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Physical activity, exercise and low-grade systemic inflammation

  • Julia Wärnberg (a1) (a2) (a3), Karen Cunningham (a4), Javier Romeo (a1) and Ascension Marcos (a1)


Prospective studies have shown that chronic low-grade inflammation may contribute to the pathogenesis of the most common chronic diseases and in particular CVD. Obesity has repeatedly been associated with moderately raised levels of inflammation, and this observation has led to the view that obesity is characterised by a state of chronic low-grade inflammation. There is now great interest in elucidating how physical activity and exercise modulate inflammation. This review summarises the current research addressing the influence of physical activity and exercise in mitigating the risks of obesity and diseases such as type-II diabetes and CVD, through its action on the low-grade inflammatory state. Most research on this topic hypothesised that the association between physical activity and inflammatory markers is independent of fatness, but very few studies have proven this. Given that physical activity and obesity are often inversely related, it is not clear as to whether the anti-inflammatory health benefits of a physically active lifestyle are due to exercise per se or result from favourable changes in the body composition.

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Corresponding author

*Corresponding author: Dr Julia Warnberg, fax +34 91 549 36 27, email


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1.Hotamisligil, GS (2006) Inflammation and metabolic disorders. Nature 444, 860867.
2.Kahn, SE, Hull, RL & Utzschneider, KM (2006) Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 444, 840846.
3.Libby, P (2006) Inflammation and cardiovascular disease mechanisms. Am J Clin Nutr 83, 456S460S.
4.Hansson, GK (2005) Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 352, 16851695. Visser, KE, Eichten, A & Coussens, LM (2006) Paradoxical roles of the immune system during cancer development. Nat Rev Cancer 6, 2437.
6.Britschgi, M & Wyss-Coray, T (2007) Immune cells may fend off Alzheimer disease. Nat Med 13, 408409.
7.Vogt, B, Fuhrnrohr, B, Muller, R et al. (2007) CRP and the disposal of dying cells: consequences for systemic lupus erythematosus and rheumatoid arthritis. Autoimmunity 40, 295298.
8.Pearson, TA, Mensah, GA, Alexander, RW et al. (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107, 499511.
9.Hansson, GK (2001) Regulation of immune mechanisms in atherosclerosis. Ann N Y Acad Sci 947, 157165; discussion 165–156.
10.Ridker, PM, Buring, JE, Cook, NR et al. (2003) C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation 107, 391397.
11.Ridker, PM, Stampfer, MJ & Rifai, N (2001) Novel risk factors for systemic atherosclerosis: a comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA 285, 24812485.
12.Gustafson, B, Hammarstedt, A, Andersson, CX et al. (2007) Inflamed adipose tissue: a culprit underlying the metabolic syndrome and atherosclerosis. Arterioscler Thromb Vasc Biol 27, 22762283.
13.Trayhurn, P & Wood, IS (2004) Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 92, 347355.
14.Pate, RR, Pratt, M, Blair, SN et al. (1995) Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 273, 402407.
15.Caspersen, CJ, Powell, KE & Christenson, GM (1985) Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 100, 126131.
16.Shephard, RJ, Allen, C, Benade, AJ et al. (1968) The maximum oxygen intake. An international reference standard of cardiorespiratory fitness. Bull World Health Organ 38, 757764.
17.Hamer, M (2007) The relative influences of fitness and fatness on inflammatory factors. Prev Med 44, 3–11.
18.Panagiotakos, DB, Kokkinos, P, Manios, Y et al. (2004) Physical activity and markers of inflammation and thrombosis related to coronary heart disease. Prev Cardiol 7, 190194.
19.Tomaszewski, M, Charchar, FJ, Przybycin, M et al. (2003) Strikingly low circulating CRP concentrations in ultramarathon runners independent of markers of adiposity: how low can you go? Arterioscler Thromb Vasc Biol 23, 16401644.
20.Northoff, H, Weinstock, C & Berg, A (1994) The cytokine response to strenuous exercise. Int J Sports Med 15, Suppl. 3, S167S171.
