Research Review: The relationship between exercise, inflammation, and respiratory immunity

The relationship between exercise and the immune systems is intensely complex with many moving variables. Exercise generally improves the immune system. The more exercise done, and the more regularly, the more the immune system is boosted. However, there is always a tipping point. Athletes are often pushed into longer bouts of exercise, and/or more intense training. This goes as well for some “general exercisers” who don’t consider themselves “athletes,” but will grind out intense workouts that are on par for athletes. I have seen this with recreational marathon runners, obstacle course racers, and people going “all in” for 30-, 60-, or 90-day challenges with their gyms or trainers. They may not think of themselves as “athletes,” yet they are putting in long hours and hard sessions, sometimes multiple workouts per day. Anyone working out intensely for over 45 minutes, more than 4 times a week, I would argue should call themselves at least “recreational athletes.”

In addition to increases in bodily pains and risk of injury, it’s not uncommon to see upper respiratory illnesses (URIs, ie: coughing, congestion, sinus drainage) and upper respiratory tract infections (URTIs, ie: common cold and influenza) in recreational and elite athletes.  In fact, URTIs are suggested to be the most common type of infection in the athletic population. But if exercise boosts the immune system, why is this happening?

Some exercise is good.

Indeed, some movement is good. Quality and consistent movement is great. Studies show that “moderately active” living poses greater resistance to pathogens by boosting the immune system surveillance of the body. “Moderate exercise” is somewhat subjective, but tends to range around 30 minutes of movement at 60-75% intensity, 4-6 days a week.

Animal studies showed that exercising for 20-30 minutes right before being exposed to a virus decreased morbidity and mortality from it, even if it was just a single session of exercise and the mouse had been sedentary outside of that bout. That lead to suggestions that exercising before traveling on an airplane, or going into other high-crowd areas, could help prevent illness.

Now, extend that exercise from a single session to a routine: research that looked at 12-15 weeks of moderate exercise saw that incidence and duration of URTIs was significantly lowered compared to sedentary individuals. Longer duration of the routine meant better adaptations in the immune system.

Acute Exercise, or just getting started

Some of you have heard me say over and over that “stress causes inflammation and health problems” and expand that ‘stress’ can mean emotional, mental, chemical, or physical. In this case, we’re looking at the physical stress of exercise, which also elevates cortisol (chemical stress.) You are tearing muscles, straining lungs, and working your heart. As many people who have “fallen off the wagon” of exercise can attest, getting back into the workout routine is the most physically painful part, compared to a few weeks in after your body has adapted. This is called the “General Adaptation Syndrome” (GAS) where the body isn’t used to the physical stress. Every exercise stress applied results in specific biochemical, neurological, and mechanical adaptions in the body. The first 2-3 weeks of this are called the “Alarm Phase” or “Shock Phase”, and typically muscle and joint pain, fatigue, and discomfort are all more extreme at this time.

Training load or volume alone does not give full information on the level of stress that an athlete (and their immune system) is under. Indeed, the way training in distributed or periodized is of key important also. Periodization is breaking down a training plan into smaller, progressive stages to build safely over several weeks or months. Rapid changes in training load (i.e., increasing too quickly) was a better predictor of URI risk than total load alone. This shows that it’s not just the amount of training, but jumping in too quickly can be detrimental to the immune system.

This is different than someone who has adapted to longer or more intense levels of exercise over time. Much like their bodies are adapted to recover faster between training sessions, the immune system also learned to rebound more rapidly.

Can it be too much?

That tipping point of “too much” strenuous and/or prolonged bouts of exercise can temporarily reduce the immune system (“exercise-induced immunodepression”) for a few hours to a few days, depending on the nature of the exercise and the health status of the person, as well as the rest time before the next round of exercise. This immunodepressed state is the time the individual is at higher risk of contracting a URI or URTI.

The less adapted to high frequency/intensity/duration of training, the higher the stress levels spike, and the lower the immune system plummets after. What goes up, must come down. But in time, you can taper the peak and the drop.

After Intense, Acute Exercise

How many people have had the experience of going through a prolonged period of intense stress (semester at school, large work projects, extended home situation) and when this intense period finally eases up, they get sick? It’s like the immune system fires on all cylinders to help get you through the stressful time, and then it rests when you do. Likewise, this can be seen in athletes.

A research review by Walsh et al. suggested that athletes most often would report URTIs either during the high-intensity and tapering period prior to competition (e.g., swimming, team sports) or in the period following competition (e.g., long distance running). Essentially, the times of illness were more common during the high intensity period (high stress and inflammation in the body), or about 1-2 weeks after as the body gets to rest (incubation period.)

