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Neuroendocrinology Letters No.4 August Vol.26, 2005
Copyright © 2005 Neuroendocrinology Letters ISSN 0172–780X www.nel.edu
ORIGINAL ARTICLE
The effects of exercise on the immune system
and stress hormones in sportswomen
Kursat Karac abey1, Ozcan Saygin2, Recep Ozmerdivenli1, Erdal Zorba2, Ahmet Godekmerdan3
& Vedat Bulut 3
1 Firat University e School of Physical Education and Sports, Elazig, Turkey.
2 Muğla University e School of Physical Education and Sports, Mugla, Turkey.
3 Firat University Medicine Faculty Immunology Department, Elazig, Turkey.
Correspondence to: Dr. Kursat Karacabey
Fırat University e School of Physical Education and Sports
(Beden Egitimi ve Spor Y.O)
TR 23119, Elazig /TURKEY
TEL: +90 424 2370000 ext 5370
FAX: +90 424 2416512
EMAIL: kkaracabey@hotmail.com
Submitted: April 8, 2005 Accepted: April 15, 2005
Key words: exercise; immune system; stress hormones; immunoglobulines
Neuroendocrinol Lett 2005; 26(4):361–366 PMID: 16136008 NEL260405A12 © Neuroendocrinology Letters www.nel.edu
Abstract BACKGROUND: Despite the numerous studies controversial results exist in specic
immune response to exercise. e aim of this study was to determining the dier-
ences in the humoral immune parameters, serum ACTH and cortisol levels exist-
ing between sportswomen and sedentary subjects and the eect of acute aerobic
and anaerobic exercise on these parameters.
MATERIALS/METHODS: 40 sportswomen (Groups 1 and 2) and 20 sedentary
women (Group 3) were enrolled and Group 1 performed aerobic exercise on a
treadmill for 30 minutes while the Group 2 was subjected to the Wingate eort
test for 30 seconds. Before exercising (at 8.30 a.m), immediately aer the exercise,
and 4 hours, days 2 and 5 days aer exercising blood samples were obtained and
the levels of IgA, IgG, IgM, complement 3 (C3) and complement 4 (C4) were de-
termined turbidometrically.
RESULTS: Before exercise: the means of IgA and IgG values in the G1 and G2
groups were higher than the Group G3, and the mean cortisol levels in the seden-
tary group was signicantly higher (p < 0.05).
Aer Exercise: Whereas the C3 and C4 levels decreased signicantly at the end
of the exercise in Group 1 and 2 (p < 0.05), the IgA, IgG (p < 0.05) and IgM lev-
els (p < 0.01) at the 4th and 5th determinations were observed to be signicantly
higher in only the Group 1. e cortisol and ACTH levels were found to have
increased signicantly (p < 0.05) in the Group 1. In Group 2, no changes were ob-
served in the IgA, IgG and IgM levels.
CONCLUSIONS: We conclude that regular and moderate exercise has favorable ef-
fects on the immune system by increasing immunoglobulines which are potent
protective factors.
362
Neuroendocrinology Letters No.4 August Vol.26, 2005 Copyright © Neuroendocrinology Letters ISSN 0172–780X www.nel.edu
Kursat Karacabey, Ozcan Saygin, Recep Ozmerdivenli, Erdal Zorba, Ahmet Godekmerdan & Vedat Bulut
Introduction
Despite the numerous studies aimed at explaining
the specific immune response to exercise, conflicts
exist in the results obtained so far from such studies.
Most of the studies examining the effects of exercise
on immune functions have either focused on only one
type of exercise or on the changes following exercise
of short duration [3,15,30]. There have been a limited
number of studies examining the effects of regular ex-
ercise in the long term on the immune system [3, 7, 40,
31]. Regular exercise has been reported to have several
favorable effects on physiological, psychological, and
immunological functions [8, 17, 29, 34], and increase
in the resistance against infections [17, 27, 32, 33 ].Vig-
orous exercise, however, has been reported to have a
negative effect on these functions [5, 15, 19, 24]. In elite
sportswomen the effects of acute aerobic and anaerobic
exercise on the immune and neuro-humoral system
has not been fully investigated.
