EGZERSİZ VE İMMUN YANIT İLİŞKİSİ

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Egzersizin hem nöroendokrin hem de immunulojik yanıtı ilk kez “Hans SELYE” tarafından “Genel Adaptasyon Sendromu (GAS)” başlığı altında açıklanmıştır (Selye, 1946). “GAS”, teorik olarak egzersizi takiben organizmanın iç çevresinde başlayan düzenleme ve kontrol sistemlerinin (nöroendokrin ve immun sistem) faaliyetlerinde görülen değişimlere verilen genel durumdur. Organizmanın iç çevresinin kontrolü ve düzenlenmesi bu sistemler aracılığıyla sağlanmaktadır. Bu sistemlerin genel çalışma mekanizması geri bildirim yolu ile gerçekleşmektedir. Bir egzersiz uygulaması sonrası, homeostatik çevre üzerinde meydana gelen stresin neden olduğu geri bildirimler sonucunda bir dizi iç ortam düzenleme ve kontrol sistemlerinin faaliyetlerinde artışlar görülmektedir. Bu durumun temel nedeni, homeostatik sürecin devamı ve yönetimi için egzersiz sırasında ve sonrasında nörendokrin sistem ve immun yanıt son derece kritik öneme sahiptir. Bu bağlamda, literatür incelendiğinde, egzersiz uygulamalarının set, tekrar ve hacim gibi akut bileşenlerinin nöroendokrin ve immünolojik yanıtı etkileme potansiyeli bilinmektedir. Direnç antrenman protokollerinin, ılımlı-orta ve yüksek yoğunluklu sergilenen egzersizlerin akut hormonal yanıtta artışlara neden olduğu ifade edilmiştir. Aynı zamanda, egzersiz uygulamaları sırasında dinlenme aralığını kısa tutulması akut yanıtların büyük oranda daha fazla olmasına neden olmaktadır. Egzersiz kaynaklı meydana gelen nöroendokrin yanıt (artan hormonal aktivite) hem kan içindeki hormon konsantrasyon düzeyinde hem de ilgili hormonların reseptör aktivitelerinde artışlara neden olabilmektedir. Aynı zamanda, egzersizin türüne, süresine, yoğunluğuna ve hacmine bağlı olarak homeostatik denge üzerinde yarattığı strese göre hem akut hem de kronik hücresel adaptasyonlar gerçekleşmektedir (Kraemer, 1988; Kraemer ve Ratamess, 2005). Egzersiz stress yanıtı, adrenal korteksten salgılanan “kortizol hormonu (adrenal korteks’ten salgılandığı için bu isim verilmiştir)” yolu ile kontrol edilmektedir. Her ne kadar kortizolun mekanizması tam olarak anlaşılmamasına rağmen akut bir egzersiz sonrası egzersizin yoğunluğu, süresi ve hacmine bağlı olarak dokuların remodellenmesi süreçlerinde görev alan önemli bir nöroendokrinal bileşendir (Kraemer ve Ratamess, 2005). Aynı zamanda, kortizol hormonu, “glokortikoid” ailenin bir parçası olduğundan dolayı kas içi protein sentez süreçlerinde aktif rol almaktadır. “Glukokortikoidler”, kas içinde protein yapımını inhibe etme protein yıkımını arttırma potansiyeline sahiptirler. Ayrıca, literatür, “glukokortikoidlerin” tüm kas fiberleri türlerinde “aktin ve miyozin ağır zincir sentezini” inhibe ettiğini de vurgulamıştır (Hickson ve ark., 1990; Auclair ve ark., 1997). Başka bir ifadeyle, egzersize yanıt olarak artma potansiyeli olan kortizol hormonu kas içi protein sentez süreçlerini ve tüm kas fiber “aktin ve miyozin ağır zincir” baskılama veya engelleme potansiyeline sahip olduğu sanılmaktadır (Peeters ve ark., 2008). Aynı zamanda, akut egzersizler boyunca kortizol hormonu sekresyonu hipofiz bezinde salgılanan “adrenokortikoid hormon (ACTH)” yoluyla başlatıldığı da bilinmektedir (Kraemer ve ark., 1993; 1992; 1999). Bir diğer önemli nokta ise, egzersizin neden olduğu laktat konsantrasyonu ile kortizol hormonu arasındaki yakın ilişkidir. Başka bir ifadeyle, egzersizin neden olduğu laktat yanıtı ne kadar artarsa o kadar kortizol hormonu salınımı da artmaktadır (Ratamess ve ark., 2005; Kraemer ve ark., 1989). Tüm bunlara ilaveten, egzersiz sonrası (24 saat içinde) meydana gelen kas hasarı belirteçlerinden olan “kreatin kinaz (CK)” enzimi konsantrasyon düzeyi ile kortizol hormonu salınımı arasında pozitif ilişki olduğu da vurgulanmıştır. Bir diğer ifadeyle, egzersiz sonrası CK düzeyinin artış düzeyi kortizol hormonu salgı düzeyini arttıran bir diğer önemli faktör olarak düşünülmektedir (Kraemer ve ark., 1993). Sonuç olarak, egzersizin yoğunluğu, süresi ve hacmine bağlı olarak homeostatik denge üzerinde negatif geri bildirimler meydana gelmektedir. Bu negatif geri bildirimler, ACTH kaynaklı kortizol hormonu salınım artışı ile gerçekleşmektedir.