Nieman et al reviewed marathon runners and respiratory illness. “Taking into account other factors influencing risk of URI (age, stress levels, and illness at home), the likelihood of URI was doubled in those who ran >96 km compared to those who ran 32 km as part of their weekly training programmes leading up to the event.”

It is interesting to note, as well, that some studies then went on to break down infectious versus non-infectious URIs. Meaning, sometimes the URI or URTI is based on a pathogenic infection (ie: bacteria, virus), and other times there is some other reason for feeling sick that didn’t have to do with a microbe. Reports show it can be due to inhaled pollutants or allergies, chlorine vapors for swimmers, cold and dry air; age; sleep quality; and more. These factors are less related to the immune system directly than they are related to inflammation. Once again, lifestyle factors pop up as important keys for staying healthy and keeping optimal respiratory functions. Keeping inflammation low before exercising may help reduce the over-inflammatory state brought on by intense exercise, and protect respiratory health.

So… What is the “Goldilocks” level? Not too little, but not too much too fast.
The J-Curve versus the S-Curve

The J-curve model suggests that an individual involved in regular moderate exercise is less likely to contract a URTI compared to a sedentary individual, but prolonged high-intensity exercise or periods of strenuous exercise training are associated with an above-average risk of a URTI. Like so:

The J-curves are the bold purple and red lines, showing that infection risk is average with a sedentary life. Then the immune system gets a boost, thus reducing infection risk, as a person moves into active or moderate exercise. But following that curve then leads to a split in research. At first, heavy or prolonged training seems to have a rebound effect, causing infection risk to go above average – but not always!

It seems that some athletes can reach “elite” status, and as their body adapts to these bouts of exercise, the curve instead moves into an S-curve and infection risk normalizes again, and the immune system can recover, coming back to average as the athlete-in-training adapts.

Lifestyle and the Elite Athlete

There have been some that suggest a prerequisite to achieving “elite” athlete status is an immune system which can withstand the strenuous nature of training and competition. Essentially, one cannot push to elite levels of training if the immune system cannot keep up.

And as past articles and posts have shown, there are ways you can help enhance your immune system through lifestyle, diet, and supplements.

Again, let’s think about that Alarm Phase. If the body is not used to the intense exercise, there is more inflammation and damage to the muscle fibers and tissues. Elite athletes, however, are trained better for this stress on the body. Likewise, elite athletes are usually tackling many aspects of their lifestyle to optimize their performance: sleeping well; properly fueling before, during, and after workouts; keeping a focused mindset; drinking plenty of water; stretching and recovering. They often tap into additional resources for support: keeping up on the latest in sport science, seeking out medical professionals, getting advice from nutrition professionals, working with trainers, and more. Genes may play a role, but this support team shows that managing other aspects is important and can help in prevention.

In the complexity of the immune system, the research does note that humans have demonstrated lower resistance to URTI when there is weakness or problems with other life stressors such as dietary deficiencies, psychological stress, sleep disturbance. In fact, the presence of nearly any of these other risk factors will cause a weaker immune response, and increase the risk of illness following prolonged exercise.

Lifestyle matters.

Could these lifestyle behaviors be another layer of protection for athletes and people looking to begin exercising, or boost their current training? Absolutely.

Overall:

Athletes and individuals involved in heavy training programs and/or prolonged bouts of exercise appear to have an increased risk of contracting URIs. This is likely related to regular acute (and possibly chronic) periods of exercise-induced immunodepression. Regular moderate exercise, on the other hand, appears to have the opposite effect and reduces infection risk. So if you are looking to boost your training, pair gradual increases in exercise with healthy lifestyle habits to keep your infection risk as low as possible.

WHAT SHOULD I DO, ESPECIALLY DURING THIS CORONAVIRUS CRISIS?

  • Move at least 30 minutes, 4-6 times per week. If you want to go above that, do so mindfully. There are benefits, but you want to give your body time to rest and adapt to an increased load. It is tempting for some who are finally getting their new quarantine routines down to want to double up workouts, or go for longer runs than they normally have time for. Be mindful, and gradually work your way up. This will reduce your risk of injury and illness.
  • Be sure to warm up and cool down appropriately.
  • Recover well. Stretch and foam roll. Rest and sleep to give your body enough time to recover between bouts of exercise.
  • Learn about proper form, get proper shoes, and ensure all other ergonomic aspects of exercise are optimized to reduce physical stress and injury.
  • Work with a trainer who knows how to periodize properly and can create workout plans that challenge you without shocking your system
  • Get a quality 7-8 hours of sleep each night
  • Fuel properly before, during, and after workouts to enhance the workout efforts as well as maximize post-workout recovery.
  • Nourish your body throughout the rest of the day as well to feed your cells with antioxidants, anti-inflammatories, vitamins, minerals, and more. Again, part of the risk of URI is the inflammation that the physical stress causes on the body, within the tissues and lungs as well as the muscles. Consider joining the Wolf program.
  • Work with a dietitian/nutritionist to personalize your food and supplement needs.

