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British Medical Bulletin Advance Access originally published online on March 31, 2009
British Medical Bulletin 2009 90(1):111-131; doi:10.1093/bmb/ldp010
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Does exercise increase the risk of upper respiratory tract infections?

André Moreira{dagger},{ddagger},*, Luís Delgado{dagger}, Pedro Moreira and Tari Haahtela§

{dagger} Department of Immunology, Faculty of Medicine, University of Porto, Porto, Portugal
{ddagger} Immuno-allergology, Hospital of São João, Porto, Portugal
Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
§ Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland

* Correspondence to: A. Moreira, Department of Immunology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4202 Porto, Portugal. andremoreira{at}med.up.pt/amasm{at}amed.up.pt

Introduction or background: Heavy exercise induces marked immunodepression, which is multifactorial in origin. Evidence showing clinical significance of this immunodepression is scarce.

Sources of data: We assessed in a systematic manner whether physical activity or intensity of exercise increase susceptibility to upper respiratory tract infections (URTI). A literature search was performed using the keywords ‘upper respiratory tract infections’, ‘athletes’, ‘exercise’ and ‘physical activity’. We considered all studies reporting of the effect of exercise, physical activity, sport and training on susceptibility to URTI. A total of 162 publications were identified and 30 studies were eligible (4 descriptive, 18 observational and 8 interventional). The 30 studies included 8595 athletes (5471 runners, 2803 swimmers) and 1798 non-athletes.

Areas of agreement: Moderate activity may enhance immune function, whereas prolonged, high-intensity exercise temporarily impairs the immune competence. Athletes, when compared with lesser active individuals, experience higher rate of URTI after training and competitions. In non-athletes, increasing physical activity is associated with a decreased risk of URTI.

Areas of controversy: The relationship between exercise and URTI is affected by poorly known individual determinants such as genetic factors, fitness, nutritional status or atopy. Elite athletes may have a decreased susceptibility to URTI.

Growing points and areas timely for developing research: The dose–response relationship between immunodepression and risk for URTI during the weeks following heavy exercise. What are the clinically relevant methods to assess exercise-induced immunodepression? Is down-regulation of immunity after intense exercise a protective response to limit inflammation? Is there a role for nutritional or pharmaceutical interventions to reduce risk of URTI?

Keywords: athletes • exercise • immunosuppression • respiratory tract infections • sports

Accepted for publication March 7, 2009.


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