For this reason, our study was aimed to investigate the
differences between the sportswomen and those leading
sedentary lives by comparing their humoral immune
parameters, serum ACTH and cortisol levels and the
effects of acute aerobic and anaerobic exercise on these.
In human, plasma cortisol level is approximately 13.2
µg/dL. The level of cortisol shows a circadian rhythm
during the day, and it is regulated by corticotrophin Re-
leasing Hormone (CRH) secreted by hypothalamus and
ACTH released by pituitary gland [9].
Materials and Method
The ethical consent to study on human subjects was
provided by The Ethical Committee of Firat University
and Marmara University according to The Declaration
of Helsinki.
Forty elite sportswomen who have been playing
volleyball three times a week for 120 minutes each for
at least 5 years and 20 healthy age-matched sedentary
females were enrolled in this study. Exclusion criteria
were history or finding of chronic cardiovascular, en-
docrine or immune diseases.
The sportswomen were randomly separated into two
groups G1 and G2. G1 (n=20) performed aerobic ex-
ercise while G2 (n=20) performed anaerobic exercise.
The control group (n=20) was the sedentary group. For
all the groups, age, height, weight and laboratory pa-
rameters of IgA, IgG, IgM, C3 and C4 were measured
with the exercise groups having the measurements be-
fore and after the exercise period. All the subjects were
taken into the same diet program. During the study,
menstrual cycle of the sportswomen were considered.
We carefully selected the subjects out of this period.
For estimation of the max. VO2 of the subjects, 20
m Shuttle run test was employed. The max VO2 values
were expressed in ml/kg/min from the results obtained
[18].
The women in the group 1 were subjected to an aer-
obic exercise program. The running pace was adjusted
to provide an exercise work load of approximately
60%–70% of their cardiac reserves. The work load was
estimated from the Karvonen’s protocol [12]. Based on
the maximum oxygen consumption value (70%) calcu-
lated indirectly, exercise was conducted for 30 minutes
on a treadmill (Star Trac Tr 900). The second group was
subjected to the Wingate Test and made to exercise for
30 seconds by turning pedals and motivated from the
side to do so as quickly as possible [1]. Resting Heart
Rates of subjects were measured by physician by means
of stethoscope.
Blood samples were taken once from subjects in
Group 3 at 8.30 in the morning of the exercise, and five
times in Groups 1 and 2; before exercise (at 8.30’), at
the end of exercising, 4 hours after exercising. During
the last days of experimental study, all the subjects fol-
lowed their regular physical training. and on 2 and 5
days after exercising. The blood samples were trans-
ported to the laboratory and sera separated as soon as
possible and stored at –80°C until analyzed.
IgA, IgG, IgM, C3 and C4 determinations were done
turbidometrically using the Space model (Schiapperelli
Table 1: Demographic properties of the Sporting and Sedentar y groups (Mean ± STD).
G1 G2 G3
(n=20) (n=20) (n=20)
Age (years) 21.60 ± 1.42 20.8 ± 1.13 20.10 ± 0.99
Height (cm) 170.1 ± 5.91 169 ± 0.39 164.1 ± 6.36 *
Body Weight (Kg) 56.50 ± 5.11 57.3 ± 6.32 61.4 ± 5.73
Max VO2 45.2 ± 2.11 46.2 ± 1.15 33.5 ± 4.08 *a
Sporting age (years) 5.5 ± 1.4 5.5 ± 1.1 – –
Resting Heart Rate 66.5 ± 3.2 65 ± 1.6 78.4 ± 5.7 *a
BP-Systolic (mmHg) 139 ± 1.5 138 ± 2.1 146.5 ± 1.5
BP-Diastolic (mmHg) 75.1 ± 1.8 76 ± 13.1 80 ± 2.7
a: Between sporting (G1 and G2) and Sedentar y groups (G3), *: p<0.05
G1– Aerobic group, G2 – Anaerobic group, G3 – Sedentary group
STD: standard deviation
363
Neuroendocrinology Letters No.4 August Vol.26, 2005 Copyright © Neuroendocrinology Letters ISSN 0172–780X www.nel.edu
Exercise and Immunity in Sportswomen
Biosystems, USA) specific protein analyzer. ACTH and
cortisol determination was done using the IMMULYTE
(DPC, Diagnostic Product Corporations, Losangeles
USA) model hormone analyzer employing the chemi-
luminesence method.
