Sports Medicine

, Volume 36, Issue 5, pp 373–384 | Cite as

Trauma-Induced Systemic Inflammatory Response versus Exercise-Induced Immunomodulatory Effects

  • Elvira Fehrenbach
  • Marion E. Schneider
Current Opinion


Accidental trauma and heavy endurance exercise, both induce a kind of systemic inflammatory response, also called systemic inflammatory response syndrome (SIRS). Exercise-related SIRS is conditioned by hyperthermia and concomitant heat shock responses, whereas trauma-induced SIRS manifests concomitantly with tissue necrosis and immune activation, secondarily followed by fever. Inflammatory cytokines are common denominators in both trauma and exercise, although there are marked quantitative differences. Different anti-inflammatory cytokines may be involved in the control of inflammation in trauma- and exercise-induced stress. Exercise leads to a balanced equilibrium between inflammatory and anti-inflammatory responses. Intermittent states of rest, as well as anti-oxidant capacity, are lacking or minor in trauma but are high in exercising individuals. Regular training may enhance immune competence, whereas trauma-induced SIRS often paves the way for infectious complications, such as sepsis.


Natural Killer Cell Systemic Inflammatory Response Syndrome Endurance Exercise Immune Competence Systemic Inflammatory Response Syndrome Criterion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    Bone RC. Sir Isaac Newton, sepsis, SIRS, and CARS. Crit Care Med 1996 Jul; 24 (7): 1125–1128PubMedGoogle Scholar
  2. 2.
    Levy MM, Fink MP, Marshall JC, et al. 2001 Sccm/Esicm/Accp/Ats/Sis International Sepsis Definitions Conference. Crit Care Med 2003 Apr; 31 (4): 1250–256PubMedGoogle Scholar
  3. 3.
    Salo DC, Donovan CM, Davies KJ. HSP70 and other possible heat shock or oxidative stress proteins are induced in skeletal muscle, heart, and liver during exercise. Free Radic Biol Med 1991; 11 (3): 239–246PubMedGoogle Scholar
  4. 4.
    Shephard RJ. Sepsis and mechanisms of inflammatory response: is exercise a good model? Br J Sports Med 2001 Aug; 35 (4): 223–230PubMedGoogle Scholar
  5. 5.
    Shephard RJ, Shek PN. Immune responses to inflammation and trauma: a physical training model. Can J Physiol Pharmacol 1998 May; 76 (5): 469–472PubMedGoogle Scholar
  6. 6.
    Northoff H, Enkel S, Weinstock C. Exercise, injury, and immune function. Exerc Immunol Rev 1995; 1: 1–25Google Scholar
  7. 7.
    Moldoveanu AI, Shephard RJ, Shek PN. The cytokine response to physical activity and training. Sports Med 2001 Feb; 31 (2): 115–144PubMedGoogle Scholar
  8. 8.
    Shek PN, Shephard RJ. Physical exercise as a human model of limited inflammatory response. Can J Physiol Pharmacol 1998 May; 76 (5): 589–597PubMedGoogle Scholar
  9. 9.
    Camus G, Deby-Dupont G, Duchateau J, et al. Are similar inflammatory factors involved in strenuous exercise and sepsis? Intensive Care Med 1994 Nov; 20 (8): 602–610PubMedGoogle Scholar
  10. 10.
    Pedersen BK, Kappel M, Klokker M, et al. The immune system during exposure to extreme physiologic conditions. Int J Sports Med 1994 Oct; 15 Suppl. 3: S116–S121PubMedGoogle Scholar
  11. 11.
    Pedersen BK, Hoffman-Goetz L. Exercise and the immune system: regulation, integration, and adaptation. Physiol Rev 2000 Jul; 8 (3): 1055–1081Google Scholar
  12. 12.
    Dremsizov TT, Kellum JA, Angus DC. Incidence and definition of sepsis and associated organ dysfunction. Int J Artif Organs 2004 May; 27 (5): 352–359PubMedGoogle Scholar
  13. 13.
    Lakier SL. Overtraining, excessive exercise, and altered immunity: is this a T helper-1 versus T helper-2 lymphocyte response? Sports Med 2003; 33 (5): 347–364Google Scholar
  14. 14.
