Special feature for the Olympics: effects of exercise on the immune system: exercise effects on mucosal immunity

Effect of hospitalization on equine local intestinal immunoglobulin A (IgA) concentration measured in feces

During hospitalization horses may develop gastrointestinal conditions triggered by a stress-associated weak local immune system. The prospective, clinical trial was conducted to find out whether fecal immunoglobulin A (IgA) concentrations could be determined in hospitalized horses and how they changed during hospitalization and in response to various stressors. Samples were obtained from 110 horses and a control group (n = 14). At arrival in the hospital, horses were categorized into pain grades (1-5), and elective versus strenuous surgery (> 2 hours, traumatic and emergency procedures). Feces were collected on day 1, day 2, day 3, and day 7 in all horses. Blood samples were obtained at the same intervals, but additionally after general anaesthesia in horses undergoing surgery (day 2). IgA concentration in feces was determined by ELISA and measured in optical density at 450nm. The control group showed constant IgA concentrations on all days (mean value 0.30 OD450 ±SD 0.11, 1.26 mg/g; n = 11). After general anaesthesia fecal IgA concentrations decreased considerably independent of duration and type of surgery (P < 0.001 for elective and P = 0.043 for traumatic surgeries). High plasma cortisol concentrations were weakly correlated with low fecal IgA on the day after surgery (P = 0.012, day 3, correlation coefficient r = 0.113). Equine fecal IgA concentrations showed a decline associated with transport, surgery, and hospitalization in general, indicating that stress has an impact on the local intestinal immune function and may predispose horses for developing gastrointestinal diseases such as enterocolitis.

Impact of exercise on markers of B cell-related immunity: A systematic review

BACKGROUND

B cells represent a crucial component of adaptive immunity that ensures long-term protection from infection by generating pathogen-specific immunoglobulins. Exercise alters B cell counts and immunoglobulin levels, but evidence-based conclusions on potential benefits for adaptive immunity are lacking. This systematic review assessed current literatures on the impact of acute exercise and exercise training on B cells, immunoglobulins, and markers of secretory immunity in human biofluids.

METHODS

According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, MEDLINE, Web of Science, and Embase were searched on March 8, 2023. Non-randomized controlled trials and crossover trials investigating the impact of acute exercise or exercise training on B cell counts and proportions, immunoglobulin levels, salivary flow rate, or secretory immunoglobulin A secretion rate were included. Quality and reporting of exercise training studies were assessed using the Tool for the Assessment of Study Quality and reporting in Exercise. Study characteristics, outcome measures, and statistically significant changes were summarized tabularly.

RESULTS

Of the 67 eligible studies, 22 applied acute exercise and 45 applied exercise training. All included outcomes revealed significant alterations over time in acute exercise and exercise training context, but only a few investigations showed significant differences compared to control conditions. Secretory and plasma immunoglobulin A levels were most consistently increased in response to exercise training.

CONCLUSION

B cell-related outcomes are altered by acute exercise and exercise training, but evidence-based conclusions cannot be drawn with high confidence due to the large heterogeneity in populations and exercise modalities. Well-designed trials with large sample sizes are needed to clarify how exercise shapes B cell-related immunity.

Immunosurveillance associated with upper respiratory symptoms in elite swimmers: The 8-month period leading into Commonwealth Games

OBJECTIVES

To monitor individual mucosal immunity and identify potential risk factors of upper respiratory symptoms in elite swimmers over a competitive season.

DESIGN

Eight-month longitudinal study, observing mucosal immunity, Epstein-Barr virus status, training loads and illness symptoms of elite international swimmers, leading into the Commonwealth Games 2018.

METHODS

Participants were fourteen elite swimmers (age ± standard deviation = 19.9 ± 0.8 years, height = 178.9 ± 6.3 cm, and mass = 75.0 ± 7.7 kg). Self-reported upper respiratory symptoms, training load and saliva samples were collected weekly. Venous blood samples were taken at study commencement to determine Epstein-Barr virus status.

RESULTS

Throughout the study, 70 episodes of upper respiratory symptoms were recorded resulting in 34 days of missed training. Incidence (p = 0.001), severity (p = 0.022), and duration of upper respiratory symptoms (p = 0.001) were significantly higher during high training loads, compared to low. Eight swimmers (61 %) had evidence of past infection with Epstein-Barr virus, but this had no relationship with incidence, severity, or duration of upper respiratory symptoms (p > 0.05). Relative individual salivary immunoglobulin A concentration was 12 % lower when upper respiratory symptoms were present but was not statistically significant (p = 0.101).

CONCLUSIONS

This study highlights the importance of individual athlete monitoring, to identify swimmers at increased illness risk. Identification of possible risk factors for upper respiratory symptoms, such as increased training load, may allow for modifications in training or other illness preventative strategies for elite swimmers.

Salivary Markers Responses in the Post-Exercise and Recovery Period: A Systematic Review

The use of saliva to monitor immune and hormonal responses in training, competitions, and during recovery is an easy and non-invasive alternative means of collecting samples compared to serum collection. Saliva can provide insight into a number of interesting biomarkers such as cortisol, testosterone, immunoglobulins, alpha-amylase, and melatonin, among others. High-intensity and exhaustive exercises, such as training or competition, provide variations in immune, protein and hormonal markers. An adequate recovery period, calming down, and recovery methods can contribute to a fast normalization of these markers, decreasing illness, as well as the likelihood of overtraining and injuries, but their effectiveness is still inconclusive. The aim of this review was to investigate the evidence of salivary markers in post-exhaustive exercise during the recovery period. This study is a systematic review from three electronic databases with studies from 2011 to 2021 within healthy humans. The search found 213 studies, and after applying the inclusion and exclusion criteria, while excluding duplicated studies, 14 studies were included in this review. The most cited salivary markers were cortisol and testosterone, as well as their ratio, alpha-amylase and IgA. Half of the studies applied a variety of recovery methods that showed controversial results over salivary markers' impact. However, they showed an impact on the markers from the exercise, which was still dependent on exercise intensity, methodology, and duration.

Effect of Saengmaeksan on Fatigue, Liver Function, and Immunity Combined with High-Intensity Training

Saengmaeksan (SMS) is a traditional drink that consists of three natural herbs, Lirio platyphlla, Panax ginseng, and Schisandra chinensis, and improves fatigue, liver function, and immunity. Moderate-intensity exercise has a positive effect on fatigue, liver function, and immune function, whereas long-term high-intensity training has a negative effect on these aspects. We hypothesized that SMS intake will improve fatigue (ammonia, lactic acid), liver function (aspartate transaminidase (AST) and alanine aminotransferase (ALT)), and immunity (IgA, IgG, IgM) with high-intensity training. To investigate this hypothesis, 17 male college tennis players were randomly assigned to SMS and placebo groups with high-intensity training. SMS and placebo were consumed in 110 mL doses for a total of 770 mL. High-intensity training was performed at 70%-90% of heart rate reserve, conducted five times weekly for 4 weeks. A significant interaction effect was observed between the SMS and control (CON) groups regarding ammonia, ALT, and IgA levels. Ammonia levels significantly decreased in the SMS group, but there was no difference in the lactic acid levels. AST significantly decreased in the SMS group. IgA significantly increased in the SMS group, IgM significantly decreased in both groups, but there was no change in IgG. The correlation analysis revealed positive correlation in ΔAST vs. ΔALT, ΔALT vs. ΔIgG, and ΔIgA vs. ΔIgG in the SMS group. These findings demonstrate that SMS intake can reduce ammonia, AST, ALT, and IgM levels, while causing an increase in IgA, which has a positive effect on fatigue reduction, liver function, and immunoglobulins in a high-intensity training or related environment.

