Decreased secretory immunoglobulins following intense endurance exercise

Physical activity in lactating women influences SARS-CoV-2-specific antibodies in human milk

Background

Moderate exercise results in a significant increase in serum and salivary immunoglobulins. Maternal physical activity might therefore also be a factor influencing antibody levels in human milk. This study aims to determine the influence of physical activity on SARS-CoV-2-specific Immunoglobulin A (IgA) in human milk and Immunoglobulin G (IgG) in serum.

Methods

In this prospective cross-sectional cohort study, all lactating women in the Netherlands were eligible to participate. SARS-CoV-2-specific IgA in human milk and IgG in serum were determined using an enzyme-linked immunosorbent assay (ELISA). Data on performed physical activity was collected using the Short Questionnaire to Assess Health enhancing physical activity (SQUASH), which includes intensity and duration of the performed activity.

Findings

In total, 356 out of 2312 lactating women tested positive for SARS-CoV-2-specific antibodies in serum. Of them, 323 filled in the questionnaire and were included in the analysis. An association between the activity score and SARS-CoV-2-specific antibodies in human milk (B = 1·035, 95·0% CI = 1·019 to 1·052, p = 0·042) and serum (B = 1·019, 95·0% CI = 1·009 to 1·029, p = 0·048) was demonstrated. No association was found between the duration of physical activity and SARS-CoV-2-specific antibodies in human milk or serum.

Interpretation

Our findings suggest that physical activity is beneficial for the levels of SARS-CoV-2-specific antibodies in human milk and serum, with the intensity of the physical activity being the most important contributor to this relationship. A higher level of antibodies in human milk might provide better immunological protection for infants against COVID-19.

Measurement of Lipid Peroxidation Products and Creatine Kinase in Blood Plasma and Saliva of Athletes at Rest and following Exercise

This study aimed to assess the agreement between quantitative measurements of plasmatic and salivary biomarkers capable of identifying oxidative stress and muscle damage in athletes at rest and following exercise. Thirty-nine high-level athletes participating in track and field (running), swimming or rowing were recruited and assigned to one of three groups depending on the sport. Each athlete group underwent its specific exercise. Blood and saliva samples were collected before and immediately after the exercise. Diene conjugates (DC), triene conjugates (TC), Schiff bases (SB), and creatine kinase (CK) were measured. Comparisons were made using Wilcoxon signed-rank test. Correlation analysis and Bland−Altman method were applied. DC levels were elevated in plasma (p < 0.01) and saliva (p < 0.01) in response to exercise in all three groups, as were the plasmatic (p < 0.01) and salivary (p < 0.01) TC and SB concentrations. CK activity was also significantly higher at postexercise compared to pre-exercise in both plasma (p < 0.01) and saliva (p < 0.01) in all groups. Strong positive correlation between salivary and plasmatic DC (p < 0.001), TC (p < 0.001), SB (p < 0.01), and CK (p < 0.001) was observed at rest and following exercise in each athlete group. The bias calculated for DC, TC, SB, and CK using the Bland−Altman statistics was not significant at both pre-exercise and postexercise in all three groups. The line of equality was within the confidence interval of the mean difference. All of the data points lay within the respective agreement limits. Salivary concentrations of DC, TC, SB, and CK are able to reliably reflect their plasma levels.

The Impact of Acute and Chronic Exercise on Immunoglobulins and Cytokines in Elderly: Insights From a Critical Review of the Literature

The level of immunoglobulins and cytokines changes with an ageing immune system. This review summarizes findings from studies that have examined the impact of acute and chronic exercise on immunoglobulins and cytokines in the elderly. Our literature analysis revealed that acute endurance exercise resulted in increased secretory salivary immunoglobulin A (SIgA), while acute bouts of muscle strengthening exercise (i.e., isokinetic, eccentric, knee extensor exercise) increased plasma/muscle interleukin (IL)-6, IL-8 and tumor necrosis factor alpha (TNF-α) levels. Chronic exercise in the form of short-term endurance training (i.e., 12-16 weeks) and long-term combined endurance and resistance training (i.e., 6-12 months) induced increases in salivary SIgA concentration. We additionally identified that short-term endurance training at moderate intensities and the combination of endurance, strength, balance, and flexibility training increase plasma IL-10 and reduce plasma IL-6 and TNF-α in healthy elderly adults and male patients with chronic heart failure. Strength training for 6-12 weeks did not alter plasma IL-1β, IL-2, IL-6 and TNF-α concentration in healthy elderly adults and patients with chronic-degenerative diseases, while 12 weeks of resistance training decreased muscle TNF-α mRNA in frail elderly individuals. Short-term (i.e., 10-24 weeks) moderate- to high-intensity strength training reduced LPS–IL-6, LPS, IL-1β, LPS–TNF-α and circulating concentrations of TNF-α and increased IL-10 in healthy elderly women and older people with cognitive impairment, respectively. In conclusion, it appears that acute bouts of endurance exercise and short-term chronic exercise training exercise are appropriate methods to enhance mucosal immune function, reduce systemic markers of inflammation, and promote anti-inflammatory processes in elderly individuals.

