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Jaeger E, Maurer DJ, Wallimann A, Kistler W, Villiger B, Agache I, Jutel M, Nadeau K, Rukhadze M, Bonini M, Price OJ, Akdis CA, Villiger M. Immunity, Inflammation and Airway Dysfunction in Elite Cross-Country Skiers and Ice Hockey Players: A Systematic Review. Scand J Med Sci Sports 2025; 35:e70046. [PMID: 40223161 PMCID: PMC11994846 DOI: 10.1111/sms.70046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Revised: 03/24/2025] [Accepted: 03/24/2025] [Indexed: 04/15/2025]
Abstract
Strenuous exercise in elite sports impacts the immune system, leading to high rates of upper respiratory tract infections and airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB). Cross-country (XC) skiers and ice hockey (IH) players are particularly affected due to their training environments and sports disciplines. This systematic review (SR) evaluates immune and inflammatory responses and the risk of developing airway dysfunction in these athletes. Original articles focusing on immune response, systemic inflammation, and airway dysfunction in competitive XC skiers and IH players were retrieved from MEDLINE/Ovid, EMBASE, and the Cochrane Library. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Of 3582 studies screened, 50 met the inclusion criteria. Both elite XC skiers and IH players exhibit increased cortisol levels and altered systemic immune cell compositions in response to training and competition. Both groups show neutrophilic or mixed neutrophilic/eosinophilic airway inflammation, in contrast to the primarily eosinophilic inflammation associated with allergic asthma. Both XC skiers (27%) and IH players (14%) had a high prevalence of physician-diagnosed asthma. This SR highlights the notable burden of airway dysfunction in elite winter athletes, with elevated rates of asthma and EIB. The observed inflammatory patterns support the concept of a "sport asthma" endotype, which may be a result of chronic exposure to cold, dry air. Effective management may benefit from refined diagnostic criteria, the identification of specific biomarkers, and tailored prevention and treatment strategies for asthma and EIB.
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Affiliation(s)
- Eva Jaeger
- Swiss Research Institute for Sports Medicine (SRISM)DavosSwitzerland
- Department of Sports MedicineHospital DavosDavosSwitzerland
| | - Debbie J. Maurer
- Swiss Research Institute for Sports Medicine (SRISM)DavosSwitzerland
| | - Alexandra Wallimann
- Swiss Research Institute for Sports Medicine (SRISM)DavosSwitzerland
- Christine Kühne – Center for Allergy Research and Education (CK‐CARE)DavosSwitzerland
| | - Walter Kistler
- Swiss Research Institute for Sports Medicine (SRISM)DavosSwitzerland
- Department of Sports MedicineHospital DavosDavosSwitzerland
- Medical Committee International Ice Hockey Federation (IIHF)ZürichSwitzerland
| | - Beat Villiger
- Swiss Research Institute for Sports Medicine (SRISM)DavosSwitzerland
- Swiss Olympic Medical Center and Clinic Bad RagazBad RagazSwitzerland
| | - Ioana Agache
- Faculty of MedicineTransylvania UniversityBrasovRomania
| | - Marek Jutel
- Department of Clinical ImmunologyFaculty of Medicine of Wroclaw Medical UniversityWroclawPoland
- ALL‐MED Medical Research InstituteWroclawPoland
| | - Kari Nadeau
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Division of Allergy and Inflammation, Department of MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Maia Rukhadze
- Center of Allergy & Immunology, TbilisiGeorgia Teaching University Geomedi LLCTbilisiGeorgia
| | - Matteo Bonini
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
- National Heart and Lung Institute – NHLIImperial College LondonLondonUK
| | - Oliver J. Price
- School of Biomedical Sciences, Faculty of Biological SciencesUniversity of LeedsLeedsUK
| | - Cezmi A. Akdis
- Swiss Research Institute for Sports Medicine (SRISM)DavosSwitzerland
- Swiss Institute of Allergy and Asthma Research (SIAF)Davos, University of ZurichZürichSwitzerland
| | - Michael Villiger
- Swiss Research Institute for Sports Medicine (SRISM)DavosSwitzerland
- Department of Sports MedicineHospital DavosDavosSwitzerland