    Suzuki K, Nakaji S, Kurakake S, et al. Exhaustive exercise and type-l/type-2 cytokine balance with special focus on in-terleukin-12 p40/p70. Exerc Immunol Rev 2003; 9: 48–57PubMedGoogle Scholar
  15. 15.
    Nieman DC. Is infection risk linked to exercise workload? Med Sci Sports Exerc 2000 Jul; 32 (7 Suppl.): S406–S411PubMedGoogle Scholar
  16. 16.
    Sharp NC, Koutedakis Y. Sport and the overtraining syndrome: immunological aspects. Br Med Bull 1992; 48 (3): 518–533PubMedGoogle Scholar
  17. 17.
    Shephard RJ. Chronic fatigue syndrome: an update. Sports Med 2001; 31 (3): 167–194PubMedGoogle Scholar
  18. 18.
    Kentta G, Hassmen P, Raglin JS. Training practices and overtraining syndrome in Swedish age-group athletes. Int J Sports Med 2001 Aug; 22 (6): 460–465PubMedGoogle Scholar
  19. 19.
    Welch WJ, Garrels JI, Thomas GP, et al. Biochemical characterization of the mammalian stress proteins and identification of two stress proteins as glucose- and Ca2+- ionophore-regulated proteins. J Biol Chem 1983; 258 (11): 7102–7111PubMedGoogle Scholar
  20. 20.
    Smith LL. Tissue trauma: the underlying cause of overtraining syndrome? J Strength Cond Res 2004 Feb; 18 (1): 185–193PubMedGoogle Scholar
  21. 21.
    Halson SL, Jeukendrup AE. Does overtraining exist? An analysis of overreaching and overtraining research. Sports Med 2004; 34 (14): 967–981PubMedGoogle Scholar
  22. 22.
    Gabriel H, Kindermann W. The acute immune response to exercise: what does it mean? Int J Sports Med 1997 Mar; 18 Suppl. 1: S28–S45PubMedGoogle Scholar
  23. 23.
    Silva E, Pedro MD, Sogayar AC, et al. Brazilian Sepsis Epidemiological Study (BASES study). Crit Care 2004; 8 (4): R251–R260PubMedGoogle Scholar
  24. 24.
    Matzinger P. An innate sense of danger. Ann N Y Acad Sci 2002 Jun; 961: 341–342PubMedGoogle Scholar
  25. 25.
    Heeg K, Sparwasser T, Lipford GB, et al. Bacterial DNA as an evolutionary conserved ligand signalling danger of infection to immune cells. Eur J Clin Microbiol Infect Dis 1998 Jul; 17 (7): 464–469PubMedGoogle Scholar
  26. 26.
    Macintire DK, Bellhorn TL. Bacterial translocation: clinical implications and prevention. Vet Clin North Am Small Anim Pract 2002 Sep; 32 (5): 1165–1178PubMedGoogle Scholar
  27. 27.
    Moore GE, Holbein ME, Knochel JP. Exercise-associated collapse in cyclists is unrelated to endotoxemia. Med Sci Sports Exerc 1995 Sep; 27 (9): 1238–1242PubMedGoogle Scholar
  28. 28.
    Camus G, Poortmans J, Nys M, et al. Mild endotoxaemia and the inflammatory response induced by a marathon race. Clin Sci (Lond) 1997 Apr; 92 (4): 415–422Google Scholar
  29. 29.
    Appell HJ, Soares JM, Duarte JA. Exercise, muscle damage and fatigue. Sports Med 1992 Feb; 13 (2): 108–115PubMedGoogle Scholar
  30. 30.
    Davies KJ, Quintanilha AT, Brooks GA, et al. Free radicals and tissue damage produced by exercise. Biochem Biophys Res Commun 1982; 107 (4): 1198–1205PubMedGoogle Scholar
  31. 31.
    Moseley P. Stress proteins and the immune response. Immunopharmacology 2000 Jul 25; 48 (3): 299–302PubMedGoogle Scholar
  32. 32.
    Todryk SM, Melcher AA, Dalgleish AG, et al. Heat shock proteins refine the danger theory. Immunology 2000 Mar; 99 (3): 334–337PubMedGoogle Scholar
  33. 33.
