Overtraining, Excessive Exercise, and Altered Immunity

Is This a T Helper-1 Versus T Helper-2 Lymphocyte Response?

Abstract

Overtraining syndrome (OTS) occurs where an athlete is training vigorously, yet performance deteriorates. One sign of OTS is suppressed immune function, with an increased incidence of upper respiratory tract infection (URTI). An increased incidence of URTIs is also associated with high volume/intensity training, as well as with excessive exercise (EE), such as a marathon, manifesting between 3–72 hours post-race. Presently, there is no encompassing theory to explain EE and altered immune competence. Recently, it has been conclusively established that T helper lymphocytes (TH), a crucial aspect of immune function, represent two distinct functional subsets: TH1 and TH2 lymphocytes. TH1 lymphocytes are associated with cell-mediated immunity (CMI) and the killing of intracellular pathogens, while TH2 lymphocytes are associated with humoral immunity and antibody production. When TH-precursor cells are activated, the balance is tipped in favour of one or the other. Furthermore, the most appropriate means of determining the TH-subset, is by the prevailing cytokine ‘pattern’. This paper hypothesises that exercise-related immunosuppression is due to tissue trauma sustained during intense exercise, producing cytokines, which drive the development of a TH2 lymphocyte profile. A TH2 cell response results in simultaneous suppression of CMI, rendering the athlete susceptible to infection. Additionally, increased levels of circulating stress hormones (cortisol and catecholamines), as well as prostaglandin E2, support up-regulation of TH2 lymphocytes. Marathon-related data are presented to support this hypothesis. It is concluded that an increased incidence of illness associated with OTS and in response to EE is not due to immunosuppression per se, but rather to an altered focus of immune function, with an up-regulation of humoral immunity and suppression of CMI.

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Acknowledgements

My appreciation to Dr Nicolas Terrados, School of Sports Medicine, University of Oviedo, Spain, for ‘encouraging’ me to focus on this area of research. I would like to acknowledge the following individuals: Joe Houmard, Ph.D., East Carolina University, and Andrew McKune, M.Sc. Technikon Pretoria, for editorial suggestions; Don Holbert, Ph.D. for assistance in statistical analyses; and Selma Krause, Publication and Design Services, Technikon Pretoria for Art Work. I would like to thank the Procter and Gamble Company for funding the cost of the ELISAs used to measure the cytokines reported in this paper. Thanks to David Nieman, Dr PH, the principal investigator in the marathon study reported in this article, as well as to Dru Henson, Ph.D., and Karen Person, Appalachina State University, for assistance in the measurement of cytokines. The author has no conflicts of interest that are directly relevant to the content of this manuscript.

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Correspondence to Lucille Lakier Smith.

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Smith, L.L. Overtraining, Excessive Exercise, and Altered Immunity. Sports Med 33, 347–364 (2003). https://doi.org/10.2165/00007256-200333050-00002

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Keywords

  • Natural Killer Cell
  • PGE2
  • Cell Mediate Immunity
  • Humoral Immunity
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