The role of sports and exercise in allergic disease: drawbacks and benefits

Abstract

Although training and exercise have several benefits, overdoing it might not necessarily be a good thing. For instance, elite athletes have an increased risk for asthma and allergy. Several mechanisms can be implicated for this risk, which include the interplay between environmental training factors and athlete’s personal risk factors, such as genetic susceptibility, neurogenic-mediated inflammation, and epithelial sensitivity. However, an overwhelming amount of scientific evidence shows the positive effects of sports as part of a healthy lifestyle. Training reduces breathlessness and asthma symptoms and attenuates Th2-mediated inflammatory responses. Taken together, the benefits far outweigh the potential hazards of training. An easily administered therapeutic healthy lifestyle intervention, which could be used alongside current treatment, must be developed.

Keywords:

• asthma
• athletes
• exercise
• physical activity
• sports

Acknowledgments

We thank António Macedo, MD, for critical review of the manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• The increased incidence and prevalence of asthma is multifactorial and includes epigenetic mechanisms and lifestyle factors: changes in the traditional diet, physical inactivity, and stress.

• Airway inflammation and airway hyper-responsiveness are very frequent in elite athletes; however, further studies are needed to establish whether such an inflammatory response is also present in the airways of recreational athletes.

• Given the evidence that trichloramine can be detrimental to the airways, there is a need to regulate the concentrations of this irritant and ensure that indoor swimming pools are properly ventilated.

• As the benefits of regular, moderately intense aerobic exercise have been demonstrated in allergic asthma, there is no reason to discourage asthmatics with controlled disease from regular exercise.

• Asthma has been associated with reduced physical activity and obesity, which seems to change asthma toward a more difficult-to-control phenotype; mechanisms are currently unknown, but probably multi-factorial: mechanical, adipokines, gene–environment interactions, and loss of tolerance.

• Efforts should focus on dietary advice, making weight reduction part of the treatment of asthma in obese patients, along with pharmacological interventions.

• Every subject with asthma should be questioned about exercise performance, tolerance and symptoms. If patients with asthma or allergies are able to maintain adequate physical activity levels, particularly in a natural biodiverse environment, they will be less likely to suffer adverse health events associated with a sedentary lifestyle, such as heart attack, stroke or diabetes, and they will improve their asthma.

Notes