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Clinical management of immuno-suppression in athletes associated with exercise training: Sports medicine considerations
Abstract and Figures
The Overtraining Syndrome (OTS) is a physically debilitating medical condition that results in athletes being totally compromised in their capacity to perform and compete. Many physiological systems are affected by the process of overtraining and the development of the OTS which results from it; but one system in particular, the immune, is highly susceptible to degradation resulting in a reduction in overall health and physical performance. The aim of this paper is to review; 1) the evidence-based proactive steps and actions to take to greatly reduce the risk of development of an infection or a compromised immune system in athletes; and 2) the course of action for clinicians to take when they are dealing with an athlete displaying overt signs of an infection and, or inflammation. Evidenced reported here within support that it is essential for clinicians to take practical preventative and management steps - actions with athletes (involved in intensive exercise training) in order to help preserve and maintain a healthy and robust immune system if they are going to perform optimally.
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... In addition, long-term high-intensity physical activities have been shown to suppress the immune system and cause an increased mortality rate (4,8). In some studies, the relationship between physical activity and upper respiratory tract viral infection has been explained with "J Curve Model" (Figure 1) (14,49). According to the result of these studies, it has been reported that regular moderate physical activities strengthens the immune system and reduces the risk of upper respiratory tract viral infection, but long term high intensity physical activities cause an increase at the risk of upper respiratory infection by suppressing the immune system (1,34,35). ...
... According to the result of these studies, it has been reported that regular moderate physical activities strengthens the immune system and reduces the risk of upper respiratory tract viral infection, but long term high intensity physical activities cause an increase at the risk of upper respiratory infection by suppressing the immune system (1,34,35). (14). Abbreviation: hrs=hours. ...
... Increased Susceptibility To Diseases After Intense Exercise. Theoretical concept of "open window" associated with immune responses to acute exercise (14). The relation between the susceptibility of changes in the immune system related to exercise to infections is expressed as "open window theory" (Figure 2). ...
The aim of this review is to examine the mutual interaction of the regular moderate exercises that can be performed in an isolated environment and COVID-19 virus with the immune system and to emphasize the importance of physical activity and exercise practices which are known as complementary treatment method in struggling with diseases based on the data obtained. COVID-19 pandemic has become a great problem lately for the whole world population because of its fatal effect. Staying at home for months can cause sedentary behaviors and some changes in people's immune responses by restricting their physical and social activities. The databases such as PubMed, Elsevier, Scopus and Science Direct and Google Scholar have been used for scientific surveys while working on this review. The sources cited in this review include reports on past or current public health by more than one health institution, online information, and a total of 59 scientific articles published in refereed journals. In this review, the interaction of physical activity and exercise practices with immune responses during COVID-19 pandemic has been presented and it has been indicated that according to the data obtained from the studies conducted in previous years, physical activity and moderate exercise practices have a positive effect on immune system responses, but high-intensity and long term exercises suppress the immune system. As a consequence, social isolation during COVID-19 pandemic may cause sedentary behaviors. Therefore, individualized proper exercise practices are strongly recommended.
... That's because an injury lowers your immunity, making it harder for you to fight diseases. Not the best of times, given that a highly contagious virus is the main cause of our collective lockdown [28]. According to Dr. Matthew Jackson, a lecturer in sport and health science at the university, "the science underlying exercise and immunity involves the intricate interaction of a number of different cells, including immunoglobulins, sometimes known as antibodies, which can help recognize a virus." ...
David Miranda, a physical therapist and the proprietor of Excel Rehabilitation Services in Gonzales, Louisiana, asserts that excessive exercise is harmful to human health and counterproductive. Women who exercise excessively run a higher risk of developing the “female athlete triad,” which includes eating disorders, osteoporosis, and loss of bone mineral density. Intense exercise has been shown to lower libido in men; this may be due to physical exhaustion and low testosterone levels. According to German research that was recently published online in the journal Heart, excessive high-intensity exercise may actually increase the risk of dying from a heart attack or stroke in people who already have heart disease. Too much exercise without adequate recovery might cause low testosterone levels and high amounts of the stress hormone cortisol. Overtraining can increase stress hormone levels, and increase the risk of injury, weariness, and muscle loss. The Wall Street Journal’s article “A Workout Ate My Marriage,” which was published in 2010, describes how spouses grow more estranged from one another as they become fixated on a particular exercise goal, such as extreme weight loss or an Ironman triathlon, at the expense of quality time with loved ones.
