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Moderate exercise training causes favorable perturbations in immunity and a reduction in incidence of upper-respiratory illness (URI). During each bout of moderate exercise, an enhanced recirculation of immunoglobulins, neutrophils, and natural killer cells occurs that persists for up to 3 hours postexercise. This exercise-induced surge in immune cells from the innate immune system is transient but improves overall surveillance against pathogens. As moderate exercise continues on a near-daily basis for 12 to 15 weeks, the number of symptom days with URI is decreased 25% to 50% compared with randomized sedentary controls. Epidemiological and animal studies support this inverse relationship between URI risk and increased physical activity. Recent evidence indicates that maintaining leanness and a physically active lifestyle during adulthood reduces systemic inflammation, an underlying factor in multiple chronic diseases. The anti-inflammatory influence of near-daily physical activity in lowering C-reactive protein, total blood leukocytes, interleukin-6, and other inflammatory cytokines may play a key role in lowering risk of cardiovascular disease, certain types of cancer, type 2 diabetes, sarcopenia, and dementia.
Content may be subject to copyright.
American Journal of Lifestyle Medicine
1
Moderate Exercise Improves
Immunity and Decreases
Illness Rates
David C. Nieman, DrPH, FACSM
DOI: 10.1177/1559827610392876. Manuscript received April 30, 2010; revised June 1, 2010; accepted June 2, 2010. From the Department of Health and Exercise
Science, Appalachian State University, Boone, North Carolina. Address correspondence to David C. Nieman, DrPH, FACSM, Department of Health and Exercise Science,
PO Box 32071, 111 River St, HCC Room 38, Appalachian State University, Boone, NC 28608; e-mail: niemandc@appstate.edu.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2011 The Author(s)
vol. x • no. x
Old age, avoidance of physical
activity, mental stress, poor nutrient
and energy status, and lack of sleep
have all been associated with
impaired immune function and
elevated risk of infection.
Abstract: Moderate exercise training
causes favorable perturbations in
immunity and a reduction in inci-
dence of upper-respiratory illness (URI).
During each bout of moderate exercise,
an enhanced recirculation of immu-
noglobulins, neutrophils, and natural
killer cells occurs that persists for up to
3 hours postexercise. This exercise-
induced surge in immune cells from
the innate immune system is tran-
sient but improves overall surveillance
against pathogens. As moderate exer-
cise continues on a near-daily basis for
12 to 15 weeks, the number of symptom
days with URI is decreased 25% to 50%
compared with randomized sedentary
controls. Epidemiological and animal
studies support this inverse relationship
between URI risk and increased physi-
cal activity. Recent evidence indicates
that maintaining leanness and a phys-
ically active lifestyle during adulthood
reduces systemic inflammation, an
underlying factor in multiple chronic
diseases. The anti-inflammatory influ-
ence of near-daily physical activity in
lowering C-reactive protein, total blood
leukocytes, interleukin-6, and other
inflammatory cytokines may play a key
role in lowering risk of cardiovascular
disease, certain types of cancer, type 2
diabetes, sarcopenia, and dementia.
Keywords: upper-respiratory-tract infec-
tion; physical activity; natural killer cells;
neutrophils; inflammation
Introduction
Upper-respiratory illness (URI) is the
most frequently occurring infectious
disease in humans worldwide.
1-3
More
than 200 different viruses cause the
common cold, and rhinoviruses and
coronaviruses are the culprits 25% to 60%
of the time. The US Centers for Disease
Control and Prevention has estimated that
more than 1 billion URIs occur annually
in the United States, a leading cause of
lost school and work days. The average
person has 2 or 3 respiratory infections
each year, with young children suffering
6 to 7. Non–influenza-related viral respi-
ratory infections impart an estimated
$40 billion burden in direct and indirect
costs on the US economy.
2
Lifestyle habits are strongly related to
immune function. Old age, avoidance
of physical activity, mental stress, poor
nutrient and energy status, and lack
of sleep have all been associated with
impaired immune function and elevated
risk of infection. For example, the
likelihood of getting ill is directly linked
to the magnitude and duration of stress-
ful events and demeanor.
4
During a
6-month period, for example, the num-
ber of sick days is twice as great in
high- compared with low-stress groups.
4
Sleep disruption also impairs immune
2
American Journal of Lifestyle Medicine XXX • XXX XXXX
function. For example, the antibody
response to the flu shot is reduced in
individuals experiencing sustained sleep
debt.
5
In cold virus challenge studies,
thse with a history of poor sleep quality
were more prone to illness.
6
Nutrition has a major influence on
your immune function, and nearly
all nutrients provide support for the
immune system in its work against
viruses and bacteria. The best stud-
ies, however, indicate that a balanced,
healthy diet provides all the nutrients
needed for good immune function in
most healthy adults, and vitamin/mineral
supplements do not boost immunity
above normal levels.
7
In general, the
concept of boosting immune function
through improved lifestyle habits is
misleading. A better interpretation of
the literature is that a healthy lifestyle
supports normal immunity and that
poor habits of living impair immune
function.
Low- to high-exercise workloads have
a unique effect on risk of URI. Regular
physical activity improves immune func-
tion and lowers URI risk, whereas sus-
tained and intense exertion has the
opposite effect. Figure 1 summarizes this
J-shaped-curve relationship. This article
will emphasize that each moderate exer-
cise bout causes immune system pertur-
bations that enhance immunosurveillance
against pathogens and at the same time
lowers risk of chronic disease by exerting
anti-inflammatory influences.
Moderate Exercise,
URI Risk, and
Immune Function
Several lines of evidence support the link
between moderate physical activity and
improved immunity leading to lowered
infection rates: survey, animal, epidemiolog-
ical, and randomized training data. Survey
data consistently support the common
belief among fitness enthusiasts that regular
exercise confers resistance against infection.
In surveys, 80% to 90% of regular exercis-
ers perceive themselves as less vulnerable
to viral illnesses compared with sedentary
peers, as summarized in Figure 2.
8,9
It is difficult to extrapolate animal
studies to the human condition, but in
general, they support the finding that
moderate exercise lowers morbidity and
mortality following pathogen inocula-
tion, especially when compared with
prolonged and intense exertion or physi-
cal inactivity. Mice infected with the her-
pes simplex virus, for example, and then
exposed to 30 minutes of moderate exer-
cise experience a lower mortality dur-
ing a 21-day period in contrast to higher
mortality rates after 2.5 hours of exhaus-
tive exercise or rest.