For the statistical analysis, the SPSS (SPSS for
Windows, version 11.0) program was used. For the
statistical evaluation of data, the Kruskall Wallis Vari-
ance analysis was used for continuous data, whilst the
Bonferroni’s revised Mann Whitney U test was used
for significance testing as non-parametric tests. For the
analysis of repeating measurements in the G1 and G2
groups the Friedman’s Variance analysis was employed
whiled the Wilcoxon Rank test non-parametric was
used for analyzing significant values with p < 0.05 con-
sidered significant.
Results
The demographic properties of the sporting (G1 and
G2) and sedentary groups are presented in Table 1.
When we compared the immune system parameters
and stress hormones, including ACTH and cortisol in
sporting (G1 and G2) and sedentary group (G3), it was
found that IgA and IgG approximately 30% lower and
cortisol levels were elevated as 31% in G3 groups. Re-
sults are shown at Table 2.
For aerobic and anaerobic test groups, immuno-
globulin and stress hormones before and after aerobic
exercise (at the end, 4 hours, and 2 days, and 5 days
after exercising) in sporting women of the groups G1
and G2 were evaluated and results are shown at Ta b le
3 and 4. In the group aerobic exercise, levels of cortisol
and ACTH increased as approximately 36% in post-ex-
ercise immediate period. In the 2nd and the 5th days,
IgA levels were observed to be elevated approximately
16%, and the elevations in IgG and IgM levels were re-
spectively 11% and 100% in the group of aerobic exer-
cise.
Table 2: Comparison of the Immune System and Hormonal Parameters before exercising in the
Sporting and Sedentar y groups (Mean ± STD).
G1 G2 G3
(n=20) (n=20) (n=20)
IgA (g/lt) 1.89 ± 0.13 1.81 ± 0.17 1.27 ± 0.12 *a
IgG (g/lt) 13.46 ± 0.76 13.59 ± 0.85 10.73 ± 0.87 *a
IgM (g/lt) 1.03 ± 0.07 1.05 ± 0.05 1.09 ± 0.08
C3 (g/lt) 1.64 ± 0.12 1.65 ± 0.55 1.66 ± 0.12
C4 (g/lt) 0.25 ± 0.04 0.24 ± 0.04 0.29 ± 0.12
ACTH 35.74 ± 2.32 34.50 ± 2.02 36.50 ± 3.81
Cortisol 9.48 ± 1.54 9.44 ± 1.81 12.36 ± 0.46*a
a: Between sporting (G1 and G2) and Sedentar y groups (G3), *: p<0.05
G1– Aerobic group, G2 – Anaerobic group, G3 – Sedentary group
STD: standard deviation
Discussion
Different results have been obtained in studies on
the effects of exercise on the immune system [8, 20,
28]. In addition to factors like type, duration, intensity,
and program of the exercise and the use of different
subjects [29], various complex mechanisms including
hormonal, metabolic and psychoneural stress are also
known to have effects on the immune system [14, 32].
Changes in the immune functions due to acute
exercise and training have been attributed to the in-
creased secretion of cortisol, cathecholamine and the
neuropeptides [3, 13, 37]. During exercise, when the
max O2 consumption exceeds 60% an increase in the
epinephrine and cortisol concentrations occurs. Under
any kind of stress vasopressin stimulates the release of
corticotropin-relasing factor, which in turn leads to the
release of ACTH [2]. Exercise increases the number
of lymphocytes in the circulation by acting as a lym-
phocytic β2-adrenergic agonist. Cortisol on the other
hand blocks the entry of lymphocytes which would
otherwise lead to strong neutrophilia in the circulation,
thereby facilitating the passage of lymphocytes from
the lymphoid compartments [4,16, 26, 37].
