I came across this study this morning while looking up information related to another question here in the forum. I thought it was interesting because, frankly, the results are different than I would have expected.
I have always assumed that exercise of any sort, even intensive exercise, would be good for people with multiple myeloma, assuming that the exercise didn't result in unhealthy stress on bones or the heart.
The results of this study, however, suggest there may be some negative consequences to particularly intense exercise.
The study found that, among a group of swimmers in intensive training, "there was a significant fall in natural killer (NK) cell numbers and percentages in athletes over the training season."
It concludes that "training of elite athletes at an intensive level over both short- and long-time frames suppresses both systemic and mucosal immunity. Protracted immune suppression linked with prolonged training may determine susceptibility to infection, particularly at times of major competitions."
The study is from 1995, and I have not looked to see whether the research is confirmed by later studies. Perhaps others here in the forum can help track down more recent studies on the subject.
Here's the study reference
M Gleeson, "The effect on immunity of long-term intensive training in elite swimmers," Clinical & Experimental Immunology, October 1995 (full text at PubMed)
and here's the abstract:
The impact of long-term training on systemic and mucosal immunity was assessed prospectively in a cohort of elite swimmers over a 7-month training season in preparation for national championships.
The results indicated significant suppression (P < 0.05) of serum IgA, IgG and IgM and salivary IgA concentration in athletes associated with long-term training at an intensive level. There was also a trend towards lower IgG2 subclass levels in serum in athletes compared with controls (P = 0.07). There were no significant changes in numbers or percentages of B or T cell subsets, but there was a significant fall in natural killer (NK) cell numbers and percentages in athletes over the training season (P < 0.05).
After individual training sessions there was a significant decrease in salivary IgA levels for athletes compared with controls (P = 0.002). In athletes there was a downward trend in salivary IgA levels over the 7-month training period in both the pre-exercise (P = 0.06) and post-exercise samples (P = 0.04). There were no significant trends in salivary IgG levels over the study period in either athletes or controls. The only significant change in salivary IgM levels was an increase in detection rate in the pre-competition phase in athletes (P = 0.03).
The study suggests that training of elite athletes at an intensive level over both short- and long-time frames suppresses both systemic and mucosal immunity. Protracted immune suppression linked with prolonged training may determine susceptibility to infection, particularly at times of major competitions.
Forums
Re: Impact of intense exercise on the immune system
The good news is that nearly no one on this list need worry. Nearly no one on ANY list need worry 
Some of my friends have been "competed for Canada" level athletes. The strain that high level training puts on bodies is enormous, and far beyond what most of us will ever experience. Even running marathons or rowing on local teams or other things that we might consider intense don't compare. I was quite a serious martial artist, but my 5x per week training was still nothing like what the people competing nationally did.
This study looks at full-time athletes training at national levels. The rest of us are probably safe exercising to our own version of intense, so long as we're not overly straining our own limits.
Some of my friends have been "competed for Canada" level athletes. The strain that high level training puts on bodies is enormous, and far beyond what most of us will ever experience. Even running marathons or rowing on local teams or other things that we might consider intense don't compare. I was quite a serious martial artist, but my 5x per week training was still nothing like what the people competing nationally did.
This study looks at full-time athletes training at national levels. The rest of us are probably safe exercising to our own version of intense, so long as we're not overly straining our own limits.
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LisaE - Name: Lisa
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: April 2014
- Age at diagnosis: 67
Re: Impact of intense exercise on the immune system
LisaE,
I'm well aware that people here in the forum are not training to be on national athletic teams. There are, however, people here who regularly run marathons and take part in intense, day-long bicycle races, and who train strenuously between such events. It therefore occurred to me that this line of research might actually be of interest to those people.
More broadly, I was just surprised that any level of exercise, even extreme exercise, would suppress rather than stimulate the immune system. It's not the sort of result I expected, and I thought others might also have similar expectations and thus be interested in the research.
Those are the reasons I thought to share the research with others here in the forum. I'm sorry those reasons weren't apparent to you from my original posting, or that they don't matter to you.
I'm well aware that people here in the forum are not training to be on national athletic teams. There are, however, people here who regularly run marathons and take part in intense, day-long bicycle races, and who train strenuously between such events. It therefore occurred to me that this line of research might actually be of interest to those people.