Ready to take your exercise up safely, and protect your health? I invite you to schedule a complimentary New Client call with me, so we can discuss possible best options for you and your fitness!


SOURCES

Cohen, S., Tyrrell, D.A., Smith, A.P., 1991. Psychological stress and susceptibility to the common cold. N. Engl. J. Med. 325, 606-612.

Cohen, S., Doyle, W.J., et all, 2009. Sleep habits and susceptibility to the common cold. Arch. Intern. Med. 169, 62-67.

Jones, A.W., and Dvison, Glen. Exercise, Immunity, and Illness. Muscle Metabolism and Exercise Physiolog. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149380/pdf/main.pdf Accessed 20th April, 2020.

McGill, E.A. & Montel, I.N. (Eds). 2017. NASM Essentials of Personal Fitness Training. 5th ed.

Nieman, D.C, et al. 1990. Infectious episodes in runners before and after the Los Angeles Marathon. J. Sports Med. Phys. Fitness 30, 316-328.

Walsh, N.P., et al. 2011. Position statement. Part one: immune function and exercise. Exerc. Immunol. Rev. 17, 6-63.

Article Summary: The Five Things That Happen to Your Body When You Quit Working Out

When you stop working out (even for just a week or two):

  1. Blood pressure increases (within a day, potentially!)
  2. You develop insulin resistance (body converts sugar into fat rather than using it as energy)
  3. Muscle size can shrink within a week (but not necessarily strength)
  4. VO2 max drops (ability to utilize oxygen well. “for every week you remain idle, it takes about three weeks to regain the lost adaptations” Yikes!)
  5. Grumipness takes over (“When you stop exercising, your body forgets how to handle stress. Because you’ve allowed your natural fight-or-flight response to atrophy, you’re less likely to experience something tough—whether an interval workout or a stressful workplace relationship—in a positive way. Instead, you get anxious.”)

 

The good news? They’re all pretty simple to reverse—or prevent entirely. Just keep moving! 😉

 

From <https://www.outsideonline.com/2175671/five-things-happen-your-body-when-you-quit-working-out

Zzzzz….

Let’s face it – most people these days thrive on caffeine to get through a brain-fudgy day. In such a busy world, it is so easy to want to sacrifice sleep to have more time to do other activities or errands. In fact, 42% of all healthy, middle-aged women report some kind of sleep trouble, including difficulty falling asleep, awaking during the night, or not feeling refreshed in the morning.

But sleep is essential! The journal, SLEEP, did a study that found too little sleep (less than 5 hours per night) may increase your risk of abdominal fat, versus those who got at least 6 hours of zzz’s per night.

Not only that, but it is during our visit to lullaby-land that some of our most important immune system functions occur, along with some important antioxidant activity.  How much sleep do you need? Sadly, there’s no “magic number” that’s cookie-cutter perfect for everyone. But the Sleep Foundation says the average adult can use 7-8 hours nightly as a rule of thumb, then adjust from there based on the individual. Note when you feel really well-rested versus feeling tired or foggy. The Sleep Foundation goes on to say that researchers are learning about two factors to a person’s needs: basal sleep needs, and sleep debt. Basal needs are how much your body needs on a regular, average basis. The sleep debt is what it sounds like – any extra rest you may need after skimping on sleep in the past, sickness, disrupted sleeping, etc.  The good news is they say over time, you CAN pay off sleep debt and get back to a healthy cycle!

Healthy sleep is a complex issue and takes both mind and body into consideration. So yes, you may have more trouble sleeping if you’re stressed or anxious.  You may have trouble waking if you’re depressed or ill. Poor blood sugar control or cortisol burn-out can cause waking in the middle of the night. Some things you may have little control over (noisy neighbors, for example) but other things you can control: Environment, exercise, nutrition.

Environment:

  • Make sleeping consistent: go to bed and wake around the same time, even on weekends
  • Create a wind-down program of reading, bathing, or listening to music – NOT computers or television screens
  • Make sure you have a comfortable bed
  • Keep your room free of “sleep stealers” like tv, computers, or other electronic distractions.

