Exercise, upper respiratory tract infection, and the immune system
Abstract
The relationship between exercise and upper respiratory tract infections (URTI) may be modeled in the form of a "J" curve. Various epidemiological studies suggest that unusually heavy acute or chronic exercise is associated with an increased risk of URTI. The risk appears to be especially high during the one or 2-wk period following marathon-type race events. Among runners varying widely in training habits, the risk for URTI is slightly elevated for the highest distance runners, but only when several confounding factors are controlled for. Two randomized experimental trials using small numbers of subjects have provided important preliminary data in support of the viewpoint that moderate physical activity may reduce URTI symptomatology. Clinical data support the concept that heavy exertion increases the athlete's risk of URTI because of negative changes in immune function and elevation of the stress hormones, epinephrine, and cortisol. On the other hand, there is growing evidence that moderate amounts of exercise may decrease one's risk of URTI through favorable changes in immune function without the negative attending effects of the stress hormones.
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Moderate physical exercise may decrease the risk of common cold.
“Common cold is also more likely in those suffering from psychological stress [59], while moderate physical exercise may decrease the risk [60].”
From Immune function and micronutrient requirements change over the life course (2018) · cites this paper as [60]
Heavy physical training increases the risk of respiratory infections, whereas moderate physical activity could decrease risk.
“Finally, some reports27 indicate that heavy physical training increases the risk of respiratory infections, whereas moderate physical activity could decrease risk.”
From The common cold (2003) · cites this paper as [27]
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“Exhaustive exercise induces oxidative stress and it may impair immune response, increasing athletes’ susceptibility to upper respiratory tract infections [1].”
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“While hormonal pathways offer the most convincing explanations, PA may also improve the immune response [25], possibly by promoting killer-cell, macrophage, and cytokine activity [26, 27] as well as upregulating antioxidant enzyme activity [28], which may protect against DNA damage.”
BackgroundBeneficial Effect of Glutamine on Exercise-Induced Apoptosis of Rat Neutrophils
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Influence of carbohydrate status on immune responses before and after endurance exercise
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“There may be a connection, however, between altered immune responses and the increase in the occurrence of infection that has been reported in some athletes during heavy training and after competition (2, 22, 25, 27, 32, 36).”
BackgroundThe Common Cold: Potential for Future Prevention or Cure
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“Other risk factors include day-care attendance [7] , genetic factors [8] , psychological stress [9] , smoking [10] and heavy physical training [11] .”
BackgroundREST-INTERVAL LENGTH AFFECTS LEUKOCYTE LEVELS DURING HEAVY RESISTANCE EXERCISE
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“The magnitude and duration of each response depends on the nature, intensity, and duration of exercise, with changes typically resolving within 6 hours (25).”
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Similarities and differences of the immune response to exercise and trauma: the IFN-γ concept
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The effects of single and repeated bouts of soccer-specific exercise on salivary IgA
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The effect of exercise training on the severity and duration of a viral upper respiratory illness
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Glutamine and the effects of exhaustive exercise upon the immune response
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Physical activity and risk of colon cancer: the Physicians‘ Health Study (United States)
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“Modest amounts of regular exercise are generally associated with well being and a decreased risk of upper respiratory tract infections (Nieman 1994).”
Plasma Cytokine Profiles in Long-Term Strenuous Exercise
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“The “J” means that individuals engaged in moderate physical activity are at lower risk compared with sedentary individuals [3].”
BackgroundUrinary excretion of cytokines versus their plasma levels after endurance exercise
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Stress Hormonal Factors, Fatigue, and Antioxidant Responses to Prolonged Speed Driving
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“Heavy exercise does accompany a decreased cytotoxic effect of NK cells while moderate, regular activity increases number of NK cells ([8,10]).”
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“Besides its beneficial impact on nutritional and metabolic status, regular physical activity is reported to be associated with lower severity and symptomatology of upper respiratory tract infections other than SARS-COV2 when performed at moderate intensity [107] although with higher severity if performed at high inten…”
Changes in natural killer cell subpopulations over a winter training season in elite swimmers
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“…training acts as a stressful situation that promotes an increase in cortisol secretion which in turn seems to affect the immune response, but like others before we were not successful in finding a clear link between training load and a higher incidence of illness (Nieman and Pedersen 1999).”
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Inadequate Exercise as a Risk Factor for Sepsis Mortality
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“Athletes report symptoms commonly associated with infections of the upper respiratory airways during heavy training and prolonged exercise [36–38], but it is possible that these are allergy- or inflammatory-based rather than infectious [39].”
BackgroundImpact of Physical Activity and Sport on the Immune System
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Training adaptation and biological changes among well-trained male triathletes
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- Authors
- NIEMAN, D. C.
- Affiliations
- Appalachian State University (US)
- Corresponding author
- NIEMAN, DAVID C.
- ORCID
- NIEMAN, DAVID C.
- Venue
- Medicine & Science in Sports & Exercise
- Published
- 1994-02
- Volume
- 26
- Issue
- 2
- Pages
- 128-139
- ISSN
- 0195-9131 (ISSN-L)
- OpenAlex
- W2088858431
- Cited by
- 468
- References
- 0
- Citations by year
- 2026: 10 · 2025: 8 · 2024: 9 · 2023: 8 · 2022: 16 · 2021: 17 · 2020: 19 · 2019: 8 · 2018: 21 · 2017: 9 · 2016: 17 · 2015: 22 · 2014: 22 · 2013: 21 · 2012: 24
- FWCI
- 13.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medicine & Science in Sports & Exercise (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- upper respiratory tract infection, physical activity, immune function, marathon running, long-distance runners, stress hormones, cortisol, epinephrine, J-curve, infection risk
- MeSH terms
- Humans, Immune System, Respiratory Tract Infections, Risk Factors, Exercise, Randomized Controlled Trials as Topic
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