Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
17 Jan

The Relationship Between Exercise and Inflammation (and What It Means for Your Workouts)

Since we’ve been on an inflammation kick the past couple weeks, I figured I’d start covering some of the areas of health and lifestyle that interact with inflammation. That doesn’t exactly narrow things down, seeing as how inflammation is involved in just about everything, but it does give me plenty of things to discuss. Today’s topic, exercise, was a little tricky, because the relationship between exercise and inflammation is anything but straightforward, seemingly fraught with inconsistencies and facts that appear to contradict one another. Exercise reduces inflammation, but it also increases it. And depending on the context, this increased inflammation due to exercise is either a good thing or a bad thing.

Sound confusing?

See for yourself. Study after study (epidemiological and clinical alike) shows that extended exercise programs generally reduce markers of inflammation (like C-reactive protein) over the long-term:

  • In elderly Japanese women, a 12-week resistance training program reduced circulating levels of inflammatory markers compared to baseline; reductions in CRP were associated with increases in muscle thickness.
  • American adults who engaged in frequent physical activity tended to have lower CRPs than adults who were more sedentary.
  • In type 2 diabetics, (key term coming up) long-term high intensity resistance and aerobic training reduced inflammatory markers over the course of a year (independent of changes in body weight, meaning activity was the key factor).
  • Endurance combined with resistance training reduced CRP in young, healthy women better than endurance training alone.
  • In obese, post-menopausal women, a basic moderate cardio program lowered CRP without really affecting body weight either way over the course of a year.
  • At the same time, though, several studies also show that exercise acutely spikes inflammatory markers:
  • Volleyball practice elicits spikes in IL-6 in both male and female elite volleyball players.
  • Acute exercise spiked CRP in cardiovascular disease patients (but a four-month exercise program lowered it).
  • This table of inflammatory responses to strenuous endurance events shows some massive spikes in CRP, some up to 20-fold the baseline value.

There are many more out there, but the general gist is that regular exercise tends to lower markers of systemic inflammation while acute exercise increases markers of acute inflammation. And sometimes what’s acute can become chronic. How do we make sense of this? How do we avoid making those acute spikes a chronic, constant thing?

I had originally planned on digging through the literature and assembling a handy guide explaining the specific inflammatory responses to the different types of exercise, complete with exercise prescriptions based on cytokines and C-reactive protein and all that fun stuff until I realized that such an undertaking is too massive for a blog post, impossible given the limitations of the literature, and overly complex and frankly useless for the average reader. Instead, we have this: a rambling discussion of inflammation and exercise, peppered with helpful nuggets of advice wrought from years of personal (and painful) experience.

Effective exercise is inflammatory exercise… to a point.

Some degree of inflammation is necessary if you hope to get anything tangible out of a workout regimen – hypertrophy, increased stamina, increased strength, improved work capacity – because your body gets stronger via the inflammatory response to the stress and by rebuilding and refortifying its tissues to deal with future demands. An effective training session is basically an acute stressor that initiates a transitory, temporary, but powerful inflammatory response. An effective training regimen is composed, then, of lots of those acutely stressful training sessions interspersed with plenty of recovery time against a backdrop of lots of slow moving and good nutrition. You can’t escape that.

Avoid inflammatory plateaus.

Track your training. Plotted on a graph, the inflammatory responses to your training should resemble a series of peaks, dips, and valleys. If you don’t let your last exercise-induced inflammatory spike recede before exercising again, you’ll only heap more on the pile. If you keep stringing together spikes in inflammation without recovering from the previous one, they start to overlap and that starts to look a lot like chronic inflammation. That gives you a plateau, a mesa of inflammation. Avoid the mesa.

(You don’t actually have to order CRP tests after every training session and create Excel spreadsheets to “plot your inflammation.” Feeling it out is perfectly fine. Review last week’s post for symptoms and see if you qualify.)

Remember that acute inflammation (good, healthy, necessary) is characterized by an inflammatory response that resolves quickly, or as soon as the offending factor is removed. This takes a day or two, maybe even three, but as long as you remove the stinger/take your hand out of the flame/kill the pathogen/put down the barbell for a couple days, you will recover and the inflammation will subside. Inflammation becomes chronic when the stress is not removed, when you keep getting stung by the same bug/putting your hand in the flame/licking the dirty spinach/doing heavy deadlifts every single day. Don’t do these things and expect differently.