In our study, comparison of the IgA and IgG levels
revealed significantly lower parameters in the seden-
tary group than in the groups G1 and G2 before exer-
cise. We concluded that the elevated levels of immuno-
globulines in the sporting groups may be caused by the
chronic effect of regular exercise. While Mackinon and
Smith [16, 36], reports of the acute and chronic effects
of exercise on the immune system other investigators
emphasized that no matter the duration of the exercise
there is always an increase in the parameters of the im-
mune system. In another study on the topic, the IgG,
IgA, and IgM levels in male marathon runners at rest
have been reported to be within clinically normal lim-
its [25]. Nehlsen et al., reported that at 60% of max VO2
moderate exercise results in transient increases in the
IgG, IgA, and IgM levels [21]. In the same study, it was
found that at the 6th week of the training exercise pro-
gram with intensity of 60% max VO2, similar increase
in the basal immunoglobulin levels was noted. In a dif-
364
Neuroendocrinology Letters No.4 August Vol.26, 2005 Copyright © Neuroendocrinology Letters ISSN 0172–780X www.nel.edu
ferent study, it has been reported that the plasma im-
munoglobulin levels was increased by regular exercise
of moderate intensity [40]. The results from our study
in which the IgA, IgG, and IgM levels were increased by
regular exercise are in agreement with these data and
demonstrate the positive effects of exercise on the im-
mune system [3, 11, 15, 23, 33].
While the IgA level at 4 hours after exercise was
found to have returned to the pre-exercise levels, at
2 and 5 days post-exercise it was found to be higher
than the pre-exercise level. In the studies reported
in previous, in the measurements conducted after
the aerobic and anaerobic exercise, the IgA level was
found to have fallen. However, the fall was not statisti-
cally significant. This fall was thought to be probably
due to the inflammation that results from the micro-
trauma in which the muscle tissue is subjected to dur-
ing exercise [24, 32].
The IgG and IgM levels at 2 and 5 days after exer-
cise were found to be statistically higher than that be-
fore exercise. In another study, the observation that no
change in the IgA, IgG, and IgM levels occurred, was
explained by the fact that the duration of exercise did
not probably lead to any significant changes in the glu-
tamine levels that would otherwise affect the function
of lymphocytes and macrophages [39].
From studies conducted, it has been found that,
though the measured resting state C3 and C4 levels in
long distance runners is significantly lower than that in
individuals leading sedentary lives, with aerobic exer-
cise the level rises [6, 22, 23, 35]. It is known that short
duration exercise leads to activation of the C3 and C4
levels [11, 23 ]. In a study conducted on experienced
athletes, despite the small increase in the C3a and C4a
levels between the pre-exercise and immediately after
exercise, a corresponding fall in the C4H level was noted
[22, 35]. In the study presented here, no difference was
observed in the C3 and C4 levels before exercise be-
tween the sporting and sedentary groups. However, in
the sporting groups (G1 and G2) the measurement after
both aerobic and anaerobic exercise showed statistically
significant falls in the and C4 levels after exercise. The
fact that mild acidosis that occurs in the blood of these
sporting subjects during anaerobic exercise leads to ac-
tivation of the alternative pathway in the utilization of
the C3 and C4 system together with the inflammation
due to microtrauma of the muscles during exercise of-
fers an explanation for this fall [6, 32].
Kursat Karacabey, Ozcan Saygin, Recep Ozmerdivenli, Erdal Zorba, Ahmet Godekmerdan & Vedat Bulut
Table 3: Comparison of the Immunoglobulin and Hormonal System Parameters before and after aerobic exercise
(at the end, 4 hours, and 2 days, and 5 days after exercising) in Sporting women (Mean ± STD)
(n=20) Pre-Exercise Post-Exercise 3rd Measurement 4th Measurement 5th Measurement
immediate 4 hrs after exer. 2 days af ter exer. 5 days after exer.
