Current perspective on exercise immunology.

By far, the most important finding that has emerged from exercise immunology studies is that positive immune changes take place during each bout of moderate physical activity. Over time, this translates to fewer days of sickness with the common cold and other upper respiratory tract infections. This is consistent with public health guidelines urging individuals to engage in near-daily physical activity of 30 minutes or more. Risk of upper respiratory tract infections can increase when athletes push beyond normal limits. The infection risk is amplified when other factors related to immune function are present, including exposure to novel pathogens during travel, lack of sleep, severe mental stress, malnutrition, or weight loss. Many components of the immune system exhibit adverse change after prolonged, heavy exertion lasting longer than 90 minutes. These immune changes occur in several compartments of the immune system and body (eg, the skin, upper respiratory tract mucosal tissue, lung, blood, and muscle). During this "open window" of impaired immunity (between 3 and 72 hours, depending on the immune measure), viruses and bacteria may gain a foothold, increasing the risk of subclinical and clinical infection. In general, if symptoms are from the neck up, moderate exercise is probably acceptable (and some researchers would argue even beneficial) when an athlete is sick, whereas bed rest and a gradual progression to normal training are recommended when the illness is systemic.