Effects of Ingesting Food Containing Heat-Killed Lactococcus lactis Strain Plasma on Fatigue and Immune-Related Indices after High Training Load: A Randomized, Double-Blind, Placebo-Controlled, and Parallel-Group Study

Lactococcus lactis strain Plasma (LC-Plasma) is a unique lactic acid bacterium that activates plasmacytoid dendritic cells (pDCs). We evaluated the effect of LC-Plasma on fatigue indices and dendritic cells activity in athletes after 14 days’ continuous exercise load. Thirty-seven participants were divided into two groups and consumed placebo (PL) or LC-Plasma capsules (containing 100 billion cells) daily for 14 days. Maturation markers on dendritic cells, blood parameters, physiological indices, and fatigue-related indices were recorded on days 1 and 15 (before and after exercise). Cumulative days of symptoms relating to physical conditions were also recorded during the continuous exercise period. We observed that CD86 as a maturation marker on pDCs was significantly higher and that cumulative days of fatigue were significantly fewer in the LC-Plasma group than in the Placebo group on day 15. We also conducted 2 h ergometer exercise on day 15 to evaluate fatigue. The results showed that autonomic fatigue parameters (LF/HF) were significantly lower in the LC-Plasma group. These results suggest that LC-Plasma supplementation alleviates fatigue accumulation and increases pDC activity caused by a continuous high training load.

Effects of probiotic supplementation on performance of resistance and aerobic exercises: a systematic review

CONTEXT

Strenuous exercise may lead to negative acute physiological effects that can impair athletic performance. Some recent studies suggest that probiotic supplementation can curtail these effects by reducing the permeability of the intestinal barrier, yet results are inconsistent.

OBJECTIVE

The aim of this systematic review is to assess the effects of probiotic supplementation on athletic performance.

DATA SOURCES

The PubMed/MEDLINE, Cochrane, and Scopus databases were searched for articles that assessed the effects of probiotic supplementation on athletic performance.

DATA EXTRACTION THIS SYSTEMATIC REVIEW IS REPORTED ACCORDING TO

PRISMA guidelines. Risk of bias was assessed through the Cochrane RoB 2.0 tool. Seventeen randomized clinical trials assessing athletic performance as the primary outcome were included. In total, 496 individuals (73% male) comprising athletes, recreationally trained individuals, and untrained healthy individuals aged 18 to 40 years were investigated.

DATA ANALYSIS

Three studies showed an increase or an attenuation of aerobic performance (decline in time to exhaustion on the treadmill) after supplementation with probiotics, while 3 found an increase in strength. However, most studies (n = 11) showed no effect of probiotic consumption on aerobic performance (n = 9) or muscular strength (n = 2). The most frequently used strain was Lactobacillus acidophilus, used in 2 studies that observed positive results on performance. Studies that used Lactobacillus plantarum TK10 and Lactobacillus plantarum PS128 also demonstrated positive effects on aerobic performance and strength, but they had high risk of bias, which implies low confidence about the actual effect of treatment.

CONCLUSION

There is not enough evidence to support the hypothesis that probiotics can improve performance in resistance and aerobic exercises. Further well-controlled studies are warranted.

Effects of caffeinated beverage ingestion on salivary antimicrobial proteins responses to acute exercise in the heat

Caffeine is commonly used by athletes as an energy supplement, but studies on its effects on salivary antimicrobial proteins (sAMPs) in humans during exercise are rare with ambiguous findings. It is also still controversial whether hot environments affect sAMPs. Using a double-blind, randomized crossover design, we examined 12 endurance-trained male collegiate athletes who completed the following two experiments: a caffeine experiment (CAF) and a placebo experiment (PLA). The participants acutely consumed caffeine-containing (6 mg/kg body weight) sports drink (3 ml/kg body weight) or an equivalent amount of placebo sports drink and subsequently performed cycling exercise for 40 min in the heat (33 ± 0.24°C, 64 ± 2.50% relative humidity) at 50% of maximum output power, maintaining a pedal frequency of 60 rpm. Saliva was collected at 60 min pre-exercise (T–60), the start of exercise (T0), 20 min of exercise (T20), and the end of the exercise (T40), and salivary α-amylase (sAA) and lactoferrin (sLac) were tested. The rating of perceived exertion (RPE) was measured at T0–T40, while core body temperature (Tre) and heart rate (HR) were monitored continuously. Tre, HR, and RPE increased with time during the exercise (p &lt; 0.01), with no difference in Tre and HR between the CAF and PLA (p &gt; 0.05), but RPE was higher in the PLA than in the CAF (p &lt; 0.05). sLac concentrations were significantly higher at T20 and T40 than at T–60 (p &lt; 0.01) and higher at T40 than at T0 and T20 (p &lt; 0.01), with no difference between the CAF and PLA (p &gt; 0.05). Compared with T–60, sAA activity was significantly increased at T0, T20, and T40 (p &lt; 0.01). sAA activity was significantly higher at T40 than at T0 and T20 (p &lt; 0.01), at T20 than at T0 (p &lt; 0.05), and in the CAF than in the PLA (p &lt; 0.01). Heat stress caused by acute exercise in hot environments did not impair the sAMPs parameters of the participants. Instead, the participants showed transient increase in sAA activity and unchanged sLac concentrations. Caffeine may increase salivary markers related to immune response during exercise.

A Case Series of SARS-CoV-2 Reinfection in Elite Athletes

OBJECTIVES

The actual frequency and the risk factors of SARS-CoV-2 reinfection is still a matter of intense scientific discussion. In this case series, we report three elite athletes who underwent COVID-19 reinfection with a short time frame.

CASE PRESENTATIONS

As a part of contact tracing, three speed skaters (22-, 24-, and 29-year-old males) were found to be SARS-CoV-2 positive by polymerase chain reaction (PCR) tests. Later on, only one of the athletes experienced mild symptoms, such as fatigue, loss of smell and taste and subfebrility, while the other two athletes were asymptomatic. Following the quarantine period, detailed return-to-play examinations, including laboratory testing, ECG, 24-h Holter monitoring, transthoracic echocardiography and cardiac magnetic resonance imaging, revealed no apparent abnormality; therefore, the athletes restarted training. After a median of 74 days, all three athletes presented with typical symptoms of COVID-19, such as fever, marked fatigue and headache. SARS-CoV-2 PCR tests were performed again, showing recurrent positivity. Repeated return-to-play assessments were initiated, finding no relevant abnormality. Athletes were also tested for SARS-CoV-2 anti-nucleoprotein antibody titers, showing only modest increases following the second infection.

CONCLUSIONS

We report a small cluster of elite athletes who underwent a PCR-proven SARS-CoV-2 reinfection. According to these findings, athletes may be considered as a high-risk group in terms of recurrent COVID-19.

Physical Exercise in the Context of Air Pollution: An Emerging Research Topic

Physical exercise (PE) brings physiological benefits to human health; paradoxically, exposure to air pollution (AP) is harmful. Hence, the combined effects of AP and PE are interesting issues worth exploring. The objective of this study is to review literature involved in AP-PE fields to perform a knowledge-map analysis and explore the collaborations, current hotspots, physiological applications, and future perspectives. Herein, cluster, co-citation, and co-occurrence analysis were applied using CiteSpace and VOSviewer software. The results demonstrated that AP-PE domains have been springing up and in rapid growth since the 21st century. Subsequently, active countries and institutions were identified, and the productive institutions were mainly located in USA, China, UK, Spain, and Canada. Developed countries seemed to be the major promoters. Additionally, subject analysis found that environmental science, public health, and sports medicine were the core subjects, and multidimensional communications were forming. Thereafter, a holistic presentation of reference co-citation clusters was conducted to discover the research topics and trace the development focuses. Youth, elite athletes, and rural population were regarded as the noteworthy subjects. Commuter exposure and moderate aerobic exercise represented the common research context and exercise strategy, respectively. Simultaneously, the research hotspots and application fields were elaborated by keyword co-occurrence distribution. It was noted that physiological adaptations including respiratory, cardiovascular, metabolic, and mental health were the major themes; oxidative stress and inflammatory response were the mostly referred mechanisms. Finally, several challenges were proposed, which are beneficial to promote the development of the research field. Molecular mechanisms and specific pathways are still unknown and the equilibrium points and dose-effect relationships remain to be further explored. We are highly confident that this study provides a unique perspective to systematically and comprehensively review the pieces of AP-PE research and its related physiological mechanisms for future investigations.

