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 Professor Paula Drosescu MD PhD
Societatea Romana de Medicina Sportiva



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CORRELATIONS BETWEEN THE RESPIRATORY COMPONENT AND THE IMMUNE SYSTEM IN ATHLETES








  In order to support athletic effort, one of the basic compulsory conditions is ensuring the necessary oxygen intake to the contracting muscles and, in as much as possible, a quick elimination of the carbon dioxide. Hematosis and myocardial contraction are the two organic support elements for any athlete.
  In order to cover the gas exchanges, it is necessary first and foremost to have an increased pulmonary elasticity (and not a big-sized chest cavity). In fact, one of the indexes that can predict an athlete’s performance is considered to be the pulmonary elasticity.
  Starting from this general data, we have measured in the athletes included in this research the values of the perimeter of their thorax. By making the subtraction between the maximum perimeter in inhalation and the maximum perimeter in exhalation, we have calculated the values of pulmonary elasticity which can be considered as good to very good, and are shown in Table 1 and Picture 1:

Picture 1. Pulmonary elasticity
Legend: the ordinate shows the values in centimeters for the pulmonary elasticity; test I, II, III represent the three moments when the values were recorded


  We notice the very good values obtained by judoka as compared to the control group. This can be explained on one hand by the type of sport (the thorax is blocked and therefore it increases the vital capacity) and by the fact that being a sport of force and symmetry it ensures a harmonious development of the accessory thorax muscles.
  The effects of smoking on the respiratory apparatus are indisputably reflected by the values obtained by the control group: 4 out of 10 were moderate smokers (an average of 7-8 cigarettes declared per day), which has considerably lowered the average value of the elasticity. In judo, only the athlete with values of 6,5 cm smoked in average 5 cigarettes / day.

Table 1. Pulmonary elasticity
Test ITest IITest III
Judo8,5 cm8,7 cm9,2 cm
Atletism7,4 cm7,4 cm7,5 cm
Maraton5,1 cm5,1 cm5,4 cm


  In this context Pate R.R. and col. 1995 presented in their studies about smoking a negative association between the habit of smoking and the participation in physical activities. Among the selected athletes, the number of smokers decreases in proportion with the increase of the intensity of training.
  For the athletics group, the situation needs further detailing. Two of the athletes showed in their medical history pulmonary disease with a possible defective healing of the alveo-capilary barrier. One of the cases showed a lung abscess at the age of 5, following which came a number of repeated acute bronchitis (4 occurrences in 10 months), which represented the factor that determined his parents to direct him towards training. This boy also showed two viral afflictions through the duration of the testing: a tracheal-bronchial respiratory infection (nu gasesc viroza in dictionar) and labial herpes, and the pulmonary elasticity values were at the low end recorded for this group.
  The second case showed pneumonia of the right inferior lobe at the age of 9 and a tracheal-bronchial respiratory infection through the duration of the tests. In both cases, immunological tests showed an important depression after physical effort, which is also maintained after resting.
  Compared to the laboratory data on pulmonary elasticity (which does not show any significantly increased values), the good athletic results of the speed group can be explained by looking at the characteristics of the type of effort involved: being an explosive effort and with a small duration, a great deal of the energy used in this time frame is based on the accumulation of the energetic sub-layer (cica exista substrate, dar mi se pare ca e altfel ca sens; poti sa mai verifici pls?) in the skeletal muscles and does not rely on the consumption of oxygen during the effort itself.
  The superior values for pulmonary elasticity (8-9 cm) were recorded in the endurance subgroup, as an adjustment to the requests of their particular type of effort – predominantly aerobe, with an intense demand on the cardio-respiratory function.
  For the control group, the pulmonary elasticity recorded was lower than in the two other groups, but superior to the values that are deemed normal (3-4 cm). This is consistent with the lower degree of training of these subjects, with fewer hours per week and lower intensity.
  We can consider that from the point of view of the growing process, the athletes have a symmetrical aspect, harmonious and without any modifications such as could be diagnosed in asymmetric sports (i.e. fencing).
  As a consequence of correctly-lead and coordinated training, we have noticed a proportional development of the chest cavity, which creates the premises for the support of effort during training. As a direct result of this, we observed the adjustment of the respiratory apparatus (very good in judo, good in athletics, moderate in the control group).
Consistent with the somatometric aspect of the chest cavity we recorded a pulmonary elasticity of optimum value.
 The problem of sustaining the physical effort from the point of view of the respiratory apparatus is an extremely important one in practice if it is approached from several points of view. Achieving a pulmonary elasticity at superior parameters ensures the optimal exchange of gases, which for the body equals with the possibility of charging hemoglobin with oxygen. Thus, the oxygen intake achieved in the neural cell through the blood can be increased, which represents an important factor for a full maintenance of the cognitive processes, of neural-muscular coordination, of general local and integrating adjustment. One of the factors that are frequently quoted as aiding athletic trauma is central nervous fatigue.
  This in turn has four groups / types of causes:
  • The first is hypoxia;
  • The second is determined by the accumulation in the blood of toxic circulating degradation products as well as that of amino acids (leucine, valine, isoleucine, tryptophan) which result from the decomposition of proteins, especially in sports which emphasize force, and a lack of the 5-hydrotriptamine enzyme;
  • The third id generated by a droop in the blood sugar levels, which is inherent in endurance sports, being known the high consumption of glucose which takes place in the nervous cell;
  • The fourth cause is competition-related stress.
  As another consequence of appropriate pulmonary elasticity through oxygen intake, the body is capable of achieving optimal growth and development processes.
  The exchanges occurring in the alveo-capilary barrier have been proven to be relevant for the cancellation of the so-called oxygen debt that characterizes all forms of movement, but especially the anaerobe short-duration ones (speed tests in athletics).
  Starting from these aspects and having in mind the fact that one of the elements tracked in the tests throughout this research concerned the subjective symptoms of fatigue as being the expression of a possible immunological type, we have introduced as a supplement a stage of pulmonary hyperventilation at the end of the training session. This is not an innovation, and it has been known as a means of immediate recovery after effort, but the difference resides in the duration for which this was applied: hyperventilation until the appearance of a feeling of vertigo, as an expression of hemoglobin being supersaturated in oxygen.
  Inhibiting the production of NO determines the increase of sensitivity towards infections, which makes NO play an important part in the defense of the mucosa. The variable susceptibility of the NK function to the modulation from the physical effort, as it appears in literature, can be explained through the variety of types of studies: comparisons between types of sports that are opposing as training types, using uni-directional efforts, observing a certain stage of the practice and not an entire training cycle. Therefore, a category of studies do not show significant modifications of the NK activities when analyzing athletes for variable lengths of time (4-8 weeks) while conducting medium to maximum intensity effort (Pedersen B.K. and col. 1994).
  On the other hand, numerous other studies show a significant drop of NK values after high-intensity efforts, suggesting that this immune suppression could be caused mainly by prostaglandin (Watson R.R. and col. 1986) and / or associated with a decrease of glutamine in the plasma (Newsholme E.A. 1994). The same authors warn that the low levels of LT, IL, NK are not recorded only immediately after effort, but they remain depleted for long periods of time (Nieman D.C., Pedersen B.K., Shephard R.J.).