... Expending a large proportion of daily energy on exercise (i.e. having 'low energy availability') has long been recognized as a risk factor for 'overtraining syndrome' or 'relative energy deficiency in sport', with symptoms including hypogonadism, immunosuppression, and slower recovery from illness and injury [106][107][108] . ...
Economic models predominate in life history research, which investigates the allocation of an organism's resources to growth, reproduction, and maintenance. These approaches typically employ a heuristic Y model of resource allocation, which predicts trade-offs among tasks within a fixed budget. The common currency among tasks is not always specified, but most models imply that metabolic energy, either from food or body stores, is the critical resource. Here, we review the evidence for metabolic energy as the common currency of growth, reproduction, and maintenance, focusing on studies in humans and other vertebrates. We then discuss the flow of energy to competing physiological tasks (physical activity, maintenance, and reproduction or growth) and its effect on life history traits. We propose a Ψ model of energy flow to these tasks, which provides an integrative framework for examining the influence of environmental factors and the expansion and contraction of energy budgets in the evolution of life history strategies.
... Bu nedenle, futbolda iç yükün izlenilmesinde GPS verileri ile AZD yanıtları birlikte kullanılabilir. Futbolda, dış yükün GPS ile belirlenmesinde, kat edilen toplam mesafe oldukça fazla kullanılmaktadır (Hackney, 2013). İç yükün belirlenmesindeki zorluklardan dolayı, dış yükün takibi ile iç yükün tahmini mümkündür (Vanrenterghem vd, 2017 ...
Futbol sporunun yarattığı ekonomik sermaye nedeniyle, futbolda üst düzey performansa verilen önem artmaktadır. Sporcu ve takım performansının iyileştirilmesi ve takibi için kullanılan giyilebilir teknoloji ürünü olan GPS kullanımı giderek önem kazanmaktadır. GPS teknolojisi sayesinde araştırmacılar sporcuların fiziksel, teknik, taktik becerilerini araştırılabilmektedir. Bu çalışma geleneksel derleme yöntemi kullanılarak yazılmıştır. Farklı veri tabanlarında (Google Scholar, PubMed, Web of Science ve YÖK Tez) “futbol”, “GPS”, “futbol ve GPS”, “futbolda performans analizi” anahtar kelimeleri kullanılarak arama yapılmış ve 2015-2022 yılların arasında futbol oyuncularında GPS kullanılan çalışmalar derlenerek özetlenmiştir. İncelenen çalışmalar neticesinde en fazla sporcuların maç yükleri (iç- dış), pozisyonları, hareket modellerinin ve hız verilerinin analiz edildiği görülmektedir. Bu araştırmada, verilen bilgiler ışığında sporcu performans takibinde en çok kullanılan cihazlar ve frekanslar, analiz programları, elde edilen parametreler sunulmaktadır.
... Respiratory and gastrointestinal symptoms are the most common medical presentations in elite athletes [4]. For athletes to be able to maintain their physical health, proactive approaches to support immunity and reduce susceptibility to infections are called for, and they may benefit from training adaptation and competitive performance [5]. ...
The possible effect of probiotic interventions on immunological markers in athletes is inconclusive. Therefore, to synthesize and quantitatively analyze the existing evidence on this topic, systematic literature searches of online databases PubMed, Scopus, Cochrane Library, and ISI Web of Sciences was carried out up to February 2021 to find all randomized controlled trials (RCTs) concerning the immunological effects of probiotics in athletes. In the random-effects model, weighted mean difference (WMD) and 95% confidence interval (CI) explained the net effect. The authors assessed the likelihood of publication bias via Egger's and Begg's statistics. A total of 13 RCTs (836 participants) were retrieved. Probiotic consumption reduced lymphocyte T cytotoxic count significantly (WMD=-0.08 cells×109/L; 95% CI: -0.15 to -0.01; p=0.022) with evidence of moderate heterogeneity (I2=59.1%, p=0.044) and monocyte count when intervention duration was ≤ 4 weeks (WMD=-0.08 cells×109/L; 95% CI: -0.16 to -0.001; I2=0.0%). Furthermore, leukocyte count was significantly elevated (WMD=0.48 cells×109/L; 95% CI: 0.02 to 0.93; I2=0.0%) when multi-strain probiotics were used. Probiotic supplements may improve immunological markers, including lymphocyte T cytotoxic, monocyte, and leukocyte in athletes. Further randomized controlled trials using diverse strains of probiotics and consistent outcome measures are necessary to allow for evidence-based recommendations.
