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Edwards,JP,Walsh,NP,Diment,PCandRoberts,RAnxietyandperceivedpsychologicalstressplayanimportantroleintheimmuneresponseafterexercisehttp://researchonline.
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uk/Citation(pleasenoteitisadvisabletorefertothepublisher'sversionifyouintendtocitefromthiswork)Edwards,JP,Walsh,NP,Diment,PCandRoberts,R(2018)Anxietyandperceivedpsychologicalstressplayanimportantroleintheimmuneresponseafterexercise.
ExerciseImmunologyReview,24.
pp.
26-34.
ISSN1077-5552LJMUResearchOnline1AnxietyandperceivedpsychologicalstressplayanimportantroleintheimmuneresponseafterexerciseRUNNINGHEAD:Psychologicalstress,exerciseandimmunityJasonP.
Edwards1,NeilP.
Walsh1,BethanyC.
Diment1,2andRossRoberts31CollegeofHealthandBehaviouralSciences,BangorUniversity,Bangor,Gwynedd,UK.
2NorwichMedicalSchool,UniversityofEastAnglia,Norwich,Norfolk,UK.
3InstituteforthePsychologyofElitePerformance,BangorUniversity,Bangor,Gwynedd,UK.
CorrespondingAuthor:Prof.
NeilP.
WalshFACSMCollegeofHealthandBehaviouralSciences,BangorUniversity,Bangor,LL572PZ,UK.
Email:n.
walsh@bangor.
ac.
ukTelephone:+4412483834802ABSTRACTTherearecommonpathwaysbywhichpsychologicalstressandexercisestressalterimmunity.
However,itremainsunknownwhetherpsychologicalstressplaysaroleintheinvivoimmuneresponsetoexercise.
WeexaminedtherelationshipbetweenanxietyandperceivedpsychologicalstressreportedbeforeexerciseandinvivoimmunityafterexerciseusingskinsensitisationwithDiphenylcyclopropenone(DPCP).
Inarandomiseddesign,sixtyfour,thoroughlyfamiliarised,malescompletedwidelyusedpsychologicalinstrumentstoassessstate-anxietyandperceivedpsychologicalstressbeforeexercise,andraneither30minutesat60%(30MI)or80%(30HI)VO2peak,120minutesat60%(120MI)VO2peakorrested(CON)beforeDPCPsensitisation.
CutaneousrecalltoDPCPwasmeasuredasthedermalthickeningresponsetoalow-doseseriesDPCPchallenge4-weeksaftersensitisation.
Afteraccountingforexercise(R2=0.
20;P3,000peer-reviewedpublicationsinexerciseimmunology(usingthesearchterms'exercise'and'immune',WebofScienceTM)yet<5%ofthesepublicationsincludethesearchterms'psychologicalstress'or'anxiety'.
Closerinspectionofthissmallsubsetofexerciseimmunologypublicationsrevealsthatthelargemajoritymentionaputativeroleforpsychologicalstressoranxietyinexercise-immunemodulation;however,onlyasmallhandfuloforiginalinvestigationseitherattempttomanipulatepsychologicalstressorincludeobjectivemeasuresofpsychologicalstress(27,32,38,39).
Thepresentstudyanswerstherecentcallstophysiologists(51)andexerciseimmunologists(49)toincorporateobjectivepsychologicalmeasurementsintheirhumanstudies.
Thefindingshereinsupporttherecommendationthatexerciseimmunologistsshouldincludeaspectsofmentalhealth(e.
g.
psychologicalstressandothers),inabroaderconceptualframeworkofexercise-immuneinteractionsalongsideotherfactorsthoughttodecreaseimmunityinathletesandmilitarypersonnel(e.
g.
prolongedtrainingsessions,poornutritionetc.
).
Thiswillinformanddirectresearchquestionsandexperimentaldesignswiththeaimofimprovingourunderstandingofthecomplicatedexercise-immuneinteractionsandwiththepotentialtoprovideeffectivecountermeasurestoimmuneimpairmentinthoseconcerned.
Tothisend,theexerciseimmunologist'stoolkitwillbeenhancedbyjoiningforceswithexpertsintheeverexpandingfieldofpsycho-neuro-immunologytobegintodisentanglethepsychosocialandphysiologicalunderpinningofdecreasedimmunityandincreasedinfectionriskinhighlevelathletes,militarypersonnelandothersinphysicallydemandingoccupations.
Ourfindingthatpre-exerciseanxietyandperceivedpsychologicalstressaccountedforadditionalvarianceinpost-exerciseinvivoimmunityafteraccountingforexercise(usingTRIMP)emphasisestheimportanceofincorporatingpsychologicalmeasurementsinstudiesinvestigatingtheimmuneresponsetoexercise.
Asdothesimilarstrengthcorrelationsforpre-19exerciseanxiety(STAI-S;r=0.
39)andphysiologicalstressduringexercise(TRIMP;r=-0.
37)withinvivoimmunityafterexercise.
Thesefindingsindicateabeneficialeffectofmoderate(vs.
low)anxietyandperceivedpsychologicalstressoninvivoimmunityafterexercise(Fig.
2AandD);assuch,thefindingsaccordwiththeimmune-enhancementtheoryofmoderatestress(13,20,21).
