Hasta aquí hemos tratado de la actividad física moderada. ¿Pero qué ocurre cuando es intensa, por ejemplo en los deportistas de élite? El ejercicio intenso, más del 75% VO2max., suele tener efectos negativos sobre el sistema inmune porque distorsiona negativamente los sistemas defensivos inmunólogos lo que incluso puede conducir a un deterior de la salud de las personas que practican este tipo de deporte.
Se debe a que este tipo ejercicio intenso es considerado como una fuente clásica de estrés psicológico y físico que induce mediadores inhibidores del sistema inmune como es la adrenalina y el cortisol. Además su realización agota la glutamina con efectos muy negativos para la salud y para el propio sistema inmune cuya desregulación provoca una inflamación transitoria pero que en algunos casos se hace crónico.
Esta distorsión del sistema inmune abre la puerta a infecciones, tumores y patologías de base inflamatoria como son las enfermedades autoinmunes, alergias y muchos de los procesos degenerativos que sabemos tienen un componente inflamatorio importante en su etiología.
En este capítulo analizaremos todos esos aspectos en general y también presando especial atención a lo que ocurre en la edad infantil y en mayores. También veremos como muchos de los inconvenientes que acarrea este tipo de ejercicio pueden ser mitigados cuando la actividad física se realiza de manera racional, con entrenamiento adecuado o con el asesoramiento de especialistas deportivos o fisioterapeutas.
Ejercicio intenso y susceptibilidad a infecciones
Las más grandes estrellas del deporte, aquellos que son líderes gracias a su gran desarrollo físico y preparación, pueden- paradojalmente- ser proclives a contraer enfermedades infecciosas con mayor frecuencia que la población en general. Los expertos culpan al sobre entrenamiento como causa de esta singular desventaja inmunológica.
Está generalmente acepado que el número de infecciones de las personas que realizan ejercicio moderado es menor que la media de las población normal pero por otra parte el número de infecciones puede ser mayor en aquellas personas que son deportista de élite.
En efecto, se ha postulado que el sobre entrenamiento puede ser el culpable de muchas enfermedades que afectan a los atletas, las que aumentan en frecuencia a medida que la etapa competitiva progresa.
Estas enfermedades varían desde persistentes resfríos, dolores de garganta y gripe, hasta estados de debilitación similares a síndrome de fatiga post-virales que pueden causar que el atleta pierda toda una temporada o aun forzarlo a renunciar al deporte.
Se dice generalmente que los atletas sufren de fiebre glandular, término bastante ambiguo que pretende dar cuenta de un sinnúmero de síntomas clínicos vagos y que en muy pocos casos es confirmado con un diagnóstico diferencial concreto (como de mononucleosis, por ejemplo)
Sobre las enfermedades que se han podido diagnosticar en atletas de competición, recae la sospecha que puede tratarse de infecciones oportunistas que se desarrollan en personas con un sistema inmune debilitado. El ejercicio intenso realizado durante el período de incubación empeora la enfermedad. Esto ha sido estudiado en la polio y en estudios similares realizados en animales de experimentación. Monos sometidos a ejercicios intensos durante el período de incubación de poliomielitis tenían una incidencia mayor y más severa de parálisis que los controles.
Los mejores corredores son usualmente más vulnerables a infecciones respiratorias altas. De 150 corredores encuestados acerca de síntomas respiratorios después de 56 Km de carrera en un maratón, los síntomas fueron más comunes en aquellos que alcanzaron mayores velocidades y en aquellos que tenían un entrenamiento semanal mayor (Nieman, 2010).
Ejercicio intenso y estrés psíquico y físico
El ejercicio muy intenso, cuando se realiza sin un entrenamiento previo adecuado, puede ser perjudicial para la salud en general y para el sistema inmune en particular debido a que el estrés psíquico y físico puede generar debido a la ansiedad competitiva, fatiga o incluso el daño muscular y articular a que puede dar lugar.
Hay que tener presente que el ejercicio físico intenso es un modelo de estrés clásicamente establecido cuyas señales se inician en el hipotálamo por impulsos periféricas. Se produce así el consiguiente estimulo del eje hipotálamo-hipófisis-adrenal con la producción de CRH, ACTH y glucocorticoides. Debido al efecto bloqueante de los corticoides sobre el sistema inmune se produce una marcada inmunodeficiencia.