    Christians ES, Yan LJ, Benjamin I J. Heat shock factor 1 and heat shock proteins: critical partners in protection against acute cell injury. Crit Care Med 2002 Jan; 30 (1 Suppl.): S43–S50Google Scholar
  34. 34.
    Hickman-Miller HD, Hildebrand WH. The immune response under stress: the role of HSP-derived peptides. Trends Immunol 2004 Aug; 25 (8): 427–433PubMedGoogle Scholar
  35. 35.
    Doody AD, Kovalchin JT, Mihalyo MA, et al. Glycoprotein 96 can chaperone both MHC class I- and class II-restricted epitopes for in vivo presentation, but selectively primes CD8+ T cell effector function. J Immunol 2004 May 15; 172 (10): 6087–6092PubMedGoogle Scholar
  36. 36.
    Milani V, Noessner E, Ghose S, et al. Heat shock protein 70: role in antigen presentation and immune stimulation. Int J Hyperthermia 2002 Nov; 18 (6): 563–575PubMedGoogle Scholar
  37. 37.
    Asea A. Chaperokine-induced signal transduction pathways. Exerc Immunol Rev 2003; 9: 25–33PubMedGoogle Scholar
  38. 38.
    Ryan M, Levy MM. Clinical review: fever in intensive care unit patients. Crit Care 2003 Jun; 7 (3): 221–225PubMedGoogle Scholar
  39. 39.
    Fehrenbach E, Niess AM. Role of heat shock proteins in the exercise response. Exerc Immunol Rev 1999; 5: 57–77PubMedGoogle Scholar
  40. 40.
    Fehrenbach E, Niess AM, Voelker K, et al. Exercise intensity and duration affect blood soluble HSP72. Int J Sports Med 2005 Sep; 26 (7): 552–557PubMedGoogle Scholar
  41. 41.
    Berwin B, Hart JP, Rice S, et al. Scavenger receptor-A mediates gp96/GRP94 and calreticulin internalization by antigen-presenting cells. EMBO J 2003 Nov 17; 22 (22): 6127–6136PubMedGoogle Scholar
  42. 42.
    Torres M, Forman HJ. Redox signaling and the MAP kinase pathways. Biofactors 2003; 17 (1–4): 287–296PubMedGoogle Scholar
  43. 43.
    Asehnoune K, Strassheim D, Mitra S, et al. Involvement of reactive oxygen species in toll-like receptor 4-dependent activation of NF-kappa B. J Immunol 2004 Feb 15; 172 (4): 2522–2529PubMedGoogle Scholar
  44. 44.
    Vabulas RM, Ahmad-Nejad P, Ghose S, et al. HSP70 as endogenous stimulus of the toll/interleukin-1 receptor signal pathway. J Biol Chem 2002 Apr 26; 277 (17): 15107–15112PubMedGoogle Scholar
  45. 45.
    Vabulas RM, Ahmad-Nejad P, da Costa C, et al. Endocytosed HSP60s use toll-like receptor 2 (TLR2) and TLR4 to activate the toll/interleukin-1 receptor signaling pathway in innate immune cells. J Biol Chem 2001 Aug 17; 276 (33): 31332–31339PubMedGoogle Scholar
  46. 46.
    Calandra T. Pathogenesis of septic shock: implications for prevention and treatment. J Chemother 2001 Nov; 13 Spec No 1 (1): 173–180PubMedGoogle Scholar
  47. 47.
    Child NJ, Yang I A, Pulletz MC, et al. Polymorphisms in toll-like receptor 4 and the systemic inflammatory response syndrome. Biochem Soc Trans 2003 Jun; 31 (Pt 3): 652–63PubMedGoogle Scholar
  48. 48.
    Yu BJ, Li JS, Zhang DL, et al. The associations of the single nucleotide polymorphisms on TNF and CD14 promoters with the mortality of infection, systematic inflammatory response syndromec and sepsis in surgical patients [in Chinese]. Zhonghua Yi Xue Za Zhi 2003 Dec 25; 83 (24): 2132–2136PubMedGoogle Scholar
  49. 49.
    Flynn MG, McFarlin BK, Phillips MD, et al. Toll-like receptor 4 and CD 14 mRNA expression are lower in resistive exercise-trained elderly women. J Appl Physiol 2003 Jun 27; 95 (5): 1833–1842PubMedGoogle Scholar
  50. 50.
