What is the level of evidence for the impact of respiratory exercise on the immune system?

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Last updated: February 10, 2025View editorial policy

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From the Guidelines

The level of evidence for the impact of respiratory exercise on the immune system is limited and inconclusive.

Key Findings

  • The current evidence suggests that exercise may have an impact on regulatory T cells, which play a crucial role in the immune system, but the findings are inconsistent and require further research 1.
  • Some studies propose that exercise-related increases in regulatory T cell counts or function may contribute to a higher susceptibility to upper respiratory tract infections in athletes 1.
  • However, other studies found positive correlations between cardiorespiratory fitness (CRF) and Treg counts or proportions, suggesting a potential beneficial effect of exercise on the immune system 1.

Respiratory Exercise and Immune System

  • Respiratory exercise, such as pulmonary rehabilitation, has been shown to improve exercise tolerance and reduce symptoms in individuals with chronic respiratory disease, including COPD 1.
  • Regular respiratory physiotherapy has also been found to increase sputum expectoration, improve cough-related health status, quality of life, and exercise capacity in individuals with stable bronchiectasis and chronic sputum expectoration 1.

Conclusion Not Applicable - As per the instructions

Instead, the evidence highlights the need for further research to fully understand the impact of respiratory exercise on the immune system, particularly in the context of chronic respiratory disease.

Future Directions

  • Future studies should aim to investigate the effects of exercise on regulatory T cell function and phenotypic changes in both healthy and diseased individuals 1.
  • The development of standardized exercise protocols and outcome measures would help to improve the consistency and comparability of findings across studies 1.

From the Research

Level of Evidence for Respiratory Exercise on the Immune System

The current evidence suggests that regular moderate-intensity exercise has a beneficial effect on the immune system, while prolonged periods of intensive exercise training can depress immunity 2, 3, 4.

  • Moderate-intensity exercise is considered to enhance immune function and prevent acute upper respiratory infections 2, 3.
  • High-intensity exercise, on the other hand, can induce inflammation and reduce cell-mediated immune system function 3, 4.
  • The impact of exercise on the immune system is influenced by factors such as exercise intensity, duration, and individual characteristics, including atopic disposition 5.
  • Regular exercise of moderate intensity may improve immunity due to reductions in inflammation, maintenance of thymic mass, alterations in the composition of immune cells, enhanced immunosurveillance, and/or the amelioration of psychological stress 2, 6.

Exercise and Immune Regulation

Exercise and immune regulation are interrelated and affect each other, with exercise changing immune regulation by affecting leucocytes, red blood cells, and cytokines 6.

  • Regular exercise could reduce the risk of chronic metabolic and cardiorespiratory diseases, partially by the anti-inflammatory effects of exercise 6.
  • However, these effects are also likely to be responsible for the suppressed immunity that makes our bodies more susceptible to infections 2, 4.

Specific Findings

A study on the influence of exercise duration on respiratory function and systemic immunity found that a 90-min bout of moderate-intensity exercise at -15°C did not cause substantial lung function decrements, airway epithelial damage, or respiratory symptoms compared to 30 min running in the same environment 5.

  • However, exercise at -15°C may cause airway injury and evoke respiratory symptoms, even at moderate intensity 5.
  • Atopic status may lead to greater peripheral bronchodilation and higher frequency of respiratory symptoms after long-duration exercise in cold 5.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Exercise and the Regulation of Immune Functions.

Progress in molecular biology and translational science, 2015

Research

Effect of Exercise Intensity on Cell-Mediated Immunity.

Sports (Basel, Switzerland), 2021

Research

Exercise Regulates the Immune System.

Advances in experimental medicine and biology, 2020

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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