Además, se estimula paralelamente el sistema nervioso simpático con la consiguiente liberación de catecolaminas, adrenalina y noradrelina, lo que afecta aun desfavorablemente la función inmunitaria.
En estas condiciones de estrés se produce un marcado descenso de glutamina, que es un nutriente importante para las células inmunocompetentes. Así la carencia de este aminoácido contribuye a la inmunosupresión severa que se hace patente en muchas de las personas que practican ejercicios intensos. Esto hace a su vez que aumente su susceptibilidad a padecer más catarros e infecciones respiratorias que otras personas .
En los efectos negativos del ejercicio físico intenso pueden intervenir, además de por el aumento de catecolaminas, el hecho de que la primera berrera de defensa del organismo esté afectada. Hablamos de las superficies mucosas de los órganos abiertos al exterior (fosas nasales, pulmones, etc.) que en estos deportistas se ven atropellados por las intensas corrientes de aire, a veces contaminadas por gérmenes, en la ventilación forzada propia de estos deportistas.
Esto unido a la deshidratación que suele presentarse, unido a cambios de temperatura y severo descenso del grado de humedad de las mucosas, hacen que se facilite la colonización por gérmenes o la reactivación de los que se encuentran acantonados pero que no daban problemas en condiciones normales.
Ejercicio intenso y estrés oxidativo
La práctica de deporte intenso hace aumentar los radicales libres (ROS) que a su vez afectan negativamente el funcionamiento del sistema inmune, de ahí que muchos competidores de élite se produzca una mayor susceptibilidad de infecciones.
Esto se debe a que el ejercicio físico interno y extenuante incrementa el consumo de oxígeno molecular que respiramos y puede generar grandes cantidades de estos radicales. (esquema de habitos ampliar) Al mismo tiempo en estos deportistas suelen producir daños en los músculos con incluso rotura de su fibras o incluso destrucción de neutrófilos y macrófagos, todo lo cual hace que se libere una gran cantidad de radicales libres de forma descontrolada. El problema es que no son neutralizados por el sistema antioxidante y por tanto pueden dañar a los leucocitos con lo cual interfieren con la función de estas células conduciendo a una inmunodeficiencia que puede ser severa.
Este estado de deterioro inmunológico puede durar varias horas después de realizado el ejercicio intenso y extenuante y es lo que hace más deportista sean más vulnerables a infecciones respiratorias y gastrointestinales durante esta periodo de tiempo.
¿Cómo el deporte intenso daña al sistema inmune?
El ejercicio extenuante o intenso puede influenciar en varios elementos del sistema inmune de las personas que lo practican. A medida que se está realizando un ejercicio exhaustivo (un maratón por ejemplo) se visualizan cambios importantes en el sistema inmune que pueden perdurar incluso varios días. Entre estos destacan los cambios producidos en los niveles de linfocitos y su capacidad funcional en cuanto a su capacidad secretora de citocinas, citotoxicidad o producción de anticuerpos.
Ejercicio intenso y niveles de linfocitos
Cuando se realiza ejercicio físico moderado los niveles de linfocitos tanto T, B y de células Natural Killer (NK) ascienden mientras dura la actividad para después descender hasta los niveles basales, esto no ocurre cuando se realiza ejercicio intenso. En este caso los linfocitos ascienden a niveles más altos durante el ejercicio pero una vez terminado suelen descender a valores más bajos que los que los de partida. Este descenso incluso puede durar varios días en lo que se viene en denominarse “ventana inmune abierta” lo que explica que el deportista se haga muy receptivo a contraer infecciones sobre todo de tipo viral en los días posteriores a la terminación de la actividad. Este descenso de linfocitos ocurre después de la actividad deportiva y sobre todo de células NK explica el estado de vulnerabilidad a las infecciones a que están sujetos estas personas.
Una representación esquemática de la evolución de los niveles de linfocitos en sangre durante e inmódicamente después de la realización de ejercicio moderado y de ejercicio intenso se aprecia en la figura adjunta en la que también se incluyen los cambios en las hormonas adrenalina, cortisol y glutamina.