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Drummond LR, Campos HO, Drummond FR, de Oliveira GM, Fernandes JGRP, Amorim RP, da Costa Monteiro M, Lara HFG, Leite LHR, Coimbra CC. Acute and chronic effects of physical exercise on IgA and IgG levels and susceptibility to upper respiratory tract infections: a systematic review and meta-analysis. Pflugers Arch 2022; 474:1221-1248. [PMID: 36251066 PMCID: PMC9574171 DOI: 10.1007/s00424-022-02760-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 10/26/2022]
Abstract
This systematic review and meta-analysis aimed at evaluating acute and chronic effects of physical exercise on IgA and IgG levels, as well as its relationship with the susceptibility to develop upper respiratory tract infections (URTI). This systematic review and meta-analysis was conducted and reported in accordance with PRISMA statement. A systematic search of PubMed, Web of Science, and EMBASE was performed in July 2020. This systematic review and meta-analysis included studies in which participants performed acute exercise or chronic physical training and were subjected to analyses of URTI incidence and concentrations of IgA and IgG. The selected studies for systematic review were divided into the following three groups: (I) trials that evaluated the effects of acute exercise in sedentary subjects, (II) trials that evaluated the effects of acute exercise in athletes/trained individuals, and (III) trials that evaluated the effects of chronic physical training on the incidence of URTI, as well as on the levels of IgA and IgG. Acute exercise increases the IgA levels in trained subjects but does not affect its levels in untrained subjects. Such increase in IgA levels induced by acute exercise is greater in trained individual that performed ultramarathon. On the other hand, chronic physical training reduces IgA levels in both trained and untrained subjects, does not change IgA levels in non-military subjects, besides from not affecting IgG levels. The present systematic review and meta-analysis indicates that acute exercise positively influences IgA levels in trained individuals, being this effect pronounced when a strenuous exercise such as ultramarathon is executed. Chronic physical training, in turn, does not affect IgG levels.
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Affiliation(s)
- Lucas Rios Drummond
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. .,Departamento de Educação Física, Universidade do Estado de Minas Gerais - Unidade Divinópolis, Av. Paraná, 3001 - Jardim Belvedere I, Divinópolis, MG, Brazil.
| | - Helton Oliveira Campos
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Departamento de Ciências Biológicas, Universidade do Estado de Minas Gerais - Unidade Carangola, Carangola, MG, Brazil
| | - Filipe Rios Drummond
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gabriel Moraes de Oliveira
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - João Guilhermo Rios Pimenta Fernandes
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rodrigo Prates Amorim
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Mateus da Costa Monteiro
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Henrique Fernandes Gerspacher Lara
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Laura Hora Rios Leite
- Departamento de Fisiologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Cândido Celso Coimbra
- Laboratório de Endocrinologia E Metabolismo, Departamento de Fisiologia E Biofísica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Cai Z. EFFECT OF REGULAR PHYSICAL EXERCISE ON HUMAN IMMUNITY. REV BRAS MED ESPORTE 2022. [DOI: 10.1590/1517-8692202228032021_0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: A suitable combination of physical exercise and nutrition can effectively improve the body’s immunity and function. It has a positive effect and value on the healthy development of the body. Objective: To compare the immune function of athletes and non-athletes. We study the immune effect of spleen gland peptides on athletes. Methods: This study used different exercise methods, intensities, durations, and evaluated the effect of spleen peptide on the immune function of the body. Results: Physical exercise can improve human immunity. The spleen peptide directly exerts a positive two-way regulation effect on the immune function of athletes after intense and stressful exercise. Conclusion: The oral administration of spleen aminopeptidase enhances the athlete’s body fluid and cellular immune function and effectively reduces the infection rate of the athlete’s respiratory tract. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Sellami M, Bragazzi NL, Aboghaba B, Elrayess MA. The Impact of Acute and Chronic Exercise on Immunoglobulins and Cytokines in Elderly: Insights From a Critical Review of the Literature. Front Immunol 2021; 12:631873. [PMID: 33936044 PMCID: PMC8079972 DOI: 10.3389/fimmu.2021.631873] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