Health Benefits of Probiotics in Sport and Exercise - Non-existent or a Matter of Heterogeneity? A Systematic Review

Background

The use of probiotics in sports has been growing in recent years, as up to 50% of athletes suffer from training- and performance-limiting gastrointestinal (GI) problems. Moreover, repeated exhaustive exercise and high training loads may lead to a transiently depressed immune function, associated with an increased risk of upper respiratory tract infection (URTI).

Aim

To provide a qualitative analysis of probiotic effects on URTI, GI symptoms and the immune system in healthy individuals under consideration of performance level as main classifier.

Methods

A systematic review of the literature was conducted (PubMed, SPORTDiscus with Full Text, Web of Science) to analyze the effects of probiotics in athletes and healthy active individuals on GI problems, URTI, and the immune system. A qualitative synthesis with performance level and treatment duration as main classifiers was performed.

Results

Of 41 eligible studies, 24 evaluated the effects of probiotic supplements in athletes, 10 in recreationally active individuals and 7 in healthy untrained adults. Large heterogeneity was observed in terms of probiotic strains, mode of delivery, performance level, treatment duration and outcome assessment. Overall, studies provided inconsistent observations.

Conclusion

The effects of probiotics on immune system, URTI, and GI symptoms in athletes, healthy adults and recreationally active individuals remain inconclusive. Based on the analyzed studies and identified parameters, this article provides suggestions to align future research on the effects of probiotics in exercise.

Systematic Review Registration

PROSPERO, identifier: CRD42021245840.

Effect of SunGold Kiwifruit and Vitamin C Consumption on Ameliorating Exercise-Induced Stress Response in Women

INTRODUCTION

Markers of oxidative and psychological stress are elevated during high-intensity exercise. Additionally, when energy intake does not match expenditure, women who actively participate in sports and exercise are at risk of developing menstrual dysfunction, infertility, and osteoporosis. Vitamin C is known to reduce exercise-induced stress. Here, this study investigates the efficacy of consuming vitamin C from SunGold kiwifruit compared to in isolation, in ameliorating exercise-induced stress in recreationally active women.

METHODS AND RESULTS

Ten eumenorrheic women are recruited in this crossover study and attended three exercise and one rest trial. In the exercise trials, participants consumed 300 mg vitamin C from kiwifruit or drink, or have a placebo drink, followed by 30-min exercise on a cycle ergometer at 60% power. During rest visit, participants sat quietly and consumed a placebo drink. Salivary uric acid (oxidative stress) and cortisol (psychological stress) are measured before and immediately after exercise for 2 h. Both vitamin C and kiwifruit reduced exercise-induced uric acid, immediately after exercise. Vitamin C drink continued to decrease uric acid for a further 30 min and slightly attenuated exercise-induced cortisol.

CONCLUSIONS

Consuming liquid vitamin C prior to high-intensity cycling appears more effective than eating kiwifruit, in ameliorating exercise-induced stress in recreationally active women of reproductive age.

Lozenges with probiotic strains enhance oral immune response and health

OBJECTIVE

Probiotics participate in regulating oral microbiota and reducing the prevalence of oral diseases; however, clinical research on probiotics is insufficient. Therefore, in this study, we performed in vitro screening of potential oral protective probiotic strains and then evaluated the clinical efficacy of the selected strains on maintaining oral health.

MATERIALS AND METHODS

Fifty healthy individuals were recruited and randomly assigned into the placebo group and probiotics group, which included three strains of probiotics, Lactobacillus salivarius subs. salicinius AP-32, Lactobacillus paracasei ET-66, and Lactobacillus plantarum LPL28. Each group was blindly administered placebo or probiotics for four weeks.

RESULTS

Next-generation sequencing results showed that the oral microbiota of Lactobacillus salivarius in the oral cavity were significantly increased in subjects supplemented with mixed probiotic lozenges. The anti-bacterial activities of viable probiotics were observed within two weeks. Both IgA levels and Lactobacillus and Bifidobacterium abundances in the oral cavity were significantly increased in the experimental groups, along with a reduced formation of plaque. Most participants reported that their oral health conditions and intestinal symptoms had improved.

CONCLUSIONS

Overall, our clinical study suggests that oral probiotic lozenges may enhance oral immunity, modulate oral microbiota, and improve oral health.

The effect of probiotics, parabiotics, synbiotics, fermented foods and other microbial forms on immunoglobulin production: a systematic review and meta-analysis of clinical trials

The aim of this systematic review and meta-analysis was to evaluate the effect of probiotics, parabiotics, synbiotics, fermented foods and other microbial forms on immunoglobulin production. We searched PubMed, Scopus, Web of Science, National Institute of Health Clinical Trials Register, and Cochrane Central Register of Clinical Trials, up to February 2020. All clinical trials that investigated the effects of oral intake of probiotics, parabiotics, synbiotics, fermented foods and other microbial forms on immunoglobulin (Ig)A, IgE, Japanese cedar pollen (JCP)-specific IgE, IgG, and IgM, for a duration of >7 days were included. Fifty-nine studies met the inclusion criteria, of these 54 studies were included in the analysis. The results indicated a significant increase in salivary IgA secretion rate (SMD = 0.21, 95% CI 0.02-0.39), while no significant effect was observed on other Igs. In conclusion, mentioned supplementation induced a small but significant effect on salivary secretion rate of IgA.

Kinetics of immune reconstitution after anti-CD19 chimeric antigen receptor T cell therapy in relapsed or refractory acute lymphoblastic leukemia patients

INTRODUCTION

Anti-CD19 chimeric antigen receptor (CAR) -T cells, which recognize and kill both B lymphoblasts and normal B cells, result in B cell aplasia and humoral immunodeficiency. However, there were only a few detailed reports on the profile of immune reconstitution after anti-CD19 CAR-T cell therapy.

METHODS

Thirty nine patients with relapsed or refractory (R/R) B cell acute lymphoblastic leukemia (ALL) receiving anti-CD19 CAR-T cell therapy were enrolled. Subjects died, relapsed, received other treatment, or lost to follow-up within 60 days post-infusion were excluded. 21 patients were finally selected. Laboratory and clinical data were collected for analysis of immune reconstitution.

RESULTS

CD8+ cells were the first to recover with a median time on day 21(7-87), followed by CD16/CD56+ cells on day 28(14-87), and finally CD4+ cells with only 5(23.81%) patients recovered within 60 days post-infusion. CD4/CD8 ratio was inverted, sustaining for at least 1 year. B cell aplasia occurred in all patients and CD19+ cells returned to normal on a median time of day 79(41-118). All patients developed hypogammaglobulinemia with a median onset time of 2 weeks post-infusion. IgG recovered in 6 patients with a median time on day 184(89-346). IgM recovered on days 212, 242, and 346 in 3 patients. IgA recovered most slowly and remained low >1 year postinfusion. A total of 9 infections occurred in 6(28.57%) patients.

CONCLUSIONS

Our data showed prolonged reconstitution of immune function, especially humoral immunity, in R/R B cell ALL patients receiving anti-CD19 CAR-T cell therapy.

