The human immune system is an extremely complex system that comprises a variety of cells and actions. It can be classified into cell mediated immunity and humeral immunity. Cell mediated immunity involves cells such as macrophages, natural killer cells, cytotoxic T cells and the release of cytokines in response to the presence of an antigen. The humeral immune system is mediated by the secretion of antibodies, namely IgA, IgD, IgE, IgG, and IgM, from plasma and mucosal cells. These antibodies are responsible for binding extracellular pathogens and their toxins (Burford and Rossi) for destruction. The production of secretory IgA (SIgA) is the major effect or function of the mucosal immune system providing the ‘first line of defence’ against pathogens in the respiratory and gastrointestinal tracts (Walsh et al 2011).
It has long been observed that exercise affects the immune system in a dose dependent way – a phenomenon known as hormesis. This is where a low dose exposure to regular exercise has a positive effect on the immune system, but whereby a high dose exposure has a negative effect. In real terms regular bouts of exercise reduces the severity and occurrence of illness for some, however it has been observed that in others, particularly endurance athletes, prolonged exercise and intensified training can evoke a decrease in the mucosal antibody SIgA (Walsh et al 2011). This can increase the occurrence of upper respiratory tract infections (URTI’s), that one would assume correlates with a suppressed immune system.
Some studies have reported SIgA levels to remain suppressed for many hours after exercise. Mackinnon, et al (1989) demonstrated that SIgA levels were still suppressed 60 minutes after maximal effort cycling and that it took 24 hours for them to recover to pre-exercise levels. Nehlsen-Cannarella et al (2000) demonstrated that pre-exercise SIgA concentrations were 77% higher in elite rowers compared to non athletes and that after two hours of rowing training there was a 45% reduction in SIgA concentrations in the elite rowers five minutes after training ended, and that SIgA still had not recovered to pre-exercise levels 90 minutes after training had ceased (Gleeson and Pyne 2000). Whereas Li, and Gleeson (2004) demonstrated that a three hour rest was enough to recover immune system markers from a prolonged bout of cycling at 60% VO2max for two hours before the performance of a second prolonged exercise bout. Moreira et al (2009) assessed SIgA levels after 70 minutes of a friendly football match and suggested that the variability of the responses among the players called for individually analysed results and interventions or what might also be termed as individual recovery strategies.
Measuring SIgA and detecting changes in immune system function is only half the battle. Implementing interventions to prevent and boost the immune system at times of increased training stress and suppressed SIgA to prevent URTI’s is the major challenge and focus of the data collection. One modality that is being used is acupuncture.
Matsubara et al (2010) aimed to examine the effects of acupuncture treatment on the SIgA levels after acute high intensity exercise.
In this crossover experiment twelve men were divided into two groups, each group completing an incremental cycle test to exhaustion. After the exercise one group received acupuncture (bilateral LU6, LI4, ST36 and ST6) and the other group just rested. At a future point each group then repeated the cycle test and received the reserve order intervention. To assess the effects of acupuncture on SIgA levels, saliva samples were taken before, immediately after and at 1, 2, 3, 4 and 24 hours after exercise. Blood samples were also taken to assess catecholamine response to acupuncture after exercise and heart rate belts were worn to assess heart rate response to acupuncture after exercise at each time point.
Figure 1 shows that acupuncture produced a significant increase in SIgA secretion rate after exercise.
Figure 2 shows that acupuncture did produce an increase in SIgA concentration after exercise, but this was not statistically significant.
Figure 3 shows that acupuncture did produce a significant increase in saliva flow rate of exercise.
Acupuncture did not lead to any significant changes in catecholamine concentrations after exercise, but it did seem to reduce mean heart rate compared to the control group for all time points except immediately after exercise.
This research suggests that acupuncture is effective at increasing SIgA secretion and saliva flow rate, through activation of the autonomic nervous system, after an acute bout of exercise and may be an effective tool to help boost mucosal immunity. However, as athletes who train vigorously many times a week are the ones who suffer suppressed mucosal immunity and URTI’s it is unclear whether acupuncture offers any prophylaxis long term. This research offers a good starting place to look at the use of acupuncture in athletes who train many times a week and this line of research should be followed.
What I have learnt and how i can improve my practice
It seems that using bilateral LU6, LI4, ST36 and ST6 is effective at increasing SIgA secretion after an acute bout of exercise. As measuring SIgA, testosterone, cortisol, heart rate variability and hydration in players after games is part of my role as a sports nutritionist / sports scientist, I can use this preliminary research as a starting point to identify those who may benefit from acupuncture after exercise (through measuring SIgA) and assess whether using these points after successive and intense bouts of exercise can help to maintain SIgA levels and prevent or reduce the incidence of URTI’s.
Gleeson, M. and Pyne, D. B (2000). Exercise effects on mucosal immunity. Immunology and Cell Biology 78, 536–544
Li, T. L. and Gleeson, M. (2004). The effect of single and repeated bouts of prolonged cycling and circadian variation on saliva flow rate, immunoglobulin A and alpha-amylase responses. J Sports Sci; 22 (11-12): 1015 – 1024.
Mackinnon, L. T. Chick, T. W. van As, A. Tomasi, T. B. (1989). Decreased secretory immunoglobulins following intense endurance exercise. Sports Training Med. Rehab; 1: 1–10.
Matsubara, Y., Shimizu, K., Tanimura, Y., Miyamoto, T. M., Akimoto, T., Kono, I. (2010). Effect of acupuncture on salivary immunoglobulin A after a bout of intense exercise. Acupuncture in Medicineaim.bmj.comAcupunct Med; 28: 28 – 32.
Moreira, A. Arsati, F. Cury, P. R. Franciscon, C. de Oliveira, P. de Araújo, V. C. (2009). Salivary immunoglobulin a response to a match in top-level Brazilian soccer players. J Strength Cond Res. 23 (7): 1968 – 1973.
Nehlsen-Cannarella, S. L. Nieman, D. C. Fagoaga, O. R. Kelln, W. J. Henson, D. A. Shannon, M. and Davis, J. M. (2000). Saliva immunoglobulins in elite women rowers. Eur. J. Appl. Physiol; 82: 222–8.
Walsh, N. P. Gleeson, M. Shephard, R. J. Gleeson, M. Woods, J. A. Bishop, N. C. Fleshner, M. Green, C. Pedersen, B. K. Hoffman-Goetz, L. Rogers, C. J. Northoff, H. Abbasi, A. and Simon, P (2011). Position Statement Part one: Immune function and exercise. Exerc Immunol Rev. 17: 6 – 63.
Walsh, N. P. Gleeson, M. Shephard, R. J. Gleeson, M. Woods, J. A. Bishop, N. C. Fleshner, M. Green, C. Pedersen, B. K. Hoffman-Goetz, L. Rogers, C. J. Northoff, H. Abbasi, A. and Simon, P (2011). Position Statement Part two: Maintaining immune health. Exerc Immunol Rev.17: 64 – 103.