The level of immunoglobulins and cytokines changes with an ageing immune system. This review summarizes findings from studies that have examined the impact of acute and chronic exercise on immunoglobulins and cytokines in the elderly. Our literature analysis revealed that acute endurance exercise resulted in increased secretory salivary immunoglobulin A (SIgA), while acute bouts of muscle strengthening exercise (i.e., isokinetic, eccentric, knee extensor exercise) increased plasma/muscle interleukin (IL)-6, IL-8 and tumor necrosis factor alpha (TNF-α) levels. Chronic exercise in the form of short-term endurance training (i.e., 12-16 weeks) and long-term combined endurance and resistance training (i.e., 6-12 months) induced increases in salivary SIgA concentration. We additionally identified that short-term endurance training at moderate intensities and the combination of endurance, strength, balance, and flexibility training increase plasma IL-10 and reduce plasma IL-6 and TNF-α in healthy elderly adults and male patients with chronic heart failure. Strength training for 6-12 weeks did not alter plasma IL-1β, IL-2, IL-6 and TNF-α concentration in healthy elderly adults and patients with chronic-degenerative diseases, while 12 weeks of resistance training decreased muscle TNF-α mRNA in frail elderly individuals. Short-term (i.e., 10-24 weeks) moderate- to high-intensity strength training reduced LPS-IL-6, LPS, IL-1β, LPS-TNF-α and circulating concentrations of TNF-α and increased IL-10 in healthy elderly women and older people with cognitive impairment, respectively. In conclusion, it appears that acute bouts of endurance exercise and short-term chronic exercise training exercise are appropriate methods to enhance mucosal immune function, reduce systemic markers of inflammation, and promote anti-inflammatory processes in elderly individuals.
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Affiliation(s)
- Maha Sellami
- Physical Education Department (PE), College of Education, Qatar University, Doha, Qatar
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy
| | - Baha Aboghaba
- Program of Exercise Science, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Rico-González M, Clemente FM, Oliveira R, Bustamante-Hernández N, Pino-Ortega J. Part I: Relationship among Training Load Management, Salivary Immunoglobulin A, and Upper Respiratory Tract Infection in Team Sport: A Systematic Review. Healthcare (Basel) 2021; 9:366. [PMID: 33805186 PMCID: PMC8064383 DOI: 10.3390/healthcare9040366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 01/25/2023] Open
Abstract
Immunoglobulin A (IgA), which is the first line of defense against upper respiratory tract viruses, has been related with training load management. This article aimed to systematically identify and summarize (1) the studies that have found a relationship between training load and salivary IgA in team sports, and (2) the studies that have highlighted a relationship between IgA and upper respiratory tract infection (URTI) in team sports. A systematic review of relevant articles was carried out using two electronic databases (PubMed and WoK) until 3 October 2020. From a total of 174 studies initially found, 24 were included in the qualitative synthesis. This systematic review confirmed that lower values of IgA occurred after greater training load (intensity/volume) and congested periods. In this scenario, a low level of IgA was correlated with higher URTI, which makes training load management mandatory to healthcare avoiding immunosuppression. Therefore, physical fitness and conditioning coaches should carefully manage training load progression, avoiding high-intensity sessions in two consecutive days. In addition, they should not program high-intensity training sessions during at least the two days following competition.
