Friday, March 27, 2009

Is Too Much Exercise Bad For You?

My sister writes for Scientific Blogging and wrote this post back in November but it's too intriguing not to respond:

She writes,

"There are a few things that are a given when it comes to understanding the human body. Long periods of stress are bad. We all know this. Stress from relationships, work or other causes are bad for us. We get less sleep, eat worse and we get sick more often. We also know that exercise is good for us. This is also a given.When we exercise, our hearts get stronger, our muscles get more efficient, our metabolism is balanced and we protect ourselves from complications like high cholesterol, high blood pressure, heart disease and diabetes. But these two assumptions are contradictory. When we imagine chronic stress it is always psychological stress, but that is not the only kind. Physical stress also triggers release of corticosteroids (our family of stress reducing hormones). Therefore, can exercise actually impair our immune function?

The answer is not just a simple yes or no, and requires some careful evaluations. The immune system is made up of many types of cells and supporting systems, all which have complex relationships to other signals, such as hormones acting within the body. Research tells us that regular moderate exercise is not only good for our muscles and hearts, but also for our immune systems. But can you have too much of a good thing and exercise to the point of immune suppression?

My sister is one of the most athletic people that I have ever met. She rejoices at a chance to do a “century ride” where she and a group of other likewise insane people take their bikes on Amtrak up to around Irvine, California and bike 100 miles back down to San Diego, CA. As someone who regards exercise as a necessary evil, it gets kind of irritating when she tries to get me to go on a “ short run” with her at 8:00 AM during Christmas vacation. To date, she has completed an Iron Man, a half Iron Man, a full marathon and countless other races, rides, swims and other combinations of the three.

Taking to heart the research on exercise (of which she does plenty), you would think that she would have the immune system of a brick wall, that nothing could possible make her sick. However, this is not the case, and more often than not, she is afflicted with some illness or another. Most noticeable is that she gets sick after a period of intense training. After completing her Iron Man, she immediately got sick and took weeks to recover.

It is more and more likely, that she is not an isolated case, and demonstrates a clearer picture of the relationship between exercise, stress and immune system function. In a study, published in the August issue of Medicine and Science in Sports and Exercise, 1995, Dr. J. Duncan MacDougall and colleagues at McMaster University in Ontario investigated this same phenomenon. They examine the effects of exercise training on the immune systems of long distances runners and uncovered some interesting results.

His study looked at immune system functions in response to increased training volume and/or intensity as separate variables as well as both immediate (acute) and long-term (chronic) stressors of the body. Results showed reductions in the ratio of immune helper cells to immune suppressor cells in both the increase of volume and intensity of exercise. This ratio is indicative of normal immune function, and its decreases shows a likewise depression of immune function. This means an increased risk of infection and illness due to immune suppression.

The study also found that increasing the intensity of the training suppressed immune function more than increasing the volume of exercise training. Another study, published in this month’s issue of Brain, Behavior and Immunity, lead by researchers at University of South Carolina’s Arnold School of Public Health showed that stress from exercise causes an increased risk for developing upper respiratory tract infections, while moderate exercise, causing less stress on the body, decreases the risk of developing such infections.

Their results demonstrate that stress from exercise caused increased vulnerability to infections from HSV-1 viral respiratory infections as well as from certain strains influenza viruses. However, even though significantly suppressed, the immune system showed a rapid adaption to the increased training. MacDougall also found that the immune systems of his patients were modulated and adapted to the added stressors during the rest of the 10 day training period. Immune systems were shown to recover back to normal rates by the next day following a workout. This suggests that you are most susceptible to contracting an illness due to incomplete immune protection in the hours following a hard workout, but that your immune system will recover quickly to the added stress. But what about long term exercise? Can our immune systems recover as quickly after a marathon or a 14 hour Iron Man? According to a study done by David Neiman, PhD. and colleagues at Loma Linda University, some elements of our immune system may take longer to recover.

Examining 2,000 runners after completion of the Los Angeles marathon demonstrated that immune systems may be suppressed enough to significantly increase our chances of contracting infections and developing illnesses. The study found that 13% of the runners who participated in the marathon developed an illness in the following week. The combination of increased volume and intensity of the exercise left an significant impact on the participants and as a result, many of them contracted infections as a consequence of impaired immune function.Neiman suggests that over-exercising, which is 90-plus minutes/day or running upwards of 60 miles/week can increase vulnerability to illness. His study shows that marathon runners are six times more likely to become ill after a race due to excessive exercise impairing their natural immune function.