10
Epidemiological reports have retro-
spectively or prospectively compared
URI incidence in large groups of mod-
erately active and sedentary individu-
als. Collectively, the epidemiological
studies consistently show reduced URI
rates in physically active or fit individu-
als. A 1-year epidemiological study of 547
adults showed a 23% reduction in URI
risk in those engaging in regular versus
irregular moderate-to-vigorous physical
activity, as summarized in Figure 3.
11
In a group of 145 elderly people, URI
symptomatology during a 1-year period
was reduced among those engaging in
higher compared with lower amounts
of moderate physical activity.
12
During a
1-year study of 142 men aged 33 to 90,
the odds of having at least 15 days with
URI was 64% lower among those with
higher physical activity patterns.
13
In
Project PRIME, a randomized clinical trial
that investigated interventions to increase
physical activity, the odds ratio for
reporting URI symptoms was 0.50 (95%
confidence interval = 0.28 to 0.91) among
participants who engaged in a minimum
of 150 minutes per week of moderate
and vigorous activity compared with less
active participants.
14
A group of 1002 adults (ages 18 to
85 years, 60% female, 40% male) were
followed for 12 weeks (half during the
Physically
Inactive
Moderately
Active
Heavy Exertion
Exercise Workload
High Risk for
Common Cold
Average
Risk
Low Risk
Figure 1.
J-Curve Model on the Relationship
Between Exercise Workload, and Risk of
Upper-Respiratory-Tract Infection (URI).
81
16
3
0
10
20
30
40
50
60
70
80
90
Fewer Same Greater
Percentage of Runners (N = 226)
Cold Frequency Compared to Sedentary Peers
Figure 2.
Survey Responses by WSER athletes in response to this question: “Compared
to others who do no run or exercise do you feel that you generally have
_____________ episodes of sickness with the common cold or flu?” Data From
Reference 8.
[AQ: 1]
American Journal of Lifestyle Medicinevol. X • no. X
3
winter, half during the fall) while monitor-
ing URI symptoms and severity using the
Wisconsin Upper Respiratory Symptom
Survey.
15,16
Participants reported frequency
of moderate-to-vigorous aerobic activity
and rated their physical fitness level using
a 10-point Likert scale. Figure 4 shows that
the number of days with URI was signifi-
cantly reduced by 43% in those reporting
an average of 5 or more days of aerobic
exercise (20 minute bouts or longer) com-
pared with those who were largely seden-
tary (1 day per week). This relationship
occurred after adjustment for important
confounders, including age, education
level, marital status, gender, BMI, and per-
ceived mental stress. The number of days
with URI was reduced by 46% when com-
paring those in the highest versus lowest
tertile for perceived physical fitness, even
after adjustment for confounders.
Regular physical activity may lower
rates of infection for other types of dis-
eases. For example, women who were
regular and active walkers had an 18%
lower risk of pneumonia compared with
women who walked the least.
17
In the
same cohort, women who reported run-
ning or jogging more than 2 hours per
week had a significantly lower risk of
pneumonia compared with women who
spent no time running or jogging.
17
Randomized experimental trials have
provided important data in support of the
viewpoint that moderate physical activity
reduces URI symptomatology. In 1 ran-
domized, controlled study of 36 women
(mean age 35 years), those in the exer-
cise group walked briskly for 45 minutes,
5 days a week, and experienced one half
the days with URI symptoms during the
15-week period compared with the sed-
entary control group (5.1 ± 1.2 vs 10.8 ±
2.3 days; P = .039).
18
The effect of exercise training (five
45-minute walking sessions/wk at 60%-
75% maximum heart rate) and/or mod-
erate energy restriction (1200-1300 kCal
per day) on URI was studied in non-
obese, physically active women (N = 30)
and obese women (N = 91, body mass
index 33.1 ± 0.6 kg/m
2
) randomized to
1 of 4 groups: control, exercise, diet,
exercise and diet.
19
All participants self-
reported symptoms of sickness in health
logs, using a precoded checklist. Energy
restriction had no significant effect on URI
incidence, and those from the 2 exercise
groups were contrasted with those from
the 2 nonexercise groups. The number
of days with symptoms of URI for those
in the exercise groups was reduced rela-
tive to the nonexercise groups (5.6 ± 0.9
and 9.4 ± 1.1 sickness days, respectively),
similar to that of the nonobese, physically
active controls (4.8 ± 0.9). Figure 5 sum-
marizes the combined data set from these
2 training studies.
18,19
A 1-year randomized study of 115 over-
weight, postmenopausal women showed
that those who had regular moderate exer-
cise (166 minutes per week, ~4 days per
week) had lowered URI risk compared
with controls (who engaged in a stretch-
ing program).
20
In the final 3 months of
the study, the risk of colds in the control
group was more than 3-fold that of the
exercise group, as summarized in Figure 6.
During moderate exercise, several pos-
itive changes occur in the immune sys-
tem.
21-24
Moderate exercise increases the
recirculation of immunoglobulins, and neu-
trophils and natural killer cells, 2 cell types
that play a critical role in innate immune
defenses. Animal data indicate that lung
macrophages play an important role in
mediating the beneficial effects of moder-
ate exercise on lowered susceptibility to
infection.
25
Stress hormones, which can
suppress immunity, and pro-inflammatory
and anti-inflammatory cytokines, indica-
tive of intense metabolic activity, are not
elevated during moderate exercise.
Although the immune system returns to
preexercise levels within a few hours after
the exercise session is over, each session
represents a boost in immune surveillance
that reduces the risk of infection over the
long term. Other immune-related benefits
of exercise include enhanced antibody-
specific responses to vaccinations. For
example, several studies indicate that
both acute and chronic moderate exer-
cise training improve the body’s antibody
response to the influenza vaccine.
26-29
In
1 study, a 45-minute moderate exercise
bout just before influenza vaccination
improved the antibody response.
26
These data provide additional evi-
dence that moderate exercise favorably
influences overall immune surveillance
against pathogens. Taken together, the
data on the relationship between mod-
erate exercise, enhanced immunity, and
lowered URI risk are consistent with
guidelines urging the general public to
engage in near-daily brisk walking.