Any type of exercise – besides maybe walking – has the potential to become chronic and induce a state of chronic inflammation. Doing high-intensity Crossfit WODs every single day will do it. Training for a marathon will do it. Do what you enjoy without it becoming chronic. Endurance events aren’t going to kill you, but training for them might.

The reason why I single out Chronic Cardio, marathoning, triathlons, and other ultra-endurance events (and why it’s the easiest way to overtrain and become systemically inflamed in the process) is because excelling at those activities usually requires a ridiculous amount of training time. If you want to be the best Olympic weight lifter you can be, you’ll have to train hard and train often and undergo serious stress, but you won’t be under load for more than a second or two at a time. If you want to be the best endurance athlete you can be, you’re likely going to be “under load” for hours and hours each day. There is very little give in these sports, which is why regular endurance work is so problematic for so many people.

Endurance training is problematic for another reason: you can always complete the workout even when you should be resting. If you’re having a bad training day as an Olympic lifter, you simply won’t make the lift. You can’t slog through a heavy snatch; the necessary effort precludes you even attempting it. You’ll deload or call it a day or make it a light workout, but you’re not going to “power through,” because you physically cannot. But because endurance work is lower intensity, you can slog through the days when your body is trying to tell you to rest. It won’t be pretty, and you’ll feel awful and slow and heavy, but you’ll finish – and you’ll dig yourself in even deeper.

Interestingly, folks who run ultramarathons tend to have lower resting CRPs than marathoners. This threw me for a loop at first, but after thinking some more, it makes sense. All the ultramarathoners I knew were the guys who either couldn’t hack it as marathoners or simply didn’t want to push themselves to the brink. They were generally fairly laid back, while we marathoners were the hyper-competitive types. They would just kinda mosey along at a reasonable pace, while we treated 26.2 miles almost like an extended sprint. Our pacing was GO GO GO *slurp glucose gel pack* GO GO GO. Though they covered far more ground – sometimes more than 100 km – they never dug deep, not in the same way we did. They never had to “go to the well.” My well was running dry by the time I finished my career.

Yeah, exercise is a funny subject. There isn’t really a one-size-fits-all detailed prescription, which is why when I offer my suggestions for exercise on this blog, I try to keep them very general. Rather than prescribe this many sets of these specific lifts for this many reps at this weight, I say “lift heavy things.” That could be bodyweight, sandbags, barbells, kettlebells, or the latest in HIT machine technology. Rather than tell you to jog at this heart rate for this long at this grade this many times a week, I suggest you “move frequently at a slow pace” and “run really fast once in awhile.” You could move slowly or really quickly on your feet on the street, on a trail, on a bike, in a pool, as you garden, or even in place (burpees, anyone?). Sure, I think a day or two of lifting, one session of sprinting, and as much slow movement as you can possibly stand each week are reasonable targets for the general public, but it’s honestly really wide open.

Thanks for reading, everyone, and let me know what you think in the comment board!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. My marathon training years ago was definitely a mesa of inflammation. That coupled with eating tons of gluten… Sounds like a lot of athletes really.

    Peggy The Primal Parent wrote on January 17th, 2012
    • Ugh and don’t forget the gatorade and goo-packs… I vividly remember the syrupy sludge sloshing around my belly for 26 miles. So grim.

      Abel James wrote on January 17th, 2012
  2. I have found I just enjoy exercise so much more now that I am no longer pressuring myself to “get up and do it” every day.

    I love casually riding my bike to work instead of the sprinting on my bike I used to do. I have managed to see deer eating at a mulberry tree, watched a mother squirrel carry one of her babies up a tree I was just riding past. I never saw anything like this when I just “dug deeper” and pushed myself harder.