So what does this all mean? Exercise is not only good for us, but is absolutely essential to maintain a healthy lifestyle. For those of us that wish to get in shape, moderate daily exercise will give the most benefit and cause us the least amount of cost. Since the increase of volume or intensity will suppress immune function the most, aim for gradual increases in exercise training and your immune system will adapt quickly enough to avoid most illnesses.As for those budding or seasoned marathon runners and triathletes, intense exercise training is part of your lifestyle, so paying attention to other aspects of life which can cause illness are key. Getting enough sleep, eating healthy and avoiding other forms of stress can bypass other avenues of contracting sickness. Allowing enough time for recovery and care in avoiding injury are also essential to continue a strenuous exercise regimen. Like a double edged sword, exercise can be our greatest protection against a host of illnesses and infections, but if over-done, we can leave ourselves defenseless from invaders normally caught by our immune systems. So get out there and work up a sweat and feel the burn, just don't overdo it."

For more detail, go to:

My Response:
Since I am used as an example in this post, I would like to clarify a few things. First, I was not deathly ill after my Ironman as implicated, just tired, which is to be expected. In fact, I flew thousands of miles the very next day to give a talk at a national meeting for my job, which would have been impossible if I had been very sick. Also, the record-high heats (97+ degrees) I experienced during my Ironman was a contributing factor to my fatigue, separate to the high volume of exercise demanded of my body.

Yes, it is true that the immune system is depressed for 72 hours after a long endurance event, such as a marathon or Ironman. Many athletes suffer a minor cold (note—minor) after undertaking such a feat. However, it is important to note that most of the effects experienced from this dampening of the immune system are mild and reversible. Even athletes suffering from overtraining do not exhibit symptoms similar to patients afflicted with an immunosuppressive disease, such as AIDS.

Second, although long-lasting, negative effects to the immune system can occur in endurance athletes over time (called overtraining), resulting in injury, illness, and chronic fatigue, precautions are taken to avoid this from happening. For instance, a “recovery week” is taken every 3rd or 4th week of training for a long endurance event, where the athlete drastically reduces his training volume to allow for rest, repair, and rejuvenation, thus allowing the immune system to recover. In addition, most athletes take a 1-2 month “off-season” after their final big race of the year to fully recover before starting a new season.

Finally, an amateur athlete undertaking a marathon or Ironman for the first time is much more susceptible to negative effects on the body and immune system than an experience pro-athlete because their body has not yet had a chance to adapt to the high volume of training necessary to prepare for such an event. Over time (years), the body slowly adapts and becomes stronger, enabling it to withstand high volumes without negative effects. In fact, Dean Karnazes, famous ultrarunner, can run a marathon every day without negatively impacting his body. Surprisingly low amounts of inflammatory markers were observed in his plasma while running 50-50-50 (50 marathons in 50 states in 50 days) ( I would be very interested in the results of a study that investigated the effects of a marathon on a group of professionals, as opposed to age-groupers running a marathon for the first time.

It is also important to note that many factors can contribute to suppressing the immune system, and that these factors become critical in restoring the body during periods of high exercise volume. For instance, proper nutrition and adequate sleep are key in allowing the body to recover from heavy training. Although too much exercise can suppress your immune system, there are a myriad of studies that show the serious adverse health effects from not exercising enough. In fact, I would argue that not enough exercise is probably worse than too much. My overall point is that, yes, exercising too much can hurt you but, done properly, your body can adapt, and you can prepare and train for a long endurance event, like an Ironman, without hurting yourself. In fact, you may actually enjoy a wide range of positive health benefits instead.

Your thoughts?


Wes said...

I agree that being a healthy athlete involves more than just exercising. It involves recovery and doing the right thing between training sessions. I cannot remember the last time I was sick (knock on wood). My doctor rolls her eyes and sez, "Oh, you have THOSE genes!" :-)

Chad in the AZ Desert said...

It's amazing the lengths that people who "regard exercise as a necessary evil" will go to try and prove that people who love endurance activities are killing themselves. There are already too many excuses out there keeping people on the coach to live short, sickly, uninspired lives. We don't need 'experts' inventing even more excuses.