Ejercicio intenso y función linfocitaria
Muchos estudios han informado que varias funciones de las células inmunitarias se ven afectadas temporalmente por episodios prolongados de ejercicio, por ello los atletas involucrados en periodos intensivos de entrenamiento son más susceptibles a las infecciones (dolor de garganta y síntomas parecidos a la gripe) que la población general, y una vez infectados, los resfriados pueden durar más tiempo.
Asociado al ejercicio intenso se produce también una intensa secreción de linfocinas proinflamatorias (TNF-α, IL-1β, IL-6, CCL2, histamina, PGE2 o NGF). La causa de esta tormenta de citocinas está ligada al daño muscular que se produce, al estrés asociado, e inclusos dolores articulares musculares, etc.
La consecuencia de todo ello es la aparición de una inflamación generalizada que es una de las complicaciones más serias del ejercicio intenso. Es llamativo como una de las actividades más importantes de linfocitos durante el ejercicio intenso es la sobreproducción de la citocina proinflamatoria IL-6. Además los macrófagos y neutrófilos producen también durante ese tipo de ejercicio grandes cantidad de otro factor, TNF alfa, también con acciones proinflamatorias. Tanto la IL-6 como el TNF alfa se producen normalmente en respuesta a antígenos bacterianos y es la principal citocina responsable del shock séptico por su gran capacidad proinflamatoria de ahí la importancia de que se pueda producir durante el ejercicio muy intenso. Y es que la inflamación es un arma de doble filo, por un lado es necesaria para nuestra defensa frene a infecciones y agresiones externas pero por otro cuando se produce fuera de ese contexto, es un elemento agravante que además predispone a problemas inmunológicos importantes, sobre todo en personas mayores.
Como corrector del dolo crónico, se empieza a proponer el uso de fármacos inhibidores del sistema inmune como alternativa eficaz para su tratamiento. En este sentido, cabe señalar el uso de fármacos ya empleados en otras patologías inflamatorias, como los antagonistas del TNF-α, podían utilizarse en estos casos.
Precisamente el precalentamiento es importante porque la actividad física de intensidad media está produciendo factores antinflamatorios que pueden beneficiar contraponiéndose a la acción proinflamatoria del ejercicio intenso. De igual manera las actividades de relajación post ejercicio son igualmente importantes para la producción de citocinas con carácter antiinflamorio tan necesarias en esa fase de recuperación y reparación de los tejidos y del sistema inmune dañados por el ejercicio intenso.
La inmunidad innata, principalmente mediada por macrófagos y neutrófilos, se encuentra deprimida cuando se comparan deportistas altamente competitivos y sujetos normales. Tanto la adherencia de esas células como su actividad bactericida decrecen significativamente en los deportistas después de un ejercicio intenso.
También cambian los niveles de inmunoglobulinas que se hace más patente en la IgA, que normalmente se mide en saliva en los deportistas, y que desciende muy ostensiblemente durante y después de la realización del ejercicio intenso. Volver a los niveles de esta inmunoglobulina que se tenía previamente al ejercicio intonso, normalmente tarda varios días, aumentando así el riesgo de infección.
Ejercicio intenso en niños y personas mayores
La actividad física intensa tanto en niños como en mayores esta contraindico por el daño que produce en el sistema inmune. Las razones son diferentes porque en los niños el sistema inmune se está desarrollando mientras que en los mayores se encuentra distorsionado y envejecido.
El problema en niños se debe esencialmente a que este tipo de ejercicio impacta sobre el timo que como sabemos es la glándula donde están madurando los linfocitos T y muchas células NK. Y es que esta glándula es especialmente sensible a los corticoides que producen su atrofia cuando los niveles se elevan demasiado. Así, como se puede deducir el ejercicio intenso que se caracterizada por una alta tasa de producción de estas hormonas está impactando negativamente sobre el timo induciendo su atrofia, precisamente en las edades que su función es máxima.
Esta es pues la razón por la que los niños pueden jugar pero no realizar trabajos forzados ni ejercicios muy intensos porque la atrofia tímica en los mismos les dejaría sin desarrollo normal el sistema inmunológico que tan importante es en la defensa del individuo frente a infecciones, tumores y enfermedades de base inflamatoria. Por el contrario el ejercicio moderado es bueno por sus efectos antinflamatorios y por la inducción de hormona de crecimiento que es importante para muchos procesos metabólicos de los niños.
