Clinical Management of Immuno-Suppression in Athletes Associated with Exercise Training: Sports Medicine Considerations

  • Anthony Carl Hackney Mail Department of Exercise & Sport Sciences, Applied Physiology Laboratory, University of North Carolina, Chapel Hill, North Carolina, USA. AND Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
Athletes, Cytokines, Hormones, Overtraining, Sports performance, Stress


The Overtraining Syndrome (OTS) is a physically debilitating medical condition that results in athletes being totally compromised in their capacity to perform and compete. Many physiological systems are affected by the process of overtraining and the development of the OTS which results from it; but one system in particular, the immune, is highly susceptible to degradation resulting in a reduction in overall health and physical performance. The aim of this paper is to review; 1) the evidence-based proactive steps and actions to take to greatly reduce the risk of development of an infection or a compromised immune system in athletes; and 2) the course of action for clinicians to take when they are dealing with an athlete displaying overt signs of an infection and, or inflammation. Evidenced reported here within support that it is essential for clinicians to take practical preventative and management steps - actions with athletes (involved in intensive exercise training) in order to help preserve and maintain a healthy and robust immune system if they are going to perform optimally.


Budgett R, Newsholme E, Lehmann M, Sharp C, Jones D, Peto T, Collins D, Nerurkar R, White P. Redefining theovertraining syndrome as the unexplained underperformance syndrome. Br J Sports Med 2000;34:67-8.

Hackney AC, Battaglini CL. The Overtraining Syndrome: Neuroendocrine imbalances in athletes. Brazil J Biomotricity (BrJB) 2007;1(2):34-44.

Hopkins WG. How to interpret changes in an athletic performance test. Sports Sci 2004;8:1-7.

Lehmann M, Lormes W, Opitz-Gress A, Steinacker J, Netzer N, Foster C, Gastmann U. Training and overtraining: an overview and experimental results in endurance sports. J Sports Med Phys Fitness 1997;37(1):7-17.

Raglin J, Barzdukas A. Overtraining in athletes: the challenge of prevention - a consensus statement. Health Fitness J 1999;3:27-31.

Fry AC, Steinacker JM, Meeusen R. Endocrinology of overtraining. In: Kraemer WJ, Rogol AD, eds. The Endocrine System in Sports and Exercise. Blackwell Publishing, Oxford, UK, 2005: 584-593.

Smith, LL. Tissue trauma: the underlying cause of the overtraining syndrome? J Strength Cond Res 2004;18(1):185-93.

Abbas AK, Lichtman AH. Cellular and Molecular Immunology. Philadelphia, PA: Elsevier Saunders; 2005.

Robson PJ. Elucidating the unexplained underperformance syndrome in endurance athletes. Sports Med 2003;33(10):771-81.

Robson-Ansley PJ, Demilander L, Collins M, NoakeS TD. Acute interleukin-6 administration impairs athletic performance in healthy, trained male runners. Can J Appl Physiol 2004;29(4):411-8.

Robson-Ansley PJ, Blannin A, Gleeson M. Elevated plasma interleukin-6 levels in trained male tri-athletes following an acute period of intensive interval training. Eur J Appl Physiol 2007;99(4):353-60.

Walsh NP, Gleeson M, Pyne DB, Nieman DC, Dhabhar FS, Shephard RJ, Oliver SJ, Bermon S, Kajeniene A. Position statement: Part two: Maintaining immune health. Exerc Immunol Rev 2011;17:64-103.

Czepluch FS, Barrès R, Caidahl K, Olieslagers S, Krook A, Rickenlund A, Zierath JR, Waltenberger J. Strenuous physical exercise adversely affects monocyte chemotaxis. Thromb Haemost 2011;105(1):122-30.

Mackinnon L. Overtraining effects on immunity and performance in athletes. Immunol Cell Biol 2000;78(5):502-9.

Walsh NP, Gleeson M, Shephard RJ, Gleeson M, Woods JA, Bishop NC, Fleshner M, Green, C, Pedersen BK, Hoffman-Goetz L, Rogers CJ, Northoff H, Abbasi A, Simon P. Position statement: Part one: Immune function and exercise. Exercuu Immunol Rev 2011;17:6-63.

Nieman DC. Exercise effects on systemic immunity. Immunol Cell Biol 2000;78(5):496-501.

Perdersen BK. Exercise and cytokines. Immunol Cell Biol 2000;78(5):532-5.

Gleeson M, Bishop NC. The T cell and NK cell immune response to exercise. Ann Transplant 2005;10(4):43-8.

Koch AJ. Immune response to resistance exercise. Am J Lifestyle Med 2010;4:244-52.

Urhausen A, Gabriel H, Kindermann W. Blood hormones as markers of training stress and overtraining. Sport Med 1995;20(4):251-76.

Meeusen R, Duclos M, Gleeson M, Rietjens G, Steinacker J, Urhausen A. Prevention, diagnosis and treatment of the Overtraining Syndrome: ECSS Position Statement 'Task Force'. Eur J Sport Sci 2006;6(1):1-14.

Mayer F, Bonaventura K, Cassel M, Mueller S, Weber J, Scharhag-Rosenberger F, Carlsohn A, Baur H, Scharhag J. Medical results of pre-participation examination in adolescent athletes. Br J Sport Med 2012;46(7):524-30.

Ronsen O. Prevention and management of respiratory tract infections in athletes. New Student Athlete 2005;20:49-56.

Christakou A, Lavallee D. Rehabilitation from sports injuries: from theory to practice Perspect Public Health 2009;129(3):120-6.

Bergeron MF, Nindl BC, Deuster PA, Baumgartner N, Kane SF, Kraemer WJ, Sexauer LR, Thompson WR, O'connor FG Bergeron. Consortium for Health and Military Performance and American College of Sports Medicine consensus paper on extreme conditioningprograms in military personnel. Current Sports Med Rep2011;10(6):383-9.

Jaworski CA, Donohue B, Kluetz J. Infectious disease. Clin Sport Med 2011;30(3):575-90.

How to Cite
Hackney AC. Clinical Management of Immuno-Suppression in Athletes Associated with Exercise Training: Sports Medicine Considerations. Acta Med Iran. 51(11):751-756.