    Calvano JE, Agnese DM, Um JY, et al. Modulation of the lipopolysaccharide receptor complex (CD 14, TLR4, MD-2) and toll-like receptor 2 in systemic inflammatory response syndrome-positive patients with and without infection: relationship to tolerance. Shock 2003 Nov; 20 (5): 415–419PubMedGoogle Scholar
  51. 51.
    Smith SL. Physical exercise as an oncology nursing intervention to enhance quality of life. Oncol Nurs Fomm 1996 Jun; 23 (5): 771–778Google Scholar
  52. 52.
    Steppich B, Dayyani F, Gruber R, et al. Selective mobilization of CD 14 (+)CD16 (+) monocytes by exercise. Am J Physiol Cell Physiol 2000 Sep; 279 (3): C578–C586PubMedGoogle Scholar
  53. 53.
    Clanton TL, Zuo L, Klawitter P. Oxidants and skeletal muscle function: physiologic and pathophysiologic implications. Proc Soc Exp Biol Med 1999; 222 (3): 253–262PubMedGoogle Scholar
  54. 54.
    Jansky L, Vybiral S. Thermal homeostasis in systemic inflammation: modulation of neuronal mechanisms. Front Biosci 2004 Sep 1; 9: 3068–3084PubMedGoogle Scholar
  55. 55.
    Brooks GA, Hittelman KJ, Faulkner JA, et al. Tissue temperatures and whole-animal oxygen consumption after exercise. Am J Physiol 1971; 221 (2): 427–431PubMedGoogle Scholar
  56. 56.
    Suzuki K, Nakaji S, Yamada M, et al. Systemic inflammatory response to exhaustive exercise. Cytokine kinetics. Exerc Immunol Rev 2002; 8: 6–48PubMedGoogle Scholar
  57. 57.
    Cavaillon JM, Adib-Conquy M, Fitting C, et al. Cytokine cascade in sepsis. Scand J Infect Dis 2003; 35 (9): 535–544PubMedGoogle Scholar
  58. 58.
    Plank LD, Hill GL. Sequential metabolic changes following induction of systemic inflammatory response in patients with severe sepsis or major blunt trauma. World J Surg 2000 Jun; 24 (6): 630–638PubMedGoogle Scholar
  59. 59.
    Ostrowski K, Hermann C, Bangash A, et al. A trauma-like elevation of plasma cytokines in humans in response to treadmill running. J Physiol 1998 Dec 15; 513 (Pt 3): 889–894PubMedGoogle Scholar
  60. 60.
    Mokart D, Merlin M, Sannini A, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth 2005 Jun; 94 (6): 767–773PubMedGoogle Scholar
  61. 61.
    Starkie RL, Rolland J, Angus DJ, et al. Circulating monocytes are not the source of elevations in plasma IL-6 and TNF-alpha levels after prolonged running. Am J Physiol Cell Physiol 2001 Apr; 280 (4): C769–C774PubMedGoogle Scholar
  62. 62.
    Ostrowski K, Rohde T, Asp S, et al. Pro- and anti-inflammatory cytokine balance in strenuous exercise in humans. J Physiol 1999 Feb 15; 515 (1): 287–291PubMedGoogle Scholar
  63. 63.
    Hirai S. Systemic inflammatory response syndrome after cardiac surgery under cardiopulmonary bypass. Ann Thorac Cardi-ovasc Surg 2003 Dec; 9 (6): 365–370Google Scholar
  64. 64.
    Simmons EM, Himmelfarb J, Sezer MT, et al. Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int 2004 Apr; 65 (4): 1357–1365PubMedGoogle Scholar
  65. 65.
    Barton BE. IL-6: insights into novel biological activities. Clin Immunol Immunopathol 1997 Oct; 85 (1): 16–20PubMedGoogle Scholar
  66. 66.
    Starkie R, Ostrowski SR, Jauffred S, et al. Exercise and IL-6 infusion inhibit endotoxin-induced TNF-alpha production in humans. FASEB J 2003 May; 17 (8): 884–886PubMedGoogle Scholar
  67. 67.
    Steensberg A, Fischer CP, Keller C, et al. IL-6 enhances plasma IL-lra, IL-10, and Cortisol in humans. Am J Physiol Endocrinol Metab 2003; 285 (2): E433–E437PubMedGoogle Scholar
  68. 68.