Egzersiz kaynaklı meydana gelen akut streslere karşı tıpkı nöroendokrinal yanıtlar gibi immünolojik aktivite de duyarlıdır. Her ne kadar immünolojik yanıtın dış ortam zararlıları nedeniyle veya patojenleri yoluyla faaliyet gösteren bir organ olduğu düşünülmesine rağmen egzersiz veya fiziksel yüklenmelere yanıt verdiği bilinmektedir (Weigent ve ark., 1988; Herbert ve Cohen, 1993; Kiecolt-Glaser ve ark., 1992; Blalock, 1984). Özellikle, akut aerobik egzersizler sonrası kan içinde “beyaz küre (nötrofil ve lenfosit) kontsantrasyon” düzeyinde artışlar olduğu bildirilmiştir (Shek ve ark., 1995; Simpson ve ark., 2006). Özellikle nötrofil düzeyinin hemen egzersizi başlangıcını takiben arttığı ve devam eden birkaç saat içinde artma eğilimini sürdürdüğü iyi dokümante edilmiştir. Diğer taraftan, dolaşım lenfosit düzeyinin egzersize yanıt olarak arttığı ama egzersiz sonrası başlangıç düzeyine gerilediği belirtilmiştir (McCarthy, 1988). Tüm bu yanıtların egzersizin süresi, yoğunluğu ve hacmi ile doğrudan ilişkili olduğu vurgulanmaktadır. Literatür genel olarak, 90 dk’ dan fazla ve maksimal oksijen tüketimi (VO2maks) düzeyi %75’ in üzerinde olan egzersizlerin immünolojik yanıt üzerinde yüksek strese neden olacağı vurgusunu yapmaktadır. Ayrıca, aerobik egzersizler sonrası artan dolaşım lökosit sayısının 3 ila 24 saat içinde tekrar başlangıç düzeyine döndüğü de vurgulanmıştır (Gleeson, 2007). Ancak aerobik egzersizlere kıyasla direnç antrenmanlarının immünolojik yanıt üzerine etkileri araştıran çok sınırlı sayıda araştırma bulunmaktadır. Erkekler üzerinde yapılan bir araştırmada, direnç egzersizleri sırasında ve sonrasında dolaşım toplam lökosit sayısında artışlar olduğu rapor edilmiştir (Kraemer ve ark., 1996). Benzer şekilde, kadın katılımcılar üzerinde yapılan bir çalışmada ise yoğun bir direnç antrenmanı sonrası dolaşım lenfosit düzeyinde artışlar olduğu bildirilmiştir (Miles ve ark., 1998). Literatür açısından en ilgi çekici bulgulardan biri de, uzun dönem direnç antrenmanları sonrası bazal sitokin ve inflamasyon düzeyinde tespit edilen azalmalar olduğudur (Calle ve Fernandez, 2010).

Egzersiz uygulamalarının immünolojik yanıt üzerine etkileri on yıllardır merak edilen konular arasındadır. Egzersiz bilimi açısından incelendiğinde, egzersizin immünolojik yanıtlar üzerine negatif veya pozitif etkilerinin neler olduğu görece olarak yeni araştırma konusu olmuş bir alandır. Egzersiz süresinin ve yoğunluğunun üst solunum yolu enfeksiyonları riskleri ve “J tipi eğrilerin” varlığı gibi konular ilk kez “Dr. David Nieman” tarafından ortaya konulmuştur (Nieman, 1994, 1997). Aşağıda egzersiz yoğunluğu ve süresinin olası enfeksiyon risk durumunu gösteren “J tipi eğri” gösterilmiştir.

