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EXERCISE TO BOOST YOUR IMMUNITY Photsawee Kwanchuay MD

MSc. MBA

DURING COVID-19 PANDEMIC

ACSM’s Clinical Exercise Specialist
Rehabilitation Medicine Department
Faculty of Medicine, Thammasat University
SCOPE
• Human immunity & Immune response against COVID-19
• Effect of exercise on immunity
• Key factors to predict positive or negative effects of exercise on immunity
• Practical recommendation of exercise training during COVID-pandemic
FIRST MESSAGE
• Boost immune = ส่งเสริม เสริมสร้าง เพื่อลดโอกาส ลด
ความเสี่ยง
• Boost immune เพียงปั จจัยเดียว≠Prevention 100%
• Make the best of a bad situation

Nwabuko OC, et al. IOSR-JDMS, 2020

HUMAN IMMUNITY

Anatomy & Physiology

• Specificity
• Memory
• More Effective
at second time

Cytokine
Inflammation

ด่านหน้า

https://leonheart15.tistory.com/201
Monye and Adelowo, Lifestyle Med, 2020
Catecholamine

DR. Alex Wadley. PA factsheets, 2020

DR. Alex Wadley. PA factsheets, 2020
Market et al., 2020
Increase number Increase activity

Fernández et al., 2020

Enhance Innate & Adaptive Immunity

Increase potency of vaccination

Regular exercising of moderate intensity for 25-30 minutes at 3 days/wk for a period of 10 months
induced a significant increase in antibody titer to influenza vaccination (Kohut ML, 2004)

Valenzuela et al., 2021

 May help in infection prevention

May help in severity attenuation

May improved vaccination response

Silviera et al., Clinical and Experimental Medicine, 2021

J-Shaped curve, classic study by Nieman.

Self-questionnaire, no lab confirm

1-2wk postrace
time period

• 40-60% VO2max, HRR

• 64-76% HR max
ความหนักระดับปานกลาง
• RPE 12-13 (Borg6-20) = moderate to somewhat hard
• Can speak comfortably but can not sing a song Nieman and Wentz, 2019
Chagas et al., AIMS Bioengineering, 2020
 30-45min walking

Cortisol
Temporary

ถ้า Immune ตา่ ลงอยูน่ านๆ และ/หรือ เกิดขึ้ นบ่อยๆ → ย่อมเสี่ยงต่อการติดเชื้ อได้มากขึ้ น
Hachney, Acta Medica Iranica, 2013
Nieman and Wentz, 2019
Scudiero et al., Int. J. Environ. Res. Public Health, 2021
 KEY FACTORS AFFECTING IMMUNO-SUPPRESSION
Exercise (stress, load) Non-exercise
• Intensity • Host: gender, aging, underlying, mental stress
• Duration • Lifestyle habit: nutrition, hydration, sleep, hygienic
• Recovery period (consecutive sessions) alcohol/smoking
• Environment: extreme temp, high altitude, humidity,
Exhaustion
pollution, travel across time-zone
• Pathogen exposure
Immune cell exhaust
(depletion of energy reserve, glycogen)
Nieman and Wentz, 2019
DR. Alex Wadley. PA factsheets, 2020
 Open access
Impact Factor = 7.5
CiteScore = 8.1

AGING WITH IMMUNOSENESCENSE

• ด่านหน้าจัดการเชื้ อไม่ได้ (กลุ่ม phagocytosis)
• APC นาเสนอไม่ได้
• Adaptive ทางานด้ไม่ดี
• เกิดการอักเสบที่มากเกินไป (cytokines)
• Impaired autophagy

• Exercise is able to reverse hallmarks

of immune senescence.
• T cell, NK cell, Phagocytes
• Gerokines, TNF-α, IL-6 and CRP →
inflamm-aging

Pietrobon et al., Frontiers in Immunology, 2020

Kruger et al., German J of Sports MED, 2019
VERY HIGH RISK GROUP
NCD
Sedentary Chronic
disease

Stress
Aging Poor
High lifestyle
risk
group
Infection Exercise-induced
Complication Immunosuppression
 INDICATORS FOR TOO HARD INTENSITY

• Chronic fatigue
• Mood, emotion, motivation, concentration disturbance
Overtraining • Eating/appetite change
Syndrome • Sleep-wake abnormality
• Reduced tolerance/performance to training overload
• Altered HR response to submaximal exercise
• MSK pain, soreness, injury
ELITE ATHLETES TAKE HIGH RISK FOR INFECTION ?