Exercise-Immune Benefits
for Elderly People
Immune senescence or age-associated
immune deficiency is partly responsible
for some of the afflictions of old age.
30-33
1
0.87
0.88
0.77
0
0.2
0.4
0.6
0.8
1
1.2
Sedentary Low-Moderate High-Moderate High
URTI, Incidence Rate Ratio
Physical Activity Level
Figure 3.
This 1-Year Study of 547 Adults Showed a 23% Reduction in Upper-
Respiratory-Tract Infection (URTI) Risk in Those Engaging in Regular Versus
Irregular Physical Activity. Data From Reference 11.
4
American Journal of Lifestyle Medicine XXX • XXX XXXX
8.7
7.3
3.3
8.6
5.5
4.9
5.1
5.7
8.0
4.7
6.0
8.3
7.1
5.4
7.0
5.4
6.3
5.3
6.2
7.2
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
URI (days during 12 week period)
StressAge Exercise Education Marital Sex BMI
Figure 4.
The Number of Days With Upper-Respiratory Illness (URI) During a 12-Week Period (Winter or Fall) in a Group of 1002 Adults
(Ages 18 to 85 Years) by Various Lifestyle and Demographic Factors. Means Are Adjusted Statistically After Weighting for Each
Factor Through a General Linear Model. Data From Reference 15.
5.5
10
0
2
4
6
8
10
12
Walkers
(N = 61)
Sedentary Controls
(N = 65)
Days With URI Over 12 Weeks
Figure 5.
The Number of Upper-Respiratory
Illness (URI) Symptom Days Was
Decreased by Approximately Half
Through a Walking Program (5 Days
Per Week, 45 Minutes Per Session, for
15 Weeks) by Previously Sedentary,
Overweight Adult Women. Data
Combined From References 18 and 19.
0.12
0.22
0.1
0.08
0.2
0.18
0.24
0.3
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0 to 3 3 to 6 6 to 9 9 to 12
Number of Colds, Group Average
Every 3 Months
Months
Exercise Control
Figure 6.
A 1-Year Randomized Study of 115 Overweight, Postmenopausal Women Showed
That 166 Minutes Per Week (~4 d/wk) of Moderate Exercise Lowered Upper-
Respiratory Illness Risk Compared With Controls (Stretching), Especially During the
Past 3 Months. Data from reference 20.
Elderly persons are more susceptible to
vaccine failure and many infections, auto-
immune disorders, and cancers when
compared with younger adults. The age-
related decline is most apparent in
T cell–dependent immune functions and
is related to thymus involution.
33,34
Aging is a complex process that ulti-
mately leads to irreversible biologi-
cal changes. However, health habits
can have a sizable influence on life
expectancy and quality of life, even in
old age.
35
A new and growing area of
research is the relationship between
certain lifestyle factors (in particular,
physical activity and diet) and immune
senescence.
35-39
Older adults exercise less and have
lower levels of cardiorespiratory fitness
than younger adults, and recent stud-
ies indicate that this may contribute to
American Journal of Lifestyle Medicinevol. X • no. X
5
immune senescence. Acute and chronic
physical activity has a major influence
on various measures of immune func-
tion in older adults according to studies
conducted during the past 2 decades.
39-41
Although research on the role of endur-
ance exercise on the immune systems of
elderly human subjects is just beginning,
data from the few available studies are
intriguing and have potential for wide-
spread public health influence.
Several cross-sectional studies have
compared immune function in highly
conditioned and sedentary elderly
(ie, 65 years) men and women.
42-44
One
study contrasted immune function in
30 sedentary elderly women and 12 age-
matched, highly conditioned elderly
women (mean age, 73 years) who were
active in state and national senior game
and road race endurance events.
44
The
highly conditioned elderly women (aver-
age VO
2max
of 31 mL
.
kg
-1.
min
-1
) had been
physically active for an average of 11 years
and had trained an average of 1.6 hours
daily during the previous year. The
highly conditioned participants exhibited
superior function of natural killer and T
lymphocytes compared with the 30 sed-
entary elderly women (Figure 7).
Another study compared immune func-
tion in 17 elderly runners, who had
trained for about 17 years, and 19 elderly
controls, and reported significantly higher
T lymphocyte function in the elderly run-
ners.
42
The elderly runners, when com-
pared with the elderly controls, also
demonstrated significantly higher rates
of interleukin-2 (IL-2), interferon-g, and
IL-4 production from activated T cells.
Another cross-sectional study of 13 sed-
entary and 13 physically active and
physically fit older adults (ages 60-76
years) revealed an augmented antibody
response to the flu vaccine.
43
Randomized exercise training stud-
ies have investigated the response of the
aging immune system to 2 to 6 months of
exercise training.
44-50
In 1 study, 30 sed-
entary elderly women (mean age, 73
years) were assigned to walking or sed-
entary groups.
44,45
The exercise group
walked 30 to 40 minutes, 5 days per
week, for 12 weeks at 60% heart rate
reserve; 12 weeks of moderate cardiore-
spiratory exercise improved the VO
2max
(ie, maximum aerobic fitness) of the pre-
viously sedentary elderly participants by
12.6% but did not result in any chronic
improvement in natural killer or T cell
function relative to the sedentary con-
trol group. Incidence of URI in the highly
conditioned, walking, and calisthenic
control groups was compared during
the 12-week study (September through
November). Half of the elderly women in
the calisthenic group suffered a URI dur-
ing the study as compared with 3 of 14
women in the walking group and 1 of
12 in the highly conditioned group (c
2
= 6.36; P = .042; Figure 8). Thus, elderly
women not engaging in cardiorespira-
tory exercise were more likely than their
exercising counterparts to experience URI
during the fall season. Although the initi-
ation of moderate exercise by the elderly
did not alter chronic immunity, the acute
and transient immune changes during
each exercise bout may have improved
overall immunosurveillance, decreasing
the risk of URI.
A 10-month exercise training study
showed that the antibody titer response
to the influenza vaccine was increased in
elderly adults who had undergone train-
ing as compared with sedentary controls
27
(Figure 9). Those who exercised trained
at 65% to 75% heart rate reserve, 25 to
30 minutes, 3 days per week. Another
10-month training study with elderly par-
ticipants showed a significant reduction
in inflammatory measures, including IL-6,
C-reactive protein (CRP), and IL-18 com-
pared with controls.