More broadly, I was just surprised that any level of exercise, even extreme exercise, would suppress rather than stimulate the immune system. It's not the sort of result I expected, and I thought others might also have similar expectations and thus be interested in the research.
Those are the reasons I thought to share the research with others here in the forum. I'm sorry those reasons weren't apparent to you from my original posting, or that they don't matter to you.
Re: Impact of intense exercise on the immune system
There was another recent study on the link between long term intensive endurance exercise and heart arrhythmia:
K Andersen et al, "Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study," European Heart Journal, June 11, 2013 (full text of article, related Medscape article from Google Cache)
It was my conclusion that it did not apply to we weekend warriors, which is I think the thrust of the comment above from LisaE.
Even those of us who exercise regularly, sometimes for long stretches, rarely reach the intensity level of the elite athletes who are the subject of these studies. I agree that it seems counterintuitive that exercise can cause either immune system or heart issues. But long term, regular exercise at high intensity levels turns out to be too much of a good thing.
K Andersen et al, "Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study," European Heart Journal, June 11, 2013 (full text of article, related Medscape article from Google Cache)
It was my conclusion that it did not apply to we weekend warriors, which is I think the thrust of the comment above from LisaE.
Even those of us who exercise regularly, sometimes for long stretches, rarely reach the intensity level of the elite athletes who are the subject of these studies. I agree that it seems counterintuitive that exercise can cause either immune system or heart issues. But long term, regular exercise at high intensity levels turns out to be too much of a good thing.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Impact of intense exercise on the immune system
I'm not surprised by the findings of the study you mentioned, TerryH.
I've been a long distance runner for 46 years. In my early days I ran on my high school and college (US NCAA Division III) track and cross country teams. My teammates and I were not national caliber athletes. But it was common wisdom among our coaches and us that if we caught a cold or got a minor infection, that was often a sign that we were over-training and needed to cut back.
We didn't have any scientific evidence for that thinking, but it certainly fit our observations. The study you cited supports our intuitions.
And, Andrew, the study you cited fits my current situation. Bradycardia (heart rate too slow) on one hand and atrial fibrillation-related tachycardia (heart rate too fast) on the other hand have caused my cardiologist and oncologist to stop Revlimid maintenance for me. Again, I'm sure I never was the running equivalent of the top cross-country skiers in that study, but I have some of the cardiac issues they had. And I have another long-time runner friend who has similar a-fib problems.
So in the case of both studies here, I expect these issues may be happen to many endurance athletes who are non-elite.
(I asked my cardiologist if we could just take the average between my too slow and too fast heart rates and be happy, but she wasn't too keen on that idea.)
Mike
I've been a long distance runner for 46 years. In my early days I ran on my high school and college (US NCAA Division III) track and cross country teams. My teammates and I were not national caliber athletes. But it was common wisdom among our coaches and us that if we caught a cold or got a minor infection, that was often a sign that we were over-training and needed to cut back.
We didn't have any scientific evidence for that thinking, but it certainly fit our observations. The study you cited supports our intuitions.
And, Andrew, the study you cited fits my current situation. Bradycardia (heart rate too slow) on one hand and atrial fibrillation-related tachycardia (heart rate too fast) on the other hand have caused my cardiologist and oncologist to stop Revlimid maintenance for me. Again, I'm sure I never was the running equivalent of the top cross-country skiers in that study, but I have some of the cardiac issues they had. And I have another long-time runner friend who has similar a-fib problems.
So in the case of both studies here, I expect these issues may be happen to many endurance athletes who are non-elite.
(I asked my cardiologist if we could just take the average between my too slow and too fast heart rates and be happy, but she wasn't too keen on that idea.)
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Impact of intense exercise on the immune system
Mike,
I hope that I didn't ask you this before and forget the answer: what is your "too low" heart rate. Mine is pretty low and no one has ever raised an issue about it.