Salivary IgA as a Potential Biomarker in the Evaluation of Respiratory Tract Infection Risk in Athletes

In recent years, there has been attention focused on the value of salivary IgA (sIgA) as a potential biomarker for the identification of athletes who may be at increased risk of developing respiratory tract infection (RTI). The utility of sIgA, in this context, is based on biological plausibility and several observational studies revealing an apparent association between sIgA and RTI susceptibility. The overall published evidence evaluating the value of sIgA in this context is however conflicting, and there is currently a lack of clear guidance as to whether this marker has a place in the health surveillance and care of athletes. In this review, we critically appraise the literature assessing the potential for sIgA to be used in this context, evaluating it against 4 key biomarker characteristics, including its (1) practicality, (2) reproducibility, (3) specificity/sensitivity, and (4) potential clinical impact and relevance. This process reveals that although there is an apparent association between respiratory illness and sIgA in many studies, with some promising results, overall there remains a paucity of evidence supporting its overall value in this context. Key deficiencies in the metrics employed to endorse a valid biomarker are apparent, including a lack of reproducibility and low specificity and sensitivity in the detection of RTI susceptibility. The review outlines these issues and makes future recommendations.

Effects of Probiotic (Bacillus subtilis DE111) Supplementation on Immune Function, Hormonal Status, and Physical Performance in Division I Baseball Players

We sought to determine the effects of probiotic supplementation (Bacillus subtilis DE111; 1 billion CFU∙d⁻¹) on markers of immune and hormonal status in collegiate male athletes following 12 weeks of offseason training. Twenty-five Division I male baseball athletes (20.1 ± 1.5 years, 85.5 ± 10.5 kg, 184.7 ± 6.3 cm) participated in this double blind, placebo-controlled, randomized study. Participants were randomly assigned to a probiotic (PRO; n = 13) or placebo (PL; n = 12) group. Pre- and post-training, all athletes provided resting blood and saliva samples. Circulating concentrations of testosterone, cortisol, TNF-α, IL-10, and zonulin were examined in the blood, while salivary immunoglobulin A (SIgA) and SIgM were assayed as indicators of mucosal immunity. Separate analyses of covariance (ANCOVA) were performed on all measures collected post intervention. No differences in measures of body composition or physical performance were seen between groups. TNF-α concentrations were significantly (p = 0.024) lower in PRO compared to PL, while there were no significant group differences in any other biochemical markers examined. A main effect for time was observed (p < 0.05) for increased testosterone (p = 0.045), IL-10 (p = 0.048), SIgA rate (p = 0.031), and SIgM rate (p = 0.002) following offseason training. These data indicate that probiotic supplementation had no effect on body composition, performance, hormonal status, or gut permeability, while it may attenuate circulating TNF-α in athletes.

Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan

Epidemiological evidence indicates that regular physical activity and/or frequent structured exercise reduces the incidence of many chronic diseases in older age, including communicable diseases such as viral and bacterial infections, as well as non-communicable diseases such as cancer and chronic inflammatory disorders. Despite the apparent health benefits achieved by leading an active lifestyle, which imply that regular physical activity and frequent exercise enhance immune competency and regulation, the effect of a single bout of exercise on immune function remains a controversial topic. Indeed, to this day, it is perceived by many that a vigorous bout of exercise can temporarily suppress immune function. In the first part of this review, we deconstruct the key pillars which lay the foundation to this theory-referred to as the "open window" hypothesis-and highlight that: (i) limited reliable evidence exists to support the claim that vigorous exercise heightens risk of opportunistic infections; (ii) purported changes to mucosal immunity, namely salivary IgA levels, after exercise do not signpost a period of immune suppression; and (iii) the dramatic reductions to lymphocyte numbers and function 1-2 h after exercise reflects a transient and time-dependent redistribution of immune cells to peripheral tissues, resulting in a heightened state of immune surveillance and immune regulation, as opposed to immune suppression. In the second part of this review, we provide evidence that frequent exercise enhances-rather than suppresses-immune competency, and highlight key findings from human vaccination studies which show heightened responses to bacterial and viral antigens following bouts of exercise. Finally, in the third part of this review, we highlight that regular physical activity and frequent exercise might limit or delay aging of the immune system, providing further evidence that exercise is beneficial for immunological health. In summary, the over-arching aim of this review is to rebalance opinion over the perceived relationships between exercise and immune function. We emphasize that it is a misconception to label any form of acute exercise as immunosuppressive, and, instead, exercise most likely improves immune competency across the lifespan.

Serum immunoglobulin concentrations in horses racing a multiday endurance event

Chronic exercise can alter immune function. The objective of this study was to determine the effect of training and racing on serum immunoglobulin fractions (sIg) in horses participating in a multiday endurance event. Blood was obtained from 54 horses the day before a multiday race event with distance categories of 40 km (n=10) or 80 km (n=44) per day; from all available horses after completing each day; and once from 15 sedentary control horses. sIgGa, IgGb, sIgG(T), sIgA, and sIgM concentrations were measured via equine-specific ELISA, and data were analysed via repeated measures ANOVA (P<0.05, mean ± standard error). Ten horses completed 40 km once, and 44, 18 and 9 horses completed one, two and three 80 km days, respectively. Distance category and number of days raced had no effect on any immunoglobulin subtype. For horses in the 80 km category, sIgA before racing (1.97±0.14 mg/dl) was similar to controls (1.48±0.19) and after one, two or three days of racing (1.98±0.13, 1.80±0.15 and 1.76±0.26, respectively). Similarly, sIgM before racing (1.02±0.05 mg/dl) was not different to controls (1.08±0.12) and after one, two or three days of racing (1.03±0.06, 0.91±0.08 and 0.89±0.11). Similar findings were observed for sIgG(T) and sIgGa. For horses in the 40 km category, immunoglobulin subtype concentrations did not differ from before to after one day of racing, or from control horses, with the exception that sIgGb before racing (7.00±0.57), similarly to horses racing 80 km days (7.65±0.41), was significantly higher than in sedentary horses (5.71±0.54 mg/dl). This study identified higher sIgGb concentrations in trained endurance horses compared to sedentary horses, perhaps reflecting immune stimulation from disease exposure or more frequent vaccination.

Stimulating whole saliva affects the response of antimicrobial proteins to exercise

This study investigated the salivary secretion rates of antimicrobial proteins in response to prolonged, exhaustive exercise in both stimulated (STIM) and unstimulated (UNSTIM) saliva flow sample methods. Twenty-four trained men cycled for 2.5 h at 60% V̇O₂max and then to exhaustion at 75% V̇O₂max. Timed collections of whole saliva were made before exercise, mid-exercise, at the end of the moderate exercise bout and post-exhaustive exercise. After each UNSTIM collection, a STIM sample was collected following chewing flavored gum for 1 min. Saliva was analysed for lysozyme, α-amylase and salivary immunoglobulin A (s-IgA), and secretion rates were calculated. Saliva flow was 156% higher in STIM compared with UNSTIM (P < 0.001) and decreased with exercise in STIM only (P < 0.001). Exercise increased lysozyme and α-amylase levels and secretion rates were 144% higher and 152% higher in STIM compared with UNSTIM for lysozyme and α-amylase, respectively (all P < 0.001). S-IgA concentration (P < 0.05) and secretion rate (P < 0.001) increased with exercise but were both lower in STIM compared with UNSTIM (P < 0.001). In conclusion, a STIM saliva flow collection during exercise by chewing flavored gum increased the quantity of saliva and the secretion of lysozyme and α-amylase, but had a limited impact on the secretion of s-IgA.

Upper respiratory tract infection symptoms in ultramarathon runners not related to immunoglobulin status

OBJECTIVE

To determine the association between variation in exercise load, immunoglobulin (Ig) status, and self-reported symptoms of upper respiratory tract infection (URTI) in ultramarathon runners.