Exercise:

  • Daily! Even if it’s only a 15 minute walk: Your body needs to have at least a little bit of physical fatigue to sleep. Just because you’re mentally exhausted at the end of the day does not mean your body will be ready to sit still and rest.
  • Exercise will also help you re-regulate your appetite to help balance out a healthy diet
  • For most people, it is not recommended to exercise closely to bed time (aim for at least 1-2 hours before) or it may stir you up more than help you relax.

Nutrition:

  • As is so commonly shared: avoid stimulating food or drink such as coffee, tea, cola, chocolate. (Go for caffeine free – NOT “decaffeinated” as it may still have small amounts of caffeine!)
  • Also avoid alcohol – while is seems like a relaxing idea, studies show that it does interfere with good, restful and rejuvenating sleep.
  • For dinner, avoid sugar-spiking foods (sugar, refined flours and grains, pop) and stick to whole foods. Be sure to include some protein and healthy fats.
  • Avoid a large dinner shortly before bed – aim for 4 hours before; only have a light snack if you’re truly hungry, not just because you’ve got a case of the munchies

Still can’t sleep? Consider getting your blood sugars checked, and a Stress & Resiliency test.

You may think a heavy meal will be an enjoyable way to give yourself a ticket to food-coma land, but like the alcohol, it is not actually restorative sleep. You may feel tired after a large meal, but your body actually goes in to over-time – your circulatory system is pumping more blood to the digestive tract, your stomach is secreting extra gastric acids while the smooth muscles start roiling and churning for digestion, and your pancreas is spitting out its enzymes. Your body is working hard!

Make sure you eat regularly through the day: don’t eat a huge meal because you neglected to eat, and are trying to “make up” for the missed needs! Instead of trying to “treat” nutritional neglect done during the day, “prevent” it from happening in the first place. Nutrition isn’t really retroactive. It takes time to break down in your body and be utilized – and if you ingest more than your body can handle, it gets excreted or stored as fat. 

I know – all easier said than done. So many things that could affect your sleep and your health! So, pick one or two to aim for – if you’re going to have a huge dinner, at least keep it healthy and light; if you’re going to insist on ice cream for dessert, at least try to limit the portion and have it early; if you can’t take that tv out of your room, at least unplug it.

Pick your own goal, but make sure you’re taking care of yourself.

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Fuel Up! Pre-Workout Eats

You lace up your sneakers, don your effects, and rush out the door to get to you workout. You start exuberantly, motivated, and energetic… but halfway through, you start to slow, and feel there’s just no wind in your sails. Or you finish, and you’re famished, entering that “hangry” state.

Did you skip a pre-exercise meal or snack?

The topic of what to eat before exercise can be confusing. A multitude of different organizations, from the Academy of Nutrition and Dietetics, to the American College of Sports Nutrition, or Dietitians of Canada, and more, all have their own recommendations for what you should consume before you go workout, down the specific gram of carbs/proteins/fat to kilograms of your body weight. (We can dive deeper into that another time. The focus here today is just on some baseline ideas.)

Thankfully, they all agree on one important point: do what feels best for you! And it may take some trial and error.

“Training Low,” or intentionally training in a carb-depleted or fasted state, is starting to be studied more. But currently, it is not a typical recommendation. (Speak to your coach or dietitian to see if this is an individualized approach that can safely be done for you, if you are interested) Normally depleted stores are associated with fatigue, reduced work rates, impaired skill and concentration, and increased perception of effort. So generally it is recommended that you consume some proper foods before physical activity to help fuel you towards your goals of weight loss and/or muscle gain.

Having something to eat before going to workout can greatly enhance your efforts. Eating some carbohydrate-rich foods will give you more fuel in your body to help push harder in your workout. A little bit of protein will help with muscle feeding and repair. Hydration is also key, as even mild dehydration can cause drops in your performance, which usually means fewer calories burned or less weights moved. Why not get the most bang for your exercise buck?

It is the amounts, timing, and form of food that are highly dependent upon your own preferences and tolerances. The goal is to provide enough food and fuel before your workout that you can achieve a top-notch effort without feeling hungry, but not too much nor too close to the workout time as to cause cramping, nausea, or other stomach distress.

If you eat 3-4 hours before you exercise, you may do better with a more meal-sized intake. If you eat only 1-2 hours before, a snack will usually do. If you don’t have time to eat well ahead of the activity, a small snack or liquid form may sit best. Just make sure you’re not undoing your weight goals by consuming excess calories! Simply plan ahead to spread your food out around your workout time.

