Exercise and the Immune System

      Exercise has a variable effect on the immune system. The underlying reasons for this variability are multifactorial and include infectious, neuroedocrine, and metabolic factors, with nutritional status of the athlete and the training load playing a role. Environmental factors such as living quarters, travel requirements, and the type of sport (team versus individual) also contribute to infectious risk. Regarding the direct effect of exercise on the immune system, moderate exercise seems to exert a protective effect, whereas repeated bouts of strenuous exercise can result in immune dysfunction. Understanding the relationship between exercise and infectious disease has important potential implications for public health and for clinicians caring for athletes and athletic teams.
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        • Nieman D.C.
        Risk of upper respiratory tract infection in athletes: an epidemiologic and immunologic perspective.
        J Athl Train. 1997; 32: 344-349
        • Delhagen K.
        • Miller B.
        Running from colds.
        Runner's World. 1990; 25: 18-21
        • Adams P.F.
        • Benson V.
        Current estimates form the National Health Interview Survey, 1990. National Center for Health Statistics.
        Vital Health Stat. 1991; 10: 1-212
        • Simon H.D.
        The immunology of exercise, a brief review.
        JAMA. 1984; 252: 2735-2738
      1. Medical physiology.
        in: Rhoades R.A. Tanner G.A. The immune system. Little, Brown, and Company, Boston1995: 220-224
        • Haynes B.F.
        • Gauci A.S.
        Harrison's principles of internal medicine.
        in: Fauci A.S. Braunwald E. Isselbacher K. Disorders of the immune system, connective tissue joints. McGraw-Hill, New York1998: 1753-1772
        • Goronzy J.J.
        • Weyand C.M.
        Cecil Textbook of Medicine.
        in: Arends W.P. Armitage J.O. Drazen J.M. The innate and adaptive immune systems. 22nd edition. W.B. Saunders, Philadelphia, PA2004: 161-165
        • Pershin B.B.
        • Geliev A.B.
        • Tolstov D.V.
        • et al.
        Reactions of immune system to physical exercises.
        Russ J Immunol. 2003; 7: 1-20
        • Mackinnon L.T.
        • Chick T.W.
        • As A.V.
        • et al.
        The effect of exercise on secretory and natural immunity.
        Adv Exp Med Biol. 1987; 216A: 869-876
        • Fahlman M.M.
        • Engels H.J.
        Mucosal IgA and URTI in American college football players: a longitudinal study.
        Med Sci Sports Exerc. 2005; 37: 374-380
        • Novas A.P.
        • Rowbottom D.G.
        • Jenkins D.G.
        Tennis, incidence of URTI and salivary IgA.
        Int J Sports Med. 2003; 24: 223-229
        • Klentrou P.
        • Cieslak T.
        • MacNeil M.
        • et al.
        Effect of moderate exercise on salivary immunoglobulin A and infection risk in humans.
        Eur J Appl Physiol. 2002; 87: 153-158
        • Nieman D.C.
        • Buckley K.S.
        • Henson D.A.
        • et al.
        Immune function in marathon runners versus sedentary controls.
        Med Sci Sports Exerc. 1995; 27: 986-992
        • Tvede N.
        • Steensberg J.
        • Baslund B.
        • et al.
        Cellular immunity in highly-trained elite racing cyclists and controls during periods of training with high and low intensity.
        Scand J Med Sci Sports. 1991; 1: 163-166
        • Hack V.
        • Strobel G.
        • Weiss M.
        • et al.
        PMN cell counts and phagocytic activity of highly trained athletes depend on training period.
        J Appl Physiol. 1944; 77: 1731-1735
        • Pyne D.B.
        • Baker M.S.
        • Fricker P.A.
        • et al.
        Effects of an intensive 12-wk training program by elite swimmers on neutrophil oxidative activity.
        Med Sci Sports Exerc. 1995; 27: 536-542
        • Nieman D.C.
        • Simandle S.
        • Henson D.A.
        • et al.
        Lymphocyte proliferative response.
        Int J Sports Med. 1995; 16: 404-409
        • Crary B.
        • Borysenko M.
        • Sutherland D.C.
        • et al.
        Decrease in mitogen responsiveness of mononuclear cells from peripheral blood after epinephrine administration in humans.
        J Immunol. 1983; 130: 694-699
        • Haydon A.M.
        • Macinnis R.
        • English D.
        • et al.
        The effect of physical activity and body size on survival after diagnosis with colorectal cancer.
        Gut. 2005; 1: 62-67
        • Lee I.M.
        Physical activity and cancer prevention—data from epidemiologic studies.
        Med Sci Sports Exerc. 2003; 35: 1823-1827
        • Canonica G.W.
        • Ciprandi G.
        • Caria M.
        • et al.
        Defect of autologous mixed lymphocyte reaction and interleukin-2 in aged individuals.
        Mech Ageing Dev. 1985; 32: 205-212
        • Krishanaraj R.
        • Blandford G.
        Age-associated alterations in human natural killer cells. Increased activity as per conventional and kinetic analysis.
        Clin Immunol Immunopathol. 1987; 45: 268-285
        • Nieman D.C.
        • Henson D.A.
        • Gusewitch G.
        • et al.
        Physical activity and immune function in elderly women.
        Med Sci Sports Exerc. 1993; 25: 823-831
        • Peters I.M.
        • Bateman E.D.
        Ultramarathon running and upper respiratory tract infections.
        S Afr Med J. 1983; 64: 582-584
        • Peters E.M.
        • Goetzsche J.M.
        • Grobbelarr B.
        • et al.
        Vitamin C supplementation reduces the incidence of postrace symptoms of upper respiratory tract infections in ultramarathon runners.
        Am J Clin Nutr. 1993; 57: 170-174
        • Hemila H.
        • Virtamo J.
        • Albanes D.
        • et al.
        Physical activity and the common cold in men administered vitamin E and beta carotene.
        Med Sci Sports Exerc. 2003; 35: 1815-1820
        • Krzywkowski K.
        • Petersen E.W.
        • Ostrowski K.
        • et al.
        Effect of glutamine supplementation on exercise-induced changes in lymphocyte function.
        Am J Physiol. 2001; 281: 1259-1265
        • Speich M.
        • Pineau A.
        • Ballereau F.
        Minerals, trace elements and related biological variables in athletes and during physical activity.
        Clin Chim Acta. 2001; 312: 1-11
        • Henson D.A.
        • Nieman D.C.
        • Blodgett A.D.
        • et al.
        Influence of exercise mode and carbohydrate on the immune response to prolonged exercise.
        Int J Sport Nutr. 1999; 9: 213-228