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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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InfluentialExercise training raises expression of the cytosolic components of NADPH oxidase in rat neutrophils
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“Additionally, Nieman has reported that people who habitually do moderate exercise have less risk of URTI than those people who do not; however, he also has reported that high-intensity exercise increases the risk of URTI.”
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“Traditionally, the prevalence and characterization of upper respiratory illnesses (URIs) in sport have been assessed using health logbooks, through the use of questionnaires/ report forms or by subject recall.(16,17) A few studies have employed the use of physician/medical examinations,(10,18,19) or clinical verificat…”
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“In humans, intense exercise is associated with increased risks for upper respiratory tract infections (URTI) and suppressed immune function (28).”
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“…high-intensity, or prolonged exercise can lead to transient immunosuppression, known as the “ open window, ” associated with an increased risk of opportunistic infections, particularly respiratory viral infections (Nieman et al., 1989; Nieman, 1994; Shephard and SHEK, 1996; Matthews et al., 2002).”
Inflammation and Immune Function
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BackgroundUpper Respiratory Infections in Adults
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“Moderate-intensity exercise has a protective effect on respiratory viral infections, while high-intensity exercise may increase the risk of infections [29].”
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“increases the risk of upper respiratory tract infections (URTI) by impairing the immune function in athletes [2].”
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Vitamins, Immunity, and Infection Risk in Athletes
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Elmajnoun, H. K., Elhag, M. R. A., Mohamed, H., Haris, P. I., & Abu-Median, A.-B. (2020) · Sudan Journal of Medical Sciences · doi:10.18502/sjms.v15i5.7147 · Cited by 9
“Over the last few decades, the role of physical activities on activating the immune system to fight infections has been heavily examined [65, 66].”
BackgroundA Single Dose of Ibuprofen Impacts IL-10 Response to 164-km Road Cycling in the Heat
Vingren, J. L., Boyett, J. C., Lee, E. C., Levitt, D. E., Luk, H., McDermott, B. P., Muñoz, C. X., Ganio, M. S., Armstrong, L. E., & Hill, D. W. (2022) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.2021.1981539 · Cited by 7
“The use of NSAIDs in endurance events with the addition of environmental factors (e.g., temperature and hydration) could further reduce kidney blood flow and result in acute renal injury (Nieman, 1994; Shephard et al., 1994).”
BackgroundDonatto, F. F., Prestes, J., Ferreira, C. K. O., Dias, R., Frollini, A. B., Leite, G. S., Urtado, C. B., Verlengia, R., Palanch, A. C., Perez, S., et al. (2008) · Revista Brasileira de Medicina do Esporte · doi:10.1590/s1517-86922008000600011 · Cited by 7
“A intensidade, duração e a freqüência do exercício exercem papelchave na determinação das respostas imunes a esforço, podendo aumentar ou reduzir a função imune(1-4), sendo essas respostas altamente dependentes da habilidade dos leucócitos em migrarem do sangue para os tecidos periféricos em locais de inflamação.”
BackgroundThe immunology of exercise: Mechanisms, mediators, and therapeutic opportunities
Phelps, C. M., & Meisel, M. (2026) · Immunity · doi:10.1016/j.immuni.2026.04.016 · Cited by 12
Nasal Injuries and Issues in Athletes
Escalona, T., & Okamura, Á. (2024) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000001130 · Cited by 6
Prestes, J. (2007) · Fitness & Performance Journal · doi:10.3900/fpj.6.1.32.p · Cited by 7
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Immune function changes of rats in incremental graded exercise test
Wang, H., & Zhang, M. (2011) · African Journal of Microbiology Research · doi:10.5897/ajmr.9000370 · Cited by 6
EFFECTS OF REPETITIOUS INTENSE EXERCISE TRAINING ON RESTING SALIVARY IGA
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Swain, R. A., & Kaplan, B. (1998) · The Physician and Sportsmedicine · doi:10.3810/psm.1998.02.944 · Cited by 6
Is exercise bad for the immune system?
Horohov, D. W. (2003) · Equine Veterinary Journal · doi:10.2746/042516403776114270 · Cited by 6
Physical Exercise and Metabolic Reprogramming
Batatinha, H. P., Lira, F. S., Kruger, K., & Rosa Neto, J. C. (2022) · Essential Aspects of Immunometabolism in Health and Disease · doi:10.1007/978-3-030-86684-6_12 · Cited by 5
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Luo, L., Zeng, X., Wu, Y., An, F., Huang, J., Yang, H., Jiang, Q., Ou, Q., Du, J., & Song, N. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.787857 · Cited by 6
“And T cells are critical effector lymphocytes that protect vulnerable areas such as the upper airway and lungs (26).”
BackgroundPacqué, P. F. J., Booth, C., & Dwyer, D. (2002) · Defense Technical Information Center (DTIC) · Cited by 5
Interrelationships Between Acute and Chronic Exercise and the Immune and Endocrine Systems
Natale, V. M., & Shephard, R. J. (2000) · Humana Press eBooks · doi:10.1007/978-1-59259-016-2_16 · Cited by 5
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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