Upper respiratory symptoms (URS) and salivary responses across a season in youth soccer players: A useful and non-invasive approach associated to URS susceptibility and occurrence in young athletes

This study examined the effect of a competitive season on salivary responses [cortisol (sC), testosterone (sT), Testosterone/Cortisol ratio (sT/C), Immunoglobulin A (sIgA), sIgA secretion rate (srIgA), alpha-amylase (sAA)] and upper respiratory symptoms (URS) occurrence in three teams of male soccer players (Under-15, Under-17 and Under-19 yrs.). Training and competition volumes, salivary biomarkers and URS were determined monthly. No differences were found for monthly training volume between teams. Incidence of URS was higher for the U15 (44.9% of the total cases). Higher sT and srIgA were observed for the U19, lower sC were found for the U17 and sAA showed higher values for the U15 throughout the season. In the U15, significant difference (p = .023) was found for sIgA concentration with higher concentration values in January compared to December (-42.7%; p = .008) and the sT showed seasonal variation (p < .001) with the highest value in January significantly different from October (-40.2%; p = .035), November (-38.5%; p = 0.022) and December (-51.6%; p = .008). The U19 presented an increase in sC in March compared to February (-66.1%, p = .018), sT/C were higher in February compared to March (-58.1%; p = .022) and sAA increased in March compared to September (-20.5%; p = .037). Negative correlations, controlled for age group, were found between URS occurrence and srIgA (r = -0.170, p = .001), sAA (r = -0.179, p = .001) and sT (r = -0.107, p = .047). Monitoring salivary biomarkers provides information on mucosal immunity with impact in URS occurrence. Coaches could manipulate training loads to attenuate the physical stressors imposed on athletes, especially at demanding and stressful periods.

HNP-1 and HBD-1 as Biomarkers for the Immune Systems of Elite Basketball Athletes

Acute or strenuous exercise is sometimes related to upper respiratory tract infections in athletes. Practicing intense and regular exercise can lead to incorrect activation of the immune system, causing athletes to be excluded from training programs and competitions. Defensins are small antimicrobial peptides that are part of the innate immune system and dynamically involved in several biological activities. In this study, we highlight the role of human defensins in competitive basketball athletes. In particular, we consider the behavior of alpha- and beta-defensins together with white blood cells in a cohort of players. Moreover, we focus our attention on cortisol, a physiological indicator of stress, and testosterone, both of which are human hormones involved in muscle metabolism. The free-testosterone/cortisol ratio is considered to be an indicator of overtraining among athletes. This paper provides an up-to-date information of the role of human defensins as self-defense molecules during a continuous stressor such as long-term exercise, and it recognizes them as potential markers of infection.

Immunological Outcomes of Bovine Colostrum Supplementation in Trained and Physically Active People: A Systematic Review and Meta-Analysis

Bovine colostrum (BC) is a promising natural product applied to improve immunological functions. However, there is very little evidence on the true benefits of BC treatment on the immune function of trained and physically active people; moreover, there is no consensus on the supplementation strategy. For this reason, the aim of this meta-analysis was to quantify the effects of BC supplementation on immunological outcomes in physically active people. Data from 10 randomised controlled trials (RCTs) investigating the effect of BC supplementation in athletes and physically active adults were analysed, involving 239 participants. The results show that BC supplementation has no or a fairly low impact on improving the concentration of serum immunoglobulins (IgA, IgG), lymphocytes and neutrophils, and saliva immunoglobulin (IgA) in athletes and physically active participants. Previous research has shown BC to reduce upper respiratory tract infections; nevertheless, there is a gap of scientific knowledge on the mechanisms underlying these effects. Future RCTs are needed to focus on finding these mechanisms, as well as on preparing a clear consensus on a BC supplementation strategy in trained athletes and the physically active population.

Effects of Carbohydrate Mouth Rinsing on Salivary Lysozyme, Mood States and Running Performance Among Recreational Runners

Introduction

Carbohydrate (CHO) mouth rinsing can enhance sports performance through a central action mediated by receptors in the mouth. This study examined the effect of a CHO mouth rinse on salivary lysozyme concentrations, mood states and running performances.

Methods

Ten males recreational runners were randomised to three running trials with a 1 week recovery period between the trials. Each trial involved running at 75% maximum heart rate (HRmax) for 1 h, followed by a 15 min time trial. The participants used a CHO mouth rinse, placebo (PLA) solution or control (CON, no solution) every 15 min during the exercise. Heart rate (HR), rating of perceived exertion (RPE) and mood states were recorded pre-, during and post-exercise. Saliva samples were collected pre-, post- and 1 h post-exercise.

Results

There was no significant interaction and time effect (P > 0.05) on the salivary lysozyme concentration and running performance, but it was significant (P < 0.05) for HR and RPE (increase in all trials). However, there was no significant difference (P > 0.05) in salivary lysozyme concentrations, running performances, HR values or RPE between the trials. Mood states were not significantly different (P > 0.05) between the trials, but one of the mood sub-scales showed a significant (P < 0.001) time effect (increase fatigue in all trials).

Conclusion

CHO mouth rinsing did not affect physiological parameters, salivary lysozyme concentrations, mood states or running performance among recreational runners.

Daily Consumption of an Anthocyanin-Rich Extract Made From New Zealand Blackcurrants for 5 Weeks Supports Exercise Recovery Through the Management of Oxidative Stress and Inflammation: A Randomized Placebo Controlled Pilot Study

Background: Regular exercise is essential to a healthy lifestyle but evokes an oxidative and inflammatory stress. Depending upon its intensity and duration this can result in either beneficial adaptive changes or underlying tissue damage that impacts upon long-term health and individual sporting training schedules. Functional foods containing plant bioactives have potential to support exercise through management of the detrimental aspects of exercise and complement ergonomic adaptive benefits. Aim: Previously we reported that a single consumption of a 3.2 mg/kg New Zealand blackcurrant anthocyanin-rich extract (BAE) 1 h before a 30 min rowing exercise attenuated moderate exercise-mediated oxidative stress and supported innate immunity. Here we evaluate whether the efficacy of a single consumption of BAE 1 h prior to exercise is changed after extended daily BAE consumption for 5 weeks. Results: On week 1, a single consumption of BAE 1 h before a 30 min row mediated a significant (p < 0.05) 46% reduction in post-exercise-induced malondialdehyde (MDA) by 2 h compared to a 30% reduction in the placebo group. Similar efficacy was observed 5 weeks later after daily consumption of BAE. In addition, daily BAE consumption for 5 weeks improved the efficacy to (a) resolve acute inflammation, and (b) increased plasma IL-10, salivary beta-defensin 2 (BD2) and secretory IgA. Although no change in plasma antioxidant capacity was detected, a significant (p < 0.009) positive correlation between plasma IL-10 and plasma antioxidant capacity (R 2 = 0.35) was observed on week 6 after 5 week BAE consumption suggesting IL-10 influences antioxidant properties. Using a differentiated myotubule cell-line revealed that whilst IL-10 had no direct antioxidant neutralizing action, longer-term exposure (24 h) attenuated 2,2'-Azobis(2-amidinopropane) dihydrochloride (AAPH)-induced myotubule oxidative stress, supporting a putative role for IL-10 in the modulation of cellular antioxidant systems. Conclusions: Daily consumption of BAE for 5 weeks serves to enhance the exercise recovery effectiveness of a single consumption of BAE and promotes beneficial/protective antioxidant/anti-inflammatory cellular events that facilitate exercise recovery.

Effects of Repetitive Altitude Training on Salivary Immunoglobulin A Secretion in Collegiate Swimmers

Background

Altitude training has often been conducted just before main competition games in many sports. An increase in the frequency of upper respiratory tract infections and gastrointestinal infections due to an altitude-induced suppression of the immune system has been reported after altitude training. Salivary secretory immunoglobulin A (SIgA) is the major immunoglobulin of the mucosal immune system. A suppressive effect of heavy training on SIgA has been reported. However, little is known regarding the effects of repetitive altitude training and hypoxic exposure on SIgA. The objective of this study was to evaluate the changes in SIgA in swimmers undergoing repetitive altitude training at 1,900 m.

Methods

Nine collegiate swimmers who experienced their first altitude training experience (FT group) were compared to nine swimmers who experienced repetitive training (RT group) and non-training subjects (Con group). Saliva was collected before ascent and eight times every 2 days during altitude training. SIgA levels were measured by enzyme-linked immunosorbent assays.