Furtherresearchisrequiredtoinvestigateexercise-immuneresponsesinathletes,militarypersonnelandothersinphysicallydemandingoccupations(e.
g.
firefightersandmountainrescueworkers)experiencinghigherlevelsofpsychologicalstressthanthosereportedinthisstudye.
g.
asmightoccurinrelationtoimportantcompetition,majorlifeeventsetc.
Theimmuno-suppressiveeffectsofchronichighstressinrats(3weeksofrestraintandshakingstress)(14)andhumans(examinationperiod)(44)arewidelyacknowledged(13).
Assuch,researchisrequiredtotestthehypothesisthatchronichighlevelsofpsychologicalstressexacerbatethedecreaseininvivoimmunityafterexercise.
Irrespective,thepresentfindingssupporttherecommendationthatexercisescientistsshouldaccountforanxietyandpsychologicalstresswhenexaminingtheimmuneresponsetoexercise,andforcoachesandsupportstafftomonitoranxietyandpsychologicalstressalongsidemoretraditionalphysiologicalmeasuresoftrainingstress.
Accordingly,recentevidencehighlightsthataspectsofmentalhealthsuchaspsychologicalstressanddepressionareimportantriskfactorsforillnessinOlympicathletes(18).
Intime,studiesmaydemonstratetheutilityofinterventionstoalterpsychologicalstressinordertooptimiseimmunityandhostdefenceinathletes,militarypersonnelandthoseinphysicallydemandingoccupations.
Thereisgoodreasonforoptimismasan8-weekmindfulnessmeditationprogrammeincreasedtheantibodyresponsetoinfluenzavaccineinemployeesworkinginahighlystressfulenvironment(vs.
waiting-listcontrols)(12).
Also,althoughsomewhatlimitedmethodologically,preliminaryworkincompetitiveathletesshowedthata3-weekstressmanagementinterventionreducedthenumberofdaysoutduetoillnessandinjury(35).
20CONCLUSIONSInconclusion,thesefindingsshowthatanxietyandperceivedpsychologicalstresslevelspriortoexerciseplayanimportantroleindeterminingthestrengthoftheinvivoimmuneresponseafterexercise.
Moreover,thesefindingsindicateasimilar,moderatestrengthrelationshipforthelevelofstate-anxietypriortoexerciseandthelevelofphysiologicalstressduringexercisewiththeinvivoimmuneresponseafterexercise.
Futureresearchisrequiredtoinvestigateexercise-immuneresponsesinathletesandothersinphysicallydemandingoccupationsexperiencinghigherlevelsofpsychologicalstressthanthosereportedinthisstudye.
g.
relatedtoimportantcompetitionandmajorlifeevents.
Nevertheless,thesefindingssupporttherecommendationthatexercisescientistsshouldaccountforanxietyandpsychologicalstresswhenexaminingtheimmuneresponsetoexercise.
ACKNOWLEDGEMENTSBethanyDimentreceiveda125thanniversaryresearchscholarshipfromBangorUniversity.
Thisstudyreceivednoexternalfunding.
Noneoftheauthorshadaconflictofinterest.
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24FIGURELEGENDSFIGURE1.
Effectofstate-anxietypriortoexerciseontheinvivoimmuneresponseafterexercise.
(A)Low(LOW)andmoderate(MOD)levelsofanxiety.
DataareMean±SD.
(B)Contacthypersensitivity(CHS)assessedaselicitationchallenge28dafterDPCPinduction.
Dermalthickeningresponsetothefulldose-serieschallengewithDPCPisshown(30MIand30HI).
DataareMean±SEMforclarity.
1Shownforcomparison.
FIGURE2.
Effectofstate-anxietypriortoexerciseontheinvivoimmuneresponseafterexerciseofvaryingintensityandduration.
(AD)SummedincreaseinskinfoldthickeningresponsetoDPCPchallengeforeachexercisegroup(30MI,30HIand120MI)andrestedCON.
DataareMean±SD.
25TABLE1.
Multiplelinearregressionanalysisexaminingtheinfluenceofstate-anxietyandperceivedpsychologicalstresslevelpriortoexerciseonthesubsequentinvivoimmuneresponseafterexercise.
Contacthypersensitivity(CHS)assessedasthesummeddermalthickeningresponsetothefulldose-serieselicitationchallengewithDPCP28dafterDPCPinduction.
Afteraccountingforthenegativeinfluenceofexerciseinstep1,separatemodelsshowthepositiveinfluenceofanxiety(fromlowtomoderatelevels),assessedusingSTAI-Sinstep2(A)andperceivedpsychologicalstress(fromlowtomoderatelevels)overthelastmonth,assessedusingPSSinstep2(B),respectively.
Dependentvariable:CHSBSEβtΔFR2ΔR2A.
Step1Exercise(TRIMP)1-0.
0050.
002-0.
44-2.
938.
560.
20**0.
20**Step2STAI-S0.
060.
020.
443.
2410.
500.
39**0.
19**B.
Step1Exercise(TRIMP)1-0.
0050.
002-0.
44-2.
938.
560.
20**0.
20**Step2PSS0.
060.
020.
362.
546.
450.
33**0.
13*1TRIMP=trainingimpulse;STAI-S=StateTraitAnxietyInventory;PSS=PerceivedStressScale;*P<0.
05;**P<0.
01.
26FIGURE1.
27FIGURE2.