DESIGN

Longitudinal observational field study.

SETTING

Four weeks before and 2 weeks after an 86.5-km Comrades Marathon, South Africa.

PARTICIPANTS

Fourteen randomly selected, amateur, male, ultramarathon runners.

MAIN OUTCOME MEASURES

Daily record of training and URTI symptom incidence. Salivary IgA and IgM at 28 days, 14 days, and 1 day (01PRE) before the race, immediately post race (IPR) and 1 (01 PR), 3, and 14 days post race. Serum cortisol, IgG, IgM, and IgA concentrations at 01PRE, IPR, and 01PR.

RESULTS

Mean weekly training distance varied from 89.4 kilometers per week (28.9 kilometers per week) to 4.2 kilometers per week (6.7 kilometers per week). Absolute and relative mucosal IgA and IgM concentrations were unaffected by pre-race taper in training volume (P > 0.05). IgA and IgM secretion rates decreased post race (P = 0.018; 0.008), returning to baseline by 01PR. Blood leukocyte, serum cortisol, and serum IgG concentrations increased at IPR (P < 0.001, <0001) and 01PR (P = 0.009), respectively. Upper respiratory tract infection symptom incidence was highest at 28PRE and 7 to 14 days post race but not related to salivary IgA and IgM secretion rates. Eight subjects (57%) who reported URTI symptoms pre race also reported these during days 7 to 14 post race.

CONCLUSIONS

Upper respiratory tract infection symptom incidence was not associated with secretory Ig concentrations. Reactivation of pre-race viruses during the 2 weeks post race and exercise-induced inflammatory response are proposed as causes of the elevated URTI incidence at 28PRE and 7 to 14 days post race.

Can nutrition limit exercise-induced immunodepression?

Prolonged exercise and heavy training are associated with depressed immune cell function. To maintain immune function, athletes should eat a well-balanced diet sufficient to meet their energy, carbohydrate, protein, and micronutrient requirements. Consuming carbohydrate during prolonged strenuous exercise attenuates rises in stress hormones and appears to limit the degree of exercise-induced immune depression. Recent evidence suggests that antioxidant vitamin supplementation may also reduce exercise stress and impairment of leukocyte functions. Further research is needed to evaluate the effects of other antioxidants and dietary immunostimulants such as probiotics and echinacea on exercise-induced immune impairment.

Variation of salivary immunoglobulins in exercising and sedentary populations

PURPOSE

This study examined the nature of the variability in salivary immunoglobulin and albumin concentrations within an individual, between individuals, and between populations with differing levels of habitual physical activity.

METHODS

Fourteen elite swimmers, and 21 active and 18 sedentary individuals provided 12 saliva samples over a 30-d period. Group classifications were based on interviews, anthropometric measurements, and physical activity records. Symptoms of illness and physical activity data were recorded daily. Salivary IgA, IgG, and IgM were measured by ELISA, and albumin concentrations were measured by nephelometry. Variability was assessed using ANOVA procedures.

RESULTS

Elite swimmers, compared with active and sedentary individuals, had higher concentrations of salivary IgA (geometric mean=65 vs 32 and 40 mg.L, P=0.002) and greater variability in salivary IgA concentrations as individuals (P=0.007) and as a group (P=0.03). Salivary IgG variability in swimmers was also twofold greater than the other two groups (P=0.008). Salivary IgM and albumin variability were not significantly different between groups, but individual variability differed for swimmers and active individuals. The intraclass correlations for salivary IgA and IgG (but not for IgM or albumin) were 50% lower for swimmers than the other two groups (ICC for IgA: 20% swimmers vs 54% active and 46% sedentary individuals; ICC for IgG: 36 vs 59 and 57%).

CONCLUSION

The variability and fluctuation of salivary immunoglobulin concentrations were consistently greater in the elite swimmers, but multiple samples from individual swimmers were less correlated compared with participants with lower physical activity levels. These findings have implications for monitoring mucosal immune status within individuals and when comparing salivary immunoglobulin concentrations between groups with differing levels of physical fitness and activity.

Salivary IgA response to prolonged exercise in a cold environment in trained cyclists

PURPOSE

The purpose of the present study was to determine the effect of a prolonged bout of exercise in freezing cold conditions on saliva immunoglobulin A (s-IgA) responses in endurance-trained males.