Results

Compared to the Con group, SIgA levels and the secretion velocity were decreased after ascent and were slowly restored in both the FT and RT groups. The chronological trends in SIgA levels were similar, even though the decline in SIgA levels in the FT group was larger than that in the RT group.

Conclusion

Altitude training and experience with altitude training may be one of the factors influencing SIgA.

Exercise, Immunity, and Illness

It is generally accepted that moderate amounts of exercise improve immune system functions and hence reduce the risk of infection whereas athletes engaged in regular prolonged and/or intensive training have a higher than “normal” incidence of minor infections, especially of the upper respiratory tract (URT, e.g., common cold and influenza). This is likely related to regular acute (and possibly chronic) periods of exercise-induced changes in immune function. URT infections can compromise performance directly if suffered shortly before or during competition or indirectly if suffered at other times via effects on training and/or physiological adaptations. This chapter covers the effects of exercise (acute and chronic), both positive and negative, on immune function and consequent infection risk, and considers the current state-of-the-art for monitoring and assessing this in athletes.

Upper Respiratory Symptoms, Gut Health and Mucosal Immunity in Athletes

Upper respiratory symptoms remain the most common illness in athletes. Upper respiratory symptoms during heavy training and competition may impair performance. Preventing illness is the primary reason for the use of supplements, such as probiotics and prebiotics, for maintaining or promoting gut health and immune function. While exercise-induced perturbations in the immune system may increase susceptibility to illness and infection, growing evidence indicates that upper respiratory symptoms are related to a breakdown in the homeostatic regulation of the mucosal immune system of the airways. Balancing protection of the respiratory tract with normal physiological functioning requires dynamic orchestration between a wide array of immune parameters. The intestinal microbiota regulates extra-intestinal immunity via the common mucosal immune system and new evidence implicates the microbiota of the nose, mouth and respiratory tract in upper respiratory symptoms. Omics’ approaches now facilitate comprehensive profiling at the molecular and proteomic levels to reveal new pathways and molecules of immune regulation. New targets may provide for personalised nutritional and training interventions to maintain athlete health.

Effects of Acute and Chronic Exercise on Immunological Parameters in the Elderly Aged: Can Physical Activity Counteract the Effects of Aging?

Immunosenescence is characterized by deterioration of the immune system caused by aging which induces changes to innate and adaptive immunity. Immunosenescence affects function and phenotype of immune cells, such as expression and function of receptors for immune cells which contributes to loss of immune function (chemotaxis, intracellular killing). Moreover, these alterations decrease the response to pathogens, which leads to several age-related diseases including cardiovascular disease, Alzheimer's disease, and diabetes in older individuals. Furthermore, increased risk of autoimmune disease and chronic infection is increased with an aging immune system, which is characterized by a pro-inflammatory environment, ultimately leading to accelerated biological aging. During the last century, sedentarism rose dramatically, with a concomitant increase in certain type of cancers (such as breast cancer, colon, or prostate cancer), and autoimmune disease. Numerous studies on physical activity and immunity, with focus on special populations (i.e., people with diabetes, HIV patients) demonstrate that chronic exercise enhances immunity. However, the majority of previous work has focused on either a pathological population or healthy young adults whilst research in elderly populations is scarce. Research conducted to date has primarily focused on aerobic and resistance exercise training and its effect on immunity. This review focuses on the potential for exercise training to affect the aging immune system. The concept is that some lifestyle strategies such as high-intensity exercise training may prevent disease through the attenuation of immunosenescence. In this context, we take a top-down approach and review the effect of exercise and training on immunological parameters in elderly at rest and during exercise in humans, and how they respond to different modes of training. We highlight the impact of these different exercise modes on immunological parameters, such as cytokine and lymphocyte concentration in elderly individuals.

Effects of Probiotic (Bifidobacterium longum 35624) Supplementation on Exercise Performance, Immune Modulation, and Cognitive Outlook in Division I Female Swimmers

Our aim was to determine the effects of probiotic supplementation (Bifidobacterium longum 35624; 1 billion CFU·d^-1) on exercise performance, immune modulation, and cognitive outlook in collegiate female athletes during six weeks of offseason training. Seventeen National Collegiate Athletic Association (NCAA) Division 1 collegiate female swimmers participated in this two-group matched, double-blind, placebo controlled design. Via stratified randomization, participants were assigned to probiotic (B. longum 35624; n = 8) or placebo (n = 9) groups. Pre, mid, and post-training, all participants completed exercise performance testing (aerobic/anaerobic swim time trials and force plate vertical jump) as well as provided serum (cytokine and gastrointestinal inflammatory markers) and salivary immunoglobulin A samples. Recovery-stress questionnaire for athletes (RESTQ-Sport) was administered at baseline and conclusion of each week. Data were analyzed by analysis of covariance (ANCOVA) by time point with the respective baseline values of each dependent variable being the covariate. No significant differences in exercise performance and biochemical markers were observed between groups following offseason training. Recovery-Stress Questionnaire for Athletes (RESTQ-sport) values in B. longum 35624 group had significantly higher (i.e., more desired; p < 0.05) values in sport recovery (weeks five and six) than placebo. Probiotic supplementation in collegiate female swimmers did not affect exercise performance or immune function throughout offseason training, but did indicate alterations in cognitive outlook.

Efficacy of heat-killed Lactococcus lactis JCM 5805 on immunity and fatigue during consecutive high intensity exercise in male athletes: a randomized, placebo-controlled, double-blinded trial

Background

Lactococcus lactis JCM 5805 (LC-Plasma) is a unique lactic acid bacteria (LAB) which activates plasmacytoid dendritic cells (pDC). We aimed to evaluate the effect of LC-Plasma on dendritic cell (DC) activity and subjective indices of upper respiratory tract infections (URTI) and fatigue in athletes under high intensity exercise.

Methods

We conducted a randomized, placebo-controlled, double-blinded trial. Fifty-one male subjects belonging to a university sports club were randomized into placebo (n = 25) and LC-Plasma (n = 26) groups. Individuals ingested placebo capsules containing cornstarch or LC-Plasma capsules containing 100 billion cells of heat-killed LC-Plasma per day for 13 days. During the intervention period, subjects performed high intensity exercise according to their sports club training regime. Blood and saliva sampling were obtained at days 1 and 14, and physical conditions were recorded in a diary. We investigated expression of maturation markers on DCs, muscle damage and stress markers and used student’s t test adjusted by Bonferoni’s method for multiple comparison between groups. These data were presented as mean ± SD. We also investigated cumulative days of symptoms regarding infections and fatigue and used Chi-square test for comparison between groups. These data were presented as cumulative number.

Results

CD86 as maturation marker on pDC was significantly increased in the LC-Plasma group at day 14 (Placebo: 296 ± 70 vs. LC-Plasma: 365 ± 115; Mean Fluorescent Intensity; p = 0.013). Cumulative days of URTI were significantly lower in the LC-Plasma group (Placebo: URTI positive 56, URTI negative 256 vs. LC-Plasma: URTI positive 39, URTI negative 299; days; p = 0.028) and symptoms like sneeze or running nose were significantly lower in the LC-Plasma group (Placebo: Symptom positive 52, Symptom negative 258, vs. LC-Plasma: Symptom positive 36, Symptom negative 301; days; p = 0.032). Moreover, the cumulative days of fatigue were significantly fewer in the LC-Plasma group (Placebo: Symptom positive 128, Symptom negative 182, vs. LC-Plasma: Symptom positive 110, Symptom negative 225; days; p = 0.032). Markers of muscle damage and stress markers were not significantly different between groups.

Conclusion

We consider that heat-killed LC-Plasma supplementation relieves morbidity and symptoms of URTI via activation of pDC and decreases fatigue accumulation during consecutive high intensity exercise in athletes. However, LC-Plasma ingestion did not affect markers of muscle damage and stress.

