EC Orthopaedics

The initial response to infection always involves the innate immune system, which consists of a variety of cell types and factors. The inflammatory response causes vasodilation thus increased vascular permeability. This facilitates the recruitment of cells with the bloodstream.
If the infection is not resolved, the second procedure of the immune system, the specific immune system recruits special cells and mediators to fight the infection.
Regarding the acute immune response to exercise, a variety of mechanisms are involved, including exercise-induced changes in stress hormone and cytokine concentrations, elevated body temperature, increases in blood flow and dehydration.
Following prolonged running at high intensity, cortisol concentrations are significantly higher than control levels for several hours. Glucocorticoids can cause increased neutrophils, low numbers of eosinophils, lymphocytopenia and a reduction of both NK and T-cells, all of which happen after prolonged, high-intensity cardiorespiratory exercise.
Athletes during periods of heavy training have low neutrophil counts. Neutrophils are an important component of the innate immune system, initiating the phagocytosis of many bacterial and viral pathogens and releasing immunomodulatory cytokines. Moreover, two other environmental factors, improper nutrition and psychological stress can negatively influence the immune system.

Keywords: Immune Response; Exercise; Infection; Athletes

1. Johnston R. “An Overview of the Innate Immune System”. UpToDate (2017).
2. Abbas A., et al. “Cellular and Molecular Immunology”. 9th edition, Philadelphia: Elsevier (2017).
3. Delves P., et al. “Roitt’s Essential Immunology”. 13th edition, West Sussex, UK: John Wiley and Sons, Ltd (2017).
4. Nieman DC. “Clinical implications of exercise immunology”. Journal of Sport and Health Science1 (2012): 12-17.
5. Terra R., et al. “Effect of exercise on immune system: response, adaptation and cell signaling”. Revista Brasileira de Medicina do Esporte3 (2012): 208-214.
6. Campbell J and Turner J. “Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan”. Frontiers in Immunology 9 (2018).
7. Peake J., et al. “Recovery of the immune system after exercise”. Journal of Applied Physiology5 (2017): 1077-1087
8. , et al. Position statement part one: immune function and exercise (2011).
9. Nieman DC. “Exercise and resistance to infection”. Canadian Journal of Physiology and Pharmacology Figure 1, graph (1998a).
10. Nieman DC and Pedersen BK., “Exercise and immune function”. Sports Medicine2 (1999): 73-80.
11. Nieman DC and Wentz LM. “The compelling link between physical activity and the body’s defense system”. Journal of Sport and Health Science3 (2019): 201-217.
12. Batatinha HA., et al. “Nutrients, Immune System and Exercise: Where it will take us?” Nutrition (2018).
13. Louis J., et al. “The impact of sleeping with reduced glycogen stores on immunity and sleep in triathletes”. European Journal of Applied Physiology10 (2016): 1941-1954.
14. Gleeson M and Bishop N. “Modification of immune responses to exercise by carbohydrate, glutamine and anti-oxidant supplements”. Immunology and Cell Biology5 (2000): 554-561.
15. Gunzer W., et al. “Exercise-Induced Immunodepression in Endurance Athletes and Nutritional Intervention with Carbohydrate, Protein and Fat-What Is Possible, What Is Not?”. Nutrients 4 (2012): 1187-1212.
16. Fullagar H., et al. “Sleep and Athletic Performance: The Effects of Sleep Loss on Exercise Performance, and Physiological and Cognitive Responses to Exercise”. Sports Medicine2 (2014): 161-186.
17. Asif N., et al. “Human immune system during sleep”. American Journal of Clinical and Experimental Immunology6 (2017): 92-96.
18. Fitzgerald D., et al. “The influence of sleep and training load on illness in nationally competitive male Australian Football athletes: A cohort study over one season”. Journal of Science and Medicine in Sport [online] 22 (2018): 130-134.
19. Sobana R and Many J. “Analysis of knowledge, attitudes and practices between male and female college athletes on hydration and fluid replacement”. International Journal of Sports Sciences and Fitness2 (2014).
20. Maughan R and Shirreffs S. “Nutrition and hydration concerns of the female football player”. British Journal of Sports Medicine 41 (2007): 60-63.
21. Mangili A and Gendreau M. “Transmission of infectious diseases during commercial air travel”. Lancet 9463 (2005): 989-996.
22. Schwellnus M., et al. “Elite athletes travelling to international destinations >5 time zone differences from their home country have a 2-3-fold increased risk of illness”. British Journal of Sports Medicine 11 (2012): 816-821.
23. Herxheimer A and Fellow E. “Jet Lag”. BMJ Clinical Evidence (2014).
24. Wilder-Smith A. “Impact of partial sleep deprivation on immune markers”. Sleep Medicine10 (2013): 1031-1034.
25. Walsh N. “Recommendations to maintain immune health in athletes”. European Journal of Sport Science6 (2018): 820-831.
26. Toumi H. “Bahrain records hottest July in 115 years” (2017).
27. Keaney L., et al. “The impact of sport related stressors on immunity and illness risk in team-sport athletes”. Journal of Science and Medicine in Sport 21 (2018): 1192-1199.
28. Nieman DC. “Exercise immunology: practical applications”. Rehabilitation Oncology3 (1998b): 31.
29. Purcell L. “Exercise and febrile illnesses”. Paediatrics and Child Health10 (2007): 885-887.
30. Kelly J and Rosenberg J. “Diagnosis and management of concussion in sports”. Neurology3 (1997): 575-580.
31. May Kh., et al. “Pediatric sports specific return to play guidelines following concussion. International Journal of Sports Physical Therapy2 (2014): 242-55.
32. D’Lauro C., et al. “Reconsidering Return-to-Play Times: A Broader Perspective on Concussion Recovery”. Orthopaedic Journal of Sports Medicine3 (2018): 232596711876085.
33. Meyer T. “Infection Management in Elite Athletes” (2019).
34. , et al. “How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness”. British Journal of Sports Medicine 50.17 (2016): 1043-1052.