46
These data add to
the growing consensus that moderate
exercise training helps improve vaccine
efficacy and counter chronic low-grade
inflammation in the elderly.
47
Collectively, these data from studies of
elderly participants provide good support
for the role of regular physical activity
35
20
0
5
10
15
20
25
30
35
40
Highly
Conditioned
Sedentary
Controls
T Cell Function (lymphocyte
proliferative response, CPM)
120
75
0
20
40
60
80
100
120
140
Highly
Conditioned
Sedentary
Controls
Natural Killer Cell Function
(lytic units)
A B
Figure 7.
T Cell Function (A) and Natural Killer Cell Function (B) in Highly Conditioned
Female, Elderly Athletes Compared With Age- and Gender-Matched Sedentary
Controls. Data From Reference 44.
8
20
50
0
10
20
30
40
50
60
Highly
Conditioned
Walking Group Control Group
URI Incidence Over 12 Weeks (% group)
Figure 8.
Upper-Respiratory Illness (URI)
Incidence in 3 Groups of Elderly
Women During 12 Weeks: Highly
Conditioned, Walkers, and Controls.
Data From Reference 44.
6
American Journal of Lifestyle Medicine XXX • XXX XXXX
as therapy against immune senescence.
Physical activity has acute and chronic
beneficial effects on the immune systems
of elderly people. Cross-sectional studies
of highly active, highly conditioned, rela-
tively lean elderly men and women indi-
cate that T cell function is superior to that
of their sedentary peers but still below
the levels of untrained, young adults.
Several 2- to 6-month training studies
(both resistance and endurance exercise)
have shown that elderly persons can sig-
nificantly improve strength and aero-
bic fitness, lower URI rates, and improve
vaccine efficacy but without meaningful
changes in chronic immune function.
44-49
These data suggest that each moder-
ate exercise bout by elderly participants
causes temporary but positive improve-
ments in immunosurveillance that improve
host protection and vaccine antibody
responses. Research on the acute effects
of moderate exercise suggest that both
young and old adults recruit immune cells
in a similar fashion, and this increased
recirculation of cells may enhance immu-
nosurveillance when physical activity is
conducted on a near-daily basis.
50-52
Exercise Influences
on Inflammation and
Clinical Outcomes
Acute inflammation is a normal response
of the immune system to infection and
trauma. Chronic, low-grade inflammation,
however, is linked with multiple disor-
ders and diseases, including atheroscle-
rosis and cardiovascular disease (CVD),
the metabolic syndrome, diabetes mel-
litus, sarcopenia, arthritis, osteoporosis,
chronic obstructive pulmonary disease,
dementia, depression, and various types
of cancers.
53-55
CRP is the most frequently
measured inflammatory biomarker, and
individuals with CRP values in the upper
tertile of the adult population (>3.0 mg/L)
have a 2-fold increase in CVD risk com-
pared with those with a CRP concentra-
tion below 1.0 mg/L.
55
Large population observational stud-
ies show reduced serum CRP and other
inflammatory biomarkers (eg, the white
blood cell count, IL-6, and tumor necrosis
factor [TNF]-a) in adults with higher lev-
els of physical activity and fitness.
56-60
The
–0.5
0
0.5
1
1.5
2
2.5
One Month Three Months
Mean Fold Increase in Influenza
Antibody Titer
Elderly Controls Exercise Group Young Controls
Figure 9.
Comparison at 1 and 3 Months of Antibody Response to the Influenza Vaccination in
Elderly Controls, Elderly Exercisers, and Young Controls. Data From Reference 27.
1.06
2.10
3.92
2.63
1.61
2.72
1.99
1.61
2.00
1.85
2.36
1.80
2.36
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
Serum CRP (mg/L, adjusted mean anti-log)
Smoking
Status
BMI Gender Exercise
Frequency
Age
Group
Figure 10.
The Influence of Aerobic Exercise Frequency and Other Lifestyle and Demographic
Factors on C-Reactive Protein (CRP). Means Are Adjusted Statistically After Weighting
for Each Factor Through a General Linear Model. Data From Reference 61.
inverse association between physical
activity/fitness with inflammation is
related in part to the effect of activity
on fat mass.
58
In most studies, however,
adjustment for adiposity attenuates but
does not negate the strength of the rela-
tionship between inflammatory biomark-
ers and physical activity/fitness.
58
In a recent study of 1002 community-
dwelling adults (age range, 18- 85 years),
a general linear model analysis adjusted
CRP means for frequency of physical
activity, BMI, and several other lifestyle
and demographic factors (Figure 10).
61
As summarized in Figure 10, BMI had the
strongest effect on CRP followed by gender,
American Journal of Lifestyle Medicinevol. X • no. X
7
exercise frequency, age, and smoking
status.
An elevated fasting IL-6 concentration
is a significant component of the chronic
low-grade inflammation that underlies the
metabolic syndrome, CVD, diabetes, and
various cancers.
62
During prolonged exer-
cise, IL-6 is produced by muscle fibers
and stimulates the appearance in the cir-
culation of other anti-inflammatory cyto-
kines such as IL-1ra and IL-10.
63
IL-6 also
inhibits the production of the proinflam-
matory cytokine TNF-a and stimulates
lipolysis and fat oxidation.
63
With weight
loss from energy restriction and exercise,
plasma levels of IL-6 fall, skeletal mus-
cle TNF-a decreases, and insulin sensitiv-
ity improves.
64,65
Thus, IL-6 release from
the exercising muscle may help mediate
some of the health benefits of exercise,
including metabolic control of type 2 dia-
betes.
65
Muscle IL-6 release, however, is
very low during moderate physical activ-
ity, and additional research is needed to
determine if other exercise-induced fac-
tors mediate the anti-inflammatory influ-
ence of regular physical activity.
Conclusions
By far, the most important finding that
has emerged from exercise immunology
studies during the past 2 decades is that
positive immune changes take place during
each bout of moderate physical activity.
Over time, this translates to fewer days of
sickness with the common cold and other
URIs. These data are strengthened by sev-
eral lines of evidence across both animal
and human studies. The 25% to 50% reduc-
tion in sick days with near-daily moderate
exercise exceeds levels reported for most
medications and supplements and bolsters
public health guidelines urging individuals
to be physically active on a regular basis.