Pre-workout Meal Ideas:

  • Bowl of oatmeal with fruit or honey
  • Brown Rice and Veggie Stir Fry
  • Whole grain bagel with chicken and avocado
  • Salad topped with beans and corn or quinoa

Pre-workout Snack Ideas:

  • Handful of almonds and a cheese stick
  • Fruit and a ½ cup of yogurt
  • Slice or two of wheat toast with nut butter
  • Wheat pita and hummus

Pre-workout Drink Ideas:

  • Low fat milk (some people like chocolate milk, but there is added sugar, so decide if that is right for you)
  • Small fruit, protein powder, and milk/milk substitute smoothie
  • Meal-replacement drink that includes 15-30g Carbohydrate

Bonus Boost: having coffee about an hour before a workout has been shown to boost results! Caffeine is a common aid to help increase time to exhaustion in aerobic endurance exercise bought, decrease ratings of perceived exertion, and improve physical performance even during periods of sleep deprivation.


SOURCES:

American College of Sports Medicine, Academy of Nutrition and Dietetics, Dietitians of Canada, a Joint Position Statement. “Nutrition and Athletic Performance.” Medicine & Science in Sports & Exercise. (2016) 543-568. Print.

Campbell, Bill I., Spano, Marie A. NSCA’s Guide to Sport and Exercise Nutrition. Human Kinetics. 2011. Book.

Dunford, Marie; Macedonio, Michele. “A Step-by-step Process for Helping Athletes Achieve Optimal Performance Weight and Body Composition.” Food and Nutrition Conference & Expo. Nashville, TN. 4 Oct 2015. Conference Presentation.

Patgieter, S. “Sports Nutrition: A review of the latest guidelines for exercise and sport nutrition from the American College of Sport and Nutrition, the International Olympic Committee and the International Society for Sports Science” S Afr Journal of Clinical Nutrition 26.1 (2013). 6-16. Print.

“Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance” Journal of the American Dietetic Association. March. 109.3 (2009): 509-527. Print.

Don’t Be Sabotaged by Sports Drinks

We’ve all seen them: the average gym-goer pumping away on the elliptical machine, sweating and striving towards their goals, and 15 minutes in, they pick up a neon-pink fluid and chug away. Bless their hearts, they really are trying to improve their health!

While I don’t think of sports drinks as necessary for anyone, really, and I think there are more natural ways of replenishing after a good workout, I know a lot of people still prefer to turn to an easy bottle after getting their sweat on at the gym. But even so, popular sports drinks, such as Gatorade and Powerade, are not usually necessary for the average person. Named after the Florida Gators, Gatorade was originally created to help re-hydrate and provide electrolytes for professional athletes who are training intensely for several hours.

If you’re a calorie counter, here are some numbers you may want to keep in mind:

1 bottle of a sports drink tends to contain 2.5  8-ounce servings, and packs an average of 150 to 160 calories.

  • 30 minutes of moderate walking (3 mph) burns: 100 calories
  • 30 minutes of elliptical machine: 210 calories
  • 30 minutes of moderate biking (12-13 mph): 250 calories
  • 30 minutes of jogging (6 mph): 310 calories

Replenishing drinks, if you drink them, are more for workouts that last longer than 30 minutes and if you have been working quite intensely and sweating heavily. If you only workout 30 minutes, water is sufficient for rehydrating – you won’t have lost enough electrolytes to even need anything more! Don’t let the calories of these drinks sabotage your workout. Be label savvy! 

Coconut water is being looked at more and more as a natural way to replenish your electrolyte balance after a long sweat. It has a good balance of potassium, natural sodium, manganese and magnesium; as well as some calcium and copper and other trace minerals – without added chemicals, colorings, or preservatives. It does still contain natural sugars and it does have calories, so it’s still something to be aware of.  But when you want a refreshing replenishment, maybe give this a try and see how you feel!  You can find coconut water at most grocery stores, or if you’re a lucky Saipan resident, coconuts are usually found as close as your own back yard.

In the states, Chocolate Milk has become a common post-workout recovery drink. Not only does it contain protein and the slow-carbs of lactose, but the sugar added from the chocolate is a quick source to replenish your glycogen stores. It’s your call on the idea of the processed sugars – I prefer to avoid it, but you can experiment on yourself after a long, intense workout and see how you feel and how you recover.

For me, even with an hour of HIIT work or heavy lifting supersets each day, I still prefer to use water for my hydration needs. And then refuel with a collagen protein shake when I’m finished. Find what works for you!

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