Training Strategies to Maintain Immunocompetence in Athletes

D. B. Pyne; M. Gleeson; W. A. McDonald; R. L. Clancy; C. Perry Jr; P. A. Fricker

doi:10.1055/s-2000-1452

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2000; 21(Supplement 1): 51-60
DOI: 10.1055/s-2000-1452

Georg Thieme Verlag Stuttgart · New York

Training Strategies to Maintain Immunocompetence in Athletes

D. B. Pyne^{1, 4} , M. Gleeson^{2, 3} , W. A. McDonald^{1, 4} , R. L. Clancy^{2, 3} , C. Perry Jr¹ , P. A. Fricker^{1, 4}

¹ Sports Science and Sports Medicine Centre, Australian Institute of Sport, Canberra, ACT, Australia
² Hunter Immunology Unit, Hunter Area Pathology Service, Newcastle, NSW, Australia
³ Faculty of Medicine and Health Sciences, University of Newcastle, Newcastle, NSW, Australia
⁴ GADI Research Centre, University of Canberra, Canberra, ACT, Australia

Abstract

Clinical experience and empirical evidence have led to the modeling of exercise and training as a form of stress on the immune system. Coaches, athletes, and medical personnel are seeking guidelines on ways to reduce the risk of illness that compromises training or competitive performance. The immune system is influenced by a wide range of physical, environmental, psychological, and behavioural factors which, combined with clinical assessment, collectively form the basis of the following intervention strategies: 1) training: careful management of training volume and intensity, variety to overcome training monotony and strain, a periodised approach to increasing loads, and provision of adequate rest and recovery periods; 2) environmental: limiting initial exposure when training or competing in adverse environmental conditions (heat, humidity, altitude, air pollution) and acclimatising where appropriate; 3) psychological: teaching athletes self-management and coping skills and monitoring of athletes' responses to the psychological and psychosocial stresses of high-level training and competition; 4) behavioural: adopting a well-balanced diet with adequate intake of macro- and micro-nutrients, limiting transmission of contagious illnesses by reducing exposure to common infections, airborne pathogens, and physical contact with infected individuals; and 5) clinical considerations: medical screening, pathology testing, immunization and prophylaxis, and routine management of illness-prone athletes. Future experimental studies are required to develop and enhance the effectiveness of these strategies in reducing illness in athletes.

Key words:

Immunity, athletes, training, environment, medical intervention.