The anti-inflammatory effect of near-
daily physical activity may play a key
role in many health benefits, includ-
ing reduced CVD, type 2 diabetes, var-
ious types of cancers, sarcopenia, and
dementia. This is an exciting area of sci-
entific endeavor, and additional research
is needed to determine how immune
perturbations during each exercise bout
accumulate over time to produce an anti-
inflammatory influence.
AJLM
References
1. National Institute of Allergy and Infectious
Diseases. The common cold fact sheet.
http://www3.niaid.nih.gov/topics/com-
monCold. Accessed November 9, 2009.
2. Fendrick AM, Monto AS, Nightengale B,
Sarnes M. The economic burden of non-
influenza-related viral respiratory tract
infection in the United States. Arch Intern
Med 2003;163:487-494.
3. Monto AS. Epidemiology of viral
respiratory infections. Am J Med.
2002;112(6A):4S-12S.
4. Cohen S. Keynote Presentation at
the Eight International Congress of
Behavioral Medicine: the Pittsburgh com-
mon cold studies: psychosocial predictors
of susceptibility to respiratory infectious
illness. Int J Behav Med. 2005;12:123-131.
5. Spiegel K, Sheridan JF, Van Cauter E. Effect
of sleep deprivation on response to immu-
nization. JAMA. 2002;288:1471-1472.
6. Cohen S, Doyle WJ, Alper CM, Janicki-
Deverts D, Turner RB. Sleep habits and
susceptibility to the common cold. Arch
Intern Med. 2009;169:62-67.
7. Wolvers DA, van Herpen-Broekmans WM,
Logman MH, van der Wielen RP, Albers R.
Effect of a mixture of micronutrients, but
not of bovine colostrum concentrate, on
immune function parameters in healthy
volunteers: a randomized placebo-con-
trolled study. Nutr J. 2006;5:28.
8. Nieman DC. Immune function responses
to ultramarathon race competition. Med
Sportiva 2009;13:189-96.
9. Shephard RJ, Kavanagh T, Mertens DJ,
Qureshi S, Clark M. Personal health benefits
of Masters athletics competition. Br J Sports
Med. 1995;29:35-40.
10. Davis JM, Kohut ML, Colbert LH, Jackson DA,
Ghaffar A, Mayer EP. Exercise, alveo-
lar macrophage function, and susceptibil-
ity to respiratory infection. J Appl Physiol.
1997;83:1461-1466.
11. Matthews CE, Ockene IS, Freedson PS,
Rosal MC, Merriam PA, Hebert JR.
Moderate to vigorous physical activity and
risk of upper-respiratory tract infection.
Med Sci Sports Exerc. 2002;34:1242-1248.
12. Kostka T, Praczko K. Interrelationship
between physical activity, symptomatology
of upper respiratory tract infections, and
depression in elderly people. Gerontology.
2007;53:187-193.
13. Kostka T, Drygas W, Jegier A, Praczko K.
Physical activity and upper respira-
tory tract infections. Int J Sports Med.
2008;29:158-162.
14. Strasner A, Barlow CE, Kampert JB, Dunn AL.
Impact of physical activity on URTI symp-
toms in Project PRIME participants. Med Sci
Sports Exerc. 2001;33(suppl):S304.
15. Heinz SA, Henson DA, Austin MD, Jin F,
Nieman DC. Quercetin supplementation
and upper respiratory tract infection: a ran-
domized community clinical trial. Pharm
Res. In press.
16. Barrett B, Brown R, Mundt M, et al. The
Wisconsin Upper Respiratory Symptom
Survey is responsive, reliable, and valid.
J Clin Epidemiol. 2005;58:609-617.
17. Neuman MI, Willett WC, Curhan GC.
Physical activity and the risk of community-
acquired pneumonia in US women.
Am J Med. 2010;123:281.e7-281.e11.
18. Nieman DC, Nehlsen-Cannarella SL,
Markoff PA, et al. The effects of moderate
exercise training on natural killer cells and
acute upper respiratory tract infections.
Int J Sports Med. 1990;11:467-473.
19. Nieman DC, Nehlsen-Cannarella SL,
Henson DA, et al. Immune response to
exercise training and/or energy restric-
tion in obese women. Med Sci Sports Exerc.
1998;30:679-686.
20. Chubak J, McTiernan A, Sorensen B, et al.
Moderate-intensity exercise reduces the
incidence of colds among postmenopausal
women. Am J Med. 2006;119:937-942.
21. Nehlsen-Cannarella SL, Nieman DC,
Jessen J, et al. The effects of acute moder-
ate exercise on lymphocyte function and
serum immunoglobulins. Int J Sports Med.
1991;12:391-398.
22. Nieman DC. Exercise effects on sys-
temic immunity. Immunol Cell Biol.
2000;78:496-501.
23. Nieman DC, Nehlsen-Cannarella SL. The
immune response to exercise. Semin
Hematol. 1994;31:166-179.
24. Nieman DC, Henson DA, Austin MD,
Brown VA. The immune response to a
30-minute walk. Med Sci Sports Exerc.
2005;37:57-62.
25. Murphy DA, Davis JM, Brown AS, et al.
Role of lung macrophages on suscep-
tibility to respiratory infection follow-
ing short-term moderate exercise training.
Am J Physiol Regul Integr Comp Physiol.
2004;287:R1354-R1358.
26. Edwards DM, Burns VE, Reynolds T,
Carroll D, Drayson M, Ring C. Acute
stress exposure prior to influenza vac-
cination enhances antibody response
in women. Brain Behav Immun.
2006;20:159-168.
27. Kohut ML, Arntson BA, Lee W, et al.
Moderate exercise improves antibody
response to influenza immunization in
older adults. Vaccine. 2004;22:2298-2306.
28. Kohut ML, Lee W, Martin A, et al. The
exercise-induced enhancement of influ-
enza immunity is mediated in part by
improvements in psychosocial factors
in older adults. Brain Behav Immun.
2005;19:357-366.
8
American Journal of Lifestyle Medicine XXX • XXX XXXX
29. Lowder T, Padgett DA, Woods JA.
Moderate exercise early after influenza
virus infection reduces the Th1 inflam-
matory response in lungs of mice. Exerc
Immunol Rev. 2006;12:97-111.