The IOC consensus group provided support for the J-curve

• Very High Cardio-Respiratory Fitness
• Good non-exercise factors
• Tolerate to intense exercise stress with
strategic management
model, but cautioned that the right side of the model may not
apply to elite athletes on the highest level, where high training
loads are not consistently associated with an increased risk of
illness.
Nieman and Wentz, 2019
 ออกกาลังกายอย่างหนักแต่ร่างกายมีความพร้อม สมบูรณ์สุดขีด = Elite athlete

• The very elite athletes are

better adapted to the demands
“S-shape” Elite
of their training
curve Athlete
• Accumulating evidence suggests
the incidence of infection among
athletes is not substantially
different to other populations

!แต่ก็ยงั อาจมีภาวะ open window ช่วงหลังการแข่งมาราธอน → need adequate Nieman and Wentz, 2019
recovery period + ดูแลสุขภาพ + ป้ องกันการติดเชื้ อ Chagas et al., AIMS Bioengineering, 2020
Campbell and Turner, Frontiers of Immunology, 2018
DO WEEKS OF INTENSE EXERCISE TRAINING RESULT IN
A CHRONIC STATE OF IMMUNE DEPRESSION?
• The answer = No

• Because following an acute bout of exercise, circulating leukocyte number

and function return to pre-exercise levels within 3 to 24 hr.

• Comparisons of leukocyte number and other markers of immune function

between athletes and nonathletes do not differ markedly in the resting state.

• Immune depression after intense and prolong exercise is temporary

Powers and Howley, Exercise Physiology, 10th edn. 2018

RESISTANCE EXERCISE AND IMMUNITY
• 200% Increase in NK cells following a short-term bout of resistance exercise,
a response similar to the short-term effect of moderate aerobic exercise

• Resistance training activated monocytes more than typically observed for

aerobic training → activation releases prostaglandins that downregulate NK
cells following physical activity → blunting the long-term positive effect of
physical activity on NK cells

• No resting NK cell activity or number changes after long-term (many year) of

resistance exercise training compared to sedentary controls
McArdle. Exercise Physiology 7th edn. 2010
EFFECTS OF EXERCISE TO IMMUNITY
Positive effect Negative effect Short-term Long-term
Moderate, short Present Present
duration aerobic (enhance immunity) (enhance immunity)
exercise
Resistance exercise Present Absent
(enhance immunity)
Intense prolonged Present Absent
aerobic exercise (Immuno-suppression,
increase susceptibility
to infection after exc)
Moderate, short Absent Absent
duration aerobic (no open window)
exercise
Exercise TIPs during COVID-19 pandemic
Intensity: low to moderate, moderate, moderate to vigorous
Duration : Short exercise session up to 30-60 min (avoid long-lasting >90 min)
Volume: moderate intensity 150 min/wk (recommendation), can increase to 250-300 min/wk
avoid consecutive vigorous exercise sessions

Type: Aerobic (MICT may add with HIIT*), should combine with resistive exercise
Monitor signs of overtraining syndrome
Avoid rapid weight loss and severe caloric restriction but IF may have benefit (autophagy)
For sedentary & chronic disease: start low go slow
For Athlete: time to maintain your fitness, avoid increasing exercise performance, avoid anaerobic

Keep healthy lifestyle: active, minimize screen and sitting time, sleep, nutrition, stress management

Have fun with exercise and keep motivation

* HIIT can be done with appropriate volume

 No Load Resistance Training (NLRT)
• Without external load, use BW
• Easy to perform
• Hospitalized patients
• Increase muscle size by US
• Muscle strength gains
• 20 rep x4set, rest 30s between set

NLRT
Chagas EFB. AIMS Bioengineering 2020
EXERGAMING
 Nutrition
Physical Activity
Sleep
Harmful substance
Stress management
Social connectedness
Positive psychology

Monye and Adelowo, Lifestyle Med, 2020

ANY QUESTION?

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