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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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“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]
In the citing paper
“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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The effect of glutamine supplementation on the function of neutrophils from exercised rats
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“The URTS usually seen following prolonged and exhaustive exercise [3] have conventionally been attributed to a transient immune depression that eventually progresses into infection [5].”
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“The relationship between infection risk and exercise training load has long been described as a J-shaped curved (Figure 1), with high training loads believed to increase the risk of opportunistic infections, particularly of the upper respiratory tract (Nieman, 1994).”
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“Exercise-induced oxidative stress is directly associated with muscle fatigue, decreased physical performance, and increased risk of suffering upper respiratory tract infections (Nieman, 1994).”
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“Because high-intensity exercise may reduce immunological functions (24) and increase free radical production (38), one may speculate that, in terms of the prevention of any type of cancer, high-intensity exercise training may have no effects or adverse effects.”
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“Transient immunosuppression induced by prolonged, intense exercise is reported to increase the risk of acquiring respiratory tract infections in humans (Martin et al., 2009; Nieman, 1994).”
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“This impaired neutrophil function may lead to a predisposition to infection after extensive exercise.([10]) The role of neutrophils after exercise is not exactly known.”
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“According to the “J-shape” curve theoretical model proposed by Nieman describing the relationship between the intensity of training and the risk of infection of the upper respiratory tract, the incidence of respiratory infections was higher among people who practice strenuous physical activity compared with those enga…”
ResultAlterations in the innate immune system due to exhausting exercise in intensively trained rats
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“Furthermore, there are epidemiological data available to suggest that regular participation in moderate-intensity physical activity may reduce the incidence of infection (Nieman 1994).”
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Virus Activation and Immune Function During Intense Training in Rugby Football Players
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“During the 1990s, a J-shaped paradoxical relationship was described between exercise intensity and immune response.(1,2) This was based on earlier reports that prolonged bouts of intense endurance exercise are associated with increased infection incidence,(3,4) whereas regular exercise of moderate intensity and volume…”
BackgroundInfectious diseases and football – lessons not only from COVID-19
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“Finally, other factors such as a well-balanced diet, adequate sleep, reduction of stress (Nieman 1993) as well as a correct application of most recent return-to-play strategies (Scharhag and Meyer 2014) also contribute to decrease the risk of infectious illnesses.”
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BackgroundInnate immune responses to a single session of sprint interval training
Davison, G. (2011) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/h11-033 · Cited by 36
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Exercise-Induced Oxidative DNA Damage and Lymphocytopenia in Sedentary Young Males
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“It has been suggested that moderate, regular exercise helps to reduce the level of infection in sedentary individuals, whereas, in individuals who undertake intensive or excessive training, the incidence of infection increases markedly (Fitzgerald, 1991; Nieman, 1994 1997).”
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“This has been thought to be a consequence of post-exercise immunosuppression, as indicated by the suppression of lymphocyte proliferation, neutrophil phagocytosis and microbicidal activity (Nieman 1994) and high occurrence of lymphocyte and neutrophil apoptosis (Mars et al.”
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“There has been limited research on the relationship between exercise and URTIs in the elderly population.”
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Effects of competition, exercise, and mental stress on secretory immunity
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“It has been recently suggested that the commonly reported increased susceptibility to infection in athletes (Nieman, 1994a,b; Peters, 1997) may be attributable, at least in part, to changes in immunity resulting from the psychological stress of competition (Perna et al., 1997; Gleeson & Bishop,…”
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“Accordingly, exhaustive exercise-induced IFN-a suppression may be one reason why prolonged strenuous exercise increases the risk for viral infection (Nieman 1994).”
Snyders, C., Pyne, D. B., Sewry, N. A., Hull, J. H., Kaulback, K., & Schwellnus, M. P. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-104719 · Cited by 33
Effects of Exercise on S-IGA and URS in Postmenopausal Women
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“Others have suggested that lymphocytopenia may be related to a reduction of lymphocytes’ proliferation, microbicidal activity [22], and increased oxidative DNA damage and apoptosis [23].”
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Seidu, S., Khunti, K., Yates, T. E., Almaqhawi, A., Davies, M. J., & Sargeant, J. A. (2021) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/20420188211054686 · Cited by 30
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“It has been suggested, mainly from epidemiological studies, that exhaustive exercise leads to a temporary immunosuppression, since athletes report more episodes of respiratory infections during periods of intense training and following competition (7,29,30).”
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“Nieman & Wentz [58] reported that intense physical activity lasting less than 60 min can suppress the immune system.”
