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Int J Sports Med 2006; 27(4): 336-341
DOI: 10.1055/s-2005-865670
Immunology

© Georg Thieme Verlag KG Stuttgart · New York

Physical Activity and the Risk of Pneumonia in Male Smokers Administered Vitamin E and β-Carotene

H. Hemilä1 , J. Kaprio1 , 2 , D. Albanes4 , J. Virtamo3
  • 1Department of Public Health, University of Helsinki, Helsinki, Finland
  • 2Department of Mental Health and Alcohol Research, National Public Health Institute, University of Helsinki, Helsinki, Finland
  • 3Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
  • 4Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
Further Information

Publication History

Accepted after revision: 12. März 2005

Publication Date:
11 July 2005 (online)

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Abstract

It has been proposed that moderate exercise may enhance the immune system. We evaluated whether physical activity at work or at leisure is associated with the risk of pneumonia, and whether the antioxidants vitamin E and β-carotene affect pneumonia risk in physically active people. A cohort of 16 804 male smokers aged 50 - 69 years and working at study entry was drawn from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study, which examined the effect of vitamin E, 50 mg/day, and β-carotene, 20 mg/day, on lung and other cancers. Physical activity at work, and the type of leisure-time exercise, were recorded at study entry. We retrieved the first occurrence of hospital-treated pneumonia during a 3-year follow-up from the National Hospital Discharge Register (133 cases). Physical activity at work and at leisure had no association with the risk of pneumonia. In participants with physically loading jobs, neither vitamin E nor β-carotene affected the risk of pneumonia. In participants carrying out moderate or heavy exercise at leisure, β-carotene had no effect, but vitamin E reduced the risk of pneumonia by 50 % (95 % CI: 16 - 70 %). Previously, exercise has been shown to affect diverse laboratory measures of the immune system which are, however, only surrogate markers for the resistance to infections. The lack of association between physical activity and the risk of pneumonia observed in our study emphasizes the problem of drawing conclusions from surrogate end points. The finding that vitamin E reduced the risk of pneumonia in persons carrying out leisure-time exercise warrants further study.

Key words

Antioxidants - exercise - oxidative stress - randomized controlled trials - smoking

