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  • Writer's pictureAnnie Bothma


Updated: Feb 2, 2023

By Annie Bothma, September 2022


During the Global Covid Pandemic, I did altitude training in Kenya. I lived and trained in a small Township located about 3000m above sea-level amongst the best in the world, including the current female world record holder in the marathon, Brigid Kosgei. In March 2021, I was in the best shape of my life when I finally received an opportunity to race a marathon in Tuscany, Italy. Earlier the year I was announced as part of the South African Olympic Squad for the marathon, but I still needed to secure an olympic qualifying time to represent South Africa at the postponed Tokyo Games. After going through one marathon build onto the next the past year-and-a-half, due to all the race cancellations and postponements, I grabbed the opportunity with both hands and flew back to South Africa to get my visa ready for travel.

From a warm and sunny South Africa, where I was still doing my pre-race workout on the Monday in a crop top, I flew to an icy cold Italy where the temperatures were below freezing point when we arrived on the Thursday morning. My body went into shock and that next morning I woke up as sick as a dog. My body was aching, I was coughing, my nose was running and my eyes were burning! I was sick and with just two days remaining before I had to race my Olympic Qualifying marathon my chances of even just making the start-line healthy enough to race didn't look great...

We had to perform multiple covid safety protocol tests every day leading up to the event, and although I tested negative on each one of them, I was placed into isolation. Since typical flu symptoms overlap so much with the symptoms associated with Covid-19 the organizers didn't want to risk putting any of the other athletes at risk. The morning of the race I was in isolation laying in my hotel bed watching the race on the poorest quality stream on Facebook, while I was busy coughing and crying my heart out simultaneously!


What happened to me was not a unique situation, in fact, this is a very common occurrence amongst athletes. The immune system protects the body against potentially damaging microorganisms. Athletes engaged in heavy endurance training programs often have depressed immune function and suffer from an increased incidence of upper-respiratory tract infections (URTI). Training and competitive surroundings may increase the athlete’s exposure with pathogens and provide optimal conditions for pathogen transmission.


  • Decreased sleep.

  • Air travel.

  • Large crowds and contact with others whom may have been sick recently.

  • Increased stressors such as work or family obligations that needs to be balanced around your training and racing schedule.

  • Nutritional deficits associated with traveling or/and insufficient fuel during or before and after exercise.

  • Poor hygiene protocols in certain race/competition environments.

  • Big environmental changes, for example going from a warm place to a cold place.


No protocol could completely illuminate the risk of getting sick before or after a big race. There is a few things you can do to help protect yourself and decrease the chance of getting sick.


Exercise in the appropriate dose is good, since it makes your immune system stronger by increasing your resistance against mild infections, such as common colds. But, more is not always better! Exercise is still a form of stress on the body and that it why it is important the load is appropriate for your fitness level. It is also another reason why the taper before a race is important - it gives your body time to recover from the hard work you did preparing for the race and absorb the training stimulus. Don't neglect it, it is there for a reason - so you can get the most out of yourself and arrive to the start-line healthy and ready to race!


The importance of sleep cannot be overstated! You can only absorb the training and get the proper adaptations if you recover properly. Especially during the last weeks leading up to your race try your best, given your personal circumstances, to rest as much as possible. Get your feet up, go to bed an hour earlier or take a quick nap during the day or over the weekend.


One of the biggest risk factors for getting sick, is being in a low energy availability state (LEA). Not giving your body the sufficient energy it needs to perform daily living activities and training will result in a deficit and make you more vulnerable to illnesses. You need energy to fight an infection and build a strong robust immune system. Heavy, prolonged exertion is already associated with numerous hormonal and biochemical changes, which alone can have detrimental effects on immune function. Improper nutrition can just compound the negative influence of heavy exertion on immunocompetence.


