downturn in immune function that can last from a few hours to a day," says Nieman, a professor of health and exercise science. During heavy, prolonged physical exertion, he adds, stress hormone levels such as cortisol rise, causing immune cells to function less efficiently. "During this downturn, if you have a virus, it will multiply at a higher rate and make you sick."
When dealing with a systemic virus with symptoms of general fatigue, aches and pains — rest is necessary. "If any level of exercise is engaged in," he says, "you risk making the illness more severe."
Raising body temperature may be chancy as well, he adds. "It makes physiological sense. If your core temperature is already up and you dare to add to it, you have to keep in mind that viruses like to multiply with higher body temperatures. Everything is multifactorial, and that may be one factor."
Dr. Peter Katona isn't completely anti-exercise for those who may be dealing with a virus, but cautions regular exercisers to heed what their bodies are telling them. "If you feel up to it, you can do some light working out, like stretching," says the associate professor of clinical medicine at the University of California, Los Angeles who specializes in infectious diseases. "Do things that aren't going to give you a lot of sweat and fatigue. Don't push yourself, but let your body be your guide."
Once you feel better, however, remember that regular moderate exercise may boost the immune system.
The novel H1N1 flu virus, commonly called swine flu, appears to be no more dangerous than many seasonal flu strains — but it spreads more easily than many viruses.
Most at risk for infection: Children and adults younger than 25 have been the most likely to contract the virus in the United States. For seasonal flu, the elderly, the very young and the chronically ill are usually most susceptible.
The toll: In the U.S., as of Sept. 10, the Centers for Disease Control and Prevention reported 9,079 hospitalizations and 593 deaths related to H1N1. Worldwide, the World Health Organization reported 254,206 cases and at least 2,837 deaths.
To prevent infection:
• Wash your hands frequently with soap and water for 20 seconds (about the amount of time it takes to sing "Happy Birthday" twice).
• Don't touch your eyes, nose or mouth.
• Avoid close contact with people who have the virus.
To prevent transmission:
• Cover your mouth when coughing or sneezing, preferably with a tissue. No tissue• Do the "Dracula sneeze" — into the crook of the elbow.
• Avoid close contact with healthy people.
For more information, visit www.flu.gov
The flu tends to come on suddenly — you're fine in the morning but then aching and shivering that night — whereas a cold usually develops gradually over the course of two or three days. Flu usually causes a fever and aches; a cold usually doesn't. Other symptoms of the flu include headache, fatigue, cough, sore throat, nasal congestion, chills and, usually in children, vomiting or diarrhea.
Question: How do I know if it's the novel H1N1 strain?
Answer: Unless your doctor orders a test, you won't. That test, which involves a swab of nasal secretions, isn't routinely conducted. Most likely, if your doctor thinks you have the flu, you will be sent home with advice on care.
In some cases, however, doctors will want a more precise diagnosis, which helps inform public-health officials about outbreaks. A flu test also is sometimes given to people at risk of becoming very sick, such as hospitalized patients, infants and those with underlying health conditions. Health care workers also might receive a flu test.
In general, it's not necessary for you to know whether your flu is H1N1 or a seasonal strain. They are treated similarly and have similar effects, although this H1N1 strain seems to be transmitted especially easily among children and young adults.
Q: How should I take care of myself?
A: Stay home and rest. You don't want to tax your body when it needs its strength to fight a virus.
• Drink plenty of liquids to avoid dehydration.
• Don't drink alcohol, because it can increase the risk of dehydration, and it weakens the immune system's response.
• Don't smoke; that can worsen respiratory symptoms.
• Do take over-the-counter pain relievers (but don't give aspirin to children or teens) for head and muscle aches.
• To avoid infecting others, stay in a separate room in the household and try to use a separate bathroom. Wear a mask, if tolerable, when around other people, even loved ones.
Q: When should I go to the doctor?
A: In most cases a trip to the doctor isn't necessary, because healthy people will recover on their own in about five days. However, if you have just become ill, you may want to call the doctor to obtain a prescription for an antiviral medication. Taking an antiviral, such as Tamiflu or Relenza, can shorten the course of the illness by a day or two if the medication is given within 48 hours of the onset of symptoms.
Doctors vary in their willingness to prescribe antiviral medications. In a recent update from the Centers for Disease Control and Prevention, doctors were advised to prescribe antiviral drugs only in certain cases — to treat or prevent illness in people who are severely ill or hospitalized or at higher risk of having serious complications from flu, such as babies and those with underlying illnesses. Antivirals are not recommended for prevention or treatment in otherwise healthy people. These guidelines were issued to alleviate concerns about a potential shortage of antiviral medications.
Consider seeing your doctor if you are at high risk for complications, such as developing pneumonia, sepsis or having a severe asthma attack. This includes people age 65 or older, those with chronic medical conditions, pregnant women and young children.
Q: Should an ill person go to the hospital?
A: Normally, no. But the virus can lead to other illnesses, such as bronchitis, pneumonia, sepsis or asthma flare-ups.
Here are some emergency signs in children:
• Fast or labored breathing, indicating pneumonia or sepsis.
• Bluish skin color, indicating the child may not be getting enough oxygen.
• Not drinking enough fluids, which puts the child at risk for dehydration.
• Not waking up or interacting, which can indicate a more severe case.
• Being so irritable that they don't want to be held, which also can indicate more severe illness.
• A return of flu symptoms after the child appeared to be getting better, which could indicate that the child developed a secondary illness or was misdiagnosed with flu.
• Fever with a rash, which can indicate an illness other than flu.
• Difficult breathing or shortness of breath, which could indicate pneumonia or sepsis.
• Pain or pressure in the chest or abdomen, which could indicate a more serious case or that flu is not the right diagnosis.
• Sudden dizziness, which can mean the person is not getting enough oxygen.
• Confusion, which can mean the person is not getting enough oxygen.
• Severe or persistent vomiting, which can lead to dehydration.
Q: How long should I stay home?
A: That depends. Your primary goal should be to avoid infecting others. Always stay home if you have a fever or think you may be coming down with the flu. Adults can spread the flu to others for as long as five days after getting sick, so stay home until you feel better and for 24 hours after the fever is gone (without use of fever-lowering medications). You may have lingering symptoms, such as nasal congestion, cough or fatigue. That is normal. But if your cough or congestion or any symptom hasn't abated much from its peak, you could still be infectious.
Sources: U.S. Centers for Disease Control and Prevention; Dr. Aaron Getty, spokesperson for the Infectious Diseases Society of America; Los Angeles County Department of Health Services
— Shari Roan
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