En las personas mayores, sobre todo de más de 60 años, las limitaciones del ejercicio intenso se deben no solo por la fragilidad de sus huesos, músculos y articulaciones sino también porque en estas edades la distorsión fisiológica sufrida por el sistema inmune suele derivar hacia un proceso inflamatorio muy manifiesto. Por ello si a esta inflamación natural se añade la producida por el ejercicio intenso, la situación en personas mayores se agrava.
Apoyo al sistema inmune en deportista de élite
Al objeto de evitar los posibles efectos negativos del deporte intenso (de elite) sobre las defensas inmunitarias es necesario que el deportista tenga un apoyo en su plan de entrenamientos en el control del estrés psicológico, una adecuada hidratación y nutrición.
Está demostrado que la respuesta homeostática producida por el ejercicio físico intenso, se atenúan cuando se ha realizado entrenamiento adecuado. Esto demuestra que las células del sistema inmune parecen presentar mecanismos de tolerancia que permiten la mejora de sus funciones en respuesta a ejercicio físico intenso.
Cuando el deportista dispone de un entrenador adecuado se amortiguan las complicaciones derivadas del ejercicio intenso de los. Esto ha sido reiteradamente demostrado por especialistas como Nieman que resume su visión en el grafico que se adjunta donde insiste en la conveniencia de un adecuado entrenamiento a ser posible dirigido por personal especializado para amortiguar las complicaciones inmunológicas y antioxidantes en estos deportistas.
Como este tipo de ejercicio va acompañado de estrés, estos deportistas requieren apoyo psicológico y emocional al objeto de conseguir, sin detrimento de su rendimiento. Además con el entrenamiento adecuado se debe de evitar lesiones y dolores que de si tiene efecto proinflamatoria a atreves de la activación del sistema inmune.
Además es importante que estos deportistas para controlar su sistema antioxidante en buenas condiciones, tomen una dieta equilibrada con suficientes a) vitaminas antioxidantes como son la A, C, y E, b), tomar también el aminoácido glutamina para compensar lo que se gasta en este tipo de deporte c) minerales como Zinc y Selenio y d) cubrir adecuadamente los requerimientos energéticos con una dieta mediterránea y variada y con suficiente cantidad de líquidos que fluidifiquen las mucosas respiratorias y así protegernos de infecciones debido al alto volumen de aire respirado y a las bajas defensas que pueden tener en el periodo ventana post ejercicio.
Resumen
Es indicativo de que la actividad física intensa y de alta competición daña al sistema inmune porque en muchos casos nos predispone para el padecimiento de enferemdades precisamente relacionadas con un fallo de nuestra inmunidad (infecciones, cánceres y enfermedades autoinmunes). Además este tipo de ejercicio implica que las superficies mucosas de los órganos abiertos al exterior (fosas nasales, pulmones, etc.) se ven desbordadas por intensas corrientes de aire y cierta deshidratación, todo lo cual facilita la colonización por gérmenes.
El daño al sistema inmune en estos deportistas tiene muchas causas. Hay que tener presente que el ejercicio físico intenso y sin entrenamiento adecuado es un modelo de estrés clásicamente establecido en el que se estimula el eje hipotálamo-hipófisis-adrenal, con la consecuente producción de glucocorticoides que tienen un efecto bloqueante del sistema inmune muy marcado.
Con este tipo de ejercicio también se produce una estimulación del sistema nervioso simpático, lo que puede producir un aumento en la liberación de catecolaminas, como la adrenalina y la noradrelina, lo que va a incidir desfavorablemente en la función inmunitaria.
Para evitar estas complicaciones, el ejercicio intenso requiere de una buena programación, incluyendo una fase de precalentamiento y de relajación posterior, y apoyo emocional al deportista, pues de lo contrario produce un deterioro importante de las defensas, como prueba el mayor número de catarros e infecciones respiratorias en muchas de las personas que lo practican fuera del control y supervisión de entrenadores u otros profesionales adecuados en relación con las personas que no practican ningún tipo de deporte.
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