I hope that I didn't ask you this before and forget the answer: what is your "too low" heart rate. Mine is pretty low and no one has ever raised an issue about it.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Impact of intense exercise on the immune system
Like others who have already posted I am not surprised by this finding based on my anecdotal experience with athletes I know who do what could be considered extreme training. My GF has done 12 full Ironman and many more marathons and Half Ironmans, and some extreme bike events like 200 mile double century rides or the Death Ride in the Eastern Sierra Nevada or the Breathless Agony ride in the San Bernardino Mountains. Yes I am bragging about her. Since I have known her after a full Ironman she almost always gets sick in the days following the event. When she over trains between events she often get run down and sick then too. The vast majority of us with myeloma are not training at this would not be something that would be applicable to us.
Having said that though I do believe exercise is important for us. Walking and exercise will help a lot with preventing blood clots for those on Revlimid and Pomalyst. It can also help with GI and blood pressure issues. But with a comprised immune system is there a point where even moderate exercise effects on a comprised immune system need to be considered? Is there a careful balance between not enough and too much that needs to be maintained? I do not know the answer but it is something I think about.
Mike and Andrew,
Since my initial induction therapy treatment 4 years ago my blood pressure has dropped and I really do not know why. My heart rate however has the same or higher overall with one exception. When I have been hospitalized they have always had a heart rate monitor on me. When I was sleeping my heart rate would sometimes drop into the low 30s, I forget the exact value, and set off the alarm on the monitor at the nurse station. They would come in to check on me and wake me up and immediately the heart rate would jump back up to the mid 40s or higher. Never had a good explanation for this and if it was a real concern or not. I probably should have brought it up with my GP.
My blood pressure was good before but now it tends to be on the low side. Four years ago after three months of Velcade and dexamethasone treatment had to be stopped and I was hospitalized for a week with orthostatic blood pressure. I was blacking out when I stood up. My blood pressure would drop to 72 over nothing standing up and the heart rate would soar to 140 or more. It took a while for this to go away. But to this day years later when I go in for medical appointments my blood pressure is always checked and I still get low readings like 92 over 48. I get asked if this is normal for me and I really do not know what to say other than only for the last 4 years it has been. Other days I get more normal readings like 105 over 75 but that is about as high as it gets anymore, even on the days I take dexamethasone. Going back to the original topic of this thread when by blood pressure is that low it impacts my ability to do exercise. I can feel the weakness when I stand or sit up. I feel that my heart is not the same as it was before this myeloma experience but I really do now know why or what is different. Have you had any trouble with too low blood pressure or have you heart problems just been too low a heart rate?
Having said that though I do believe exercise is important for us. Walking and exercise will help a lot with preventing blood clots for those on Revlimid and Pomalyst. It can also help with GI and blood pressure issues. But with a comprised immune system is there a point where even moderate exercise effects on a comprised immune system need to be considered? Is there a careful balance between not enough and too much that needs to be maintained? I do not know the answer but it is something I think about.
Mike and Andrew,
Since my initial induction therapy treatment 4 years ago my blood pressure has dropped and I really do not know why. My heart rate however has the same or higher overall with one exception. When I have been hospitalized they have always had a heart rate monitor on me. When I was sleeping my heart rate would sometimes drop into the low 30s, I forget the exact value, and set off the alarm on the monitor at the nurse station. They would come in to check on me and wake me up and immediately the heart rate would jump back up to the mid 40s or higher. Never had a good explanation for this and if it was a real concern or not. I probably should have brought it up with my GP.
My blood pressure was good before but now it tends to be on the low side. Four years ago after three months of Velcade and dexamethasone treatment had to be stopped and I was hospitalized for a week with orthostatic blood pressure. I was blacking out when I stood up. My blood pressure would drop to 72 over nothing standing up and the heart rate would soar to 140 or more. It took a while for this to go away. But to this day years later when I go in for medical appointments my blood pressure is always checked and I still get low readings like 92 over 48. I get asked if this is normal for me and I really do not know what to say other than only for the last 4 years it has been. Other days I get more normal readings like 105 over 75 but that is about as high as it gets anymore, even on the days I take dexamethasone. Going back to the original topic of this thread when by blood pressure is that low it impacts my ability to do exercise. I can feel the weakness when I stand or sit up. I feel that my heart is not the same as it was before this myeloma experience but I really do now know why or what is different. Have you had any trouble with too low blood pressure or have you heart problems just been too low a heart rate?