    Bethin KE, Vogt SK, Muglia LJ. Interleukin-6 is an essential, corticotropin-releasing hormone-independent stimulator of the adrenal axis during immune system activation. Proc Natl Acad Sci U S A 2000 Aug 1; 97 (16): 9317–9322PubMedGoogle Scholar
  69. 69.
    Bone RC. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med 1996 Jan; 24 (1): 163–172PubMedGoogle Scholar
  70. 70.
    Syk I, Mangell P, Bjartell A, et al. Systemic interleukin-6 response to colorectal surgery originates from the bowel. Dig Surg 2002; 1 (3): 210–215Google Scholar
  71. 71.
    O’Neill PJ, Ayala A, Wang P, et al. Role of Kupffer cells in interleukin-6 release following trauma-hemorrhage and resuscitation. Shock 1994 Jan; 1 (1): 43–47PubMedGoogle Scholar
  72. 72.
    Steensberg A. The role of IL-6 in exercise-induced immune changes and metabolism. Exerc Immunol Rev 2003; 9: 40–47PubMedGoogle Scholar
  73. 73.
    Pedersen BK, Steensberg A, Keller P, et al. Muscle-derived interleukin-6: lipolytic, anti-inflammatory and immune regulatory effects. Pflugers Arch 2003 Feb 18; 446 (1): 9–16PubMedGoogle Scholar
  74. 74.
    Febbraio MA, Steensberg A, Keller C, et al. Glucose ingestion attenuates interleukin-6 release from contracting skeletal muscle in humans. J Physiol 2003 Apr 17; 549 (2): 607–612PubMedGoogle Scholar
  75. 75.
    Zhou D, Kusnecov AW, Shurin MR, et al. Exposure to physical and psychological stressors elevates plasma interleukin 6: relationship to the activation of hypothalamic-pituitary-adrenal axis. Endocrinology 1993 Dec; 133 (6): 2523–2530PubMedGoogle Scholar
  76. 76.
    Toth B, Yokoyama Y, Schwacha MG, et al. Insights into the role of interleukin-6 in the induction of hepatic injury after trauma-hemorrhagic shock. J Appl Physiol 2004 Dec; 97 (6): 2184–2189PubMedGoogle Scholar
  77. 77.
    Beeton CA, Chatfield D, Brooks RA, et al. Circulating levels of interleukin-6 and its soluble receptor in patients with head injury and fracture. J Bone Joint Surg Br 2004 Aug; 86 (6): 912–917PubMedGoogle Scholar
  78. 78.
    Robson PJ. Elucidating the unexplained underperformance syndrome in endurance athletes: the interleukin-6 hypothesis. Sports Med 2003; 33 (10): 771–781PubMedGoogle Scholar
  79. 79.
    Ethuin F, Delarche C, Gougerot-Pocidalo MA, et al. Regulation of interleukin 12 p40 and p70 production by blood and alveolar phagocytes during severe sepsis. Lab Invest 2003 Sep; 83 (9): 1353–1360PubMedGoogle Scholar
  80. 80.
    Kolls JK, Linden A. Interleukin-17 family members and inflammation. Immunity 2004 Oct; 21 (4): 467–476PubMedGoogle Scholar
  81. 81.
    Chuang CC, Hung CJ, Tsai MC, et al. High concentrations of circulating macrophage migration inhibitory factor in patients with severe blunt trauma: is serum macrophage migration inhibitory factor concentration a valuable prognostic factor? Crit Care Med 2004 Mar; 32 (3): 734–739PubMedGoogle Scholar
  82. 82.
    Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med 2003 Jan 9; 348 (2): 138–150PubMedGoogle Scholar
  83. 83.
    Pedersen BK. Leukocytes. In: Mooren FC, Voelker K, editors. Molecular and cellular exercise physiology, 1st ed. Muenster: Human Kinetics, 2005: 321–329Google Scholar
  84. 84.
    Peake JM. Exercise-induced alterations in neutrophil degranulation and respiratory burst activity: possible mechanisms of action. Exerc Immunol Rev 2002; 8: 49–100PubMedGoogle Scholar
  85. 85.