Trial registration

UMIN-CTR, UMIN000020372. Registered 28 December 2015.

Acute high-intensity exercise test in soccer athletes affects salivary biochemical markers

Saliva has been reported as a potential biological fluid for biochemical monitoring. This study investigated salivary markers of exercise intensity, oral mucosal immunity, and redox homeostasis in soccer athletes subjected to an acute high-intensity interval exercise (HIIE) protocol characterised by a repeated sprint ability test. Thirty-two professional soccer athletes were recruited and saliva aliquots were collected at rest and immediately after HIIE protocol. When compared with pre-test values we observed that HIIE protocol induced moderate changes for total protein (p = .015; effect size (ES) = 0.51; smallest worthwhile change (SWC)_factor = 5.7) and for cortisol levels (p < .0001; ES = 0.49; SWC_factor = 3.9). Lactate levels showed very large changes (p < .000; ES = 1.35; SWC_factor = 10.8), while Ig-A alterations were considered unclear. Besides, transferrin changes were trivial and maintained its levels at rest and after HIIE below the proposed threshold of 0.5 mg/dL. Regarding redox homeostasis we observed unclear effects for TBARs, MDA, GSH, GSSG, CAT, and SOD while uric acid showed large decreases (p = .005; ES = 0.80; SWC_factor = -5.4). HIIE protocol as a physical test conducted in soccer athletes increased salivary concentration of exercise intensity markers, such as lactate, total protein, and cortisol, but did not affect Ig-A levels. Redox homeostasis in saliva seems to be more related with uric acid levels as a possible key factor TBARs homeostasis.

Intensified training increases salivary free light chains in trained cyclists: Indication that training volume increases oral inflammation

Periods of short-term intensified training (IT) are often used by athletes during training cycles over the season and undergoing phases of increased physical stress may impact upon the immune system. This study investigated the effects of a period of IT on free light chains (FLCs) in saliva - an emerging immune biomarker of oral inflammation - and matched serum samples in well-trained athletes. It also examined if IT influences basal FLC levels and FLC flux during acute exercise. Highly trained male cyclists (n = 10) underwent a 9-day period of IT; before and after IT participants performed a 1 h time trial (TT) on a cycle ergometer, with blood and saliva samples collected pre- and post-exercise. FLCs were assessed in serum and saliva, and IgG, IgA, IgM and creatinine were also measured in serum. Weekly training volume increased by 143% (95% CI 114-172%), p < 0.001, during IT compared with pre-trial baseline training. Following IT, the cyclists demonstrated higher salivary FLC levels. Both salivary lambda FLC concentrations (p < 0.05, η² = 0.384) and secretion rates, and kappa FLC concentrations and secretion rates increased after IT. Salivary FLCs concentration and secretion rates decreased in response to the TT following IT (p < 0.05, η² = 0.387-0.428), but not in response to the TT prior to IT. No significant effects of IT on serum FLCs were observed. There were no significant changes in serum FLCs in response to the TT, before or after the IT period, nor did IT impact upon other serological responses to the TT. In conclusion, IT increased basal salivary FLC parameters and amplified decreases in salivary FLCs in response to acute exercise. Increases in salivary FLC concentration likely reflects alterations to oral inflammation during times of heavy training, and we show for the first time that FLCs may have utility as a marker of exercise stress and oral health status.

The Effects of a 4-Week, Intensified Training, and Competition Period on Salivary Hormones, Immunoglobulin A, Illness Symptoms, and Mood State in Elite Synchronised Swimmers

Given the limited research into the physiological and psychological demands of elite synchronised swimming, the aim of this study was to examine 10 elite female synchronised swimmers and analyse the relationship between training load, stress, illness episodes, and salivary biomarkers during a period of training and competition. Saliva samples were collected before (BASE), during an intensified training camp (CAMP), during an international competition period (COMP), and post competition recovery (REC) for analysis of cortisol, testosterone, and secretory immunoglobulin A (SIgA). Illness symptoms, Daily Analysis of Life Demands of Athletes (DALDA), and training load were also monitored. Training load significantly increased from BASE during CAMP and COMP (p < 0.01), and SIgA secretion was higher during COMP compared to BASE and CAMP (p < 0.01). There was no change in salivary testosterone; however, salivary cortisol was elevated during COMP compared to BASE (93%, p < 0.05). DALDA ‘a scores’ were correlated with salivary cortisol (r = 0.429, p = 0.0001). The study demonstrates that a short period of intensified training and competition did not have a detrimental effect on mucosal immunity in elite synchronised swimmers; however, swimmers displayed higher cortisol levels during the competition and increased stress symptoms.

Cytokine profile of NALT during acute stress and its possible effect on IgA secretion

Stress stimuli affect the immune system responses that occur at mucosal membranes, particularly IgA secretion. It has been suggested that acute stress increases the levels of IgA and that sympathetic innervation plays an important role in this process. We herein explore in a murine model how acute stress affects the Th1/Th2/Treg cytokine balance in NALT, and the possible role of glucocorticoids in this effect. Nine-week-old male CD1 mice were divided into three groups: unstressed (control), stressed (subjected to 4h of immobilization), and stressed after pretreatment with a single dose of the corticosterone receptor antagonist RU-486. The parameters evaluated included plasma corticosterone and epinephrine, IgA levels in nasal fluid (by ELISA), the percentage of CD19⁺B220⁺IgA⁺ lymphocytes and CD138⁺IgA⁺ plasma cells, and the mRNA expression of heavy α chain, J chain and pIgR. Moreover, the gene and protein expression of Th1 cytokines (TNFα, IL-2 and INF-γ), Th2 cytokines (IL-4 and IL-5) and Treg cytokines (IL-10 and TGFβ) were determined in nasal mucosa. The results show that acute stress generated a shift towards the dominance of an anti-inflammatory immune response (Th2 and Treg cytokines), evidenced by a significant rise in the amount of T cells that produce IL4, IL-5 and IL-10. This immune environment may favor IgA biosynthesis by CD138⁺IgA⁺ plasma cells, a process mediated mostly by glucocorticoids.

PARÂMETROS IMUNOLÓGICOS E INFECÇÕES DO TRATO RESPIRATÓRIO SUPERIOR EM ATLETAS DE ESPORTES COLETIVOS

RESUMO Entre atletas e treinadores, existe uma percepção comum de que altas cargas de treinamento e competições, aplicadas de forma crônica, com controle nutricional e/ou períodos de recuperação inadequados, podem reduzir a resistência imunológica, aumentando a predisposição aos episódios de infecções, principalmente infecções do trato respiratório superior (ITRS). Nesse sentido, o presente estudo está centrado em revisar as interações entre os parâmetros imunológicos com a síndrome do sobretreinamento, especificamente em esportes coletivos, considerando a sua natureza intermitente. Assim, foi realizada uma revisão de periódicos nacionais e internacionais relacionados com o tema. As correlações entre exercício, sistema imunológico e suscetibilidade às ITRS têm sido avaliadas principalmente em esportes individuais e de resistência em comparação aos coletivos. As modulações dos leucócitos ao longo da temporada, frente ao efeito somatório das cargas de treinamento e competições, quando analisadas especificamente quanto aos neutrófilos e monócitos, possivelmente se relacionam com os processos de reparo tecidual e incidência de ITRS. As modulações relacionadas com os linfócitos parecem estar relacionadas mais diretamente com a incidência das ITRS. Ademais, o entendimento de todos os marcadores propostos, incluindo os imunológicos em associação com os indicadores de desempenho e controle do treinamento, parece ser um caminho mais promissor para o diagnóstico clínico do estado imunológico do atleta e da prevenção da síndrome do sobretreinamento do que necessariamente a busca por um marcador exclusivo de excesso de treinamento.