    I simply love this new approach to exercise (and my body does too) 😉

    Happycyclegirl wrote on January 17th, 2012
    • I completely agree, I used to be the same way! If I’m not enjoying it, then what’s the point? Doing it all for vanity, as I used to, will only get you so far

      Burn wrote on January 17th, 2012
    • Who wouldn’t? I remember running on the pavement thinking that more was better even though I literally hated it. I now just run when I want and stop when I want. I prefer taking long walks and mixing in bodyweight exercises.

      MovNat is huge and will continue to grow. I’ve never been involved with one but I can’t wait to be soon!

      With that being said, my awesome sister asked me if I wanted to run in a half marathon this year….

      Primal Toad wrote on January 17th, 2012
      • I completely agree. I’m currently training for a half marathon that I didn’t wholeheartedly want to participate in, but the athlete in me wants to perform better than last year and felt the pressure looming. I’m actually in the midst of writing an update about how I finally decided that this mentality was making me miserable and I’ve completely changed my training plan so that I’ll enjoy the process and not ruin it for myself. I enjoyed a leisurely 1 hour run on Sunday and even saw some beautiful swans while out – much better this way!

        Jess @ The Paleo Professional wrote on January 14th, 2013
    • i honestly miss doing bodyrock everyday, especially for mental reasons, but i hold back because i really think moving slow everyday, and 2-3 intense workouts a week is better in the long run.

      pixel wrote on January 21st, 2012
  3. Agree and disagree about ultra-marathon.

    I think it is a training issue. Basically, the training is less taxing. Actually running 100+ KM — hell even 36 miles — is really, really painful. For a few days.

    People who are attracted to that might also be people who can deal with it better.

    charlie wrote on January 17th, 2012
  4. My experience is that one has to be careful with any type of repetitive exercise. It can lead to injury and acute inflammation, which can become chronic. Building up your strength slowly, changing up your exercise routine, rest in between workouts are all important to help prevent these types of nagging injuries. Thanks for the post.

    Michelle wrote on January 17th, 2012
  5. Interesting reading-dealing with Celiac (Gfree for 2 years) but issues of intestinal cramping & inflammatory response to upper levels of exersion during exercise-running up hills, prolonged riding, even moderate weight lifting-getting my markers checked!

    jemima wrote on January 17th, 2012
    • that’s interesting; i don’t have celiac but i do have IBS and a very sensitive gut…can’t handle wheat/fructose/dairy–basically all short-chain carbs (I follow the FODMAP diet)…anyhow, I can tolerate carbs SO much better when I am working out and moving–I can eat about 4 times the carbs without gut upset during strenuous exercise; carbs during car trips/sedentary times/meetings spell disaster for me. exercise calms my gut. i wonder if you eat something different when you exercise (before, during or after)…maybe something that’s not gluten but a short-chain carb. try it on an empty stomach? …or fat and protein only maybe.

      DThalman wrote on January 17th, 2012
      • really interested in hearing more about your thoughts on the FODMAP diet…I think it appears to be the answer for me but am interested in your thoughts around exercise…

        Lisa wrote on January 18th, 2012
  6. Realistically, health and wellness is ultimately about controlling inflammation – both short and long term. It makes sense that during a start up period or times of acute, sporadic training you would see increased inflammation, but that if you look at the long game, your inflammation profile would be much better.

    From food to exercise, it’s best to keep your inflammation down, period.

    Hal wrote on January 17th, 2012
  7. So… How does Grok train for a marathon? Or does he just not?

    Egle Makaraite wrote on January 17th, 2012
  8. Hey Mark,

    I actually have wondered about inflammation and exercise. It seems that every time I do something like intense jump squats, I am on the mend for 3-4 days, which really wrecks havoc on having a consistent workout (sometimes the inflammation is INTENSE around the day 2-3…walking hurts…).

    Do you think this is a case of lack of protein in my diet or some other diet factor that needs to be addressed? I mean, should I up the protein on my days where I am doing intense full body workouts?

    Leo Dimilo wrote on January 17th, 2012
    • That’s classic delayed-onset muscle soreness (DOMS). 2-3 days is pretty typical. It happens to most people when they start out on a regimen of anything high-intensity. A good diet and lots of protein definitely helps, but it’s something that has to be toughed out in the beginning. It will stop happening, though, if you get through the first couple of weeks. Your body will adapt to being put under that kind of stress regularly and you’ll stop getting so sore (a little soreness is expected from time to time, of course).

