Athletic development specialists dedicated to the art and science of excellence in movement

Psychosocial Stress and Immune Function in Athletes


Previously we wrote about the impact that psychosocial stress can have on musculoskeletal health (Does Psychosocial Stress Elevate Musculoskeletal Injury Risk?).  Though many view musculoskeletal injuries purely as mechanical breakdown, the truth is that musculoskeletal health depends on many factors besides biomechanics.   What matters is not any theory that psychosocial factors but rather that psychosocial stress may increase injury risk. 

The connection between psychosocial stress and physical setbacks may also extend to immunity levels, something of particular importance during intense competitive buildups.  Anecdotally, many observe that athletes often get last minute illnesses that seem unexplainable on the surface, but which may make perfect sense when viewed more introspectively. (see also, Immune System and Elite Swimmers

One recent study addressed the potential link between stress and immunity by studying a sample of nineteen recreational marathoners.  Authors administered psychological surveys and measured immunity markers 4 weeks prerace, 1-2 days prerace, and one week postrace.   

Results: Stress increased significantly between the baseline (4 weeks prerace) and the 1-2 day prerace 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 [the immunity markers] Treg, IL4 production and the IFNγ/IL4 cytokine ratio”  Authors concluded “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.”


The conclusion is common sense but is a good reminder for those who simply try to “get the training done” and survive.  Psychosocial stress has an unavoidable cost that must be considered in program design, but more importantly, in the willingness to make adjustments to an original plan.

Some may question the validity of this study to advanced athletes but I would suggest the results are instructive for anyone.  Most athletes toe a fine line between health and illness when balancing training demands with physical readiness.  Addressing psychosocial stress may be a purely psychological issue but it may also be a training load issue.  Many athletes reach their taper mentally worn down from the stress of surviving the previous training, yet to simply call this overtraining would be too glib.  Instead, it’s a matter of aligning the plan with the athlete’s overall faculties for physical and mental regeneration.    

That said, some are concerned that too focus on risk factors may lead to a sort of hypochondriac attitude (people getting stressed because they realize the consequences of being stressed).  This concern is legitimate.   But ultimately it’s upon the coach to know the athlete and ensure the athlete is adequately prepared for the physical and mental demands foisted by the training program.  When assigning high training loads, it’s imperative to ensure the athlete has the surrounding lifestyle to absorb the inevitable psychological stress that accompanies high training loads. 


Rehm KEElci OU, Hahn K, Marshall Jr GD.  The Impact of Self-Reported Psychological Stress Levels on Changes to Peripheral Blood Immune Biomarkers in Recreational Marathon Runners during Training and Recovery.  Neuroimmunomodulation. 2013 Mar 27;20(3):164-176. [Epub ahead of print]


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