21.Wärnberg, J, Nova, E, Romeo, J et al. (2007) Lifestyle-related determinants of inflammation in adolescence. Br J Nutr 98, S116S120.
22.Pedersen, BK, Steensberg, A, Fischer, C et al. (2003) Searching for the exercise factor: is IL-6 a candidate. J Muscle Res Cell Motil 24, 113119.
23.Pedersen, BK (2006) The anti-inflammatory effect of exercise: its role in diabetes and cardiovascular disease control. Essays Biochem 42, 105117.
24.Fischer, CP, Berntsen, A, Perstrup, LB et al. (2007) Plasma levels of interleukin-6 and C-reactive protein are associated with physical inactivity independent of obesity. Scand J Med Sci Sports 17, 580587.
25.Ostrowski, K, Rohde, T, Zacho, M et al. (1998) Evidence that interleukin-6 is produced in human skeletal muscle during prolonged running. J Physiol 508 (Pt 3), 949953.
26.Fischer, CP (2006) Interleukin-6 in acute exercise and training: what is the biological relevance? Exerc Immunol Rev 12, 6–33.
27.Philippou, A, Bogdanis, G, Maridaki, M et al. (2009) Systemic cytokine response following exercise-induced muscle damage in humans. Clin Chem Lab Med 47, 777782.
28.Fallon, KE, Fallon, SK & Boston, T (2001) The acute phase response and exercise: court and field sports. Br J Sports Med 35, 170173.
29.Mattusch, F, Dufaux, B, Heine, O et al. (2000) Reduction of the plasma concentration of C-reactive protein following nine months of endurance training. Int J Sports Med 21, 2124.
30.Nicklas, BJ, You, T & Pahor, M (2005) Behavioural treatments for chronic systemic inflammation: effects of dietary weight loss and exercise training. CMAJ 172, 11991209.
31.Hammett, CJK, Prapavessis, H, Baldi, JC et al. (2006) Effects of exercise training on 5 inflammatory markers associated with cardiovascular risk. Am Heart J 151, 367.
32.Fischer, CP, Plomgaard, P, Hansen, AK et al. (2004) Endurance training reduces the contraction-induced interleukin-6 mRNA expression in human skeletal muscle. Endocrinol Metabol 287, E1189E1194.
33.Bautmans, I, Njemini, R, Vasseur, S et al. (2005) Biochemical changes in response to intensive resistance exercise training in the elderly. Gerontology 51, 253265.
34.Marcell, TJ, McAuley, KA, Traustadottir, T et al. (2005) Exercise training is not associated with improved levels of C-reactive protein or adiponectin. Metabolism 54, 533541.
35.Kohut, ML, McCann, DA, Russell, DW et al. (2006) Aerobic exercise, but not flexibility/resistance exercise, reduces serum IL-18, CRP, and IL-6 independent of beta-blockers, BMI, and psychosocial factors in older adults. Brain Behav Immun 20, 201209.
36.Stewart, LK, Flynn, MG, Campbell, WW et al. (2005) Influence of exercise training and age on CD14+ cell-surface expression of toll-like receptor 2 and 4. Brain Behav Immun 19, 389397.
37.Lakka, TA, Lakka, HM, Rankinen, T et al. (2005) Effect of exercise training on plasma levels of C-reactive protein in healthy adults: the HERITAGE family study. Eur Heart J 26, 20182025.
38.Elosua, R, Bartali, B, Ordovas, JM et al. (2005) Association between physical activity, physical performance, and inflammatory biomarkers in an elderly population: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 60, 760767.
39.Reuben, DB, Judd-Hamilton, L, Harris, TB et al. (2003) The associations between physical activity and inflammatory markers in high-functioning older persons: MacArthur studies of successful aging. J Am Geriatr Soc 51, 11251130.
40.Wannamethee, SG, Lowe, GD, Whincup, PH et al. (2002) Physical activity and hemostatic and inflammatory variables in elderly men. Circulation 105, 17851790.