References

  • 1 DeGruttola V, Fleming T, Lin D Y, Coombs R. Validating surrogate markers - are we being naive?.  J Infect Dis. 1997;  175 237-246
    PubMedGoogle Scholar
  • 2 Fleming T R, DeMets D L. Surrogate end points in clinical trials: are we being misled?.  Ann Intern Med. 1996;  125 605-613
    PubMedGoogle Scholar
  • 3 Gray G C, Mitchell B S, Tueller J E, Cross E R, Amundson D E. Pneumonia hospitalizations in the US Navy and Marine corps: rates and risk factors for 6522 admissions, 1981 - 1991.  Am J Epidemiol. 1994;  139 793-802
    PubMedGoogle Scholar
  • 4 Hamilton I MJ, Gilmore W S, Benzie I FF, Mulholland C W, Strain J J. Interactions between vitamins C and E in human subjects.  Br J Nutr. 2000;  84 261-267
    PubMedGoogle Scholar
  • 5 Hayek M G, Taylor S F, Bender B S, Han S N, Meydani M, Smith D E, Eghtesada S, Meydani S N. Vitamin E supplementation decreases lung virus titers in mice infected with influenza.  J Infect Dis. 1997;  176 273-276
    PubMedGoogle Scholar
  • 6 Heinzerling R H, Tengerdy R P, Wick L L, Lueker D C. Vitamin E protects mice against Diplococcus pneumoniae type I infection.  Infect Immun. 1974;  10 1292-1295
    PubMedGoogle Scholar
  • 7 Hemilä H. Vitamin C and infectious diseases. Packer L, Fuchs J Vitamin C in Health and Disease. New York; Marcel Dekker 1997: 471-503
    Google Scholar
  • 8 Hemilä H. Vitamin C supplementation and respiratory infections: a systematic review.  Mil Med. 2004;  169 920-925
    PubMedGoogle Scholar
  • 9 Hemilä H, Virtamo J, Albanes D, Kaprio J. Physical activity and the common cold in men administered vitamin E and beta-carotene.  Med Sci Sports Exerc. 2003;  35 1815-1820
    PubMedGoogle Scholar
  • 10 Hemilä H, Virtamo J, Albanes D, Kaprio J. Vitamin E and beta-carotene supplementation and hospital-treated pneumonia incidence in male smokers.  Chest. 2004;  125 557-565
    CrossrefPubMedGoogle Scholar
  • 11 Hughes D A. Dietary carotenoids and human immune function.  Nutrition. 2001;  17 823-827
    CrossrefPubMedGoogle Scholar
  • 12 Jenkins R R. Exercise and oxidative stress methodology: a critique.  Am J Clin Nutr. 2000;  72 670S-674S
    PubMedGoogle Scholar
  • 13 Ji L L. Antioxidants and oxidative stress in exercise.  Proc Soc Exp Biol Med. 1999;  222 283-292
    CrossrefPubMedGoogle Scholar
  • 14 Matthews C E, Ockene I S, Freedson P S, Rosal M C, Merriam P A, Hebert J R. Moderate to vigorous physical activity and risk of upper-respiratory tract infection.  Med Sci Sports Exerc. 2002;  34 1242-1248
    CrossrefPubMedGoogle Scholar
  • 15 Moriguchi S, Muraga M. Vitamin E and immunity.  Vitam Horm. 2000;  59 305-336
    PubMedGoogle Scholar
  • 16 Nieman D C. Exercise, infection, and immunity.  Int J Sports Med. 1994;  15 S131-S141
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Nockels C F. Protective effects of supplemental vitamin E against infection.  Fed Proc. 1979;  38 2134-2138
    PubMedGoogle Scholar
  • 18 Packer J E, Slater T F, Wilson R L. Direct observation of a free radical interaction between vitamin E and vitamin C.  Nature. 1979;  278 737-738
    CrossrefPubMedGoogle Scholar
  • 19 Packer L. Oxidants, antioxidant nutrients and the athlete.  J Sports Sci. 1997;  15 353-363
    CrossrefPubMedGoogle Scholar
  • 20 Pazzaglia G, Pasternack M. Recent trends of pneumonia morbidity in US naval personnel.  Mil Med. 1983;  148 647-651
    PubMedGoogle Scholar
  • 21 Peters E M. Exercise, immunology and upper respiratory tract infections.  Int J Sports Med. 1997;  18 S69-S77
    PubMedGoogle Scholar
  • 22 Pietinen P, Hartman A M, Haapa E, Rasanen L, Haapakoski J, Palmgren J, Albanes D, Virtamo J, Huttunen J K. Reproducibility and validity of dietary assessment instruments.  Am J Epidemiol. 1988;  128 655-666
    PubMedGoogle Scholar
  • 23 Pitt H A, Costrini A M. Vitamin C prophylaxis in marine recruits.  JAMA. 1979;  241 908-911
    CrossrefPubMedGoogle Scholar
  • 24 Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes.  Circulation. 1968;  38 1104-1115
    CrossrefPubMedGoogle Scholar
  • 25 Sen C K. Antioxidants in exercise nutrition.  Sports Med. 2001;  31 891-908
    CrossrefPubMedGoogle Scholar
  • 26 Shephard R J, Shek P N. Exercise, immunity, and susceptibility to infection: a J-shaped relationship?.  Phys Sportsmed. 1999;  27 (6) 47-71
    PubMedGoogle Scholar
  • 27 Stephens L C, McChesney A E, Nockels C F. Improved recovery of vitamin E-treated lambs that have been experimentally infected with intratracheal chlamydia.  Br Vet J. 1979;  135 291-293
    PubMedGoogle Scholar
  • 28 The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study Group . The effect of vitamin E and beta-carotene on the incidence of lung cancer and other cancers in male smokers.  N Engl J Med. 1994;  330 1029-1035
    CrossrefPubMedGoogle Scholar
  • 29 The ATBC Cancer Prevention Study Group . The alpha-tocopherol, beta-carotene lung cancer prevention study: design, methods, participant characteristics, and compliance.  Ann Epidemiol. 1994;  4 1-10
    PubMedGoogle Scholar
  • 30 Woods J A, Davis J M, Smith J A, Nieman D C. Exercise and cellular innate immune system.  Med Sci Sports Exerc. 1999;  31 57-66
    PubMedGoogle Scholar

PhD, MD Harri Hemilä

Department of Public Health
University of Helsinki

POB 41

Helsinki

00014 Finland

Phone: + 358919127573

Fax: + 35 89 19 12 75 70

Email: harri.hemila@helsinki.fi