Resim. Egzersiz Yoğunluğu-Süresi ile Enfeksiyon Riski İlişkisi

“J tipi eğri” incelendiğinde, yüksek yoğunluk ve hacimli egzersizlerin en yüksek enfeksiyon riski içerdiği görülmektedir. Başka bir ifadeyle, egzersiz yoğunluğu ve süresinin fazla olması üst solunum yolu enfeksiyonlarına daha açık/savunmasız bir duruma neden olduğu düşünülmektedir. Ilımlı-orta yoğunluk egzersizlerin enfeksiyon risk durumu açısından en optimal seçenek olduğu görülmektedir (Nieman, 2003). Dahası, sedanter olmanın yüksek yoğunluk ve hacimli egzersiz uygulamalarına kıyasla enfeksiyon riski açısından daha elverişli olduğu sanılmaktadır. Bundan dolayı, özellikle sağlık için egzersiz yapan kişilerin immunolojik yanıt optimizasyonu ve enfeksiyon riskinin minimize edilmesi için ılımlı-orta yoğunlukta egzersiz uygulamaları önerilmektedir (Nieman ve ark., 2003, 2011). Literatür incelendiğinde, hem epidemiyolojik hem de randomize kontrollü araştırmalarda düzenli ılımlı-orta yoğunluklu egzersiz uygulamalarının üst solunum yolu enfeksiyon risk durumunda “%18-67” arasında bir azalmaya neden olabileceği rapor edilmiştir (Gleeson, 2007). Enfeksiyon risk durumunu azaltma potansiyeli olan egzersiz modaliteleri açısından konu ele alındığında aerobik egzersiz türlerinden koşma, yürüme, yüzme, bisiklete binme, çeşitli oyun sporları ve dans gibi uygulamarın daha avantajlı olduğu bildirilmiştir. Ayrıca, immunolojik yanıt optimizasyonu açısından bu aktivitelerin orta-ılımlı yoğunluk durumunun rasyonel ölçüsü olarak “VO2maks düzeyinin %40-60’ ına” karşılık gelen bir zorluk düzeyinin belirlenmesi tavsiye edilmiştir. Aynı zamanda, bu egzersiz türleri ve yoğunluk düzeylerinin hem orta yaş kadın ve erkeklerde hem de yaşlı popülasyonlar için kullanılabileceği ifade edilmiştir (Nieman ve ark., 2011; Simpson ve ark., 2012).

Literatür, enfeksiyon risk düzeyi ile egzersiz yoğunluğu ve hacmi arasındaki ilişki düzeyi açısından tartışmalı bulgulara sahip olmasına rağmen genel olarak ılımlı-orta yoğunluğa sahip aerobik egzersiz lehine bir konsensus bulunmaktadır. Ilımlı-orta yoğunluklu egzersiz uygulamaları sonrası immun yanıtı etkileme mekanizması, özellikle kan içindeki doğal öldürücü hücreler, nötrofil ve antikor artışı ile açıklanmaktadır (Gleeson, 2007). Bu bağlamda, literatür tek seferlik ılımlı-orta yoğunluklu bir egzersiz sonrası hem doğuştan hem de sonradan kazanılan immun sistem üzerine etki edebileceğini vurgulamıştır. Ancak, tek seferlik ılımlı-orta yoğunluklu bir egzersiz sonrası immun yanıtın üç saat içinde tekrar başlangıç düzeyine döndüğü düşünülmektedir. Bu bağlamda, ılımlı-orta yoğunluklu düzenli egzersiz uygulamalarının katkılarının daha kalıcı olacağı da ifade edilmektedir. Aynı zamanda, güçlü bir immun sisteme sahip olmanın altın kuralları aşağıda sıralanmıştır. Belirtilen maddeler birlikte takip edildiğinde üst solunum yolu enfeksiyon riskinde azalmalar olacağı ve bağışıklık sisteminde fonksiyon gelişimi görülmektedir.

  • Düzenli egzersiz yapmak
  • Doğal ve mevsiminde beslenmek
  • Yeterli ve kaliteli uyumak
  • Stresten uzak durmak

Literatür incelendiğinde, aerobik egzersiz türlerinin enfeksiyon riski açısından en optimal seçenek olduğu vurgulanmasına rağmen sonuçlar tutarsızdır. Aerobik egzersiz türüne benzer şekilde, direnç antrenmanı sonrası da immun yanıtta her ne kadar arttışlar görülse de bu artışların geçici olduğu rapor edilmiştir. Özellikle, direnç antrenmanlarının hem akut hem de kronik düzeyde bağışıklık sistemini nasıl etkileyeceği hakkında çok az araştırma bulunmaktadır. Ancak, düzenli direnç antrenmanlarının bağışıklık sistemini olumlu etkileyeceği düşünülmektedir. 

Referanslar

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