... Note that vigorous intensity exercise leads to a transient drop in immunity. [7][8][9] Hence, running a marathon (a vigorous intensity activity) in your balcony in COVID-19 hotspot is not a good idea simply because you are more vulnerable to an infection. While the World may cheer at the bravery of an attempt like this, it is outright silly and there would be better, safer times to attempt this. ...
... However, it was inappropriate to continue at a higher running intensity. It is well known that intensity of exercise is associated with immunity (24). Another question is why doxorubicin treatment exerted no effect on cardiomyocyte contraction and relaxation even though the ejection fraction was progressively decreased in the whole heart. ...
Cardiac inflammation has been proposed as one of the primary mechanisms of anthracycline-induced acute cardiotoxicity. A reduction in cardiac inflammation might also reduce cardiotoxicity. This study aimed to evaluate the potential of estrogen therapy and regular exercise on attenuating cardiac inflammation in the context of doxorubicin-induced cardiomyopathy. Ovariectomized rats were randomly allocated into estrogen supplementation, exercise training, and mast cell stabilizer treatment groups. Eight weeks after ovariectomy, rats received six cumulative doses of doxorubicin for two weeks. Echocardiography demonstrated a progressive decrease in ejection fraction in doxorubicin-treated rats without hypertrophic effect. This systolic defect was completely prevented by either estrogen supplementation or mast cell stabilizer treatment but not by regular exercise. As a heart disease indicator, increased β-MHC expression induced by doxorubicin could only be prevented by estrogen supplementation. Decreases in shortening and intracellular Ca2+ transients of cardiomyocytes were due to absence of female sex hormones without further effects of doxorubicin. Again, estrogen supplementation and mast cell stabilizer treatment prevented these changes but exercise training did not. Histological analysis indicated that the hyperactivation of cardiac mast cells in ovariectomized rats was augmented by doxorubicin. Estrogen supplementation and mast cell stabilizer treatment completely prevented both increases in mast cell density and degranulation, while exercise training partially attenuated the hyperactivation. Our results therefore suggest that estrogen supplementation acts similarly to mast cell stabilizers in attenuating the effects of doxorubicin. Ineffectiveness of regular exercise in preventing the acute cardiotoxicity of doxorubicin might be due to a lesser effect on preventing cardiac inflammation.
Dass Sport und Bewegung das Immunsystem beeinflussen, ist seit vielen Jahren
durch zahlreiche wissenschaftliche Studien belegt. Dabei zeigte sich, dass moderate körperliche Aktivitäten (z.B. Grundlagentraining) einen positiven Einfluss auf das Immunsystem haben, während hochintensive Belastungen sich kurzfristig ungünstig auf die Funktionalität des Immunsystems auswirken können. Durch die Beeinträchtigung des Immunsystems nach starker körperlicher Anstrengung besteht vor allem eine höhere Infektionsgefahr der oberen Atemwege. Daraus lässt sich ableiten, dass sportliche Belastung und Immunfunktion in einer Art Dosis-Wirkungsverhältnis zueinanderstehen. Ziel dieses Beitrags ist es, die komplexen Zusammenhänge zwischen Immunsystem und körperlicher Aktivität zu erläutern und die Rolle von Bewegung und Sport bei der Aktivierung des Immunsystems näher zu untersuchen
Objective: consideration of the importance of vaccination as a preventive measure of support the athlets immunne system in conditions of extreme physical exertion and increased epidemic risks.
Materials and methods: analysis of local and foreign dates of immunocorrection and vaccination problems.