SIgA response and incidence of upper respiratory tract infections during intensified training in youth basketball players

The aim of the present study was to examine the effect of an intensified training phase followed by a tapering phase on the salivary immunoglobulin A concentration and on the upper respiratory tract infection (URTI) symptoms in young male basketball players. The session rating of perceived exertion method was used to quantify the internal training load, and the Wisconsin Upper Respiratory Symptom Survey-21 questionnaire was used to assess URTI symptoms. The Yo-Yo IR1 test and saliva collection were carried out at the beginning of the study (T1), after the intensified phase (T2), and after tapering (T3). A higher internal training load was observed for the intensified phase compared with the tapering phase (t=19.10; p<0.001), and a significant decrease in salivary immunoglobulin A concentration was detected (F=7.48; p=0.004) at T3 compared to T1 (p=0.02) and T2 (p=0.05). However, there was no significant difference between phases for severity of URTI (χ²= 2.83; p=0.242). The Yo-Yo IR1 test performance increased from T2 and T3 compared to T1 (F=58.24; p<0.001). There was no significant effect of aerobic fitness level on salivary immunoglobulin A response (F=1.095; p=0.344). In summary, the present findings suggest that an intensified training load followed by a tapering period negatively affects the mucosal immune function with no significant change in severity of URTI in young basketball players.

The Effect of Exercise on Salivary Viscosity

A common experience after exercise is the presence of a thick and sticky saliva layer on the oral surfaces, which causes a feeling of a dry mouth. Since the salivary mucin MUC5B is responsible for the visco-elastic behavior of saliva, in the present study we explored the effect of exercise on both the salivary viscosity and the secretion of MUC5B in saliva. Twenty healthy dental students performed an aerobic exercise by cycling for 15 min on cycle-ergometers at a heart rate of 130-140 beats per minute. Saliva was collected at three time points: before exercise, immediately after exercise and after 30 min recovery. Salivary flow rate, viscosity, amylase activity, total protein, carbohydrate and MUC5B concentration were determined. Salivary flow rate, protein and amylase did not change significantly. Immediately after exercise, the salivary viscosity and carbohydrate concentration were significantly higher than at baseline and after 30 min recovery. Immediately after exercise, the MUC5B concentration was significantly higher than after 30 min recovery. It is concluded that the presence of thick saliva after exercise is at least partially due to an increased secretion of MUC5B.

Monitoring Salivary Immunoglobulin A Responses to Official and Simulated Matches In Elite Young Soccer Players

The purpose of the present study was to examine SIgA responses (concentration [SIgAabs] and a secretion rate [SIgArate]) to official and simulated competitive matches in young soccer players. The sample was composed of 26 male soccer players (age 15.6 ± 1.1 yrs, stature 177.0 ± 6.1 cm, body mass 70.5 ± 5.7 kg). Four soccer matches (two simulated matches [SM] and two official matches [OM]) were conducted. The matches consisted of two halves of 35 min with a 10 min rest interval. Each assessed player participated in only one SM and one OM. All matches were performed in the same week, during the competitive season, and at the same time of the day (9:00 am), separated by 48 h. Saliva samples were collected before and after every match. The session rating of perceived exertion was reported 30 min after each match in order to determine the internal training load (ITL). A significant decrease in SIgAabs and SIgArate after OM was observed when compared to the pre-match value. In addition, the SIgArate was higher at pre-OM when compared to pre-SM. A higher ITL for OM was observed compared to SM. The current findings indicate that OM may lead to a decrease in the main mucosal immunity function parameter of young soccer players that could increase the risk of URTI. Coaches should be aware of it in order to plan appropriate training loads and recovery procedures to avoid or minimize the likelihood of upper respiratory tract infection occurrences.

Measurement of saliva flow rate in healthy young humans: influence of collection time and mouthrinse water temperature

The aim of the current study was to determine if unstimulated saliva flow (measured in μl min^-1 ) is affected by different durations of sample collection and by temperatures of mouthrinse water used before sample collection. In randomized order, participants provided 10 samples of unstimulated saliva at time points ranging from 1 to 6 min after rinsing with different temperatures of water (10, 20, and 30°C). Data were analysed by one-way anova with post-hoc tests. Test-retest reliability was assessed using Bland-Altman plots and correlation coefficients. A larger volume of saliva was obtained over a longer collection time. No significant difference in saliva flow rate was observed between collection times [mean: 364 (95% CI: 332-397) μl min^-1 ]. Although rinsing with different temperatures of mouthrinse water resulted in no significant difference in saliva flow rates as a result of the mouthrinse water temperatures, 60% of the participants had a higher saliva flow rate after rinsing with mouthrinse water at a temperature of 10°C compared with mouthrinse water at 20 and 30°C, suggesting large individual variation (range: 24-420 μl min^-1 ). These findings provide justification for using saliva collection times of 1-6 min during sampling of unstimulated saliva. The large individual variations in saliva flow rate in response to different mouthrinse water temperatures suggest that standardization, control, and reporting of mouthrinse water temperature is warranted.

Mucosal immunity and upper respiratory tract infections during a 24-week competitive season in young ice hockey players

The aim of this study was to examine upper respiratory tract infections (URTI) and their associations with resting saliva and blood immune and endocrine parameters in ice hockey players. Twenty-seven participants (age 16.5 ± 0.5 years) completed the 24-week study period. The counts/concentrations of immune and endocrine markers were compared between healthy-prone athletes (≤2 episodes of URTI during the study period) and illness-prone athletes (≥3 episodes of URTI) and between the URTI state (when athletes had infections) and the healthy state (the time without URTI). There were no differences in concentration/counts of saliva and blood immune and endocrine parameters between the illness-prone and illness-free athletes. Athletes had significantly lower sIgA, sIgA1 and sIgA2 concentrations (sIgA: 119.88 ± 66.88, 144.10 ± 75.0 µg/ml; sIgA1: 90.2 ± 40.64, 108.44 ± 29.8 U; sIgA2: 67.58 ± 30.1, 80.3 ± 25.61 U, respectively) and significantly higher WBC, neutrophil, monocyte and eosinophil count values and IL-1ra concentration at the time when they had symptoms of URTI than in the period without symptoms of infections. There were no differences in salivary cortisol concentration between the period of URTI symptoms and the period without URTI symptoms. In conclusion, we observed lower concentrations of salivary immunoglobulins and higher levels of blood immune parameters during URTI in athletes, which may confirm the suppression of mucosal immunity and initiation responses to pathogenic infections by innate immunity.

The World Anti-Doping Code: can you have asthma and still be an elite athlete?

KEY POINTS

The World Anti-Doping Code (the Code) does place some restrictions on prescribing inhaled β2-agonists, but these can be overcome without jeopardising the treatment of elite athletes with asthma.While the Code permits the use of inhaled glucocorticoids without restriction, oral and intravenous glucocorticoids are prohibited, although a mechanism exists that allows them to be administered for acute severe asthma.Although asthmatic athletes achieved outstanding sporting success during the 1950s and 1960s before any anti-doping rules existed, since introduction of the Code's policies on some drugs to manage asthma results at the Olympic Games have revealed that athletes with confirmed asthma/airway hyperresponsiveness (AHR) have outperformed their non-asthmatic rivals.It appears that years of intensive endurance training can provoke airway injury, AHR and asthma in athletes without any past history of asthma. Although further research is needed, it appears that these consequences of airway injury may abate in some athletes after they have ceased intensive training. The World Anti-Doping Code (the Code) has not prevented asthmatic individuals from becoming elite athletes. This review examines those sections of the Code that are relevant to respiratory physicians who manage elite and sub-elite athletes with asthma. The restrictions that the Code places or may place on the prescription of drugs to prevent and treat asthma in athletes are discussed. In addition, the means by which respiratory physicians are able to treat their elite asthmatic athlete patients with drugs that are prohibited in sport are outlined, along with some of the pitfalls in such management and how best to prevent or minimise them.

