De inflammatoire reaktie van het afweersysteem als gevolg van inspanning kan,
volgens Cooper en kollega's, in bepaalde medische situaties de gezondheid schaden.
De kern van hun verhaal laat zich als volgt samenvatten:
inspanning leidt (ook bij gezonde mensen) tot een inflammatoire response (IL-6, NO etc.)
als leukocyten (witte bloedcellen) vooraf (chronisch) geprikkeld zijn
(bijv. als gevolg van infecties, verwondingen of luchtverontreiniging),
leidt inspanning er toe dat inspanning (per saldo) negatief uitpakt.
Opvallende vaststellingen in het studierapport zijn voorts dat
- fysiologische stress een (veel) sterkere inflammatoire response tot stand lijkt te brengen
(klik hier)
dan psychologische stress
(klik hier en
hier),
en
- fysieke stress het "leaky gut"-fenomeen kan doen veroorzaken,
waardoor darmbacteriën de bloedbaan bereiken en een inflammatoire response veroorzaken
(klik hier of
hier).
Opmerkelijk is voorts het raakvlak met een grote groep ME/CVS-patiënten
(klik hier en
hier).
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Dangerous exercise: lessons learned from dysregulated inflammatory responses to...
Numerous exercise abnormalities been found in Chronic Fatigue Syndrome (CFS)
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11 March 2010
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Tom Kindlon,
Information Officer (voluntary position)
Irish ME/CFS Association
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One curious omission from this interesting review [1] is Chronic Fatigue Syndrome (CFS),
which is also sometimes known as Myalgic Encephalomyelitis (ME).
An abnormal response to physical activity is an essential part of widely used ME/CFS clinical criteria for adults [2] and children [3].
The most frequently used research criteria for CFS [4] require that patients,
along with suffering from chronic debilitating fatigue lasting at least 6 months,
have at least 4 out of a list of 8 symptoms,
one of which is "postexertional malaise lasting more than 24 hours."
There is a growing body of research on abnormal responses to exercise in CFS.
A recent review [5] covers the issue in a fairly comprehensive manner - here's a summary:
"Exertion induces post-exertional malaise
with a decreased physical performance/aerobic capacity, increased muscoskeletal pain, neurocognitive impairment,
"fatigue", and weakness, and a long lasting "recovery" time.
This can be explained by findings that exertion may amplify pre-existing pathophysiological abnormalities underpinning ME/CFS,
such as inflammation, immune dysfunction, oxidative and nitrosative stress, channelopathy, defective stress response mechanisms and a hypoactive hypothalamic-pituitary-adrenal axis." High rates of adverse reactions to graded exercise programs have been reported in patients with CFS – sometimes 50% or greater [6]. CFS remains a fairly poorly understood condition. There is increasing evidence that CFS is heterogeneous and this heterogeneity could be of relevance t therapeutic programs involving exercise [7,8].
Those interested in researching abnormal responses to physical activity, including dysregulated inflammatory responses, could find much of interest if they chose to study CFS.
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References:
1) Cooper DM, Radom-Aizik S, Schwindt C, Zaldivar F Jr.
Dangerous exercise: lessons learned from dysregulated inflammatory responses to physical activity.
J Appl Physiol. 2007 Aug;103(2):700-9. Epub 2007 May 10.
2) Carruthers BM, Jain AK, De Meirleir KL, Petersn DL, Klimas MD, Lerner AM, Bested AC, Flor-Henry P, Joshi P, Powles ACP, Sherkey JA, van de Sande MI (2003).
"Myalgic encephalomyelitis/chronic fatigue syndrome: Clinical working definition, diagnostic and treatment protocols".
Journal of Chronic Fatigue Syndrome 11 (1): 7-36.
3) Jason LA, Porter N, Shelleby E, Bell DS, Lapp CW, Rowe K, & De Meirleir K. (2008).
A case definition for children with Myalgic Encephalomyelitis/ chronic fatigue syndrome.
Clinical Medicine: Pediatrics, 1, 53-57.
4) Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A.
The chronic fatigue syndrome: a comprehensive approach to its definition and study.
International Chronic Fatigue Syndrome Study Group.
Ann Intern Med. 1994 Dec 15;121(12):953-9.
5) Twisk FN, Maes M.
