Exercising with Infection

1. Physiology: Immune reaction to Exercise
   1. Increased
      1. Granulocytes
      2. Monocytes
      3. Lymphocytes
      4. Natural Killer Cells increased
   2. Not affected
      1. B Lymphocytes
2. Physiology: Fever effect on Exercise
   1. Decreased cardiovascular parameters
      1. Cardiac Output
      2. Systemic Vascular resistance (SVR)
      3. Blood Pressure
   2. Increased cardiovascular parameters
      1. Oxygen Consumption
      2. Heart Rate
   3. Fevers overall effect on Exercise
      1. Increased Effort and Fatigue
      2. Decreased Exercise Capacity
      3. Higher risk of Dehydration and Injury
3. Contraindications to participation when febrile (>100.4F)
   1. Myalgias
   2. Cough or other Upper Respiratory symptoms
4. Specific Conditions
   1. Myocarditis
      1. Associated with URI (Coxsackie Virus)
      2. Return to play in 6 months
   2. Epstein-Barr Virus (Mononucleosis)
      1. Athletes have milder course of Mononucleosis
      2. Requires 3-6 months to return to prior fitness level
      3. Avoid Contact Sports for at least 4 weeks
         1. Incidence Splenic Rupture (days 4-21): 0.1-0.2%
      4. Return to play
         1. Three weeks: Moderate training indications
            1. No Splenomegaly
            2. No fever
            3. Liver Function Tests Normal
            4. Asymptomatic
         2. Four weeks: Strenuous activity allowed
   3. Infectious Diarrhea
      1. Prophylaxis not generally recommended
   4. Otitis Externa
      1. May return to water sports 2-3 days after treatment
      2. Tight ear plugs used for earlier return
   5. Human Immunodeficiency Virus (HIV Infection)
      1. Incidence of HIV in College Students: 1 in 500
      2. Athletes risk HIV Transmission <1 per million games
      3. NCAA, USOC, NFHSAA: unrestricted activity in HIV
      4. No routine HIV Screening in sports
5. Prevention: Immunizations for athletes
   1. Tetanus Vaccine
   2. Influenza Vaccine
   3. Hepatitis B Vaccine
   4. MMR Vaccine