METHODS

Using a randomized cross-over design, 15 trained male cyclists cycled for 2 h on a stationary ergometer at 70% VO(2max) in an environmental chamber on one occasion at a temperature of -6.4 +/- 0.1 degrees C (cold) and on another occasion at a temperature of 19.8 +/- 0.2 degrees C (control). Trials began at 12:30 h to avoid the fall in s-IgA concentration that occurs during the morning hours. Unstimulated whole-saliva samples were collected over a 2-min period at preexercise, postexercise, and 2-h postexercise. The s-IgA concentration was determined using a sandwich-type ELISA method.

RESULTS

Saliva flow rate decreased postexercise by 31%, returning to preexercise levels by the 2-h postexercise collection (main effect of time: < 0.01). The decrease in saliva flow rate postexercise in the control trial (39% compared with 22% on cold trial) approached significance (interaction: = 0.08) and may have accounted for the corresponding increase in s-IgA concentration postexercise in the control trial (s-IgA concentration: control preexercise; 91 +/- 12; postexercise; 110 +/- 13 mg x L(-1); < 0.05). Saliva IgA secretion rate decreased postexercise by 19.5% returning to preexercise levels by 2-h postexercise measure (main effect of time: < 0.05).

CONCLUSIONS

These data show that performing a bout of prolonged exercise results in a reduction in s-IgA secretion rate. Additionally, these data demonstrate that performing prolonged exercise in freezing cold conditions does not influence saliva flow rate or s-IgA secretion rate responses to prolonged exercise.

Acute exercise effects on the immune system

PURPOSE

In recent years, health professionals have placed increased attention on the benefits of physical activity for maintaining health in the general population as well as regaining health in many disease states. Conversely, reports of apparent decreases in immune cell function after acute exercise are widespread in the literature. The purpose of this article is to evaluate critically the available data and currently employed methods, with the aim of establishing whether genuine or artefactual alterations of immune function are being reported. During and immediately after exercise, the total number of white blood cells in peripheral blood samples increases, such that the relative proportions of cell types within the leukocyte pool are altered. A number of important areas of discussion arise from these shifts in the number of circulating cells after exercise, not least of which is the artefactual effects they may have on currently employed assays of immune cell function. Recent advances in methodology are beginning to call into question the assumption that acute exercise has any genuine immunosuppressive effect.

CONCLUSION

At present, there is little evidence to suggest that the range of acute exercise intensities and durations recommended by ACSM has a major detrimental effect on the function of individual T- and B-lymphocytes, natural killer cells and neutrophils. Although individual cells may not be as adversely affected as previously supposed, it is unclear whether the numerical content of the circulating population is an important clinical consideration.

Chronic exercise training effects on immune function

PURPOSE

This paper reviews the recent literature on the chronic effects of exercise training on immune function in humans. There is a general perception by athletes and other physically active individuals that regular moderate activity enhances, whereas intense exercise suppresses, resistance to minor illnesses such as upper respiratory tract infection (URTI). This perception is supported by epidemiological data in endurance athletes and limited data from intervention studies using moderate exercise in previously untrained individuals. The apparently high incidence of URTI among endurance athletes has prompted interest the relationship between chronic exercise training and immune function. Whereas immune cell number is generally normal during intense exercise training, recent evidence suggests that prolonged periods of intense training may lead to slight impairment in immune parameters such as neutrophil function, serum and mucosal immunoglobulin levels, plasma glutamine concentration, and possibly natural killer cell cytotoxic activity. In contrast. moderate exercise training has either no effect on, or may stimulate, these immune parameters.

CONCLUSION

Whereas athletes are not clinically immune deficient, it is possible that the combined effects of small changes in several immune parameters may compromise resistance to minor illnesses such as URTI. Strategies to prevent URTI in athletes include avoiding overtraining, providing adequate rest and recovery during the training cycle and after competition, limiting exposure to sources of infection, ensuring adequate nutrition, and possibly vitamin C supplementation. It is uncertain at present whether moderate exercise training is helpful in preventing infectious illness among the wider population.

