European Journal of Applied Physiology

, Volume 104, Issue 3, pp 417–426 | Cite as

Recovery after an Ironman triathlon: sustained inflammatory responses and muscular stress

  • Oliver Neubauer
  • Daniel König
  • Karl-Heinz Wagner
Original Article

Abstract

Ultra-endurance exercise, such as an Ironman triathlon, induces muscle damage and a systemic inflammatory response. As the resolution of recovery in these parameters is poorly documented, we investigated indices of muscle damage and systemic inflammation in response to an Ironman triathlon and monitored these parameters 19 days into recovery. Blood was sampled from 42 well-trained male triathletes 2 days before, immediately after, and 1, 5 and 19 days after an Ironman triathlon. Blood samples were analyzed for hematological profile, and plasma values of myeloperoxidase (MPO), polymorphonuclear (PMN) elastase, cortisol, testosterone, creatine kinase (CK) activity, myoglobin, interleukin (IL)-6, IL-10 and high-sensitive C-reactive protein (hs-CRP). Immediately post-race there were significant (P < 0.001) increases in total leukocyte counts, MPO, PMN elastase, cortisol, CK activity, myoglobin, IL-6, IL-10 and hs-CRP, while testosterone significantly (P < 0.001) decreased compared to prerace. With the exception of cortisol, which decreased below prerace values (P < 0.001), these alterations persisted 1 day post-race (P < 0.001; P < 0.01 for IL-10). Five days post-race CK activity, myoglobin, IL-6 and hs-CRP had decreased, but were still significantly (P < 0.001) elevated. Nineteen days post-race most parameters had returned to prerace values, except for MPO and PMN elastase, which had both significantly (P < 0.001) decreased below prerace concentrations, and myoglobin and hs-CRP, which were slightly, but significantly higher than prerace. Furthermore, significant relationships between leukocyte dynamics, cortisol, markers of muscle damage, cytokines and hs-CRP after the Ironman triathlon were noted. This study indicates that the pronounced initial systemic inflammatory response induced by an Ironman triathlon declines rapidly. However, a low-grade systemic inflammation persisted until at least 5 days post-race, possibly reflecting incomplete muscle recovery.

Keywords

Ultra-endurance exercise Muscle damage Systemic inflammatory response Immunoendocrine responses Recovery phase 

Notes

Acknowledgments

The present data are part of a larger study that was funded by the Austrian Science Fund (FWF). The authors would like to thank the participants for their effort, Prof. Haber and Dr. Zeibig for their medical assistance and Mr. Andrew Bulmer for the valuable discussion during the preparation of the manuscript.