      But 3-4 days is a perfectly reasonable time frame for rest periods between intense workouts. You really don’t want to do LHT or sprinting any more frequently than that–it starts getting counterproductive to strength gains because you’re not allowing enough recovery. You can work around this be eating a TON of (good, clean) food. That will speed up your recovery and allow you to work out more frequently. But slow and steady is the best for most people who aren’t interested in putting themselves through serious suffering and a lot of inconvenience just to squeeze out a few more percent of progress.

      Uncephalized wrote on January 17th, 2012
      • Maybe being fully hydrated, too? For the last five years I’ve done these 4-hour indoor climbing competitions, where it’s how many hard routes can you complete in the time frame. It’s brutal. I’ve been SO sore for SO long after these, but I’ve learned that if I go into it fully hydrated (chug water 24 hours prior) I will recover 1-2 days sooner.

        DThalman wrote on January 17th, 2012
      • A few years ago I did P90X for the full 90 days. Boy, did I ever get sore! The soreness did diminish after a month (never all the way disappeared, though!) But I found that the “cardio” (jump training, yoga or kempo) days following the lifting days really helped my soreness. Sitting still is what aggravated it. That being said, after 5 or 6 days were were pretty worn out and the day or two of total rest were great. On the few weekends where we took 3 days of total rest, we felt even better. So, perhaps “rest” isn’t always sitting and doing nothing, but is really some cardio-type activity to get your blood moving for a half hour to an hour. Incidently, P90X2 has incorporated more rest days than the original and encourages self pacing.

        Meesha wrote on January 18th, 2012
    • Might be worth taking a BCAA (branch chain amino acid) supplement after working out, as well as protein, as it can help with DOMS.

      greg grok wrote on January 17th, 2012
  9. Great article, and “licking the dirty spinach” made me laugh.

    Amy wrote on January 17th, 2012
  10. “Sound confusing?”
    Eh. I’m used to it.

    Kate wrote on January 17th, 2012
  11. I’m a thrill seeker and licking dirty spinach is one of my favorite ways to spend an afternoon.

    You did a good job covering something that could have easily become an overwhelming topic. Thank you for keeping it simple and sweet for us mere mortals. :)

    Ashley North wrote on January 17th, 2012
  12. I’m usually not to sore after lifting heavy things. I do the Enter The Kettlebell Rite of Passage now and my to heaviest days are Monday and Friday, and Wednesday is light. The snatches for between 2-12 minutes push my heart up enough to qualify as my sprint session. The most sore I have been is when I did a PBF Self-Assessment yesterday and my quads from the 80 Squats I did. Is that Level 5 now 😉

    Vance wrote on January 17th, 2012
  13. What do you think about post-workout cold showers? Will this cause the inflammation to subside more quickly? Too quickly?

    Brandon Berg wrote on January 17th, 2012
    • I’ve wondered about this too. After a hard weightlifting or sprinting workout, I like to take a two-minute dip in the cold pool. That often reduces DOMS, but now I’m wondering if I should just deal with the soreness. Exercise causes acute inflammation and then the body repairs itself. Am I short-changing any improvements in muscle growth and strength by somehow numbing DOMS?

      Godzilla wrote on January 18th, 2012
      • Brandon & Godzilla –

        I’ve used the cold showering method in previous marathon training and I personally found that a very cold shower (not an ice bath even) within 10 minutes of completing a long run had a beneficial effect on my recovery. The idea being that your capilliaries etc are drawn away from the surface of your body and hopefully the internal damage/bleeding within your muscles is slowed/stopped. I’ve also spoken to professional runners who prefer to alternate the hot/cold shower on their legs.

        It’s personal preference but it is an easy one to attempt and the studies suggest it ‘may’ hep with DOMS…

        Luke M-Davies wrote on January 18th, 2012
  14. Hmm! Thats interesting! Just one more reason to work out :)

    Meagan wrote on January 17th, 2012
  15. Thanks Mark. I just did an easy 50 mile run on Catalina Island using my persistence-hunt-trot pace. Felt great, feel great. Quick recovery. Paleo fueling. No need to go to the well. Average less than 20 miles a week training (if you want to call it training, more like short commutes and jaunts) along with Russian sauna and cold plunge training and Primal Blueprint based diet. Happy me. Blog report coming next day or two.

