(Not important) Effects of acute and chronic exercise on chronic inflammatory disease

[Dolphin]

I just read the following. I have difficulty remembering the abnormalities that have been found in ME/CFS so I wasn't particularly on the look out for specific abnormalities that are similar to ME/CFS. But I was making notes for myself and thought I might as well share them. Other people may have other observations (but I'm not saying it's the most important paper for people with ME/CFS to read).

Full free text at:http://www.medizin.uni-tuebingen.de/transfusionsmedizin/institut/eir/content/2009/6/article.pdf

The effects of acute and chronic exercise on inflammatory markers in children and adults with a chronic inflammatory disease: a systematic review.

Exerc Immunol Rev. 2009;15:6-41.

Ploeger HE, Takken T, de Greef MH, Timmons BW.

Institute of Human Movement Sciences, University of Groningen, Groningen, The Netherlands.

Abstract
BACKGROUND: Chronic inflammatory diseases strike millions of people all over the world, and exercise is often prescribed for these patients to improve overall fitness and quality of life. In healthy individuals, acute and chronic exercise is known to alter inflammatory markers; however, less is known about these effects in patients with a chronic inflammatory disease.

OBJECTIVE: The purpose of this review is to clearly define the effects of acute and chronic exercise on inflammatory markers in patients compared with healthy controls to determine whether exercise elicits an abnormal inflammatory response in those patients.

DATA SOURCES: A literature search was conducted through MEDLINE and EMBASE (until January 2009).

STUDY SELECTION: A distinction was made between children and adults, acute (i.e., single exercise session) and chronic exercise (i.e., training) and endurance and resistance exercise. To evaluate and compare the exercise responsiveness of various reported inflammatory markers, pre- to post-test effect sizes were calculated.

DATA EXTRACTION: A methodological quality scoring as well as an assessment of the quality of exercise paradigms were both made.

RESULTS: In total, 19 studies were included in this systematic review (children, n=7; adults, n=12). Of these, 7 were acute exercise studies in children, 8 were acute exercise in adults, 5 were chronic endurance exercise training studies, and I was a chronic resistance exercise training study. No exercise training studies were found involving children. Single bouts of exercise might elicit an aggravated inflammatory response in patients; this was reported for patients with type I diabetes mellitus, cystic fibrosis and chronic obstructive pulmonary disease. More severely affected patients may experience a more aggravated inflammatory response. Levels ofinflammatory markers, principally IL-6 but also T-cells, total leukocytes and lymphocytes, remained elevated longer into the recovery period following an acute bout of exercise in patients compared with healthy controls. Evidence was found that chronic endurance exercise training programs can attenuate systemic inflammation in patients with chronic heart failure and type 2 diabetes mellitus.

CONCLUSIONS: In patients with a chronic inflammatory disease, both acute and chronic exercise might elicit different inflammatory responses (i.e., exaggerated after acute exercise & attenuated after training) compared to healthy matched controls. However, the results reveal a major gap in our knowledge regarding the effects of acute and chronic exercise on inflammatory markers in patients with a chronic inflammatory disease. Results are often inconsistent, and differences in training programs (intensity, frequency and duration), heterogeneity of disease populations studied, and analytic methods may be just some of the causes for these discrepancies. To optimize exercise prescriptions and recommendations for patients with a chronic inflammatory disease, more research is needed to define the nature of physical activity that confers health benefits without exacerbating underlying inflammatory stress associated with disease pathology.

PMID: 19957870 [PubMed - indexed for MEDLINE]

 

[Dolphin]

(Not important) Some quotes from the Introduction

I would think it would be interesting to see the effects of exercise training in ME/CFS.
For example, can it increase inflammation and is this what causes relapses when relapses occur from exercise.

[T]he main objective in treating patients with an inflammatory disease is to suppress inflammation and deal with secondary consequences in order to improve the quality of life.

Extreme exercise such as marathons, and frequently executed training programs have been associated with a depression in immune function (36), which may increase the elite athletes susceptibility to infection.

It is therefore clear that acute bouts of exercise exert various effects on the immune system and are typically transient in nature [in healthy people]. The extent to which these changes occur in patients with a chronic inflammatory disease is important to address to ensure that exercise is performed in a safe manner where inflammation is not being further amplified.

However, as in acute bouts of exercise, the effect of training on inflammatory markers also seems to dependent on the intensity of exercise, training status, age and involvement of disorders (36).