30. Weinberger B, Herndler-Brandstetter D,
Schwanninger A, et al. Biology of immune
response to vaccines in elderly persons.
Clin Infect Dis. 2008;46:1078-1084.
31. Pawelec G, Larbi A. Immunity and aging
in man: annual review 2006/2007. Exp
Gerontol. 2008;43:34-38.
32. Targonski PV, Jacobson RM.
Immunosenescence: role and measurement
in influenza vaccine response among the
elderly. Vaccine. 2007;25:3066-3069.
33. Gruver AL, Hudson LL, Sempowski GD.
Immunosenescence of aging. J Pathol.
2007;211:144-156.
34. Chakravarti B, Abraham GM. Aging and
T-cell-mediated immunity. Mech Ageing
Dev. 1999;108:183-206.
35. Vitetta L, Anton B. Lifestyle and nutrition,
caloric restriction, mitochondrial health and
hormones: scientific interventions for anti-
aging. Clin Interv Aging. 2007;2:537-543.
36. Aw D, Silva AB, Palmer DB.
Immunosenescence: emerging challenges
for an aging population. Immunology.
2007;120:435-446.
37. Haase H, Mocchegiani E, Rink L.
Correlation between zinc status and
immune function in the elderly.
Biogerontology. 2006;7:421-428.
38. Meydani SN, Han SN, Wu D. Vitamin E
and immune response in the aged: molec-
ular mechanisms and clinical implications.
Immunol Rev. 2005;205:269-284.
39. Nieman DC, Henson DA. Role of endur-
ance exercise in immune senescence.
Med Sci Sports Exerc. 1994;26:172-181.
40. Henson DA, Nieman DC, Pistilli EE,
et al. Influence of carbohydrate and age
on lymphocyte function following a mara-
thon. Int J Sport Nutr Exerc Metab. 2004;
14:308-322.
41. Kohut ML, Senchina DA. Reversing age-
associated immunosenescence via exercise.
Exerc Immunol Rev. 2004;10:6-41.
42. Shinkai S, Kohno H, Kimura K, et al.
Physical activity and immune senes-
cence in men. Med Sci Sports Exerc.
1995;27:1516-1526.
43. Keylock KT, Lowder T, Leifheit KA, et al.
Higher antibody, but not cell-medi-
ated, responses to vaccination in high
physically fit elderly. J Appl Physiol.
2007;102:1090-1098.
44. Nieman DC, Henson DA, Gusewitch G, et al.
Physical activity and immune function
in elderly women. Med Sci Sports Exerc.
1993;25:823-831.
45. Nieman DC. Immune function. In:
Gisolfi CV, Lamb DR, Nadel E, eds.
Exercise in Older Adults. Carmel, IN:
Cooper Publishing Group; 1995: 435-461.
Perspectives in Exercise Science and Sports
Medicine; vol 8.
46. Kohut ML, McCann DA, Russell DW, et al.
Aerobic exercise, but not flexibility/resis-
tance exercise, reduces serum IL-18,
CRP, and IL-6 independent of beta-
blockers, BMI, and psychosocial fac-
tors in older adults. Brain Behav Immun.
2006;20:201-209.
47. Senchina DA, Kohut ML. Immunological
outcomes of exercise in older adults. Clin
Interv Aging. 2007;2:3-16.
48. Flynn MG, Fahlman M, Braun WA,
et al. Effects of resistance training on
selected indexes of immune function in
elderly women. J Appl Physiol. 1999;
86:1905-1913.
49. Woods JA, Ceddia MA, Wolters BW, Evans JK,
Lu Q, McAuley E. Effects of 6 months of
moderate aerobic exercise training on
immune function in the elderly. Mech
Ageing Dev. 1999;109:1-19.
50. Bruunsgaard H, Jensen MS, Schjerling P,
et al. Exercise induces recruitment of lym-
phocytes with an activated phenotype
and short telomeres in young and elderly
humans. Life Sci. 1999;65:2623-2633.
51. Ceddia MA, Price EA, Kohlmeier CK, et al.
Differential leukocytosis and lymphocyte
mitogenic response to acute maximal exer-
cise in the young and old. Med Sci Sports
Exerc. 1999;31:829-836.
52. Fiatarone MA, Morley JE, Bloom ET,
Benton D, Solomon GF, Makinodan T.
The effect of exercise on natural killer cell
activity in young and old subjects.
J Gerontol. 1989;44:M37-M45.
53. Khansari N, Shakiba Y, Mahmoudi M.
Chronic inflammation and oxidative stress
as a major cause of age-related diseases
and cancer. Recent Pat Inflamm Allergy
Drug Discov. 2009;3:73-80.
54. Devaraj S, Valleggi S, Siegel D, Jialal I.
Role of C-reactive protein in contribut-
ing to increased cardiovascular risk in met-
abolic syndrome. Curr Atheroscler Rep.
2010;12:110-118.
55. Pearson TA, Mensah GA, Alexander RW,
et al. Markers of inflammation and car-
diovascular disease: application to clinical
and public health practice: a statement for
healthcare professionals from the Centers
for Disease Control and Prevention and the
American Heart Association. Circulation.
2003;107:499-511.
56. Hsu FC, Kritchevsky SB, Liu Y, et al.
Association between inflammatory compo-
nents and physical function in the health,
aging, and body composition study: a princi-
pal component analysis approach. J Gerontol
A Biol Sci Med Sci. 2009;64:581-589.
57. Lavoie ME, Rabasa-Lhoret R, Doucet E,
et al. Association between physical activ-
ity energy expenditure and inflamma-
tory markers in sedentary overweight
and obese women. Int J Obes (Lond).
2010;34:1387-1395.
58. Beavers KM, Brinkley TE, Nicklas BJ. Effect
of exercise training on chronic inflamma-
tion. Clin Chim Acta. 2010;411:785-793.
59. Ford ES. Does exercise reduce inflamma-
tion? Physical activity and C-reactive pro-
tein among U.S. adults. Epidemiology.
2002;13:561-568.
60. Borodulin K, Laatikainen T, Salomaa V,
Jousilahti P. Associations of leisure time
physical activity, self-rated physical fitness,
and estimated aerobic fitness with serum
C-reactive protein among 3,803 adults.