Full Text

References

1 Adams S H, Boyce T W. Stress, personality, and infectious illness: an integrative approach. Med Ex Nutr Health. 1995; 4 146-156
2 Antonio J, Street C. Glutamine: a potentially useful supplement for athletes. Can J Appl Physiol. 1999; 21 1-14
3 Bailey D M, Davies B, Budgett R, Gandy G. Recovery from infectious mononucleosis after altitude training in an elite middle distance runner. Brit J Sports Med. 1997; 31 153-154
4 Banister E W. Modeling elite athletic performance. In: Green HJ, McDougall JD, Wenger H (eds) Physiological testing of elite athletes. Champaign, IL; Human Kinetics Publishers 1991: 403-424
5 Banister E W, Calvert T W. Planning for future performance: implications for long term planning. Can J Appl Spt Sci. 1980; 5 170-176
6 Banister E W, Morton R H, Clarke J R. Clinical dose-response effects of exercise. In: Steinacker JM, Wand SA (eds) The Physiology and Pathophysiology of Exercise Tolerance. New York; Plenum 1997: 297-309
7 Bond J. The individual athlete. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 163-181
8 Bouchama A, Hussein K A, Adra C, Rezeig M, Shail E A, Sedairy S A. Distribution of peripheral blood leukocytes in acute heatstroke. J Appl Physiol. 1992; 73 405-409
9 Brenner I, Shek P N, Zamecnik J, Shephard R J. Stress hormones and the immunological responses to heat and exercise. Int J Sports Med. 1998; 19 130-143
10 Brown R, Pang G, Husband A J, King M G, Bull D F. Sleep deprivation and the immune response to pathogenic and non-pathogenic antigens. 1992
11 Butcher J D, Lillegard W A. Sinusitis, otitis media, otitis externa, and conjunctivitis. In: Fricker PA, Fields KB (eds) Medical Problems in Athletes. Melbourne; Blackwell Science 1997: 21-25
12 Cannon J G. Exercise and resistance to infection. J Appl Physiol. 1993; 74 973-981
13 Casey J M, Dick E C. Acute respiratory infections. In: Casey JM, Foster C, Hixson EG (eds) Winter sports medicine. Philadelphia; F. A. Davis 1990: 112-128
14 Chandra R K. 1990 McCollum Award Lecture: nutrition and immunity - lessons from the past and new insights into the future. Am J Clin Nutr. 1991; 53 1087-1101
15 Chandra R K. Nutritional regulation of immunity and risk of infection in old age. Immunol. 1989; 67 141-147
16 Chapman R F, Stray-Gundersen J, Levine B J. Individual variation in response to altitude training. J Appl Physiol. 1998; 85 1448-1456
17 Chicharro J L, Lucia A, Perez M, Vaquero A F, Urena R. Saliva composition and exercise. Sports Med. 1998; 26 17-27
18 Coen B, Schwarz L, Urhausen A, Kindermann W. Control of training in middle and long-distance running by means of the individual anaerobic threshold. Int J Sports Med. 1991; 12 519-524
19 Cohen S, Tyrrell D AJ, Smith A P. Psychological stress and susceptibility to the common cold. New Eng J Med. 1990; 325 606-612
20 Currie A, Potts S G, Donovan W, Blackwood D. Illness behaviour in elite middle and long distance runners. Brit J Sports Med. 1999; 33 19-21
21 Dick E C, Jennings L C, Mink K A, Wartgow C D, Inhorn S L. Aerosol transmission of rhinovirus colds. J Infect Dis. 1987; 156 442-448
22 Eichner E R. Infection, immunity and exercise: what to tell patients?. Phys Sportsmed. 1993; 21 125-135
23 Foster C. Monitoring training in athletes with reference to overtraining syndrome. Med Sci Sports Exerc. 1998; 30 1164-1168
24 Foster C, Daines E, Hector L, Snyder A C, Welsh R. Athletic performance in relation to training load. Wisc Med J. 1996; June 1996 370-374
25 Fricker P, McDonald W, Pyne D, Perry C. Exercise, mood states and immunity in elite swimmers during an intensive 12-week training cycle. Montreal; Annual Conference of the Association for the Advancement of Applied Sports Physiology 1993
26 Fricker P A. Infectious problems in athletes: an overview. In: Fields K, Fricker P (eds) Medical Problems in Athletes. Malden; Blackwell Science 1997: 3-5
27 Fricker P A, McDonald W A, Gleeson M, Flanagan A, Pyne D B, Clancy R L. Incidence of respiratory and gut infections in elite swimmers. Int J Sports Med. 2000; 21 S 76
28 Friman G, Ilback N-G. Acute infection: metabolic responses, effects on performance, interaction with exercise, and myocarditis. Int J Sports Med. 1998; 19 S172-S182
29 Friman G, Ilback N-G. Exercise and infection - interaction, risks and benefits. Scand J Med Sci Sports. 1992; 2 177-189
30 Gabriel H, Kindermann W. The acute immune response to exercise: what does it mean?. Int J Sports Med. 1997; 18 S28-S45