References

  1. Bishop NC, Walsh NP, Scanlon GA (2003) Effect of prolonged exercise and carbohydrate on total neutrophil elastase content. Med Sci Sports Exerc 35(8):1326–1332. doi: 10.1249/01.MSS.0000078927.08049.A8 Google Scholar
  2. Davison G, Gleeson M (2006) The effect of 2 weeks vitamin C supplementation on immunoendocrine responses to 2.5 h cycling exercise in man. Eur J Appl Physiol 97(4):454–461. doi: 10.1007/s00421-006-0196-7 Google Scholar
  3. Dill DB, Costill DL (1974) Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. J Appl Physiol 37(2):247–248Google Scholar
  4. Fehrenbach E, Schneider ME (2006) Trauma-induced systemic inflammatory response versus exercise-induced immunomodulatory effects. Sports Med 36(5):373–384. doi: 10.2165/00007256-200636050-00001 Google Scholar
  5. Fischer CP (2006) Interleukin-6 in acute exercise and training: what is the biological relevance? Exerc Immunol Rev 12:6–33Google Scholar
  6. Gleeson M (2007) Immune function in sport and exercise. J Appl Physiol 103:693–699. doi: 10.1152/japplphysiol.00008.2007 Google Scholar
  7. Gomez-Merino D, Drogou C, Guezennec CY, Burnat P, Bourrilhon C, Tomaszewski A, Milhau S, Chennaoui M (2006) Comparison of systemic cytokine responses after a long distance triathlon and a 100-km run: relationship to metabolic and inflammatory processes. Eur cytokine netw 17(2):117–124Google Scholar
  8. Halson SL, Jeukendrup AE (2004) Does overtraining exist? An analysis of overreaching and overtraining research. Sports Med 34(14):967–981. doi: 10.2165/00007256-200434140-00003 Google Scholar
  9. Jeukendrup AE, Vet-Joop K, Sturk A, Stegen JH, Senden J, Saris WH, Wagenmakers AJ (2000) Relationship between gastro-intestinal complaints and endotoxaemia, cytokine release and the acute-phase reaction during and after a long-distance triathlon in highly trained men. Clin Sci (Lond) 98:47–55. doi: 10.1042/CS19990258 Google Scholar
  10. Jeukendrup AE, Jentjens RL, Moseley L (2005) Nutritional considerations in triathlon. Sports Med 35(2):163–181. doi: 10.2165/00007256-200535020-00005 Google Scholar
  11. Kim HJ, Lee YH, Kim CK (2007) Biomarkers of muscle and cartilage damage and inflammation during a 200 km run. Eur J Appl Physiol 99(4):443–447. doi: 10.1007/s00421-006-0362-y Google Scholar
  12. Knez WL, Coombes JS, Jenkins DG (2006) Ultra-endurance exercise and oxidative damage: implications for cardiovascular health. Sports Med 36(5):429–441. doi: 10.2165/00007256-200636050-00005 Google Scholar
  13. König D, Wagner KH, Elmadfa I, Berg A (2001) Exercise and oxidative stress: significance of antioxidants with reference to inflammatory, muscular, and systemic stress. Exerc Immunol Rev 7:108–133Google Scholar
  14. König D, Neubauer O, Nics L, Kern N, Berg A, Bisse E, Wagner KH (2007) Biomarkers of exercise-induced myocardial stress in relation to inflammatory and oxidative stress. Exerc Immunol Rev 13:15–36Google Scholar
  15. Malm C (2004) Exercise immunology: the current state of man and mouse. Sports Med 34(9):555–566. doi: 10.2165/00007256-200434090-00001 Google Scholar
  16. Margaritis I, Tessier F, Richard MJ, Marconnet P (1997) No evidence of oxidative stress after a triathlon race in highly trained competitors. Int J Sports Med 18(3):186–190. doi: 10.1055/s-2007-972617 Google Scholar
  17. Mastaloudis A, Morrow JD, Hopkins DW, Devaraj S, Traber MG (2004) Antioxidant supplementation prevents exercise-induced lipid peroxidation, but not inflammation, in ultramarathon runners. Free Radic Biol Med 36(10):1329–1341. doi: 10.1016/j.freeradbiomed.2004.02.069 Google Scholar
  18. Melanson SE, Green SM, Wood MJ, Neilan TG, Lewandrowski EL (2006) Elevation of myeloperoxidase in conjunction with cardiac-specific markers after marathon running. Am J Clin Pathol 126(6):888–893. doi: 10.1309/1D62H6KRFTVQRJ0A Google Scholar
  19. Millet GP, Dreano P, Bentley DJ (2003) Physiological characteristics of elite short- and long-distance triathletes. Eur J Appl Physiol 88(4–5):427–430. doi: 10.1007/s00421-002-0731-0 Google Scholar
  20. Moldoveanu AI, Shephard RJ, Shek PN (2001) The cytokine response to physical activity and training. Sports Med 31(2):115–144. doi: 10.2165/00007256-200131020-00004 Google Scholar