Ingesting carbohydrates during prolonged or intense activity can reduce the stress responses. An athlete who exercises in a carbohydrate-depleted state experiences larger increases in circulating stress hormones and a greater perturbation of several immune-function indices. Consuming carbohydrate during exercise attenuates rises in stress hormones, such as cortisol, and appears to limit the degree of exercise-induced immunodepression. The poor nutritional status of some athletes may predispose them to immunodepression. Following a restrictive diet coupled with endurance training can be a bad recipe for low energy availability or RED-S. Don't reduce your carbohydrate intake dramatically leading up to the race, just because you may be exercising less;, you still need fuel to keep you healthy! Plus, you need to ensure that you have a full glycogen storage leading into the race! Take good care of your body, so it can take good care of you and protect you from getting sick!


Maintain good personal hygiene by controlling the controllable. Avoid contact with someone who was recently sick and manage your touch-points, wash your hands, use sanitizers....and everything they drilled into us during the pandemic :)


Your body doesn’t understand the difference between work stress, life stress, training stress, nutrient deficiency stress and when the stress balance gets out of balance you can ultimately impair your immune system. There is a greater rate of upper respiratory tract infections in overreached or overtrained athletes. If training becomes too much without adequate recovery, there is a higher risk for upper respiratory tract infections, which makes sense. This is not always easy or may not always be completely in your control, but as far as possible try to balance stress. Watch out for the overflowing stress bucket around big races - remember it all adds up life stresses, relationship stress, work stress, and training stress. You have to fuel enough to carry that bucket too!



Probiotics are live microorganisms that, when administered orally for several weeks, can increase the numbers of beneficial gut bacteria. prebiotics are typically non-digestible carbohydrates that increase beneficial gut bacteria. Probiotics are associated with a range of potential benefits to gut health. This is why athletes might consider probiotic supplementation particularly during periods of increased URTI risk in the weeks before and during foreign travel, since probiotics may be helpful to prevent the severity and duration of URTI in athletes.

Here is a short summary why...


Vitamin C (ascorbic acid) is a major water-soluble antioxidant that is effective as a scavenger of reactive oxygen species in both intracellular and extracellular fluids. Good sources of vitamin C include fruit and vegetables, such as oranges, strawberries, mango, kiwi, and red bell peppers. Vitamin C is found in high concentrations in leucocytes, but the level falls dramatically during a common cold, when oxidative stress increases. By consuming sufficient vitamin C rich food sources can help to improve tolerance by mitigating against excessive tissue damage during infection.


Dietary deficiencies of protein and specific micronutrients are associated with immune dysfunction. Adequate intakes of iron, zinc, and B vitamins are particularly important, but the dangers of over-supplementation should also be considered. Many micronutrients given in quantities beyond a certain threshold reduce immune responses and may have other negative side-effects. Consuming megadoses of individual micronutrients is likely to do more harm than good. Vitamin D supplementation is may be an exception, especially in the winter months when there is limited sun exposure in your area. Vitamin D has been shown to be protective for the immune system and reducing the risk and prevalence of URTI's in athletes. However, test don't guess! If you are not deficient, excess Vitamin D can lead to toxicity.


Athletes should obtain complex mixtures of antioxidant compounds from consumption of fruits and vegetables. Consuming plant polyphenols from beverages, such as green tea, coffee, or concentrated fruit and vegetable extracts. Avoid large doses antioxidants, such as vitamin C or E, which may impair the adaptive up-regulation of the antioxidant defense system. Rather consider increasing your intake of nutritional antioxidants from fruits and vegetables. In general, the supplementation of individual micronutrients or large doses of simple antioxidant mixtures is not recommended.

Here is a short summary of why...


Countering the effects of all the factors that contribute to getting sick is impossible, but minimizing many of them is possible!

  • Get adequate rest, and sleep.

  • Allow enough recovery between training sessions and competitions.

  • Maintaining good hygiene.

  • Reducing life stresses as far as possible.

  • Eat a well-balanced diet that include sufficient protein and carbohydrates to meet your energy requirements.

  • Avoid nutrient deficiencies and restrictive diets.

  • Ensure your diet contains adequate intakes of vitamins, minerals and polyphenols.

  • Avoid overdosing with large quantities antioxidants or certain vitamins and minerals.

  • Consider certain supplements such as probiotics before traveling.

Remember, if you are sick you won't be able to race and your performance will be compromised. A healthy athlete is a happy athlete!


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