31 Gabriel H W, Urhausen A, Valet G, Heidelbach U, Kindermann W. Overtraining and the immune system: a prospective longitudinal study in endurance athletes. Med Sci Sports Exerc. 1998; 30 1151-1157
32 Gleeson M. Elite athlete immunology: the importance of nutrition. Int J Sports Med. 2000; 21 S 44-S 50
33 Gleeson M, Cripps A W, Clancy R L. Modifiers of the human mucosal immune system. Immunol Cell Biol. 1995; 73 397-404
34 Gleeson M, McDonald W A, Cripps A W, Pyne D B, Clancy R L, Fricker P A, Woldarczyk J W. Exercise, stress and mucosal immunity in elite swimmers. In: Mestecky J, Russell M, Jackson S, Michalck S, Hogenova H, Sterzl J (eds) Advances in Mucosal Immunology. New York; Plenum Publishing Corporation 1995: 571-574
35 Gleeson M, McDonald W A, Pyne D B, Cripps A W, Francis J L, Fricker P A, Clancy R L. Salivary IgA levels and infection risk in elite swimmers. Med Sci Sports Exerc. 1999; 31 67-73
36 Gong H, Krishnareddy S. How pollution and airborne allergens affect exercise. Phys Sportsmed. 1995; 23 35-42
37 Gray A B, Telford R D, Collins M, Weidemann M J. The response of leukocyte subsets and plasma hormones to interval exercise. Med Sci Sports Exerc. 1993; 25 1252-1258
38 Grove J R, Gordon A MD. The psychological aspects of injury in sport. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 194-205
39 Health G W, Macera C A, Nieman D C. Exercise and the upper respiratory tract infections: is there a relationship?. Sports Med. 1992; 14 353-365
40 Hoffman-Goetz L, Pedersen B K. Exercise and the immune system: a model of the stress response?. Immunol Today. 1994; 15 382-387
41 Hooper S L, Mackinnon L T, Ginn E M. Effects of three tapering techniques on the performance, forces and psychometric measures of competitive swimmers. Eur J Appl Physiol. 1998; 78 258-263
42 Hooper S L, Mackinnon L T, Howard A, Gordon R D, Bachmann A W. Markers for monitoring overtraining and recovery. Med Sci Sports Exerc. 1995; 27 106-112
43 Jansky L, Pospisilova D, Honzova S, Ulicny B, Sramek P, Zeman V, Kaminkova J. Immune system of cold-exposed and cold-adapted humans. Eur J Appl Physiol. 1996; 72 445-450
44 Konig D, Weinstock C, Keul J, Northoff H, Berg A. Zinc, iron, and magnesium status in athletes - influence on the regulation of exercise-induced stress and immune function. Exer Immunol Rev. 1998; 4 2-21
45 Kutsar K. Some aspects of altitude training. Mod Ath Coach. 1983; 21 27-28
46 Lehmann M, Baumgartl P, Wiesenack C, Seidel A, Baumann H, Fischer S, Spori U . et al . Training-overtraining: influence of a defined increase in training volume vs training intensity on performance, catecholamines, and some metabolic parameters in experienced middle- and long-distance runners. Eur J Appl Physiol. 1992; 64 169-177
47 Lehmann M, Dickhuth H H, Gendrisch G, Lazar W, Thum M, Kaminski R, Aramendi J F . et al . Training-overtraining. A prospective, experimental study with experienced middle- and long-distance runners. Int J Sports Med. 1991; 12 444-452
48 Lehmann M, Foster C, Dickhuth H H, Gastman U. Autonomic imbalance hypothesis and overtraining syndrome. Med Sci Sports Exerc. 1998; 30 1140-1145
49 Lehmann M, Foster C, Keul J. Overtraining in endurance athletes: a brief review. Med Sci Sports Exerc. 1993; 25 854-862
50 Lehmann M, Foster C, Netzer N, Lormes W, Steinacker J M, Liu Y, Opitz-Gress A . et al .Physiological responses to short- and long-term overtraining in endurance athletes. In: Kreider RB, Fry AC, O'Toole ML (eds) Overtraining in Sport. Champaign, IL; Human Kinetics 1998: 19-46
51 Levine B D, Stray-Gundersen J. 'Living high-training low': effect of moderate-altitude acclimatization with low-altitude training on performance. J Appl Physiol. 1997; 83 102-112
52 Mackinnon L T. Immunity in athletes. Int J Sports Med. 1997; 18 S62-S68
53 Mackinnon L T. Immunoglobulin, antibody and exercise. Exer Immunol Rev. 1996; 2 1-35
54 MacLaren D P, Reilly T, Campbell I T, Frayn K N. Hormonal and metabolite responses to glucose and maltodextrin ingestion with or without the addition of guar gum. Int J Sports Med. 1994; 15 466-471
55 Mast E E, Goodman R A. Prevention of infectious disease transmission in sports. Sports Med. 1997; 24 1-7
56 McCarthy D A, Dale M M. The leucocytosis of exercise - a review and model. Sports Med. 1988; 6 333-363
57 McDonald W A. Upper respiratory tract infections. In: Fields KB, Fricker PA (eds) Medical Problems in Athletes. Malden; Blackwell Science 1997: 6-10