A review on cognitive behavorial therapy (CBT) and graded exercise therapy (GET) in myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS):
CBT/GET is not only ineffective and not evidence-based, but also potentially harmful for many patients with ME/CFS.
Neuro Endocrinol Lett. 2009;30(3):284-99.
6) Kindlon T, Goudsmit EM.
Graded exercise for chronic fatigue syndrome: too soon to dismiss reports of adverse reactions.
J Rehabil Med. 2010 Feb;42(2):184; author reply 184-6.
7) Jason LA, Corradi K, Torres-Harding S, Taylor RR, & King C.
Chronic fatigue syndrome: The need for subtypes.
Neuropsychology Review 2005, 15, 29-58.
8) Kindlon T.
Stratification using biological factors should be performed in more CFS studies.
Psychol Med. 2010 Feb;40(2):352. Epub 2009 Oct 12.
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http://jap.physiology.org/cgi/eletters/103/2/700
Citaten uit het uitgebreide studieverslag
In this review, we examine the lessons learned from dangerous exercise,
particularly in the sense that exercise can elicit
an immunological danger type of stress and inflammatory response that,
under certain circumstances, becomes dysregulated and detrimental to health.
...
Lymphocytes, monocytes, and natural killer (NK) cells
increase rapidly with the onset of exercise
but begin to decrease immediately on its cessation.
Circulating neutrophils increase more slowly and
may remain elevated for up to several hours,
long after the initiating bout of exercise ends.
...
Indeed , in studies that have attempted
to compare the inflammatory response to exercise with psychosocial stress,
exercise was found to alter immune mediators far more profoundly.
...
There is even evidence that
exercise may be accompanied by
translocation of gut bacteria into the central circulation,
causing a classic antigen-mediated systemic immune response.
...
In particular, lymphocytes obtained from peripheral blood in asthmatics demonstrate
a predominance of T-helper lymphocyte type 2 (TH2, IL 4 producing) immune responses
relative to TH1 (IFN-γ producing).
...
This idea is corroborated by recent work from Frampton and coworkers showing that
exposure to ultrafine particles in air pollution (100 nm)
in combination with exercise
can influence activation of
circulating lymphocytes and expression of key adhesion molecules
like ICAM-1 on other leukocytes.
Dangerous exercise:
lessons learned from dysregulated inflammatory responses to physical activity.
J Appl Physiol. 2007 Aug;103(2):700-9. Epub 2007 May 10. doi:10.1152/japplphysiol.00225.2007.
Cooper DM, Radom-Aizik S, Schwindt C, Zaldivar F Jr.
Exercise
elicits
an immunological "danger" type of stress and
inflammatory response
that,
on occasion,
becomes dysregulated and
detrimental to health.
Examples include
anaphylaxis,
exercise-induced asthma,
overuse syndromes, and
exacerbation of intercurrent illnesses.
In dangerous exercise,
the normal balance
between pro- and anti-inflammatory responses
is upset.
A possible pathophysiological mechanism
is characterized by
the concept of
exercise modulation of
previously activated leukocytes.
In this model,
circulating leukocytes
are rendered more responsive than normal
to the immune stimulus of
exercise.
For example,
in the case of exercise anaphylaxis,
food-sensitized immune cells
may be relatively innocuous
until they are redistributed
during exercise
from gut-associated circulatory depots,
like the spleen,
into the central circulation.
In the case of asthma,
the prior activation of
leukocytes
may be the result of
genetic or
environmental factors.
In the case of overuse syndromes,
the normally short-lived neutrophil
may,
because of acidosis and hypoxia,
inhibit apoptosis and
play a role in
prolongation of inflammation
rather than healing.
Dangerous exercise
demonstrates that
the stress/inflammatory response
caused by physical activity is robust and
sufficiently powerful,
perhaps,
to alter subsequent responses.
These longer term effects
may occur through as yet unexplored mechanisms
of immune "tolerance" and/or
by a training-associated reduction
in the innate immune response
to brief exercise.
A better understanding of
sometimes failed homeostatic physiological systems
can lead to
new insights
with significant implication for clinical translation.
PMID: 17495117 [PubMed - indexed for MEDLINE]
inflammation; innate immunity; leukocyte; asthma
full-text:
http://jap.physiology.org/cgi/reprint/103/2/700.pdf
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