Results: the presented review provides an integral assessment of the transitory immunosuppression, developing by the intensive training and competitive activities — exercise-induced immunosuppression. These dates described as an “open window” syndrome and characterized by an increased risk of viral and/or bacterial infection with predominant damage of the upper respiratory tract and gastrointestinal tract. Widespread immunoprophylaxis provides an effective and relatively safe method of infectious control at risk groups including athletes.
Conclusion: Vaccines of National Immunization Schedule and Epidemiological Immunization Schedule provide complex impact to the athletes immune status in wide variety of physical and psychological stresses. Vaccination increases the ability of specific and nonspecific resistance to infections that provide significant prevention of the “open window” syndrome.
Egzersiz, sağlığı iyileştirmek ve zindeliği sürdürmek için vücudun herhangi bir bölümü veya bölümlerini geliştirmek amacıyla planlanan, yapılandırılan ve tekrarlanan fiziksel aktivitedir. Egzersizler akut (tek bir egzersiz periyodu) veya kronik (tekrarlayan egzersiz periyodu) planlama doğrultusunda yapılır ve bu durum vücut üzerinde bazı fizyolojik etkiler oluşturur. Egzersiz başta kardiyovasküler sistem olmak üzere immün sistem, kas ve iskelet sistemi, hormon sistemi, psikolojik durum ve uyku üzerine etkileri bulunmaktadır. Beslenme kalitesinin de önem taşıdığı egzersiz sırasında terle beraber sıvı ve elektrolit kayıpları olurken başta karbonhidratlar olmak üzere yağlar ve proteinler de enerji kaynağı olarak kullanılır.
İmmün sistem (Bağışıklık sistemi), çok çeşitli işlevlere sahip olmakla beraber temelinde insanları bakteri ve virüslere karşı korumak işlevlerinden sorumludur. İmmün sisteminin günlük işleyişini etkileyen bazı faktörler yaş, cinsiyet, yeme alışkanlıkları, tıbbi durum, antrenman ve zindelik düzeyi olarak sıralanmaktadır. Bakteriler ve virüsler vücuda zarar verebilir ve hastalık oluşabilir. İnsanları sağlıklı tutmak ve enfeksiyonları önlemek için harika bir iş çıkaran immün sistem iki işlevsel bölüme ayrılır: ilk savunma hattı olarak adlandırılan doğuştan (kalıtsal) gelen bağışıklık ve aktive edildiğinde her bulaşıcı maddeye özel bir reaksiyon ve immünolojik hafıza oluşturan edinilmiş (sonradan kazanılan) bağışıklıktır.
Egzersizin immün sistem üzerine etkileri araştırılırken, akut ve kronik egzersizin etkileri faklı olarak incelenmektedir. Yapılan egzersizin süresi, şiddeti ve yoğunluğu immün sistem üzerindeki etkiyi değiştirmektedir.
Successful training must involve overload but also must avoid the combination of excessive overload plus inadequate recovery. Athletes can experience short term performance decrement, without severe psychological, or lasting other negative symptoms. This Functional Overreaching (FOR) will eventually lead to an improvement in performance after recovery. When athletes do not sufficiently respect the balance between training and recovery, Non-Functional Overreaching (NFOR) can occur. The distinction between NFOR and the Overtraining Syndrome (OTS) is very difficult and will depend on the clinical outcome and exclusion diagnosis. The athlete will often show the same clinical, hormonal and other signs and symptoms. A keyword in the recognition of OTS might be ‘prolonged maladaptation' not only of the athlete, but also of several biological, neurochemical, and hormonal regulation mechanisms. It is generally thought that symptoms of OTS, such as fatigue, performance decline, and mood disturbances, are more severe than those of NFOR. However, there is no scientific evidence to either confirm or refute this suggestion. One approach to understanding the aetiology of OTS involves the exclusion of organic diseases or infections and factors such as dietary caloric restriction (negative energy balance) and insufficient carbohydrate and/or protein intake, iron deficiency, magnesium deficiency, allergies, etc. together with identification of initiating events or triggers. In this paper we provide the recent status of possible markers for the detection of OTS. Currently several markers (hormones, performance tests, psychological tests, biochemical and immune markers) are used, but none of them meets all criteria to make its use generally accepted. We propose a “check list” that might help the physicians and sport scientists to decide on the diagnosis of OTS and to exclude other possible causes of underperformance.