During childhood, the immune system is subject to developmental changes due to maturation and increased antigenic experience. At the other end of life, aging also impacts the immune system. For example, plasma levels of TNF-α, IL-6, IL-1ra, sTNF-r and CRP have all been shown to increase with aging (22). While exercise in children and older adults generally impacts the same types of cells and cytokines, the responsiveness of inflammatory parameters can be different (16, 71, 89). In children, acute exercise brings about an increase in leukocytes, lymphocytes, NK cells, IL-6, TNF-α, IL-1β, IL-1ra and lymphocyte expression of CD95 (14, 61, 76, 90). Chronic exercise on the other hand has been shown to increase resting levels of TNF-α and IL-1β in children (77, 83).

There is also accumulating evidence for a gender-related difference in immune
changes with exercise. For example, a greater exercise-induced response of total
leukocyte, lymphocyte and NK cell counts in adolescent girls compared to adolescent
boys (95). Moreover, the female cycle plays an important role on immunological
effects of exercise. Distinctly different patterns are found between women
(specifically contraceptive users) and men and women in their luteal phase compared
to women in their follicular phase, both under resting conditions and in
response to exercise (91, 65). In the luteal phase, the concentration of leukocyte
and lymphocyte subsets tend to be higher at rest and also after exercise, a statistically
significant different pattern of gene regulation is found, with particularly an
up regulation of pro-inflammatory genes for non contraceptive using woman
compared to both men and women in their follicular phase (65). Given these documented
differences in the effects of exercise on immune responses according to
age and gender, it is important to consider these factors when investigating
immune responsiveness to exercise performed by patients with a chronic inflammatory
disease. If exercise is to be used clinically, for example, it might be necessary
to individualize prescription according to age and gender.

(We're a long way from anything like that in ME/CFS)

In light of our expansive knowledge about the effects of exercise on immune
function and cytokines in healthy individuals, it is unfortunate that more attention
has not been given to patients with a chronic inflammatory disease in whom
inflammation is, to some extent, dysregulated.

We believe that safe and effective exercise is that which confers the benefits of being active (improved fitness, muscle strength) without exacerbating underlying inflammation associated with the
disease pathology. Understanding this balance is necessary to provide an evidence- based approach to exercise prescription for individuals with a chronic inflammatory disease.

 

[Dolphin]

Discussion and Future Research

(I'm not going to try to summarise the methods and results section)

We believe that safe and effective exercise is that which confers the benefits
of being active (improved fitness, muscle strength) without exacerbating underlying
inflammation associated with the disease pathology. Therefore, the purpose of
this systematic review was to investigate the effects of both acute and chronic
(i.e., training) exercise on systemic inflammation in patients with various inflammatory
diseases compared with healthy controls.

Overview of Evidence for Acute Exercise

Another marked finding is that five out of eleven studies (both children and adults studies) which performed a second post recovery measurement after an acute bout of exercise, found that the patients’ level of inflammatory markers (principally IL-
6, and T-cells, total leukocytes and lymphocytes as well) remained significantly
elevated while levels of control subjects already had returned to baseline values
(13, 30, 48, 97, 99).

The clinical consequences or relevance of the exaggerated immune responses
after acute bouts of exercise in chronic inflammatory disease are not clear.

Overview of Evidence for Chronic Exercise

An emerging theme from this systematic review is that exercise training effects
found for a particular inflammatory disease are not necessarily generalizable to
other inflammatory diseases.

FUTURE RESEARCH

Future studies should use blinded-observers to analyze samples. Furthermore,
they should describe the dropout rate, if any, and missing data. The quality
of reporting can be improved with a better description of the nature of the acute or
chronic exercise stimulus (in terms of frequency, intensity, time and type of exercise)
and how the amount of work performed between patients and controls was
standardized.

Missing from most of the literature is a longer followup
time and the extent to which training-induced changes in inflammatory markers
might be related to clinical status or disease severity. Information on these
issues should help individualize exercise prescription and recommendations.

Whether exercise training can alleviate the acute inflammatory response to a single bout of exercise in some patients remains an open question. Only one study investigated this topic, but did not demonstrate an effect of training on the acute response (73).

We propose that future research should be focused on the frequency, intensity
and duration of exercise that can be safe (i.e., does not exacerbate underlying
inflammation) and effective (i.e., improves fitness and quality of life, promotes
growth (in children)) for individuals with a chronic inflammatory disease.

It appears that training programs can attenuate chronic
inflammation in some of these patients; however, single bouts of exercise might
elicit an aggravated inflammatory response. The exercise training-induced
response appears highly dependent on the type of disease, severity of the disease and the frequency, duration and intensity of the exercise intervention. This review highlighted a number of strengths and weaknesses of the studies analyzed and will serve to design future studies in this field. Results of this review reveal a major gap in our knowledge regarding the evidence for safe but effective exercise for patients with a chronic inflammatory disease.

 

[Esther12]

Interesting. Differences over the hormonal cycle can make activity management really confusing.

Not surprising that these sorts of complexities are explored in work unrelated to CFS. Thanks for looking through it for us.