The effects of high-intensity intermittent exercise on saliva IgA, total protein and alpha-amylase

The aim of this study was to assess the effect of an acute bout of high-intensity intermittent exercise on saliva IgA concentration and alpha-amylase activity, since this type of training is commonly incorporated into the training programmes of endurance athletes and games players. Eight well-trained male games players took part in the study. They reported to the laboratory after an overnight fast and performed a 60-min cycle exercise task consisting of twenty 1-min periods at 100% VO2max, each separated by 2 min recovery at 30% VO2max. Unstimulated whole saliva was collected over a 5-min period into pre-weighed tubes and analysed for total protein, saliva IgA and alpha-amylase. The saliva flow rate ranged from 0.08 to 1.40 ml x min(-1) at rest and was not significantly affected by the exercise. The performance of the intermittent exercise bout did not affect the saliva IgA concentration, but caused a five-fold increase in alpha-amylase activity (P<0.01 compared with pre-exercise) and a three-fold increase in total protein concentration (P<0.01). These returned to pre-exercise values within 2.5 h post-exercise. It has been suggested that IgA concentration should be expressed as the ratio to total protein concentration, to correct for any concentrating effect due to evaporative loss of saliva water when breathing through the mouth (as in strenuous exercise). The present study clearly demonstrates that this is not appropriate, since there is an increase in salivary protein secretion rate immediately after exercise (571+/-77 microg x min(-1) compared with 218+/-71 microg x min(-1) pre-exercise; P<0.05). The increased saliva alpha-amylase activity after exercise may improve the protective effect of saliva, since this enzyme is known to inhibit bacterial attachment to oral surfaces. The saliva alpha-amylase secretion rate was lower immediately pre-exercise than at any other instant, which may have been due to anticipatory psychological stress, although the subjects were all familiar with interval exercise. This emphasizes the need for true resting non-stressed control conditions in future studies of the effects of exercise on saliva constituents.

Salivary IgA levels and infection risk in elite swimmers

The effects of exercise on the immune system has been shown to be dependent on the level of fitness of the subjects, the degree of intensity, and the duration of the exercise. A reduction in salivary IgA levels occurs after individual sessions of exercise.

PURPOSE

The purpose of this study was to assess the relationship between changes in salivary IgA and training volume, psychological stress, and infection rates in a cohort of 26 elite swimmers over a 7-month training period and to compare the changes with a group of 12 moderately exercising controls.

METHODS

Salivary IgA concentrations were measured by an electroimmunodiffusion. Exercise gradings were assessed by a standardized aerobic-anaerobic rating system. Psychological stress/anxiety was evaluated by the Spielberger State-Trait Anxiety Inventory. Infections were physician-verified.

RESULTS

Salivary IgA levels showed an inverse correlation with the number of infections in both elite swimmers and moderately exercising control subjects. The pretraining salivary IgA levels in swimmers were 4.1% lower for each additional month of training and 5.8% lower for each additional infection. The posttraining salivary IgA levels in swimmers were not significantly correlated with infection rates but were 8.5% lower for each additional 1 km swum in a training session and 7.0% lower for each additional month of training. The number of infections observed in the elite swimmers was predicted from regression models by the preseason (P = 0.05) and the mean pretraining salivary IgA levels (P = 0.006). The trends in pretraining salivary IgA levels over the 7-month season, calculated as individual slopes of pretraining IgA levels over time, were also predictive of the number of infections (P = 0.03) in the swimmers.

CONCLUSIONS

These results indicate that measurement of salivary IgA levels over a training season may be predictive for athletes at risk of infection.

Saliva composition and exercise

Little attention has been directed toward identifying the changes which occur in salivary composition in response to exercise. To address this, our article first refers to the main aspects of salivary gland physiology. A knowledge of the neural control of salivary secretion is especially important for the understanding of the effects of exertion on salivary secretion. Both salivary output and composition depend on the activity of the autonomic nervous system and any modification of this activity can be observed indirectly by alternations in the salivary excretion. The effects of physical activity (with reference to factors such as exercise intensity and duration, or type of exercise protocol) on salivary composition are then considered. Exercise might indeed induce changes in several salivary components such as immunoglobulins, hormones, lactate, proteins and electrolytes. Saliva composition might therefore be used as an alternative noninvasive indicator of the response of the different body tissues and systems to physical exertion. In this respect, the response of salivary amylase and salivary electrolytes to incremental levels of exercise is of particular interest. Beyond a certain intensity of exercise, and coinciding with the accumulation of blood lactate (anaerobic threshold or AT), a 'saliva threshold' (Tsa) does indeed exist. Tsa is the point during exercise at which the levels of salivary alpha-amylase and electrolytes (especially Na+) also begin to rise above baseline levels. The occurrence of the 2 thresholds (AT and Tsa) might, in turn, be attributable to the same underlying mechanism, that of increased adrenal sympathetic activity at high exercise intensities.

