A Systematic Review and Meta-Analysis on the Influence of Exercise-Induced Oxidative Stress on the Pathogenesis of Infectious Diseases
Subject Areas : Exercise Training and Diseases
1 - Department of Physical Education and Sport Sciences, Parand Branch, Islamic Azad University, Parand, Tehran, Iran.
Keywords:
Abstract :
Background: Exercise-induced oxidative stress (EIOS) plays a pivotal role in immune modulation and the pathogenesis of infectious diseases. While moderate-intensity exercise has been shown to enhance immune defenses and redox balance, excessive or prolonged physical activity can lead to transient immunosuppression, increasing infection susceptibility. This systematic review and meta-analysis aim to evaluate the influence of EIOS on immune function and infection risk across diverse exercise protocols and populations.
Materials and Methods: A systematic search was conducted across PubMed, Scopus, and ScienceDirect databases, encompassing studies published up to 2025. Inclusion criteria were controlled trials and observational studies that assessed oxidative stress biomarkers, immune responses, and infectious disease outcomes in human participants. Out of 1,245 initially identified studies, 28 met the inclusion criteria, representing a wide range of exercise intensities and durations. Meta-analytic methods using a random-effects model quantified standardized mean differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed via I² statistics, and subgroup analyses were conducted to explore variability by population characteristics and exercise modalities. The review protocol was registered at PROSPERO (CRD42024611777).
Results: Moderate-intensity exercise (50–70% VO2max) was associated with significant reductions in pro-oxidant markers, such as malondialdehyde (MDA; SMD: -1.08, 95% CI: -1.57 to -0.58), and enhanced antioxidant capacity, including superoxide dismutase and total antioxidant status (TAS; SMD: 1.45, 95% CI: 0.83–2.06). High-intensity exercise (≥70% VO2max) triggered elevated reactive oxygen species and pro-inflammatory cytokines, leading to a transient immune suppression. Subgroup analyses revealed that sedentary populations experienced amplified oxidative responses compared to physically active individuals. Antioxidant supplementation, particularly with compounds like resveratrol and vitamin C, showed potential in mitigating oxidative damage and improving recovery outcomes.
Conclusion: EIOS exhibits a dual nature, where moderate exercise fosters immune resilience and infection prevention, while excessive intensity compromises immune defenses. These findings emphasize the importance of tailored exercise regimens and antioxidant strategy to optimize health outcomes. Further research is needed to investigate long-term effects and develop standardized intervention protocols for at-risk populations.