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Affiliation(s)
- Markel Rico-González
- Department of Physical Education and Sport, University of the Basque Country (UPV-EHU), 01007 Vitoria-Gasteiz, Spain
- BIOVETMED & SPORTSCI Research Group, University of Murcia, 30720 San Javier, Spain;
| | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, 4900-347 Viana do Castelo, Portugal;
- Instituto de Telecomunicações, Delegação da Covilhã, 1049-001 Lisboa, Portugal
| | - Rafael Oliveira
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, 2140-413 Rio Maior, Portugal;
- Research Centre in Sport Sciences, Health Sciences and Human Development, 5001-801 Vila Real, Portugal
- Life Quality Research Centre, 2140-413 Rio Maior, Portugal
| | - Naia Bustamante-Hernández
- Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain;
| | - José Pino-Ortega
- BIOVETMED & SPORTSCI Research Group, University of Murcia, 30720 San Javier, Spain;
- Faculty of Sports Sciences, University of Murcia, 30720 San Javier, Spain
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Turner SEG, Loosemore M, Shah A, Kelleher P, Hull JH. Salivary IgA as a Potential Biomarker in the Evaluation of Respiratory Tract Infection Risk in Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:151-159. [PMID: 32781048 DOI: 10.1016/j.jaip.2020.07.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/07/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022]
Abstract
In recent years, there has been attention focused on the value of salivary IgA (sIgA) as a potential biomarker for the identification of athletes who may be at increased risk of developing respiratory tract infection (RTI). The utility of sIgA, in this context, is based on biological plausibility and several observational studies revealing an apparent association between sIgA and RTI susceptibility. The overall published evidence evaluating the value of sIgA in this context is however conflicting, and there is currently a lack of clear guidance as to whether this marker has a place in the health surveillance and care of athletes. In this review, we critically appraise the literature assessing the potential for sIgA to be used in this context, evaluating it against 4 key biomarker characteristics, including its (1) practicality, (2) reproducibility, (3) specificity/sensitivity, and (4) potential clinical impact and relevance. This process reveals that although there is an apparent association between respiratory illness and sIgA in many studies, with some promising results, overall there remains a paucity of evidence supporting its overall value in this context. Key deficiencies in the metrics employed to endorse a valid biomarker are apparent, including a lack of reproducibility and low specificity and sensitivity in the detection of RTI susceptibility. The review outlines these issues and makes future recommendations.
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Affiliation(s)
- Scarlett E G Turner
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Mike Loosemore
- Institute of Sport Exercise and Health, University College Hospital London, London, United Kingdom; Athlete Health, English Institute of Sport, Manchester, United Kingdom
| | - Anand Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter Kelleher
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Department of Infectious Disease, Imperial College London, London, United Kingdom; Infection and Immunity, Imperial College NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Institute of Sport Exercise and Health, University College Hospital London, London, United Kingdom; Athlete Health, English Institute of Sport, Manchester, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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Changes in Renal Parameters during a Training Camp among Handball Players in the Sub-Saharan Environment. JOURNAL OF SPORTS MEDICINE 2020; 2020:6031763. [PMID: 32149151 PMCID: PMC7054788 DOI: 10.1155/2020/6031763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/17/2019] [Accepted: 01/22/2020] [Indexed: 11/17/2022]
Abstract
The aim of the study was to describe the changes in kidney parameters induced by 10 days of tapering (TP) during a training camp (TC), where the players were preparing for a group competition, in 15 female handball team members of a Division 1 Amateur of Benin, in the sub-Saharan environment. Measures were taken in all the players before and after the intensive training (IT) and tapering (TP) phases in an intervention study. The estimated glomerular filtration rate (eGFR) with the CKD-EPI 4-level race formula, the fractional excretions of sodium (FeNa) and potassium (FeK), the urine potassium-to-sodium ratio (Na/K urine), and the hemoglobin rate [Hb] were determined for all participants. At the end of IT, eGFR and FeNa increased, respectively, by 22.39% (P < 0.01) and 143.85% (P < 0.01), but the variation of FeK is not significant (P > 0.05). The number of abnormally low eGFR values (<90 mL/min/1.73 m2) was reduced from 11 to 5 (P < 0.05). At the end of TP, the eGFR and urine Na-to-K ratio remained on average constant (P > 0.05) but FeNa decreased by 96.32% (P < 0.001) and FeK increased by 144.41% (P < 0.001). The [Hb] rate increased by 9.80% (P < 0.001), and players had inadequate hydration practice. The results suggested that in addition to its already known effects, TP preserves the positive effects of IT on glomerular function in athletes preparing for a competition that presents a major challenge.
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