  21. Nieman DC, Henson DA, McAnulty SR, McAnulty L, Swick NS, Utter AC, Vinci DM, Opiela SJ, Morrow JD (2002) Influence of vitamin C supplementation on oxidative and immune changes after an ultramarathon. J Appl Physiol 92(5):1970–1977Google Scholar
  22. Nieman DC, Henson DA, McAnulty SR, McAnulty LS, Morrow JD, Ahmed A, Heward CB (2004) Vitamin E and immunity after the Kona Triathlon World Championship. Med Sci Sports Exerc 36(8):1328–1335. doi: 10.1249/01.MSS.0000135778.57355.CA
  23. Nieman DC, Dumke CL, Henson DA, McAnulty SR, Gross SJ, Lind RH (2005) Muscle damage is linked to cytokine changes following a 160-km race. Brain Behav Immun 19(5):398–403. doi: 10.1016/j.bbi.2005.03.008 Google Scholar
  24. Peake JM, Suzuki K, Hordern M, Wilson G, Nosaka K, Coombes JS (2005a) Plasma cytokine changes in relation to exercise intensity and muscle damage. Eur J Appl Physiol 95(5–6):514–521. doi: 10.1007/s00421-005-0035-2 Google Scholar
  25. Peake JM, Suzuki K, Wilson G, Hordern M, Nosaka K, Mackinnon L, Coombes JS (2005b) Exercise-induced muscle damage, plasma cytokines, and markers of neutrophil activation. Med Sci Sports Exerc 37(5):737–745. doi: 10.1249/01.MSS.0000161804.05399.3B Google Scholar
  26. Pedersen BK, Hoffman-Goetz L (2000) Exercise and the immune system: regulation, integration, and adaptation. Physiol Rev 80(3):1055–1081Google Scholar
  27. Pedersen BK, Akerstrom TC, Nielsen AR, Fischer CP (2007) Role of myokines in exercise and metabolism. J Appl Physiol 103(3):1093–1098. doi: 10.1152/japplphysiol.00080.2007 Google Scholar
  28. Plaisance EP, Grandjean PW (2006) Physical activity and high-sensitivity C-reactive protein. Sports Med 36(5):443–458. doi: 10.2165/00007256-200636050-00006 Google Scholar
  29. Robson P (2003) Elucidating the unexplained underperformance syndrome in endurance athletes: the interleukin-6 hypothesis. Sports Med 33(10):771–781. doi: 10.2165/00007256-200333100-00004 Google Scholar
  30. Robson-Ansley PJ, Blannin A, Gleeson M (2007) Elevated plasma interleukin-6 levels in trained male triathletes following an acute period of intense interval training. Eur J Appl Physiol 99(4): 353–360. doi: 10.1007/s00421-006-0354-y
  31. Shaskey DJ, Green GA (2000) Sports haematology. Sports Med 29(1):27–38. doi: 10.2165/00007256-200029010-00003 Google Scholar
  32. Smith LL (2000) Cytokine hypothesis of overtraining: a physiological adaptation to excessive stress? Med Sci Sports Exerc 32(2):317–331. doi: 10.1097/00005768-200002000-00011 Google Scholar
  33. St Pierre Schneider B, Tiidus PM (2007) Neutrophil infiltration in exercise-injured skeletal muscle: how do we resolve the controversy? Sports Med 37(10):837–856Google Scholar
  34. Suzuki K, Totsuka M, Nakaji S, Yamada M, Kudoh S, Liu Q, Sugawara K, Yamaya K, Sato K (1999) Endurance exercise causes interaction among stress hormones, cytokines, neutrophil dynamics, and muscle damage. J Appl Physiol 87(4):1360–1367Google Scholar
  35. Suzuki K, Nakaji S, Yamada M, Liu Q, Kurakake S, Okamura N, Kumae T, Umeda T, Sugawara K (2003) Impact of a competitive marathon race on systemic cytokine and neutrophil responses. Med Sci Sports Exerc 35(2):348–355. doi: 10.1249/01.MSS.0000048861.57899.04 Google Scholar
  36. Suzuki K, Peake J, Nosaka K, Okutsu M, Abbiss CR, Surriano R, Bishop D, Quod MJ, Hamilton L, Martin DT, Laursen PB (2006) Changes in markers of muscle damage, inflammation and HSP70 after an Ironman triathlon race. Eur J Appl Physiol 98(6):525–534. doi: 10.1007/s00421-006-0296-4 Google Scholar
  37. Tee JC, Bosch AN, Lambert MI (2007) Metabolic consequences of exercise-induced muscle damage. Sports Med 37(10):827–836Google Scholar
  38. Tidball JG (2005) Inflammatory processes in muscle injury and repair. Am J Physiol Regul Integr Comp Physiol 288(2):R345–R353Google Scholar
  39. Whyte GP, George K, Sharma S, Lumley S, Gates P, Prasad K, McKenna WJ (2000) Cardiac fatigue following prolonged endurance exercise of differing distances. Med Sci Sports Exerc 32(6):1067–1072. doi: 10.1097/00005768-200006000-00005 Google Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Oliver Neubauer
    • 1
  • Daniel König
    • 2
  • Karl-Heinz Wagner
    • 1
  1. 1.Department of Nutritional Sciences, Faculty of Life SciencesUniversity of ViennaViennaAustria
  2. 2.Centre for Internal Medicine, Division of Rehabilitation, Prevention and Sports MedicineFreiburg University HospitalFreiburgGermany

Personalised recommendations