The effect of exercise training on aerobic fitness, immune indices, and quality of life in HIV+ patients

PURPOSE

Thirty four HIV+ patients participated in a 6-wk aerobic exercise training program to determine whether exercise improved aerobic fitness, immune indices, and quality of life.

METHODS

Subjects were assigned to three groups: control (no regular aerobic exercise), moderate exercise, and heavy exercise training. At study entry and exit (in each subject) we evaluated aerobic function with a symptom limited cardiopulmonary exercise test, immune indices with CD4 counts and Candida skin tests, viral replication with plasma HIV RNA measurements, and quality of life with a HIV+ population validated questionnaire.

RESULTS

Aerobic fitness increased significantly in both exercise groups relative to the control group; immune indices changed very little among all three groups; however, the Candida skin tests (mm2) increased significantly in the moderate group; viral replication was essentially unchanged in all three groups; quality of life (QOL) markers improved in both exercising groups but not the control group. There were no opportunistic infections during the study.

CONCLUSIONS

Exercise training resulted in a substantial improvement in aerobic function while immune indices were essentially unchanged. Quality of life markers improved significantly with exercise. Exercise training is safe and effective in this patient group and should be promoted for HIV+ patients.

Exercise and immunity: a review with emphasis on the horse

Exercise has been recognized as a stress, which can significantly alter the host's immune response and, therefore, its susceptibility to disease. Whereas research in this area has previously focused primarily on human subjects and laboratory animals, it has more recently extended to domestic animals, especially the equine athlete. Despite several studies, defining the relationship among exercise, the immune response, and disease has proven difficult due to a number of factors, including the complexity of the immune system and the variable nature of exercise itself. It now appears that exercise has dual effects on the immune system. Suppressive effects, such as a decline in the ratio of CD4+ to CD8+ cells, diminished lymphocyte function, and a decline in the number and cytolytic activity of natural killer cells have been observed in response to brief high-intensity exercise, prolonged exhaustive exercise, and overtraining. In contrast, moderate training generally has beneficial effects on host defense mechanisms. The mechanisms for regulating the dual effects of exercise are complex, involving a network of neuroendocrine hormones and cytokines.

Decreased salivary immunoglobulin A secretion rate after intense interval exercise in elite kayakers

Endurance athletes have been shown to suffer a high incidence of upper respiratory tract infection (URTI; e.g. colds, sore throat) during intense training and after competition. Previous studies have shown that concentrations of secretory immunoglobulin A (IgA), the major effector of host defense against micro-organisms causing URTI, decrease after intense endurance exercise. Many athletes perform intense interval exercise as part of their normal training. The purpose of this study was to determine whether salivary IgA concentrations also decrease after intense interval exercise during the normal training regime in elite athletes. Timed saliva samples were obtained from eight elite male kayakers immediately before and after three on-water training sessions during a 3-week period. The concentrations of IgA, IgG and IgM were determined separately by enzyme-linked immunosorbent assay, and secretion rates calculated for each Ig. The IgA secretion rate (micrograms.min-1) decreased 27%-38% after all three training sessions (P = 0.007); the largest decrease (38%) was noted after the most intense session at the end of an especially intense week of training. The IgA concentration relative to total protein (micrograms.mg protein-1) was significantly lower (P < 0.05) on this training day compared with the other 2 days. Concentrations and secretion rates of IgG and IgM did not change after exercise, indicating a specific effect on IgA. These data would suggest that, in elite athletes, IgA concentration and secretion rate are reduced by intense interval exercise, and that exercise-induced changes in IgA output may be one mechanism contributing to URTI in elite athletes.

Infection, Immunity, and Exercise

In brief How-and if-exercise alters immunity is open to debate. Research centers on changes in the number and function of granulocytes and lymphocytes and in levels of immunoglobulins. In general, these immune changes are mixed, mild, and brief. Clinical studies are inconclusive and fraught with confounders, especially the impact of psychological stress. Whether exercise enhances immunity or impairs it may, in fact, depend on whether the exercise is a joy or a stress.