In this article, emphasis was placed on the relationship between exercise and upper respiratory tract infection (URTI) in humans, experimentally induced infections in animals subjected to varying levels of exertion, and potential changes in the immune system that might explain the altered risk of infection. With regard to induced infections in animals, the influence of any exercise intervention appears to be pathogen specific, and dependent on the species, age, and sex of the animals selected for study, and the type of exercise paradigm. In general, although further research with larger subject pools and improved study designs is needed, published data at this time support a "J" curve relationship between risk of URTI and increasing exercise workloads. For example, individuals exercising moderately may lower their risk of URTI while those undergoing heavy exercise regimens may have higher than normal risk. Although researchers have investigated changes in immune function that might provide a biological rationale for the "J" curve model of infection and exercise, the wide variety of research designs, exercise protocols, subject characteristics, and methodologies combined with the innate complexity of the immune system have made interpretation of published findings equivocal. T and NK cell function, for example, is often reported to be decreased during recovery from high-intensity exercise. However, when adjustments are made for exercise-induced perturbations in blood lymphocyte subsets, any link to decreased host protection is unlikely.

Exercise, Infection, and Immunity

Tumor necrosis factor, interleukin-1, and interleukin-6 in normal human pregnancy

During the last 95 years, 629 papers (60% in the 1990s) dealing specifically with exercise and immunology have been published. Major findings of practical importance in terms of public health and athletic endeavor include: (a) In response to acute exercise (the most frequently studied area of exercise immunology), a rapid interchange of immune cells between peripheral lymphoid tissues and the circulation occurs. The response depends on many factors, including the intensity, duration, and mode of exercise, concentrations of hormones and cytokines, change in body temperature, blood flow, hydration status, and body position. Of all immune cells, natural killer (NK) cells, neutrophils, and macrophages (of the innate immune system) appear to be most responsive to the effects of acute exercise, both in terms of numbers and function. In general, acute exercise bouts of moderate duration (< 60 min) and intensity (< 60% VO2max) are associated with fewer perturbations and less stress to the immune system than are prolonged, high-intensity sessions. (b) In response to long-term exercise training, the only finding to date reported with some congruity between investigators is a significant elevation in NK cell activity. Changes in the function of neutrophils, macrophages, and T and B cells in response to training have been reported inconsistently, but there is some indication that neutrophil function is suppressed during periods of heavy training. (c) Limited data suggest that unusually heavy acute or chronic exercise may increase the risk of upper respiratory tract infection (URTI), while regular moderate physical activity may reduce URTI symptomatology. (d) Work performance tends to diminish with most systemic infectious, and clinical case studies and animal data suggest that infection severity, relapse, and myocarditis may result when patients exercise vigorously. (e) Although regular exercise has many benefits for HIV-infected individuals, helper T cell counts and other immune measures are not enhanced significantly. (f) Data suggest that the incidence and mortality rates for certain types of cancer are lower among active subjects. The role of the immune system may be limited, however, depending on the sensitivity of the specific tumor to cytolysis, the stage of cancer, the type of exercise program, and many other complex factors. (g) As individuals age, they experience a decline in most cell- mediated and humoral immune responses. Two human studies suggest that immune function is superior in highly conditioned versus sedentary elderly subjects. (h) Mental stress, undernourishment, quick weight loss, and improper hygiene have each been associated with impaired immunity. Athletes who are undergoing heavy training regimens should realize that each of these factors has the potential to compound the effect that exercise stress is having on their immune systems.

Exercise immunology: practical applications.

