Strategies for the reduction of exercise-based immunodepression

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Written by Thomas Steidten, Urs Granacher, Rico May, Holger Gabriel & Christian Puta

Background. It is well-accepted that exercise is medicine and produces a broad spectrum of health benefits. However, this accounts for moderate physical activity only, which matches individual resilience [1]. Long-lasting exhaustive endurance training causes temporary immunodepression [2]. Recent studies indicated that this effect also occurs after resistance training [1]. Therefore, evidence-based strategies are needed to effectively counteract immunodepression following exercise.

Answer. Immunodepression can be reducecd through interventions before, during and after exercise. Evidence-based means are the ingestion of carbohydrates [3] and omega-3 polyunsaturated fatty acids [4]. There is additional evidence for a positive effect of branched-chain amino acids (BCAAs), probiotica , vitamin D, and sufficient sleep [3, 4]. However, due to a void in the literature, no valid recommendations on the respective doses can be provided. With reference to the relevant literature [3, 4] effects of a high dose of protein (>2g/kg), antioxidants, the application of compression garments, massages, cold water immersions, non-steroidal anti-inflammatory drugs as well as the intake of zinc, magnesium and iron above the recommended daily dose are neglectable and do not have a clear effect on immunodepression.

Recommendations.

Figure 1 summarizes the following recommendations.

Figure 1. Carbohydrate intake over the training day [3, 4]

• We postulate that a low-carb diet immediately before or after exercise results in improved immunodepression after intensive resistance training. Therefore, a low-carb diet is not recommended during phases of intensive training [5].
• The daily intake of carbohydrates should be 6–10g/kg for up to 3h training or 8–12g/kg for more than 4h training [5].
• 3–4g/kg low fibre carbohydrates should be taken with lots of apple spritzer (pasteurized apple juice + water 1:1 up to 3:7 + pinch of salt) 2–4h in advance of the training [5].
• 5–30 min. before the training,1g/kg carbohydrates (energy bars, brown bread) should be ingested. Due to the risk of diarrhea, no fruits should be eaten [5].
• During the training, up to 60g/kg carbohydrates can be supplemented [4] through energy bars or gels (40g gel with 500 ml water) and 1l apple spritzer per hour [5].
• After the training, 1g/kg/h carbohydrates an 1l /h apple spritzer should be ingested for the next 4h. During the 1st hour, the carbohydrates should have a high glycaemic index [5].
• Fatty acids should consist of primarily omega-3 polyunsaturated fatty acids [4] which are rich in cold water fishes (salmon, mackerel, herring), canola oil and flaxseed oil [5].

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References.

[1] Puta, C., Weber, S., May, R., Steidten, T., Hildebrandt, P., Gabriel, B., Lesinski, M., Kellmann, M., Granacher, U. & Gabriel, H. (2016). Immun-Score. Entwicklung eines benutzerfreundlichen Instruments zur standardisierten Erfassung von Symptomen für die Differenzierung von belastungsinduzierter und infektbasierter Stressreaktion im Nachwuchsleistungssport. Leistungssport, 46(6), 15–18.

[2] Puta, C., Gabriel, B. & Gabriel, H. (2017). Sport und Immunsystem. In: Wonisch, M., Hofmann, P., Förster, H., Hörtnagl, H., Ledl-Kurkowski, E. & Pokan, R. (Hrsg.). Kompendium der Sportmedizin, 389–415.

[3] Peake, J. M., Neubauer, O., Walsh, N. P. & Simpson, R. J. (2017). Recovery of the immune system after exercise. Journal of Applied Physiology, 122(5), 1077–1087.

[4] Bermon, S., Castell, L. M., Calder, P. C., Bishop, N. C. et al. (2017). Consensus statement immunonutrition and exercise. Exercise Immunology Review, 23, 8–50.

[5] Lamprecht, M. (2017). Ernährung. In: Wonisch, M., Hofmann, P., Förster, H., Hörtnagl, H., Ledl-Kurkowski, E. & Pokan, R. (Hrsg.). Kompendium der Sportmedizin, 313–386.