41.Taaffe, DR, Harris, TB, Ferrucci, L et al. (2000) Cross-sectional and prospective relationships of interleukin-6 and C-reactive protein with physical performance in elderly persons: MacArthur studies of successful aging. J Gerontol A Biol Sci Med Sci 55, M709M715.
42.Albert, MA, Glynn, RJ & Ridker, PM (2004) Effect of physical activity on serum C-reactive protein. Am J Cardiol 93, 221225.
43.Jankord, R & Jemiolo, B (2004) Influence of physical activity on serum IL-6 and IL-10 levels in healthy older men. Med Sci Sports Exerc 36, 960964.
44.Colbert, LH, Visser, M, Simonsick, EM et al. (2004) Physical activity, exercise, and inflammatory markers in older adults: findings from the health, aging and body composition study. J Am Geriatr Soc 52, 10981104.
45.Bruunsgaard, H, Ladelund, S, Pedersen, AN et al. (2003) Predicting death from tumour necrosis factor-alpha and interleukin-6 in 80-year-old people. Clin Exp Immunol 132, 2431.
46.Cesari, M, Penninx, BW, Pahor, M et al. (2004) Inflammatory markers and physical performance in older persons: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 59, 242248.
47.Visser, M, Pahor, M, Taaffe, DR et al. (2002) Relationship of interleukin-6 and tumor necrosis factor-alpha with muscle mass and muscle strength in elderly men and women: the Health ABC study. J Gerontol A Biol Sci Med Sci 57, M326M332.
48.Smith, JK, Dykes, R, Douglas, JE et al. (1999) Long-term exercise and atherogenic activity of blood mononuclear cells in persons at risk of developing ischemic heart disease. JAMA 281, 17221727.
49.Goldhammer, E, Tanchilevitch, A, Maor, I et al. (2005) Exercise training modulates cytokines activity in coronary heart disease patients. Int J Cardiol 100, 9399.
50.Tisi, PV, Hulse, M, Chulakadabba, A et al. (1997) Exercise training for intermittent claudication: does it adversely affect biochemical markers of the exercise-induced inflammatory response? Eur J Vasc Endovasc Surg 14, 344350.
51.Milani, RV, Lavie, CJ & Mehra, MR (2004) Reduction in C-reactive protein through cardiac rehabilitation and exercise training. J Am Coll Cardiol 43, 10561061.
52.McGavock, JM, Mandic, S, Vonder Muhll, I et al. (2004) Low cardiorespiratory fitness is associated with elevated C-reactive protein levels in women with type 2 diabetes. Diabetes Care 27, 320325.
53.Aronson, D, Sheikh-Ahmad, M, Avizohar, O et al. (2004) C-reactive protein is inversely related to physical fitness in middle-aged subjects. Atherosclerosis 176, 173179.
54.Aronson, D, Sella, R, Sheikh-Ahmad, M et al. (2004) The association between cardiorespiratory fitness and C-reactive protein in subjects with the metabolic syndrome. J Am Coll Cardiol 44, 20032007.
55.Panagiotakos, DB, Pitsavos, C, Chrysohoou, C et al. (2005) The associations between leisure-time physical activity and inflammatory and coagulation markers related to cardiovascular disease: the ATTICA study. Prev Med 40, 432437.
56.Abramson, JL & Vaccarino, V (2002) Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Intern Med 162, 12861292.
57.King, DE, Carek, P, Mainous, AG 3rd et al. (2003) Inflammatory markers and exercise: differences related to exercise type. Med Sci Sports Exerc 35, 575581.
58.Pischon, T, Hankinson, SE, Hotamisligil, GS et al. (2003) Leisure-time physical activity and reduced plasma levels of obesity-related inflammatory markers. Obes Res 11, 10551064.
59.Mora, S, Lee, IM, Buring, JE et al. (2006) Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA 295, 14121419.
60.Rawson, ES, Freedson, PS, Osganian, SK et al. (2003) Body mass index, but not physical activity, is associated with C-reactive protein. Med Sci Sports Exerc 35, 11601166.