Successful training must involve overload, but also must avoid the combination of excessive overload plus inadequate recovery. Athletes can experience short-term performance decrement, without severe psychological, or lasting other negative symptoms. This Functional Overreaching (FOR) will eventually lead to an improvement in performance after recovery. When athletes do not sufficiently respect the balance between training and recovery, Non-Functional Overreaching (NFOR) can occur. The distinction between NFOR and the Overtraining Syndrome (OTS) is very difficult and will depend on the clinical outcome and exclusion diagnosis. The athlete will often show the same clinical, hormonal and other signs and symptoms. A keyword in the recognition of OTS might be ‘prolonged maladaptation’ not only of the athlete, but also of several biological, neurochemical, and hormonal regulation mechanisms. It is generally thought that symptoms of OTS, such as fatigue, performance decline and mood disturbances, are more severe than those of NFOR. However, there is no scientific evidence to either confirmor refute this suggestion. One approach to understanding the aetiology of OTS involves the exclusion of organic diseases or infections and factors such as dietary caloric restriction (negative energy balance) and insufficient carbohydrate and/or protein intake, iron deficiency, magnesium deficiency, allergies, etc., together with identification of initiating events or triggers. In this paper, we provide the recent status of possible markers for the detection of OTS. Currently several markers (hormones, performance tests, psychological tests, biochemical and immune markers) are used, but none of them meets all criteria to make its use generally accepted.
Resistance exercise produces transient perturbations in immunity, including alterations in circulating leukocyte numbers, cytokine concentration, and some measures of cell function. These changes are typically interpreted as being transiently detrimental to host defense. The mechanisms responsible for these immune fluctuations appear to be neuroendocrine-mediated alterations in cell trafficking and function and microtrauma-mediated alterations in cytokine release. Alterations in immunity following resistance exercise appear to be similar in pattern but smaller in magnitude than those typically seen after long, vigorous endurance exercise and are resolved within a few hours. However, resistance exercise—induced changes in immunity may become clinically relevant after repeated exercise bouts with insufficient recovery. Regular training appears to attenuate the immune response to resistance exercise. Care should be taken to ensure that resistance training is planned, with adequate variation in intensity and volume over time, to ensure recovery between sessions and to avoid chronic systemic inflammation.
Unexplained underperformance in athletes is a common problem, occurring in around 10–20% of elite endurance squads.1 The terms “overtraining syndrome”, “staleness”, “chronic fatigue in athletes”, and “sports fatigue syndrome” have been used.2 “Burn out” with depressed mood state may occur in power athletes. There has been some confusion in the literature on the definition and diagnostic criteria. On 19 April 1999 the authors held a round table discussion at St Catherine's College, Oxford in order to clarify the diagnostic criteria to be used in the future. The format of the meeting was modelled on the consensus meeting held at Green College, Oxford on 23 March 1990 on the criteria for diagnosis of patients with chronic fatigue.3
Unfortunately the term overtraining syndrome implies causation, which limits investigations of this …
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.
Strenuous exercise induces increased levels in a number of pro-inflammatory and anti-inflammatory cytokines, naturally occurring cytokine inhibitors and chemokines. Thus, increased plasma levels of TNF-α, IL-1, IL-6, IL-1receptor antagonist, TNF receptors, IL-10, IL-8 and macrophage inflammatory protein-1 are found after strenuous exercise. The concentration of IL-6 increases up to 100-fold after a marathon race. The increase in IL-6 is tightly related to the duration of the exercise and there appears to be a logarithmic relationship. Furthermore, the increase in IL-6 is related to the intensity of exercise. Given the facts that IL-6, more than any other cytokine, is produced in large amounts in response to exercise, that IL-6 is produced locally in the skeletal muscle in response to exercise and that IL-6 is known to have growth factor abilities, it is likely that IL-6 plays a beneficial role and may be involved in mediating exercise-related metabolic changes.