Assisting the Novice in Lifestyle Change

The beginning of a lifestyle intervention is a sensitive time, as doing “too much too quickly” may stress the immune system, resulting in an increase in upper respiratory symptoms and, consequently, attrition. However, “too little too slowly” may not align with patients’ motivation to change and may also result in attrition. There is also evidence that early weight loss is predictive of long-term maintenance of goal weight. Health care providers are frequently presented with contradictory information on the best model to promote enduring lifestyle change. Best practice dictates that health care provider acknowledge their patients’ motivation to change and incorporate each individual’s goals in designing the lifestyle change intervention. Additional support and advice may be warranted at the beginning of an intervention to promote the patient’s health and avoid attrition.

Respiratory inflammation and infections in high-performance athletes

Upper respiratory illness is the most common reason for non-injury-related presentation to a sports medicine clinic, accounting for 35-65% of illness presentations. Recurrent or persistent respiratory illness can have a negative impact on health and performance of athletes undertaking high levels of strenuous exercise. The cause of upper respiratory symptoms (URS) in athletes can be uncertain but the majority of cases are related to common respiratory viruses, viral reactivation, allergic responses to aeroallergens and exercise-related trauma to the integrity of respiratory epithelial membranes. Bacterial respiratory infections are uncommon in athletes. Undiagnosed or inappropriately treated asthma and/or allergy are common findings in clinical assessments of elite athletes experiencing recurrent URS. High-performance athletes with recurrent episodes of URS should undergo a thorough clinical assessment to exclude underlying treatable conditions of respiratory inflammation. Identifying athletes at risk of recurrent URS is important in order to prescribe preventative clinical, training and lifestyle strategies. Monitoring secretion rates and falling concentrations of salivary IgA can identify athletes at risk of URS. Therapeutic interventions are limited by the uncertainty of the underlying cause of inflammation. Topical anti-inflammatory sprays can be beneficial for some athletes. Dietary supplementation with bovine colostrum, probiotics and selected antioxidants can reduce the incidence or severity of URS in some athletes. Preliminary studies on athletes prone to URS indicate a genetic predisposition to a pro-inflammatory response and a dysregulated anti-inflammatory cytokine response to intense exercise as a possible mechanism of respiratory inflammation. This review focuses on respiratory infections and inflammation in elite/professional athletes.

An intensive Winter fixture schedule induces a transient fall in salivary IgA in English premier league soccer players

We examined the effects of an intensive fixture schedule on salivary IgA (SIgA) concentration in professional soccer players from the English Premier League. Salivary samples were obtained from 21 males who participated in seven games over a 30-day period during December 2013 and January 2014 (games 1-5 occurred in a 15-day period). Salivary-IgA decreased (P < 0.05) at 2 days post-game 3 (45 ± 9 μg mL(-1)), 4 (52 ± μg mL(-1)) and 5 (41 ± 10 μg mL(-1)) compared with game 1 (139 ± 25 μg mL(-1)). When the normal fixture schedule resumed (i.e. one game per week), SIgA returned towards baseline such that game 6 and 7 values were not different (P > 0.05) from game 1 (91 ± 18 and 99 ± 21 μg mL(-1), respectively). Data demonstrate for the first time that a congested winter fixture schedule induces detectable perturbations to mucosal immunity in professional soccer players.

Effect of Astaxanthin Supplementation on Salivary IgA, Oxidative Stress, and Inflammation in Young Soccer Players

The physiologic stress induced by physical activity is reflected in immune system perturbations, oxidative stress, muscle injury, and inflammation. We investigated the effect of astaxanthin (Asx) supplementation on salivary IgA (sIgA) and oxidative stress status in plasma, along with changes in biochemical parameters and total/differential white cell counts. Forty trained male soccer players were randomly assigned to Asx and placebo groups. Asx group was supplemented with 4 mg of Asx. Saliva and blood samples were collected at the baseline and after 90 days of supplementation in preexercise conditions. We observed a rise of sIgA levels at rest after 90 days of Asx supplementation, which was accompanied with a decrease in prooxidant-antioxidant balance. The plasma muscle enzymes levels were reduced significantly by Asx supplementation and by regular training. The increase in neutrophil count and hs-CRP level was found only in placebo group, indicating a significant blunting of the systemic inflammatory response in the subjects taking Asx. This study indicates that Asx supplementation improves sIgA response and attenuates muscle damage, thus preventing inflammation induced by rigorous physical training. Our findings also point that Asx could show significant physiologic modulation in individuals with mucosal immunity impairment or under conditions of increased oxidative stress and inflammation.

The influence of hydration status during prolonged endurance exercise on salivary antimicrobial proteins

PURPOSE

Antimicrobial proteins (AMPs) in saliva including secretory immunoglobulin A (SIgA), lactoferrin (SLac) and lysozyme (SLys) are important in host defence against oral and respiratory infections. This study investigated the effects of hydration status on saliva AMP responses to endurance exercise.

METHODS

Using a randomized design, 10 healthy male participants (age 23 ± 4 years, [Formula: see text] 56.8 ± 6.5 ml/kg/min) completed 2 h cycling at 60 % [Formula: see text] in states of euhydration (EH) or dehydration (DH) induced by 24 h fluid restriction. Unstimulated saliva samples were collected before, during, immediately post-exercise and each hour for 3 h recovery.

RESULTS

Fluid restriction resulted in a 1.5 ± 0.5 % loss of body mass from baseline and a 4.3 ± 0.7 % loss immediately post-exercise. Pre-exercise urine osmolality was higher in DH than EH and overall, saliva flow rate was reduced in DH compared with EH (p < 0.05). Baseline SIgA secretion rates were not different between conditions; however, exercise induced a significant increase in SIgA concentration in DH (161 ± 134 to 309 ± 271 mg/L) which remained elevated throughout 3 h recovery. SLac secretion rates increased from pre- to post-exercise in both conditions which remained elevated in DH only. Overall, SLac concentrations were higher in DH than EH. Pre-exercise SLys concentrations were lower in DH compared with EH (1.6 ± 2.0 vs. 5.5 ± 6.7 mg/L). Post-exercise SLys concentrations remained elevated in DH but returned to pre-exercise levels by 1 h post-exercise in EH.

CONCLUSIONS

Exercise in DH caused a reduction in saliva flow rate yet induced greater secretion rates of SLac and higher concentrations of SIgA and SLys. Thus, DH does not impair saliva AMP responses to endurance exercise.

Prematch salivary secretory immunoglobulin a in soccer players from the 2014 World Cup qualifying campaign

PURPOSE

To monitor resting salivary secretory immunoglobulin A (SIgA) levels in international soccer players during the short-term training period that precedes international match play.

METHODS

In a repeated-measure design, saliva samples were obtained from 13 outfield soccer players who participated in the training camps preceding 7 games (5 home and 2 away) of the 2014 FIFA World Cup qualifying campaign. Samples were obtained daily for 4 d preceding each game (and analyzed for SIgA using the IPRO oral-fluid-collection system) at match day minus 1 (MD-1), minus 2 (MD-2), minus 3 (MD-3), and minus 4 (MD-4).

RESULTS

SIgA displayed a progressive decline (P = .01) during the 4-d training period (MD-4, 365 ± 127 μg/mL; MD-3, 348 ± 154 μg/mL; MD-2, 290 ± 138 μg/mL; MD-1, 256 ± 90 μg/mL) such that MD-1 values were significantly lower (P = .01) than both MD-4 and MD-3. The 95% confidence intervals for the differences between MD-1 and MD-4 were -191 to -26 and between MD-1 and MD-3 were -155 to -28.

CONCLUSIONS

Data demonstrate that a short-term soccer-training camp in preparation for international competition induces detectable perturbations to mucosal immunity. Future studies should monitor SIgA (as a practical and noninvasive measure of immunity) alongside internal and external measures of training load in an attempt to strategically individualize training and nutritional strategies that may support optimal preparation for high-level competition.