title: The impact of self-reported psychological stress levels on changes to peripheral blood immune biomarkers in recreational marathon runners during training and recovery.
abstract: OBJECTIVE
  Marathon training is both physically and psychologically stressful, both of which can lead to altered immunity. The purpose of this study was to determine if the overall immunoregulatory changes associated with the physical stress of marathon training are affected by psychological stress.
  
  
  METHODS
  Nineteen recreational marathoners completed the Perceived Stress Scale (PSS), State-Trait Anxiety Inventory (STAI) and Penn State Worry Questionnaire (PSWQ), and had levels of T cell subpopulations and cytokine (IFNγ, IL4 and IL10) production determined 4 weeks before (baseline), 24-48 h before (prerace) and 1 week after (recovery) participation in a marathon.
  
  
  RESULTS
  PSS scores decreased at the prerace visit compared to baseline and remained low at recovery. Compared to baseline, there were significant changes to numerous immune measures at the prerace visit, including decreases in Th1/Th2 ratio, Tc1/Tc2 ratio, Tr1 and Th3 cell populations as well as decreases in IFNγ/IL4 cytokine ratio and IL10 production. Most immune parameters had returned to near baseline values at the recovery visit. Higher levels of perceived stress, anxiety and worry exacerbated many of the alterations in immunity that were observed at the prerace visit. Higher levels of perceived stress and worry had significant effects on changes to Treg, IL4 production and the IFNγ/IL4 cytokine ratio. Stress had an additional impact on changes in IL10 production. High anxiety levels resulted in significant changes to Treg, Tr1 and Th3.
  
  
  CONCLUSIONS
  These data suggest that recreational marathon runners with higher levels of psychological stress may be more at risk for the immune alterations that are common during periods of prolonged physical training.
authors.affiliation: Laboratory of Behavioral Immunology Research, Department of Medicine, Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MI 39216, USA. krehm@umc.edu
authors.forename: Kristina E
authors.initials: KE
authors.lastname: Rehm
authors.forename: Okan U
authors.initials: OU
authors.lastname: Elci
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hahn
authors.forename: Gailen D
authors.initials: GD
authors.lastname: Marshall
mesh_terms: D000328:Adult; D054874:Athletic Performance / Q000502:physiology*; D015415:Biomarkers / Q000097:blood*; D016207:Cytokines / Q000097:blood*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology*; D011569:Psychiatric Status Rating Scales; D012420:Running / Q000502:physiology*; D057566:Self Report; D013315:Stress, Psychological / Q000097:blood / Q000276:immunology / Q000503:physiopathology; D013601:T-Lymphocytes / Q000378:metabolism; D013997:Time Factors
chemical_list: D015415:Biomarkers; D016207:Cytokines