58 McKenzie D C. Markers of excessive exercise. Can J Appl Physiol. 1999; 24 66-73
59 McLatchie G R. Infections in sport. In: McLatchie GR (ed) Essentials of Sports Medicine. Edinburgh; Churchill Livingstone 1993: 112-125
60 Meehan R T. Immune suppression at high altitude. Ann Emerg Med. 1987; 16 974-979
61 Meehan R T, Duncan U, Neale L, Taylor G, Muchmore H, Scott N, Ramsey K . et al . Operation Everest II. Alterations in the immune system at high altitudes. J Clin Immunol. 1988; 8 397-403
62 Meyers A W, Whelan J P. A systemic model for understanding psychosocial influences in overtraining. In: Kreider RB, Fry AC, O'Toole ML (eds) Overtraining in Sport. Champaign, IL; Human Kinetics 1998: 335-369
63 Miller B P. Team athletes. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 182-193
64 Mitchell J B, Costill D L, Houmard J A, Flynn M G, Fink W J, Beltz J D. Influence of carbohydrate ingestion on counterregulatory hormones during prolonged exercise. Int J Sports Med. 1990; 11 33-36
65 Morgan W P, Brown D R, Raglin J S, O'Connor P J, Ellickson K A. Psychological monitoring of overtraining and staleness. Brit J Sports Med. 1987; 21 107-114
66 Morton R H, Fitz-Clarke J R, Banister E W. Modeling human performance in running. J Appl Physiol. 1990; 69 1171-1177
67 Mujika I. The influence of training characteristics and tapering on the adaptation in highly trained individuals: a review. Int J Sports Med. 1998; 19 439-446
68 Mujika I, Busso T, Lacoste L, Barale F, Geyssant A, Chatard J-C. Modeled response to training and taper in competitive swimmers. Med Sci Sports Exerc. 1996; 28 251-258
69 Nehlsen-Cannarella S L, Nieman D C, Balk-Lamberton A J, Markoff P A, Chritton D BW, Gusewitch G, Lee J W. The effects of moderate exercise training on immune response. Med Sci Sports Exerc. 1991; 23 64-70
70 Nieman D C. Exercise immunology: practical applications. Int J Sports Med. 1997; 18 S91-S100
71 Nieman D C. Immune response to heavy exertion. J Appl Physiol. 1997; 82 1385-1394
72 Nieman D C. Influence of carbohydrate on the immune response to intensive, prolonged exercise. Exer Immunol Rev. 1998; 4 64-75
73 Nieman D C, Nehlsen-Cannarella S L, Markoff P A, Balk-Lamberton A J, Yang H, Chitton D BW, Lee J W . 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
74 Pedersen B K. Immune responses to acute exercise. In: Hoffman-Goetz L (ed) Exercise and Immune Function. Boca Raton; CRC Press 1996: 80-92
75 Pedersen B K, Ullum H. NK cell response to physical activity: possible mechanisms of action. Med Sci Sports Exerc. 1994; 26 140-146
76 Peters E M. Immunology and upper respiratory tract infections. Int J Sports Med. 1997; 18 S69-S77
77 Peters-Futre E M. Vitamin C, neutrophil function and upper respiratory tract infection risk in distance runners: the missing link. Exer Immunol Rev. 1997; 3 32-52
78 Pyke F. Sport in the cold. Sports Coach. 1986; 9 36-38
79 Pyke F S, Sutton J R. Environmental stress. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 129-149
80 Pyne D B. Immune function and exercise. In: Fields K, Fricker P (eds) Medical Problems in Athletes. Malden; Blackwell Science 1997: 266-269
81 Pyne D B. Regulation of neutrophil function during exercise. Sports Med. 1994; 17 245-258
82 Pyne D B, Baker M S, Telford R D, Weidemann M J. Exercise and neutrophil oxidative activity: experimental and biological variability. Eur J Appl Physiol. 1996; 74 564-571
83 Pyne D B, Gleeson M. Effects of intensive exercise training on immunity in athletes. Int J Sports Med. 1998; 19 S183-S194
84 Pyne D B, Gray A B, McDonald W A. Exercise, training and immunity. In: Bloomfield J, Fricker P, Fitch K (eds) Textbook of Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 602-615
85 Pyne D B, Morton D S, Foster M, Smith J A, McDonald W A, Sonnenfeld G. Effects of altitude exposure and physical training on cytokine production. J Appl Physiol 1999 under review
86 Rhind S G, Shek P N, Shephard R J. The impact of exercise on cytokines and receptor expression. Exer Immunol Rev. 1995; 1 97-148
87 Rhind S G, Shek P N, Shinkai S, Shephard R J. Effects of moderate endurance exercise and training on in vitro lymphocyte proliferation, interleukin-2 production, and IL-2 receptor expression. Eur J Appl Physiol. 1996; 4 348-360
88 Rohde T, Krzywkowski K, Pedersen B K. Glutamine, exercise and the immune system - is there a link?. Exer Immunol Rev. 1998; 4 49-63