This review focuses on the response of "stress" hormones to heat, exercise (single or repeated bouts), and combinations of these stimuli, with particular reference to their impact upon immune function. Very hot conditions induce a typical stress response, with secretion of catecholamines and cortisol. The catecholamines induce a demargination of leukocytes, and cortisol subsequently causes cells to migrate to lymphoid tissue. Sustained exercise, even in a thermally comfortable environment, induces a larger hormonal response than moderate thermal stress. With moderate exercise, increases in leukocyte numbers are related mainly to plasma norepinephrine concentrations, but with more intense exercise epinephrine concentrations assume a major importance. As exercise continues, plasma cortisol levels also rise, inducing an influx of neutrophils from bone marrow and an efflux of other leukocyte subsets. A combination of exercise and heat stress augments both hormonal and leukocyte responses. But these changes seem to be reversed if temperatures are clamped by exercising in cold water. If a second bout of exercise is performed with an inter-test interval of 30-45 min, neither hormone concentrations nor immune responses show any great cumulative effect under temperate conditions. However, in a hot environment the second exercise bout induces a larger and more persistent neutrophilia. Training influences these various responses mainly by decreasing the stress imposed when exercising at a given absolute work-rate.

Stress Hormones and the Immunological Responses to Heat and Exercise

The aim of this study was to address the effect of endurance training on tissue sensitivity to glucocorticoids (GC) in both resting and exercising conditions. In vitro dexamethasone inhibition of LPS-induced interleukin-6 secretion in cultures of peripheral monocytes was compared in untrained subjects (UT) and in endurance-trained men (ET) at the end of a 2-h run and during exercise recovery. We demonstrated an in vitro plasticity of sensitivity of monocytes to GC in ET men, superimposed to changes in systemic cortisol concentrations (plasma and saliva). Compared with sedentary men, similar resting cortisol levels in ET men are associated with decreased sensitivity of monocytes to GC 8 and 24 h after the end of the last training session (P 0.05). This acute exercise-induced increase in tissue sensitivity to GC, which is synchronous with activation of the hypothalamo-pituitary adrenal axis, may act to shut off muscle inflammatory reaction and cytokine synthesis and then decrease exercise-induced muscle damage or inflammatory response. By contrast, the decreased sensitivity of monocytes to GC reported in ET men 24 h after the last bout of exercise may be related to the process of desensitization that may act to protect the body from prolonged, exercise-induced cortisol secretion. These acute and chronic effects of exercise on tissue sensitivity to GC demonstrate an adaptation of the hypothalamo-pituitary adrenal axis to repeated and prolonged exercise-induced increases in GC secretion.

https://www.physiology.org/doi/pdf/10.1152/japplphysiol.00108.2002

Acute and chronic effects of exercise on tissue sensitivity to glucocorticoids.

The extent and duration of changes in leukocyte subsets, lymphocyte subpopulations, spontaneous blastogenesis, cortisol, and catecholamines were measured in ten experienced marathoners, who ran 3 h to exhaustion in a laboratory setting. Blood samples were taken at baseline, 1 h of exercise, and 5 min, 1.5 h, 6 h, and 21 h of recovery. The 3-h endurance run was associated with significant leukocytosis, granulocytosis, neutrophilia, monocytosis, and eosinopenia during recovery. All of these parameters except for eosinophils returned to normal by 21 h of recovery. Total lymphocyte count increased 31% at 1 h of exercise, then decreased 19% at 1.5 h of recovery when compared with baseline values. T cell count showed no significant changes, but B cell lymphocytosis was measured at 5 min and 6 h of recovery. T helper/T suppressor ratio (H/S) was significantly elevated 39% at both 1.5 h and 21 h of recovery due to the decrease in number of T suppressor cells. Spontaneous blastogenesis was significantly increased 52% by 1 h of exercise and remained elevated throughout recovery. The increase in cortisol from baseline to 1.5 h of recovery correlated positively with the increase in both total leukocyte count (r = 0.78, P = 0.008) and granulocyte count (r = 0.81, P = 0.005). Our results suggest that exhaustive endurance exercise in marathon runners is associated with many significant perturbations in immune system parameters, most of which return to normal levels at 21 h of recovery.

Effects of long-endurance running on immune system parameters and lymphocyte function in experienced marathoners.

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Effects of long-endurance running on immune system parameters and lymphocyte function in experienced marathoners.