Haaland Derek A, Sabljic Thomas F, Baribeau Danielle A, Mukovozov Ilya M, Hart Lawrence E
Rheumatology Division, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Clin J Sport Med. 2008 Nov;18(6):539-48. doi: 10.1097/JSM.0b013e3181865eec.
The purpose of the current review is to synthesize the available evidence from prospective clinical trials that are relevant to the clinical question: "What, if any, are the effects of regular aerobic and/or resistance exercise on the immune system in healthy older adults?"
Electronic databases were searched, using terms pertaining to immunology, exercise, and aging. Using the Ovid interface, the following databases were explored: Allied and Complimentary Medicine (AMED) (1985 to 2008), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2008), all EBM Reviews (Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED), EMBASE (1980 to 2008), and MEDLINE (1950 to 2008). The MEDLINE database was searched a second time through the PubMed interface.
Prospective controlled clinical trials were selected for review if they investigated the effects of an exercise intervention (minimum 4 weeks in duration) on an immune outcome measure in an older but otherwise healthy population. A total of 19 articles representing 17 trials were identified.
Quality assessment of the relevant articles was performed using the Jadad et al criteria. Data extraction was performed using a standardized instrument. Data regarding the participants, interventions, and laboratory and clinical immunologic outcomes were synthesized.
Available data provide no clear evidence of acute or chronic effects of exercise on lymphocyte or natural killer (NK) cell numbers or phenotype (ie, surface markers)/activity, with 2 exceptions: (1) strength or endurance exercise may cause an acute transient elevation in circulating CD8+ T cells, and (2) regular aerobic exercise appears to enhance immunologic memory in the context of vaccination. The effects of strength training on NK cell activity are unclear. Furthermore, regular aerobic exercise appears to be associated with a reduction in chronic inflammation. Finally, no prospective controlled trials have clearly documented clinical immunologic benefits of regular exercise, which may well relate to underpowering of these studies.
Overall, in healthy older adults, regular, particularly aerobic, exercise appears to be a friend of the immune system, helping to offset diminished adaptive responses and chronic inflammation. The possibility exists that particularly strenuous exercise may cause acute immunologic changes, such as diminished NK cell activity, which could predispose to infection in certain individuals. However, given the possible benefits of regular exercise on the immune system and the many definite benefits on other systems, the evidence presented here should not dissuade practitioners from suggesting regular exercise to otherwise healthy older adults.
本次综述的目的是综合前瞻性临床试验中的现有证据，这些证据与临床问题相关：“定期进行有氧运动和/或抗阻运动对健康老年人的免疫系统有何影响（若有影响的话）？”
使用与免疫学、运动和衰老相关的术语搜索电子数据库。通过Ovid界面，检索了以下数据库：联合与补充医学数据库（AMED）（1985年至2008年）、护理及相关健康文献累积索引数据库（CINAHL）（1982年至2008年）、所有循证医学综述（Cochrane系统评价数据库、美国内科医师学会杂志俱乐部、循证医学数据库、临床对照试验注册库、临床方法学综述、卫生技术评估数据库和国家卫生服务经济评价数据库）、荷兰医学文摘数据库（EMBASE）（1980年至2008年）以及医学索引数据库（MEDLINE）（1950年至2008年）。通过PubMed界面再次检索MEDLINE数据库。
若前瞻性对照临床试验调查了运动干预（持续时间至少4周）对老年但其他方面健康人群免疫结局指标的影响，则选择其进行综述。共识别出代表17项试验的19篇文章。
使用Jadad等人的标准对相关文章进行质量评估。使用标准化工具进行数据提取。综合了有关参与者、干预措施以及实验室和临床免疫学结局的数据。
现有数据未提供明确证据表明运动对淋巴细胞或自然杀伤（NK）细胞数量或表型（即表面标志物）/活性有急性或慢性影响，但有两个例外：（1）力量训练或耐力训练可能导致循环CD8 + T细胞急性短暂升高，（2）定期有氧运动在疫苗接种的情况下似乎能增强免疫记忆。力量训练对NK细胞活性的影响尚不清楚。此外，定期有氧运动似乎与慢性炎症的减轻有关。最后，尚无前瞻性对照试验明确记录定期运动对临床免疫学的益处，这很可能与这些研究的样本量不足有关。
总体而言，在健康老年人中，定期运动，尤其是有氧运动，似乎是免疫系统的有益因素，有助于抵消适应性反应减弱和慢性炎症。特别剧烈的运动可能会引起急性免疫学变化，如NK细胞活性降低，这可能使某些个体易患感染。然而，鉴于定期运动对免疫系统可能存在的益处以及对其他系统的诸多明确益处，此处提供的证据不应阻止从业者向其他方面健康的老年人建议定期运动。