    Ibfelt T, Petersen EW, Bruunsgaard H, et al. Exercise-induced change in type 1 cytokine-producing CD8+ T cells is related to a decrease in memory T cells. J Appl Physiol 2002 Aug; 93 (2): 645–648PubMedGoogle Scholar
  86. 86.
    Tvede N, Heilmann C, Halkjaer-Kristensen J, et al. Mechanisms of B-lymphocyte suppression induced by acute physical exercise. J Clin Lab Immunol 1989 Dec; 30 (4): 169–173PubMedGoogle Scholar
  87. 87.
    Nieman DC, Nehlsen Cannarella SL. The effects of acute and chronic exercise on immunoglobulins. Sports Med 1991; 11 (3): 183–201PubMedGoogle Scholar
  88. 88.
    Nielsen HB, Pedersen BK. Lymphocyte proliferation in response to exercise. Eur J Appl Physiol Occup Physiol 1997; 75 (5): 375–379PubMedGoogle Scholar
  89. 89.
    Field CJ, Gougeon R, Marliss EB. Circulating mononuclear cell numbers and function during intense exercise and recovery. J Appl Physiol 1991 Sep; 71 (3): 1089–1097PubMedGoogle Scholar
  90. 90.
    Hotchkiss RS, Tinsley KW, Swanson PE, et al. Sepsis-induced apoptosis causes progressive profound depletion of B and CD4+ T lymphocytes in humans. J Immunol 2001 Jun 1; 166 (11): 6952–6963PubMedGoogle Scholar
  91. 91.
    Bruunsgaard H, Pedersen M, Pedersen BK. Aging and proinflammatory cytokines. Curr Opin Hematol 2001 May; 8 (3): 131–136PubMedGoogle Scholar
  92. 92.
    Bruunsgaard H, Pedersen AN, Schroll M, et al. Impaired production of proinflammatory cytokines in response to lipo-polysaccharide (LPS) stimulation in elderly humans. Clin Exp Immunol 1999 Nov; 118 (2): 235–241PubMedGoogle Scholar
  93. 93.
    Bruunsgaard H, Pedersen BK. Age-related inflammatory cytokines and disease. Immunol Allergy Clin North Am 2003 Feb; 23 (1): 15–39PubMedGoogle Scholar
  94. 94.
    Pedersen BK, Ullum H. NK cell response to physical activity: possible mechanisms of action. Med Sci Sports Exerc 1994; 26 (2): 140–146PubMedGoogle Scholar
  95. 95.
    Rao DV, Watson K, Jones GL. Age-related attenuation in the expression of the major heat shock proteins in human peripheral lymphocytes. Mech Ageing Dev 1999 Feb 1; 107 (1): 105–118PubMedGoogle Scholar
  96. 96.
    Fehrenbach E, Passek F, Niess AM, et al. HSP expression in human leucocytes is modulated by endurance exercise. Med Sci Sports Exerc 2000 Mar; 32 (3): 592–600PubMedGoogle Scholar
  97. 97.
    Bercault N, Boulain T, Kuteifan K, et al. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med 2004 Apr; 32 (4): 998–1003PubMedGoogle Scholar
  98. 98.
    Fehrenbach E, Northoff H. Free radicals, exercise, apoptosis, and heat shock proteins. Exerc Immunol Rev 2001; 7: 66–89PubMedGoogle Scholar
  99. 99.
    Bochicchio GV, Napolitano LM, Joshi M, et al. Persistent systemic inflammatory response syndrome is predictive of nosocomial infection in trauma. J Trauma 2002 Aug; 53 (2): 245–250PubMedGoogle Scholar
  100. 100.
    Croce MA, Fabian TC, Malhotra AK, et al. Does gender difference influence outcome? J Trauma 2002 Nov; 53 (5): 889–894PubMedGoogle Scholar
  101. 101.
    Armstrong RB, Warren GL, Warren JA. Mechanisms of exercise-induced muscle fibre injury. Sports Med 1991 Sep; 12 (3): 184–207PubMedGoogle Scholar
  102. 102.
    Gibot S, Cariou A, Drouet L, et al. Association between a genomic polymorphism within the CD 14 locus and septic shock susceptibility and mortality rate. Crit Care Med 2002 May; 30 (5): 969–973PubMedGoogle Scholar
  103. 103.