Picture 2. The effect of nitrogen oxide on the mucosa of the respiratory airways

   This aspect also forms the basis for the open-window theory (Brines R. and col. 1996), which tries to explain the high risk for infections, developing tumors, self-immune diseases, minimal resistance against HIV that people who practice repeated physical training close to 90-97% intensity can have. Moreover, it is suggested that performing moderate physical effort can potentially slow the evolution of HIV-1 or can be an inhibiting factor of tumors by stimulating the demarginalization of the complex monocyte / macrophage (Pyne D.B. 1994).
Picture 3. The model of susceptibility towards infection.

a)After high intensity efforts there comes a period of minimal reactivity on behalf of the immune system, an immune suppression which is an opportunity for infectious agents to act.
b)The concept of the “J-shaped curve”, according to which the relative risk of an infection of the superior respiratory airways is proportionally increased in those who train as compared to the group of sedentary people.

CONCLUSIONS

1.The growth and development processes have lead to the formation of a chest cavity with symmetrical aspect, harmonious and without modifications of its component segments.
2.The values of pulmonary elasticity in judo were 8,5 cm, 8,7 cm (second testing), 9,2 cm (third testing). The values of pulmonary elasticity in athletes were 7,4 cm (first and second testing), 7,5 cm (third testing). The values of pulmonary elasticity in the control group were 5,1 cm (first and second testing), 5,4 cm (third testing).
3.Inhibiting the production of NO causes an increased sensibility to infections.
4.A significant drop in NK levels after high-intensity efforts suggests that immune suppression might be caused mainly by prostaglandins and / or associated with a drop of glutamine in the plasma.

References

1.ACSM position stand on osteoporosis and exercise: American College of Sports Medicine. Med Sci Sports Exerc. 1995; 27:1-7.
2.Booher M. J., Thibodeau A.Gary, Athletic injury assessment, Mosby - Year Book, Inc., 1994
3.Drăgan I şi col., Medicina Sportivăaplicată, Ed. Editis, Bucureşti, 1994
4.Fătu C-tin, Doina Lucia Frîncu, Fătu C-tin, Anatomia clinică a trunchiului, Apollonia, Iaşi, 1996
5.Ifrim Mircea, Niculescu Ghe., Compendiu de Anatomie, Editura Medicală, Bucureşti, 1988
6.Nieman DC; Henson DA; Sampson CS; Herring JL; Suttles J; Conley M; Stone MH; Butterworth DE; Davis JM.The acute immune response to exhaustive resistance exercise. Int J Sports Med, 16: 5, 1995 Jul, 322-8
7.Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402-407.
8.Pedersen BK; Bruunsgaard H.How physical exercise influences the establishment of infections. Sports Med, 19: 6, 1995 Jun, 393-400.
9.Saragea M. (sub redacţia), Fiziopatologie Editura Academiei RSR, Bucureşti, 1982
10.Shephard RJ; Verde TJ; Thomas SG; Shek P Physical activity and the immune system. Can J Sport Sci, 16: 3, 1991 Sep, 169-85.
11.Teodorescu Exarcu I., Badiu G. Fiziologie, Ed. Medicală,1993.


Professor Paula Drosescu, MD. PhD
Faculty of Physical Education and Sports
“Al. I. Cuza” University Iasi
February 7, 2010
Medical Cabinet Alternative Iasi
Associate Certified Coach ICF
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