Atherosclerosis. 2006;185:381-387.
61. Shanely RA, Jin F, Henson DA, Knab AM,
Sha W, Nieman DA. Self-reported phys-
ical fitness and activity are predictive of
decreased inflammation and oxidative
stress. Med Sci Sports Exerc. In press.
62. Dekker MJ, Lee S, Hudson R, et al. An
exercise intervention without weight
loss decreases circulating interleukin-6
in lean and obese men with and with-
out type 2 diabetes mellitus. Metabolism.
2007;56:332-338.
63. Petersen AM, Pedersen BK. The anti-
inflammatory effect of exercise. J Appl
Physiol. 2005;98:1154-1162.
64. Ryan AS, Nicklas BJ. Reductions in plasma
cytokine levels with weight loss improve
insulin sensitivity in overweight and obese
postmenopausal women. Diabetes Care.
2004;27:1699-1705.
65. Ferrier KE, Nestel P, Taylor A, Drew BC,
Kingwell BA. Diet but not aerobic exer-
cise training reduces skeletal muscle TNF-
alpha in overweight humans. Diabetologia.
2004;47:630-637.
... In recent years, the potential of physical exercise as a therapeutic tool in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) maintenance treatment has been investigated [5]. Regular practice of moderate-intensity exercise has been shown to improve certain aspects of immune function and exert anti-inflammatory effects [6,7], having been associated with low levels of pro-inflammatory cytokines and high levels of anti-inflammatory cytokines [8]. These effects contribute, at least in part, to reducing the risk of infections and CVD [6,7] The persistent inflammation and immune dysregulation present in CKD patients on HD can result in a loss of skeletal muscle mass, muscle strength and functional capacity. ...
... Regular practice of moderate-intensity exercise has been shown to improve certain aspects of immune function and exert anti-inflammatory effects [6,7], having been associated with low levels of pro-inflammatory cytokines and high levels of anti-inflammatory cytokines [8]. These effects contribute, at least in part, to reducing the risk of infections and CVD [6,7] The persistent inflammation and immune dysregulation present in CKD patients on HD can result in a loss of skeletal muscle mass, muscle strength and functional capacity. Exercise produces mechanical stress on the muscle fiber, which can alter the inflammatory response that affects structural and functional adaptation, remodeling and repairing processes in the skeletal muscles [9,10] On the other hand, physical activity can induce the production of anti-inflammatory cytokines and a selective decrease in circulating CD16 + monocytes through a transient increase in endogenous glucocorticoids [11]. ...
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Background: In recent years, physical exercise has been investigated for its potential as a therapeutic tool in patients with end-stage renal disease (ESRD) undergoing hemodialysis maintenance treatment (HD). It has been shown that regular practice of moderate-intensity exercise can improve certain aspects of immune function and exert anti-inflammatory effects, having been associated with low levels of pro-inflammatory cytokines and high levels of anti-inflammatory cytokines. Purpose: The aim of this review is to examine the studies carried out in this population that analyzed the effect of intradialytic exercise on the inflammatory state and evaluate which exercise modality is most effective. Methods: The search was carried out in the MEDLINE, CINAHL Web of Science and Cochrane Central Register of Controlled Trials databases from inception to June 2022. The PEDro scale was used to assess methodological quality, and the Cochrane Risk of Bias Tool and MINORS were used to evaluate the risk of bias. The quality of evidence was assessed with GRADE scale. The outcome measures were systemic inflammation biomarkers. Results: Mixed results were found in terms of improving inflammation biomarkers, such as CRP, IL-6 or TNFα, after exercise. Aerobic exercise seems to improve systemic inflammation when performed at medium intensity while resistance training produced better outcomes when performed at high intensity. However, some studies reported no differences after exercise and these results should be taken with caution. Conclusions: The low quality of the evidence suggests that aerobic and resistance exercise during HD treatment improves systemic inflammation biomarkers in patients with ESRD. In any case, interventions that increase physical activity in patients with ESRD are of vital importance as sedentary behaviors are associated with mortality. More studies are needed to affirm solid conclusions and to make intervention parameters, such as modality, dose, intensity or duration, sufficiently clear. Keywords: chronic kidney disease; hemodialysis; inflammation; exercise
... It is especially critical for older adults to maintain good health because of their increased risk of infection and their potential for developing serious complications (e.g., pneumonia and cytokine storm) [5]. Several researchers have discovered that moderate physical activity boosts the immune response to viral respiratory infections [6], [7] and that social engagement brings health benefits to people of all ages [8]. However, the COVID-19 pandemic has posed challenges for older adults. ...
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... Although mortality rates are still being determined, preliminary COVID-19 data suggests that the likelihood of death increases exponentially with age (CDC, 2020;Onder et al., 2020). Researchers have found that moderate physical activity increases immune response to viral respiratory infections (Nieman, 2011;Nieman & Wentz, 2019), and social engagement provides protective health benefits across the lifespan (Umberson & Montez, 2010). During the shelter-in- place mandates established during COVID-19, physical activity and sporting events have been shuttered, residential communities' activities and clubs have been suspended, and municipal facilities have ceased on-site operations. ...
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This (auto)ethnographic case study documents two intertwined stories. The first traces the author’s evolutionary path from a post in full-time teaching and management to lifestyle entrepreneurship as an exercise instructor for older adults. The second arises from the experience of the participants in those classes and their interaction with the author. As the stories merge life experiences are shared and compared. Identity is formed and reformed. This is an original study covering a period exceeding fifteen years. Offered as a piece of Creative Analytical Practice the stories aim to show rather than tell how serious leisure is allied to the concept of ageing well. The work invites readers to respond and question in the light of their own experience. Attention is especially drawn to periods of life transition, for example retirement or confinement due to COVID-19. Data is drawn from doctoral and post-doctoral research supported by longer term personal diary entries. The events involved, the timescale covered and the authenticity of the interaction document a unique trajectory and an example which other older adults are being encouraged to emulate.
... Although mortality rates are still being determined, preliminary COVID-19 data suggests that the likelihood of death increases exponentially with age (CDC, 2020;Onder et al., 2020). Researchers have found that moderate physical activity increases immune response to viral respiratory infections (Nieman, 2011;Nieman & Wentz, 2019), and social engagement provides protective health benefits across the lifespan (Umberson & Montez, 2010). During the shelter-in-place mandates established during COVID-19, physical activity and sporting events have been shuttered, residential communities' activities and clubs have been suspended, and municipal facilities have ceased on-site operations. ...