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Impact of intense exercise on the immune system
Hi Andrew and Eric,
In answer to your questions - Andrew, my cardiologist seems more concerned about gaps between heart beats rather than low heart rate per se for me. I've had gaps of 3, 4, 6, and possibly 9 seconds that I've heard about from her. With the 6 and possibly 9 second gaps, I started to feel faint, and this is what she is mainly concerned about. When I was in the hospital in late July, they said my sleeping heart rate got as low as 29 and my resting heart rate (when I was awake) was around 39 or 40. I think they considered these heart rates to be lower than they wanted to see, but the main concern was with the gaps.
Eric, I had some slightly low blood pressure readings over the summer. But nothing like the readings you mentioned for yourself. I think mine were around 98 over 65 or something like that. They also had a hard time getting a BP reading for me when I was laying down. I'm not sure if that was because it was low or due to something else.
Like you, Eric, I did feel light headed pretty often when I stood up. That seems to have gone away now that I'm off Revlimid.
Since we're on the topic of heart-related side effects, here's a quick update on my condition and treatment. My cardiologist had me start taking 12.5 mg of Metoprolol one time per day beginning last Friday. The hope is that this drug will regulate my heart rate - slowing down the high a-fib events and possibly upping the slow rate a bit. I'm back on a heart event monitor, which should pick up extra slow or extra fast heart rates. It has not detected anything unusual since I started the Metoprolol Friday. If Metoprolol works as hoped, my oncologist would like me to get back onto Revlimid for continuing maintenance in a month or two. If Metoprolol doesn't work as hoped for me, I may need a pacemaker implant or ablation surgery. We'll see how things go.
Mike
In answer to your questions - Andrew, my cardiologist seems more concerned about gaps between heart beats rather than low heart rate per se for me. I've had gaps of 3, 4, 6, and possibly 9 seconds that I've heard about from her. With the 6 and possibly 9 second gaps, I started to feel faint, and this is what she is mainly concerned about. When I was in the hospital in late July, they said my sleeping heart rate got as low as 29 and my resting heart rate (when I was awake) was around 39 or 40. I think they considered these heart rates to be lower than they wanted to see, but the main concern was with the gaps.
Eric, I had some slightly low blood pressure readings over the summer. But nothing like the readings you mentioned for yourself. I think mine were around 98 over 65 or something like that. They also had a hard time getting a BP reading for me when I was laying down. I'm not sure if that was because it was low or due to something else.
Like you, Eric, I did feel light headed pretty often when I stood up. That seems to have gone away now that I'm off Revlimid.
Since we're on the topic of heart-related side effects, here's a quick update on my condition and treatment. My cardiologist had me start taking 12.5 mg of Metoprolol one time per day beginning last Friday. The hope is that this drug will regulate my heart rate - slowing down the high a-fib events and possibly upping the slow rate a bit. I'm back on a heart event monitor, which should pick up extra slow or extra fast heart rates. It has not detected anything unusual since I started the Metoprolol Friday. If Metoprolol works as hoped, my oncologist would like me to get back onto Revlimid for continuing maintenance in a month or two. If Metoprolol doesn't work as hoped for me, I may need a pacemaker implant or ablation surgery. We'll see how things go.
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Impact of intense exercise on the immune system
I'm glad that this research article was posted. I hope that none of us who are living with myeloma are training at such a high level. I'm also glad to hear that Eric and Mike's doctors are closely monitoring their cardiac status and doing something about the changes that they are seeing. We all have to remember that our bodies have changed with the treatments that we are getting and have gotten, especially those of us who have had transplants of any kind.
The first year after my transplant I had problems with low blood pressure. I had had high blood pressure for many years and was taking medication for it. After the transplant my pressure dropped quite low and I had multiple episodes of lightheadedness when standing up. When I mentiioned it to my oncologist he suggested stopping my medication and consulting with my primary doctor. I didn't need the medication for a little more than a year before my BP started to rise again. When I restarted my medication I asked for a lower dose to start with. I have been managed at that lower dose for 4 1/2 years with no problems and with a better response than my previous dose. I also have had a much lower heart rate since my transplant, 50-60 BPM. And, I wouldn't call me a particularly regular exerciser. So, we all should be aware or our cardiac status and pay attention to the numbers when they are taken at all doctor visits and infusion/injection visits.