    Barefoot Ted wrote on January 17th, 2012
    • @Ted, that’s what I’m talking about! Looking forward to the full report.

      Mark Sisson wrote on January 17th, 2012
  16. I love the primal blueprint specifically for it’s general advice! Years ago during chronic cardio I was always so sore and so hungry and dreaded the gym. Lifting heavy things and moving slow frequently while enjoying the wilderness is definitely a blueprint I can follow!

    Caleigh wrote on January 17th, 2012
  17. “controlled hormesis”…or mithridatism
    Exposure to self-administered “poisons”…exercise, produces an inverted U shaped curve or J shaped curve, of dose response: some small amount makes you stronger, larger doses kill the organism.

    Dr. John wrote on January 17th, 2012
    • I recall a website that uses applied hormesis, I think it is “getting stronger”. People do body hacks.

      liberty1776 wrote on January 17th, 2012
  18. I have been attempting to progress as a crossfitter for a couple of years now, but with little result. I recently slogged through a WOD and felt quite discouraged after. I am not sure if my determination and persistence is setting me back or perhaps its nutrition. I am still trying to figure out the primal foods/ amounts that will help me gain functional mass (another 20-30 lbs) and overall wellbeing. I think to recover and then gain will require a good amount of calories (2,500-3,000 (?)). I am currently 6’1″ and weigh 150 pounds. I attempt to crossfit/workout at least 3, but more over 4-5 days per week.

    After reading this article, it seems that my training schedule may be a bit too much. I appreciate the idea of lifting heavy a few times a week while enjoying the outdoors often. Right now, however, I am in the routine of consistent hard work. I love burpees (substitution for sprints) when the snow covers the hills too.

    I know this may read more like a brain dump than a clear question or comment, but any advice or thoughts will be much appreciated.

    Doug wrote on January 17th, 2012
    • Hey Doug, it depends on the kinds of WOD’s that your doing at Crossfit. If you want to put on mass you will have to cut the crossfit as most wod’s are metcons with heavy dosing of cardio. You might want to do your own lifting and limit the cardio. Lift heavy things, rest and eat big. Have your bigger calorie days on your lifting days. Most carbs post workout. You might be trying to do too many differnt things when your goal is mass. Going to be hard to do with all the calories you are burning at Crossfit.

      Frank wrote on January 17th, 2012
  19. chronically inflamed for years
    just starting to listen to the body at age 34
    ~ i still dont quite know how i feel about not red lining 3 days a week

    but i know i am in less pain

    its a journey for sure – trying to enjoy it

    mike wrote on January 17th, 2012
  20. I beat the heck out of my body through running– Now I’m a mess of osteoarthritis. My coping mechanism these days is to strive to be active without focusing on an exercise plan. Mostly that involves daily housecleaning (don’t scoff I like a clean house) and pilates. This works great. I have far less joint pain, keep a healthy weight and have a nice sense of accomplishment. For me it’s all about moving– even if it is only to push a vacuum. Though I do try to incorporate regular walking so I can be sure to get my sunshine.

    sqt wrote on January 17th, 2012
  21. Did the main site Crossfit WOD’s for 3 years and ended up with chronic inflammation, I could feel it but ignored it thinking I was doing the right thing. One year ago came across Gymnastics workouts on from Coach Sommer and I dumped Crossfit for gymnastics and have not looked back since. Five weeks ago came across this via gymnasticsbodies forum and it is now my program and work this with Coach Sommer progressions, have made some good gains.

    Sotiri wrote on January 17th, 2012
  22. reach your numbers and move to the next level…it’s really that simple.

    dasbutch wrote on January 17th, 2012
  23. Primal eating habits and Crossfit have helped me conquer intense inflammation! Yeah Mark!