BackgroundThe prevalence and current opinion of treatment of allergic rhinitis in elite athletes
Dijkstra, H. P., & Robson-Ansley, P. J. (2011) · Current Opinion in Allergy and Clinical Immunology · doi:10.1097/aci.0b013e3283445852 · Cited by 26
Lymphocyte antioxidant response and H2O2production after a swimming session: Gender differences
Sureda, A., Ferrer, M. D., Tauler, P., Tur, J. A., & Pons, A. (2008) · Free Radical Research · doi:10.1080/10715760801989926 · Cited by 27
Fonseca, T. R., Mendes, T. T., Ramos, G. P., Cabido, C. E. T., Morandi, R. F., Ferraz, F. O., de Miranda, A. S., Mendonça, V. A., Teixeira, A. L., Garcia, E. S., et al. (2021) · Journal of Environmental and Public Health · doi:10.1155/2021/1304139 · Cited by 26
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Guinot, M., Duclos, M., Idres, N., Souberbielle, J., Mégret, A., & Bouc, Y. L. (2006) · European Journal of Applied Physiology · doi:10.1007/s00421-006-0332-4 · Cited by 26
“Cyclists are at risk of severe injuries that may require surgery and have a high risk of infections, aVecting the upper respiratory tract in particular ( Nieman 1994 ).”
Backgroundde Lima, F. F., Pinheiro, D. H. A., & Carvalho, C. R. F. (2023) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2023.1115352 · Cited by 24
“Thus, physical exercise can increase or reduce immune responses in patients with asthma according to the intensity, duration, and frequency of training (72, 73).”
BackgroundExercise and airway injury in athletes.
Couto, M., Silva, D., Delgado, L., & Moreira, A. M. (2013) · PubMed · Cited by 24
Neutrophil Death Induced by a Triathlon Competition in Elite Athletes
Levada‐Pires, A. C., Cury‐Boaventura, M. F., Gorjão, R., Hirabara, S. M., Puggina, E. F., Peres, C. M., Lambertucci, R. H., Curi, R., & Pithon‐Curi, T. C. (2008) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31816dc89e · Cited by 24
“An intense long-duration exercise is associated with an increased risk of infections in the upper respiratory tract (25).”
BackgroundThe role of sports and exercise in allergic disease: drawbacks and benefits
Silva, D., & Moreira, A. M. (2015) · Expert Review of Clinical Immunology · doi:10.1586/1744666x.2015.1058158 · Cited by 24
“It has been suggested that the relation between exercise and respiratory infections follows a ‘J’ curve, with moderate and regular exercise improving the ability to resist infections and heavy acute or chronic exercise decreasing the infections [43].”
BackgroundEffect of resistance training on chronic inflammation: A systematic review and meta‐analysis
Rose, G. L., Mielke, G. I., Durr, M., & Schaumberg, M. A. (2021) · Translational Sports Medicine · doi:10.1002/tsm2.294 · Cited by 23
Risk factors for acute respiratory tract illness in military conscripts
Juvonen, R., Bloigu, A. H., Peitso, A., et al. (2008) · Respirology · doi:10.1111/j.1440-1843.2008.01299.x · Cited by 23
Nutrient Timing: The Means to Improved Exercise Performance, Recovery, and Training Adaptation
Ivy, J. L., & Ferguson-Stegall, L. M. (2014) · American Journal of Lifestyle Medicine · doi:10.1177/1559827613502444 · Cited by 22
Induction of Lymphocyte Death by Short- and Long-Duration Triathlon Competitions
Levada‐Pires, A. C., Cury‐Boaventura, M. F., Gorjão, R., Hirabara, S. M., Puggina, E. F., Pellegrinotti, Í. L., Filho, L. A. D., Curi, R., & Pithon‐Curi, T. C. (2009) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181a327a2 · Cited by 22
“Exercise can modulate immune function depending on its frequency, duration, and intensity (23).”
BackgroundInfluentialLate Neutrophil Priming Following a Single Session of High-intensity Interval Exercise
Ottone, V. D. O., Costa, K. B., Tossige-Gomes, R., de Matos, M. A., de Melo, G. E. B. A., Magalhães, F. D. C., Esteves, E. A., Amorim, F. T., & Rocha‐Vieira, E. (2019) · International Journal of Sports Medicine · doi:10.1055/a-0810-8533 · Cited by 22
Lee, O., Park, S., Kim, Y. S., & So, W.-Y. (2022) · Healthcare · doi:10.3390/healthcare10010122 · Cited by 27
Nutrition, exercise and the immune system
Pedersen, B. K., Ostrowski, K., Rohde, T., & Brüünsgaard, H. (1998) · Proceedings of The Nutrition Society · doi:10.1079/pns19980009 · Cited by 21
Wanderley, E. K., Cavalcante, B. D. S., Mélo, S. K. M., et al. (2015) · Journal of Equine Veterinary Science · doi:10.1016/j.jevs.2015.01.009 · Cited by 21
Blanks, A. M., Rodriguez‐Miguelez, P., Looney, J. C., Tucker, M. A., Jeong, J., Thomas, J., Blackburn, M., Stepp, D. W., Weintraub, N. J., & Harris, R. A. (2019) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2019.100011 · Cited by 21
“ratio, that are dependent on exercise intensity and not the specific mode of exercise (Keast et al., 1988; Nieman, 1994; Pedersen and Hoffman-Goetz, 2000).”
Background
Metadata
- 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 › Physiology (medical) › Exercise and Physiological Responses
- Health Sciences › Medicine › Physiology (medical) › 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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