In the last several years there has been much more research into exercise and the prevention of cancer and in people with cancer. A lot of it is in in the area of breast cancer, but it can be applied to us. A couple of really good studies have been done at UPENN by Kathryn Schmitz, PhD,MPH - the PAL study published in the New England Journal of Medicine in 2007 and a more detailed article in 2008, or thereabouts. She also did a more recent study called the WISER study. I'm not sure when that was completed because it was still on going when I retired from Penn in 2013. But, the exercise program sponsored by LIVESTRONG at many YMCA's is an outgrowth of the PAL exercise program. There are also exercise programs that PT programs, health/wellness programs, etc. are introducing that are an offshoot from that study. Some of them are call "Living Beyond Breast Cancer" and use the exercises and education that evolved from the PAL program.
So, exercise is good and higher levels of safe exercise can be reattained during and after treatment for cancer, but should be approached in a gradual basis. Starting slowly and adding more challenging exercise as you can do it without adverse physical responses and without extreme fatigue is good. I'm better at advising than I am at following through with my own advice.
Happy walking, running, bicyling, swimming, weight lifting, stretching, etc.,
Nancy in Phila
retired PT who was one of the therapists in the PAL study
The first year after my transplant I had problems with low blood pressure. I had had high blood pressure for many years and was taking medication for it. After the transplant my pressure dropped quite low and I had multiple episodes of lightheadedness when standing up. When I mentiioned it to my oncologist he suggested stopping my medication and consulting with my primary doctor. I didn't need the medication for a little more than a year before my BP started to rise again. When I restarted my medication I asked for a lower dose to start with. I have been managed at that lower dose for 4 1/2 years with no problems and with a better response than my previous dose. I also have had a much lower heart rate since my transplant, 50-60 BPM. And, I wouldn't call me a particularly regular exerciser. So, we all should be aware or our cardiac status and pay attention to the numbers when they are taken at all doctor visits and infusion/injection visits.
In the last several years there has been much more research into exercise and the prevention of cancer and in people with cancer. A lot of it is in in the area of breast cancer, but it can be applied to us. A couple of really good studies have been done at UPENN by Kathryn Schmitz, PhD,MPH - the PAL study published in the New England Journal of Medicine in 2007 and a more detailed article in 2008, or thereabouts. She also did a more recent study called the WISER study. I'm not sure when that was completed because it was still on going when I retired from Penn in 2013. But, the exercise program sponsored by LIVESTRONG at many YMCA's is an outgrowth of the PAL exercise program. There are also exercise programs that PT programs, health/wellness programs, etc. are introducing that are an offshoot from that study. Some of them are call "Living Beyond Breast Cancer" and use the exercises and education that evolved from the PAL program.
So, exercise is good and higher levels of safe exercise can be reattained during and after treatment for cancer, but should be approached in a gradual basis. Starting slowly and adding more challenging exercise as you can do it without adverse physical responses and without extreme fatigue is good. I'm better at advising than I am at following through with my own advice.
Happy walking, running, bicyling, swimming, weight lifting, stretching, etc.,
Nancy in Phila
retired PT who was one of the therapists in the PAL study
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Impact of intense exercise on the immune system
Hey Terry H
I am glad you brought this subject up. Dr. Thomas Seyfried agrees with you - He says that mild exercise is good but vigorous exercise will increase blood glucose because the muscles release lactate and glutamine.
He also says moderate exercise will not stress the body's immune system but it is not good to engage in excessive exercise- which is what your study mentions: "immune suppression"
Cathy
I am glad you brought this subject up. Dr. Thomas Seyfried agrees with you - He says that mild exercise is good but vigorous exercise will increase blood glucose because the muscles release lactate and glutamine.
He also says moderate exercise will not stress the body's immune system but it is not good to engage in excessive exercise- which is what your study mentions: "immune suppression"
Cathy
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antelope1225 - Name: Cathy1225
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: May 25 2012
- Age at diagnosis: 55
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