    Schurmann M. Angiotensin-converting enzyme gene polymorphisms in patients with pulmonary sarcoidosis: impact on disease severity. Am J Pharmacogenomics 2003; 3 (4): 233–243PubMedGoogle Scholar
  104. 104.
    Heled Y, Moran DS, Mendel L, et al. Human ACE IFD polymorphism is associated with individual differences in exercise heat tolerance. J Appl Physiol 2004 Jul; 97 (1): 72–76PubMedGoogle Scholar
  105. 105.
    Brail DJ, Dhamrait S, Moulding R, et al. The effect of fibrinogen genotype on fibrinogen levels after strenuous physical exercise. Thromb Haemost 2002 Jan; 87 (1): 37–41Google Scholar
  106. 106.
    Texereau J, Pene F, Chiche JD, et al. Importance of hemostatic gene polymorphisms for susceptibility to and outcome of severe sepsis. Crit Care Med 2004 May; 32 (5 Suppl.): S313–S319PubMedGoogle Scholar
  107. 107.
    Orflepp JR, Metrikat J, Vesper K, et al. The interleukin-6 promoter polymorphism is associated with elevated leukocyte, lymphocyte, and monocyte counts and reduced physical fitness in young healthy smokers. J Mol Med 2003 Sep; 81 (9): 578–584Google Scholar
  108. 108.
    Bennermo M, Held C, Stemme S, et al. Genetic predisposition of the interleukin-6 response to inflammation: implications for a variety of major diseases? Clin Chem 2004 Nov; 50 (11): 2136–2140PubMedGoogle Scholar
  109. 109.
    Marik PE, Zaloga GP. Adrenal insufficiency in the critically ill: a new look at an old problem. Chest 2002 Nov; 122 (5): 1784–1796PubMedGoogle Scholar
  110. 110.
    Maisel AS, Harris T, Rearden CA, et al. Beta-adrenergic receptors in lymphocyte subsets after exercise: alterations in normal individuals and patients with congestive heart failure. Circulation 1990 Dec; 82 (6): 2003–2010PubMedGoogle Scholar
  111. 111.
    Mukae H, Zamfir D, English D, et al. Polymorphonuclear leukocytes released from the bone marrow by granulocyte colony-stimulating factor: intravascular behavior. Hematol J 2000; 1 (3): 159–171PubMedGoogle Scholar
  112. 112.
    Kim PK, Deutschman CS. Inflammatory responses and mediators. Surg Clin North Am 2000 Jun; 80 (3): 885–894PubMedGoogle Scholar
  113. 113.
    Brenner IK, Zamecnik J, Shek PN, et al. The impact of heat exposure and repeated exercise on circulating stress hormones. Eur J Appl Physiol 1997; 76 (5): 445–454Google Scholar
  114. 114.
    Licinio J, Wong ML. Interleukin 1 receptor antagonist gene expression in rat pituitary in the systemic inflammatory response syndrome: pathophysiological implications. Mol Psychiatry 1997 Mar; 2 (2): 99–103PubMedGoogle Scholar
  115. 115.
    Harte JL, Eifert GH, Smith R. The effects of running and meditation on beta-endorphin, corticotropin-releasing hormone and Cortisol in plasma, and on mood. Biol Psychol 1995 Jun; 40 (3): 251–265PubMedGoogle Scholar
  116. 116.
    Pierce EF, Pate DW. Mood alterations in older adults following acute exercise. Percept Mot Skills 1994 Aug; 7 (1 Pt 1): 191–194Google Scholar
  117. 117.
    McGowan RW, Pierce EF, Eastman N, et al. Beta-endorphins and mood states during resistance exercise. Percept Mot Skills 1993 Apr: 76 (2): 376–378PubMedGoogle Scholar
  118. 118.
    Anisman H, Hayley S, Turrin N, et al. Cytokines as a stressor: implications for depressive illness. Int J Neuropsychopharma-col 2002 Dec; 5 (4): 357–373Google Scholar
  119. 119.
    Yirmiya R, Pollak Y, Morag M, et al. Illness, cytokines, and depression. Ann N Y Acad Sci 2000; 917: 478–487PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Institute of Clinical and Experimental Transfusion MedicineUniversity of TuebingenTuebingenGermany
  2. 2.Department of Experimental AnesthesiologyUniversity of UlmUlmGermany

Personalised recommendations