Exercise and febrile illnesses

Question 1

What quantitative changes occur to the immune system during exercise?

Answer 1

1. Increase in neutrophils
2. Increase in lymphocytes
3. Decreased CD4:CD8 ratio
4. salivary IgA suppressed

Question 2

What functional changes occur to the immune system during exercise?

Answer 2

1. Diminished neutrophil chemotaxis
2. Diminished phagocytosis
3. NK cell activity increases

Question 3

What is the “open window”?

Answer 3

The period of reduced immune function after intense exercise

Question 4

What is the relationship between amount of exercise and incidence of infection?

Answer 4

“J” curves
sedentary = average risk
moderate exercise = low risk
high exercise = high risk

Question 5

What are the effects of fever?

Answer 5

1. Affects the body’s ability to regulate body temperature
2. Increases insensible fluid losses
3. Increased risk of heat injury
4. increased risk of dehydration
5. decreased muscle strength
6. decreased endurance
7. reduced exercise tolerance
8. increased fatigue

Question 6

What are the recommendations regarding athlete participating in competitive sports while unwell?

Answer 6

1. If symptoms are confined to above the neck the athlete may participate.
2. Do a 10-15min trial at mild-mod intensity and stop if symptoms worsen
3. If athletes have systemic symptoms (i.e. fever, myalgias, diarrhea) refrain from exercise x 7-14d post symptom resolution

Question 7

What is the most important complication of infectious mononucleosis in athletes?

Answer 7

Splenic rupture (0.1-0.5% risk), highest in 1st 3 weeks of illness

Question 8

What is the minimum disqualification period from athletics for patients with infectious mononucleosis?

Answer 8

Minimum 3 week disqualification in all patients

Question 9

What criteria must be met to resume low-impact, non-contact training at 50% pre-illness level after the initial period of disqualification has completed?

Answer 9

1. Resolution of symptoms
2. Normalization of all laboratory markers
3. Resolution of splenomegaly (confirmed by US)
4. Resolution of any and all complications incld. fatigue, airway obstruction secondary to large tonsils and hepatitis

Question 10

What are the recommendations for patients with infectious mononucleosis after the first week of graded return to activity?

Answer 10

If no relapse of symptoms they may be fully cleared to return to sport participation, incld. contact sports

If no US available consider late return to contact sports

Question 11

How can athletes prevent illness?

Answer 11

Eat a well-balanced diet;

1. Get adequate sleep;
2. Avoid overtraining and fatigue;
3. Allow adequate recovery time following intense exercise;
4. Avoid contact with people who are ill;
5. Wash hands frequently;
6. Do not share water bottles or towels;
7. Reduce life stressors
8. Get appropriate immunizations