    Garrett wrote on January 17th, 2012
  24. I have also noticed that my inflammation is much less intense.

    rob wrote on January 17th, 2012
    • Mine too. I used to have what I assumed was carpal tunnel. I blamed it on heavy computer use, which obviously played some part.

      Since going Primal my wrist pain is completely gone. I probably use the computer more now, still no pain.

      primalzen wrote on January 18th, 2012
  25. How much primal food should a 23 year old male doing crossfit consume to beat chronic inflammation and gain functional, healthy weight?

    Doug wrote on January 17th, 2012
  26. I just began training for a marathon and I am going to try hard to “slow down” and do run/walk intervals within the “fat burning” range, thanks to what I’ve learned through Mark and The Primal Blueprint. I hope I can keep myself from pushing my pace, as my goal is to lose body fat this year!

    Tina wrote on January 17th, 2012
  27. After doing 5-6 days a week workouts, I have started to cut it back now to 3-4 days adding in some Mark’ Sisson approved fun days! Swimming, stand up boarding, hiking, camping, anything fun to workout without working out! Been going great so far. Have an upcoming 20k mud run and am training for that as well. I used to take a long time to recover but as I have dialed in my primal diet better. I have reduced that recovery considerably. Thanks Mark!!

    Frank wrote on January 17th, 2012
  28. Mark, where did you get the data that ultramarathoners have lower CRP than marathoner?

    Also, you seem to ignore that proper training for endurance events, for example Marathon, should consists of easy effort on most days. If you are indeed keeping the intensity easy on your easy days, there is no reason “chronic cardio” will cause chronic inflammation or overtraing.

    Mr. Skeptic wrote on January 18th, 2012
  29. Great article! It is really important, as you say, to do what you enjoy without it becoming chronic. I used to have that problem when playing basketball.

    John wrote on January 18th, 2012
  30. Fitness is like life, a journey to self discovery. Everyone has to find out how their bodies respond and which is the most efficient way to eat and workout for them.

    Paul Alexander wrote on January 18th, 2012
    • agree 100% !!!

      wildgrok wrote on January 13th, 2013
  31. “Volleyball practice elicits spikes” – very punny.

    Aquareef wrote on January 18th, 2012
  32. I am 48 years old and did some Burpees last night. I think I am experiencing “good inflamation”. LOL I recently discovered “Primal” and, evolution aside, I believe the information you provide is awesome and will be very beneficial. Two years ago I lost 53 lbs and recently gained 20 back. I am working on knocking that 20 off and, more than that, working to change my eating and exercise lifestyle so I never gain it back again. I want to be more FIT! I believe you can help me do that. Thanks a million for what you do, Mark!! -Justin

    Justin wrote on January 18th, 2012
  33. Hi, this is my first post here. I just started Primal (New Year’s Resolution) so I’m just a bit into it and not ready to post any Before and After photos.

    The food transition is easier than I thought it would be. I live near a couple small farms that sell their own meat and eggs. I never paid much mind to them before because it is more expensive than grocery store food but I now see the extra price is well worth it.

    As far as exercise, I have a walking buddy and we go on long walks around the area together. So that parts fine. I wanted to go with the “lift heavy things” part too so I got the P90X DVD series and jumped right in. Maybe that was a mistake but I just don’t know. Everything seemed to be going fine and I was proud of myself for going all out but later in the afternoon I couldn’t so much as bend over to pick something up off the floor and walking up stairs was excruciating.

    After about 2 days it got better. My question to the more experienced people is…was that an example of the good kind of acute inflammation that builds strength? Or did I just mildly injure myself and should not be so aggressive with the P90X? Or is mildly injuring yourself part of what helps? This is a timely article since I’m unclear on whether what happened was a good thing or a bad thing.

    Susannah wrote on January 18th, 2012
  34. I have a question; where does martial arts fall into this? I’m thinking of taking up Kali/Escrima at my local gym – Is it an endurance exercise?

    Suzanne wrote on January 18th, 2012
  35. I do intervals (4-6 30 sec w/ 3.5 min rest)three times a week, one set pullups, parallel bar dips and squats on the same days and at least 30 m walk on the other 4 days.

    Is this considered too much?

    palo wrote on January 18th, 2012

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