89 Rowbottom D G, Keast D, Morton A R. The emerging role of glutamine as an indicator of exercise stress and overtraining. Sports Med. 1996; 21 80-97
90 Rowbottom D G, Keast D, Morton A R. Monitoring and preventing of overreaching and overtraining in endurance athletes. In: Kreider RB, Fry AC; O'Toole ML (eds) Overtraining in Sport. Champaign, IL; Human Kinetics 1998: 47-66
91 Sando B G. The team physician. In: Bloomfield J, Fricker PA, Fitch KD (eds) Science and Medicine in Sport. Melbourne; Blackwell Science 1995: 478-493
92 Severs Y, Brenner I, Shek P N, Shephard R J. Effects of heat and intermittent exercise on leukocyte and sub-population cell counts. Eur J Appl Physiol. 1996; 74 234-245
93 Shephard R J, Rhind S, Shek P N. Exercise and the immune system: natural killer cells, interleukins and related responses. Sports Med. 1994; 18 340-369
94 Shephard R J, Shek P N. Acute and chronic over-exertion: do depressed immune responses provide useful markers?. Int J Sports Med. 1998; 19 159-171
95 Shephard R J, Shek P N. Exercise training and immune function. In: Hoffman-Goetz L (ed) Exercise and Immune Function. Boca Raton; CRC Press 1996: 93-119
96 Shephard R J, Shek P N. Immunological hazards from nutritional imbalance in athletes. Exer Immunol Rev. 1998; 4 22-48
97 Shephard R J, Shek P N. Interactions between sleep, other body rhythms, immune responses and exercise. Can J Appl Physiol. 1996; 22 95-116
98 Sherman A R. Zinc, copper and iron nutrition and immunity. J Nutr. 1992; 122 604-609
99 Shinkai S, Shore S, Shek P N, Shephard R J. Acute exercise and immune function: relationship between lymphocyte activity and changes in subset counts. Int J Sports Med. 1992; 13 452-461
100 Simon H B. Exercise and infection. Phys Sportsmed. 1987; 15 135-141
101 Smith J A. Guidelines, standards, and perspectives in exercise immunology. Med Sci Sports Exerc. 1995; 27 497-506
102 Smith J A, Baker M S, Gray A B, Pyne D B, Telford R D, Weidemann M J. Submaximal exercise triggers both priming and activation of neutrophils. Am J Physiol. 1996; 270 R838-R845
103 Smith J A, Pyne D B. Exercise, training and neutrophil function. Exerc Immunol Rev. 1997; 3 96-117
104 Smith R S. The immune system is a key factor in the etiology of psychosocial disease. Medical Hypotheses. 1991; 34 49-57
105 Snyder A C. Overtraining and glycogen depletion hypothesis. Med Sci Sports Exerc. 1998; 30 1146-1150
106 Snyder A C, Jeukendrup A E, Hesselink M KC, Kuipers H, Foster C. A physiological/psychological indicator of over-reaching during intensive training. Int J Sports Med. 1993; 14 29-32
107 Snyder A C, Kuipers H, Cheng B, Servais R, Fransen E. Overtraining following intensified training with normal muscle glycogen. Med Sci Sports Exerc. 1995; 27 1063-1070
108 Sonnenfeld G, Morton D, Swigget J, Foster M, Smith J, Pyne D, Watson S . et al . High altitude and intensive training affect immunological parameters of elite swimmers. Int J Sports Med. 1998; 19 S214
109 Steinacker J M, Lormes W, Lehmann M, Alternburg D. Training of rowers before and championships. Med Sci Sports Exerc. 1998; 30 1158-1163
110 Swain R A, Kaplan B. Upper respiratory infections: treatment selection for active patients. Phys Sportsmed. 1998; 26 85-96
111 Takahashi M, Fukuda H, Arito H. Brief naps during post-lunch rest: effects on alertness, performance, and autonomic balance. Eur J Appl Physiol. 1998; 78 93-98
112 Urhausen A, Gabriel H HW, Weiler B, Kindermann W. Ergometric and psychological findings during overtraining: a long-term follow-up study in endurance athletes. Int J Sports Med. 1998; 19 114-120
113 Viru A, Viru M. Adaptivity changes in athletes. Coach Sport Sci J. 1997; 2 26-35
114 Walsh N P, Blannin A K, Robson P J, Gleeson M. Glutamine, exercise and immune function - links and possible mechanisms. Sports Med. 1998; 26 177-191
115 Weidner T G. Sport and exercise participation during a common cold. Athletic Therapy Today. 1996; 1 5-8
116 Wilber R. Altitude training for the enhancement of sea level endurance performance. Olymp Coach. 1995; 5 6-10
117 Young M, Fricker P, Maughan R, MacAuley D. The traveling athlete: issues relating to the Commonwealth Games, Malaysia 1998. Clin J Sports Med. 1998; 8 130-135

Ph.D. D. Pyne

Sports Science and Sports Medicine Centre Australian Institute of Sport

PO Box 176 Belconnen A.C.T. 2616 Australia

Phone: Phone:+ 61 (2) 62141356

Fax: Fax:+ 61 (2) 62141603

Email: E-mail:david.pyne@ausport.gov.au