IgA (g/lt) 1.89 ± 0.13 1.73 ± 0.03 1.85 ± 0.20 2.13 ± 0.44 *b 2.29 ± 0.27
*b
IgG (g/lt) 13.46 ± 0.76 13.77 ± 1.38 13.70 ± 0.92 15.23 ± 1.11 *b 15.05 ± 0.46
*b
IgM (g/lt) 1.03 ± 0.07 1.08 ± 0.02 1.06 ± 0.31 2.07 ± 0.19 **b 2.10 ± 0.09
**b
C3 (g/lt) 1.64 ± 0.03 1.06 ± 0.08 *a 1.68 ± 0.04 1.67 ± 0.05 1.67 ± 0.05
C4 (g/lt) 0.25 ± 0.04 0.11 ± 0.03 *a 0.28 ± 0.11 0.22 ± 0.09 0.21 ± 0.06
ACTH 35.74 ± 2.32 45.72 ± 2.90 *a 36.30 ± 1.76 34.86 ± 2.65 34.53 ± 2.32
Cortisol 11.48 ± 1.54 15.06 ± 2.55 *a 10.56 ± 1.18 10.72 ± 1.16 11.27 ± 1.39
(a: Pre- and Post-Exercise, b: Pre-Exercise and 3rd, 4th and 5th measurements *:p<0.05**: p<0.01)
STD: standard deviation
Table 4: Comparison of the immunoglobulin and hormonal parameters before and after anaerobic exercise
(at the end, 4 hours, 2 days, and 5 days afterwards) in the sporting women (Mean ± STD)
(n=20) Pre-Exercise Post-Exercise 3rd Measurement 4th Measurement 5th Measurement
immediate 4 hrs after exer. 2 days after exer. 5 days after exer.
IgA (g/l 1.81 ± 0.13 1.76 ± 0.03 1.80 ± 0.09 1.79 ± 0.17 1.83 ± 0.18
IgG (g/lt) 13.89 ± 0.85 13.55 ± 1.53 13.52 ± 1.47 13.84 ± 1.41 13.77 ± 1.68
IgM (g/lt) 1.05 ± 0.05 1.09 ± 0.03 1.02 ± 0.03 1.03 ± 0.04 1.07 ± 0.05
C3 (g/lt) 1.66 ± 0.05 1.14 ± 0.06 *a 1.68 ± 0.04 1.67 ± 0.05 1.64 ± 0.05
C4 (g/lt) 0.24 ± 0.04 0.12 ± 0.01**a 0.23 ± 0.10 0.22 ± 0.5 0.21 ± 0.07
ACTH 34.50 ± 2.02 33.14 ± 2.48 33.77 ± 1.98 35.02 ± 2.52 34.80 ± 2.09
Cortisol 12.44 ± 1.81 12.11 ± 1.91 12.17 ± 1.68 12.16 ± 1.5 11.36 ± 1.38
(a: Pre- and Post-Exercise, *:p<0.05**: p<0.01
STD: standard deviation
365
Neuroendocrinology Letters No.4 August Vol.26, 2005 Copyright © Neuroendocrinology Letters ISSN 0172–780X www.nel.edu
In reports, a high correlation has been established
between the cortisol level and the intensity of exercise
[10, 11, 31]. The highest value of cortisol was reported
in aerobic capacity exercises [4,38]. We observed sig-
nificantly higher cortisol levels in the sedentary group
than in the sporting groups (G1 and G2). The ACTH
levels, however, showed no difference between the two
groups. Whereas anaerobic exercise for a brief period
led to no changes whatsoever in the sporting subjects,
with aerobic exercise an increase in the cortisol and
ACTH hormone secretion was observed. In studies
conducted, while the ACTH increased after exercising a
parallel increase in the level of cortisol which is secreted
under the influence of ACTH has been reported [8, 10,
11, 38, 39]. However, these findings showed differences
between individuals, with some studies demonstrat-
ing much higher increases in sporting individuals [37,
38]. Thuma and his colleagues (1995) found a positive
relationship between the rise in cortisol concentration
after exercise and the max VO2. In the light of these
findings the changes in ACTH and cortisol levels ob-
served in our study can be said to agree with those of
the literature. Aerobic exercise might lead to increased
cortisol and decreased IgA and IgG, which could in-
crease susceptibility to infections.
In conclusion, whereas the anaerobic exercise of
short duration did not lead to an increase in the cortisol
and ACTH levels in the sporting women, aerobic exer-
cise was observed to have led to changes in immuno-
globulines and caused to elevated levels of cortisol and
ACTH hormone levels. According the data obtained
from the study, we conclude that regular and moderate
exercise has favorable effects on the immune system by
increasing immunoglobulines which are potent protec-
tive factors.
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Kursat Karacabey, Ozcan Saygin, Recep Ozmerdivenli, Erdal Zorba, Ahmet Godekmerdan & Vedat Bulut