61.Raitakari, M, Mansikkaniemi, K, Marniemi, J et al. (2005) Distribution and determinants of serum high-sensitive C-reactive protein in a population of young adults: the cardiovascular risk in young Finns study. J Intern Med 258, 428434.
62.Verdaet, D, Dendale, P, De Bacquer, D et al. (2004) Association between leisure time physical activity and markers of chronic inflammation related to coronary heart disease. Atherosclerosis 176, 303310.
63.Church, TS, Barlow, CE, Earnest, CP et al. (2002) Associations between cardiorespiratory fitness and C-reactive protein in men. Arterioscler Thromb Vasc Biol 22, 18691876.
64.Church, TS, Finley, CE, Earnest, CP et al. (2002) Relative associations of fitness and fatness to fibrinogen, white blood cell count, uric acid and metabolic syndrome. Int J Obes Relat Metab Disord 26, 805813.
65.Diaz, VA, Player, MS, Mainous, AG III et al. (2006) Competing impact of excess weight versus cardiorespiratory fitness on cardiovascular risk. Am J Cardiol 98, 14681471.
66.Cook, DG, Mendall, MA, Whincup, PH et al. (2000) C-reactive protein concentration in children: relationship to adiposity and other cardiovascular risk factors. Atherosclerosis 149, 139150.
67.Nemet, D, Wang, P, Funahashi, T et al. (2003) Adipocytokines, body composition, and fitness in children. Pediatr Res 53, 148152.
68.Platat, C, Wagner, A, Klumpp, T et al. (2006) Relationships of physical activity with metabolic syndrome features and low-grade inflammation in adolescents. Diabetologia 49, 20782085.
69.Isasi, CR, Deckelbaum, RJ, Tracy, RP et al. (2003) Physical fitness and C-reactive protein level in children and young adults: the Columbia University BioMarkers study. Pediatrics 111, 332338.
70.Halle, M, Korsten-Reck, U, Wolfarth, B et al. (2004) Low-grade systemic inflammation in overweight children: impact of physical fitness. Exerc Immunol Rev 10, 6674.
71.Kelly, AS, Wetzsteon, RJ, Kaiser, DR et al. (2004) Inflammation, insulin, and endothelial function in overweight children and adolescents: the role of exercise. J Pediatr 145, 731736.
72.Wärnberg, J (2006) Inflammatory status in adolescents; the impact of health determinants such as overweight and fitness. PhD Thesis. Karolinska Institutet, University Press, Stockholm.
73.Williams, MJ, Milne, BJ, Hancox, RJ et al. (2005) C-reactive protein and cardiorespiratory fitness in young adults. Eur J Cardiovasc Prev Rehabil 12, 216220.
74.Ruiz, JR, Ortega, FB, Warnberg, J et al. (2007) Associations of low-grade inflammation with physical activity, fitness and fatness in prepubertal children; the European Youth Heart study. Int J Obes (Lond) 31, 15451551.
75.Thomas, NE, Baker, JS, Graham, MR et al. (2008) C-reactive protein in schoolchildren and its relation to adiposity, physical activity, aerobic fitness and habitual diet. Br J Sports Med 42, 357360.
76.Ruiz, JR, Ortega, FB, Warnberg, J et al. (2008) Inflammatory proteins and muscle strength in adolescents: the Avena study. Arch Pediatr Adolesc Med 162, 462468.
77.Blum, CA, Muller, B, Huber, P et al. (2005) Low-grade inflammation and estimates of insulin resistance during the menstrual cycle in lean and overweight women. J Clin Endocrinol Metab 90, 32303235.
78.Rutter, MK, Meigs, JB, Sullivan, LM et al. (2004) C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring study. Circulation 110, 380385.
79.Dandona, P, Aljada, A, Chaudhuri, A et al. (2005) Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation 111, 14481454.
80.Thorand, B, Baumert, J, Döring, A et al. (2006) Sex differences in the relation of body composition to markers of inflammation. Atherosclerosis 184, 216224.
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