Acute hamstring strains, which typically present as pain in the back of the thigh…
Critical Decision Making, Exercise, and COVID-19
COVID-19 gives us fascinating opportunities to hone our critical decision making skills. This blog post is about the balance between my desire for things to be simple, the reality that they’re rarely as straightforward as they seem and the beauty that the bottom line still doesn’t have to be complicated.
I recently had a conversation about fact checking (which can include a simple google search) information that we’re told or read about and why it’s important to take some time to scratch below the surface. It may feel like a can of worms has been opened, since that original information seems no longer so cut and dried. But it gives us a chance to consider all the nuances of a headline that appears straight forward at first glance. Ultimately we have to make the best decisions possible based off of the current information we have and there may not be an answer that’s absolutely correct one hundred percent of the time.
I’ll discuss one specific example regarding exercise, since it interests me both personally and professionally.
The above pic (as well as the “featured image”) is from this article which talks about a recent paper released by Belgium and Netherlands researchers. I was initially hoping to make a quick post about some interesting information and move on. As it often-times turns out, there’s more to the story than a catchy headline and pictures. In a nutshell, the authors, based off of simulation models, recommend increasing the social distancing recommendations from 6 feet (the standard recommendation for our typical community activities) to 13-16 feet for runners, 33 feet for slow cycling, and 66 feet for fast cycling. This is due to the idea that droplets from saliva particles stay in the air longer as they’re being expelled more forcefully during heavy breathing during exercise. These numbers are also specific to running or cycling directly behind a person, as this direct line is considered within a person’s “slipstream” where the particles are at a greater volume.
My initial thought was to post this article as is with minimal further comment. I like to read through articles before posting about them to see if anything weird stands out (who were the subjects, what was the methodology, do the conclusions seem reasonable based on the results) so I did a Pubmed and Google search to find the original paper. I have yet to find the original paper translated into English, but what I did find were several articles discussing various reasons why these new recommendations might be called into question. If you’d like to read more in-depth about the issues with these recommendations, check out these articles here, here, and here. In summary, they discuss the fact that the original paper wasn’t peer-reviewed, the results are based off of simulations from models rather than data obtained from actual people exercising, the many variables (current wind speed, population of the area, level of pollution, etc.) that could change the accuracy of the recommendations, and the fact that there still isn’t a consensus about how exactly the virus travels through the air.
Are any of these things nefarious? I don’t think so. We are now pushing many things along faster due to the severity of the situation we’re in, which is the reason for not waiting for the information to be peer reviewed or waiting until actual people can be used. This is of course a slippery slope. The concern with promoting unproven medical treatments during a crisis is that there’s the possibility of causing more harm than good. In this case, the concern is freaking people out to the point where they are no longer going outside to exercise.
Does this mean we can’t use this information to further guide our decisions? No, the bottom line is to use all the information we have to make balanced decisions with the costs and benefits in mind. Everyone still seems to be in agreement that:
- Getting outside to exercise is important for mental health and immune system function.
- Avoiding hiking, running, walking, cycling directly behind someone is a good idea to avoid that “slipstream” area.
- Running or cycling diagonally behind someone, or better yet, crossing the street until you can pass, puts you out of that “slipstream” that occurs by being directly behind.
- Finding the least crowded time or place to exercise reduces your chances of having to make decisions about how far and at what angle to be behind someone.
- Consider taking a bandana or mask along so you can cover your mouth and nose while passing someone or if you hear someone coming up behind you.
- Exercising alone is safer at this point.
- Give people a heads up when you’re getting close to passing (“on your left!”).
One final point regarding specific activities. We’re all trying to figure these things out together. Some activities may seem extreme to some people but not to others. Taking into account your personal abilities, the likelihood of something happening that will put you in the ER, and the possibility of other people being impacted by your decisions or accidents/injuries can help us all make better decisions.
Some things are more straight forward than others. For example, backcountry activities add many variables, some of which are not under our control, and also are much more likely to put other people at risk (search and rescue teams). The possibility of pulling a hamstring while running is most likely not going to effect other people or put extra stress on our medical teams. Other activities, such as rock climbing, are seen as extreme to the general population but are actually statistically safe in relation to activities that most people don’t think twice about (football, basketball, soccer…and there are even statistics showing more emergency room visits for golf cart injuries than rock climbing!).1,2,3 Does this mean all rock climbing (or any other activity) is completely safe? No, but there are things to think about to minimize risk to what may be an acceptable level. High-ball bouldering (or mountain biking, skiing, etc.) at your upper limits or climbing backcountry routes or peaks seem like some obvious irresponsible choices at this time. Is climbing safely-bolted sport routes that you’re familiar with or mountain biking trails that are below your technical upper limits ok? Maybe, maybe not. Whatever you decide, it will be judged. If the judgement is negative, consider holding off on the urge to become defensive and reevaluate the decision. There are probably lessons in there somewhere.
Climbers specifically have been shown to take risk factors into account when climbing, even in non-global-pandemic situations.4 We all need to do this with whatever activity we are choosing in order to stay safe, not directly put others at risk, and avoid putting undo stress on our medical providers during this challenging time.
Stay strong and stay safe!
Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment for more information about warming up, stretching, and other climbing (and non-climbing) injury related topics. Like my facebook page for updates and more information and rate/review Beyond Tape on my website or here. My primary motivations for Beyond Tape and any of the posts are to: 1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated 2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.
1 Schöffl V, Morrison A, Schwarz U, Schöffl I, Küpper T. Evaluation of injury and fatality risk in rock and ice climbing. Sports Med. 2010 Aug 1;40(8):657-79.
2 Backe S, Ericson L, Janson S, Timpka T. Rock climbing injury rates and associated risk factors in a general climbing population. Scand J Med Sci Sports. 2009 Dec;19(6):850-6.
3 Schöffl V, Morrison A, Schöffl I, Küpper T. The epidemiology of injury in mountaineering, rock and ice climbing. Med Sport Sci. 2012;58:17-43.
4 Jaku PM, Shaw DW. An Empirical Analysis of Rock Climbers’ Response to Hazard Warnings. Risk Analysis, Vol. 16. No. 4, I996.
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