... Subjek tidak menyisihkan waktu untuk melakukan olahraga agar tubuhnya menjadi bugar. (Nieman, 2011). Protein merupakan salah satu jenis zat gizi makro yang memiliki fungsi penting sebagai bahan dasar bagi pembentukan jaringan tubuh atau bahan dasar untuk memperbaiki jaringan-jaringan tubuh yang telah rusak. ...
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... 25 Light to moderate physical activity strengthens the immune system and help prevent and recovery from respiratory infections. 26 For sustaining physical health during pandemic context, everybody and older adults in particular should change postures several times during the day to stimulate or even improve their muscular activity. 27 P&OTs can disseminate strategies to their patients and in their communities. ...
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This research paper is an initiative to provide insight associated with physiological health of employees’ by examining the interventions of yogic exercise on physiological health. The investigation was done to study the impact of Yoga and Pranayama on functioning of Lungs (vital capacity) and functioning of heart (resting heart rate) as an ancient therapy. The purpose of the study was found out the effect of aerobic exercise and yogic practices on resting pulse rate and vital capacity among employees of a private organization engaged in production of technical equipment’s for Indian Railway & Metro Trains & other such related industries. After taking due consent from the promoter and founder of PPS International, researcher randomly selected 120 subjects all males of age group 25-35years. Yoga helps to improve the lives of all age group irrespective of gender. It can be adopted from any stage of life or started at any age; yoga has shown excellent results on physiological health related variable of stressed working professionals.
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Heavy exertion has acute and chronic influences on systemic immunity. In the resting state, the immune systems of athletes and non-athletes are more similar than disparate with the exception of NK cell activity, which tends to be elevated in athletes. Many components of the immune system exhibit adverse change after prolonged, heavy exertion. These immune changes occur in several compartments of the immune system and body (e.g. the skin, upper respiratory tract mucosal tissue, lung, blood and muscle). Although still open to interpretation, most exercise immunologists believe that during this 'open window' of impaired immunity (which may last between 3 and 72 h, depending on the immune measure) viruses and bacteria may gain a foothold, increasing the risk of subclinical and clinical infection. The infection risk may be amplified when other factors related to immune function are present, including exposure to novel pathogens during travel, lack of sleep, severe mental stress, malnutrition or weight loss.
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This study was performed in order to investigate the type of T cells recruited to the blood in response to an acute bout of exercise with regard to mean lengths of telomeric terminal restriction fragments (TRF) and surface activation markers and with special emphasis on age-associated differences. Ten elderly and ten young humans performed maximal bicycle exercise. There was no difference in the number of recruited CD4+ and CD8+ cells between the young and elderly group. In both age groups the immediate increases could be ascribed to recruitment of CD28- cells (CD8+ and CD4+ cells) and memory cells (only CD8+ cells). Furthermore, after exercise mean TRF lengths were significantly reduced in blood mononuclear cells and in CD8+ cells from young subjects and in CD4+ cells from elderly subjects compared with lengths pre-exercise. These findings suggest that the mobilization of T lymphocytes during acute exercise is mainly a redistribution of previously activated cells with an increased replicative story than cells isolated from the blood at rest. Furthermore, elderly humans fulfilling the Senieur protocol have a preserved ability to recruit T lymphocytes in response to acute physical stress.
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Quercetin in culture with target cells and pathogens exerts anti-pathogenic activities against a wide variety of viruses and bacteria. A few small-scale human quercetin supplementation studies have produced conflicting results regarding quercetin's effects on upper respiratory tract infection rates, and little is known regarding the appropriate human dose. The purpose of this randomized, double-blinded, placebo-controlled trial was to measure the influence of two quercetin doses (500 and 1000 mg/day) compared to placebo on upper respiratory tract infection (URTI) rates in a large community group (N=1002) of subjects varying widely in age (18-85 years). Subjects ingested supplements for 12 weeks and logged URTI symptoms on a daily basis using the Wisconsin Upper Respiratory Symptom Survey (WURSS). No significant group differences were measured for URTI outcomes for all subjects combined, or when analyzing separately by gender, body mass index, and age categories. Regression analysis revealed that the strongest interaction effect with group status was self-reported fitness level. A separate analysis of subjects 40 years of age and older rating themselves in the top half of the entire group for fitness level (N=325) showed lower URTI severity (36% reduction, P=0.020) and URTI total sick days (31% reduction, P=0.048) for the Q-1000 group compared to placebo. In summary, for all subjects combined, quercetin supplementation over 12 weeks had no significant influence on URTI rates or symptomatology compared to placebo. A reduction in URTI total sick days and severity was noted in middle aged and older subjects ingesting 1000 mg quercetin/day for 12 weeks who rated themselves as physically fit.
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Exercise bolsters the immune system and can prevent various infections in certain populations. However, limited data exist regarding the role of physical activity and the risk of community-acquired pneumonia. During a 12-year period, we prospectively examined the association between physical activity and the risk of community-acquired pneumonia among 83,165 women in the Nurses' Health Study II who were between the ages of 27 and 44 years in 1991. We excluded women who had pneumonia before 1991 and those with a history of cancer, cardiovascular disease, or asthma. Biennial self-administered mailed questionnaires were used to determine activity level. Cases of pneumonia required a diagnosis by a physician and confirmation with a chest radiograph. We identified 1265 new cases of community-acquired pneumonia during 965,168 person-years of follow up. After adjusting for age, women in the highest quintile of physical activity were less likely to develop pneumonia than women in the lowest quintile (relative risk [RR] = 0.72; 95% confidence interval [CI], 0.60-0.86; P for trend<.001). However, the association was attenuated and only marginally significant after further adjusting for body mass index, smoking, and alcohol use (RR=0.84; 95% CI, 0.70-1.01; P for trend=.06). Women in the highest quintile of walking were less likely to develop pneumonia compared with women who walked the least (multivariate adjusted RR=0.82; 95% CI, 0.69-0.98); however, the trend across quintiles was not significant (P for trend=.25). Higher physical activity does not substantially reduce pneumonia risk in well-nourished women.