Yes, I was sick this winter and missed a day of work - and yes I'm an endurance athlete. However, all the slovenly people in my office were sick, too. And they were out for far longer.

Rather than trying to make something out of a few random studies that may or may not prove that endurance sports are causing any damage, your sister should be focused on the millions of Americans who are without question destroying themselves and burdening the medical system by not exercising. That would be time and effort better spent rather than trying to wag a finger at the people who actually 'get it' and might just inspire some others to get of the couch.

Sorry for the rant. I think you are dead-on with your response. Keep doing what you are doing and let the doubters watch from the sidelines.

LG said...

interesting. i think it's a combination of genes as well as being smart and everything in moderation - however, moderation is different for each individual based on how he/she is adapting to new fitness levels. there are some people that are obese, smoke and live at the drive-thru and are never sick and others who are healthy, exercise and get sick at the drop of a hat...and vice versa.
as far as endurance athletes, training for these races occurs over a long period of time and a body builds up durability, it is not like one day someone who has never laced up a pair of running shoes ever says tomorrow I am going to run a marathon sub 4 hours and actually does it without any side effects, if in fact s/he actually does it, but that is because the training was not smart, not the actual event itself.

Grey Beard said...

It's very possible that the body temporarily lowers its immune response to speed up the process of evacuating waste and rebuilding tissues - in somewhat the same way RA sufferers get relief during ovulation. I personally feel I beat CFS after 3 years of feeling like I had the flu each day, by taking advantage of a temporary lowering of my immune system from anti-biotics to start a very aggressive course of body building. After 9 months or so my immune system seemed to reset itself, so even if I took a few days off I was OK.

I love what Chad had to say. People can choose to be alive, healthy and fit, or they can choose to destroy their organs taking meds to manage their diseases and live short, miserable lives without the joy of challenge and triumph.

When I talk to my sis about what I do she laughs and says she doesn't love herself enough to put herself through that much pain. It's always a poignant moment because she means it quite literally. Imagine my joy to hear that finally, she is taking those many conversations to heart.

To all those that "get it" and dare to love themselves and life enough to participate in it fully, I wish you all the best. Your rich and virtuous life is indeed its own reward.

Julie said...

I have experienced both the reduced immune system due to a jump in training without adequate baseline and the stronger immune system due to overall consistent training. While your sister has a point, I agree with what you and all of the commenters have said in that she doesn't seem to have a reference point of professional athletes to compare to newbies (who were probably the majority of that 13% of the marathoners who got sick), and that it's far more worthwhile to look at the much greater negative effects of not enough exercise. In the age of obesity, focusing on finding fault with those who pursue a healthy lifestyle seems a bit pointless.

Diana said...

I felt my strongest last summer while training for my triathlon. This year has sucked due to my gallbladder issues, but now that it's been removed, I hope to get that 100% feeling back again and move on. This was good reading for my thoughts of a IM in my future! Perfect timing....thanks!
For the record.......I haven't had a cold since? 2007 I think.

don said...

Even people who have immunosuppressive conditions like HIV/AIDS can still train their bodies to do endurance sports. Which means that you will see me next week at CA 70.3!

Grey Beard said...

Is exercise as a way to regulate the immune system being studied? Is there an active community discussing this? My hunch is there is a wealth of info about how immune systems work hiding there. Best of luck on the CA 70.3, and kudos for ignoring all the "experts" and finding your own truth.

Pete said...

I've done several marathons, a few ultras, Ironman ... blah, blah. I feel healthiest -- not strongest or fittest, but healthiest -- when I'm not in gearing-up-for-a-race mode, and I've pulled back to one solid but relaxed workout per day, plus maybe a hard effort or two every once in a while. I don't feel at my healthiest when I'm building toward Ironman (as I am now). Maybe if I didn't have to work and raise my son and could sleep 10 hours a day things would be different. But all that hard physical work combined with life is sometimes too much. But it's what I love to do and over the years I've gotten better at understanding where the line is that shouldn't be crossed. Down the road (I'm 46), I'm looking forward to doing shorter races, which will sate my appetite for competition, require a little less of me, and allow me to embrace full health.

Anonymous said...