The salivary concentration of cortisol significantly increased at days 2 and 3 in the control group (P < 0.05). In contrast, that in the acupuncture group increased at day 1 (P < 0.05) but returned to baseline at days 2 and 3 (Fig. 5). The salivary concentration of cortisol was significantly lower in acupuncture group than in the control group at days 2 and 3 (P < 0.05). The saliva flow rate and concentration of total protein did not change through the experimental period (data not shown).
Compared with the control group, “muscle tension” was significantly lighter at days 1 and 2 in the acupuncture group (P < 0.05, Fig. 6). The score of “lightness of body” was significantly lower at day 3 in the control group than at baseline (P < 0.05) but was not significantly different from the acupuncture group. The score of “fatigue” did not change throughout the study in the acupuncture group, whereas it was heavier during the period of competition in the control group. Furthermore, the score at days 1 and 2 in the acupuncture group was lighter than that in the control group (P < 0.05, P < 0.01, respectively). “Flexibility” score did not change significantly in both groups throughout the study.
In the acupuncture group, “fatigue” remained low during the period of physical competition, whereas the score at day 1 was lower than at baseline (pre, P < 0.05, Fig. 7). In the same group, “confusion” was lower after competition than at baseline (P < 0.05). In the control group, “fatigue” at days 1, 2, and 3 was higher than in the acupuncture group. The POMS score in day 3 was similar with that of day 2 (data not shown). These data suggest that mental fatigue in the control group was higher than in the acupuncture group during the period of sport activity. In contrast, the mental condition as reflected by the POMS showed an iceberg profile in the acupuncture group.
Our study provides evidence that acupuncture treatment positively affects the salivary SIgA, salivary cortisol, subjective rating of physical well-being and POMS score in elite female soccer players during a relatively short period of sports competition. These results suggest that acupuncture treatment after physical exercise may improve the immunologic and endocrine states of elite female athletes. To our knowledge, the present data are the first to demonstrate that acupuncture treatment inhibits the reduction in mucosal immune function (salivary SIgA levels) induced by intense exercise, and modulates the stress hormone response to physical and competitive stress in elite female athletes.
Our study showed that exercise-induced decrease of salivary SIgA was inhibited in the acupuncture treatment group during the competition period. These data suggest that acupuncture treatment enhances SIgA secretion in the saliva during the period of continuous physical exercise. It is possible that the increased risk of URTI in athletes during the competition period is due to a decrease in SIgA levels. Thus, acupuncture treatment improves SIgA levels and such immunogenic action could lead to a reduced likelihood of infection in athletes and maintenance of physical well-being in female athletes. The exact mechanism of acupuncture-induced improvement of salivary SIgA secretion is not well understood. Sugiyama et al. (28) and Knardahl et al. (13) reported that acupuncture at ST 36 and LI 4 increased muscle sympathetic nerve activity, whereas heart rate, blood pressure, and skin perfusion remained unaffected. Salivary glands are controlled by both sympathetic and parasympathetic nervous systems. Thus, it is possible that acupuncture enhances SIgA secretion by stimulating the sympathetic nervous system. However, our results showed that the resting saliva flow rate did not change during the experimental period. Yang et al. (30) also reported that salivary SIgA increased at 24 h after acupuncture stimulation and continuous treatment of acupuncture significantly increased basal level of SIgA.
Competition differs from training by a greater degree of anxiety and stress that can amplify the hormonal variations usually recorded during exercise (22). Among the hormone reacting to exercise and stress, cortisol is probably the more affected. Increase of plasma as well as salivary cortisol levels during exercise is directly related to the intensity of exercise (5,11). Cortisol also reacts strongly to psychological stress, as during school examination (2). Previous studies demonstrated that intensified training and competition increase plasma cortisol concentration (26,29). In addition, other studies reported enhanced resting cortisol levels in overtrained athletes (12), although resting plasma cortisol levels in overtraining is controversial. Previous studies showed that salivary cortisol levels are correlated to plasma cortisol (27). In our study, the resting salivary cortisol levels increased at days 2 and 3 in the control group. However, acupuncture inhibited exercise-induced increase of salivary cortisol, although no such effect was noted at day 1. There, results suggest that continuous acupuncture treatment modulates the response of cortisol to intense exercise and competitive stress. Although Knardahl et al. (13) reported that plasma cortisol did not change after a single session of acupuncture treatment, competition-induced changes in salivary cortisol might be modulated by acupuncture treatment. A few reports have also shown that acupuncture treatment inhibited the increase of plasma cortisol after surgery (14). It is possible that acupuncture-related stimuli modulate stress response of cortisol.
In a number of studies, self-reported measures such as fatigue, muscle tension, quality of sleep, and other indicators of physical well-being have been monitored to assess adaptation of athletes during intense training and competition period. Miyamoto (18) reported that acupuncture treatment for athletes improved muscle tension and fatigue. In the present study, the acupuncture treatment group reported improvement in most of the subjective ratings of physical well-being, especially “muscle tension” and “fatigue” during the competition period, compared with the control group. Thus, acupuncture treatment improved the perception of physical well-being among elite soccer players.
It is conceivable that other factors, such as fitness level, might influence the effects of acupuncture treatment on exercise capacity and perception of exertion. Furthermore, it should be recognized that acupuncture is generally practiced within a framework in which the therapy is individualized to the patients and the condition being treated. The present study design, by its very nature of uniformity, is inconsistent with this concept of therapeutic application and therefore may be limited in examining the effectiveness of acupuncture on an individual subject.
In this study, the playing time on day 2 differed between groups. The treatment group demonstrated significantly lower cortisol and greater SIgA levels than the control group, although the treatment group played significantly longer than the control group. These data certainly support the positive influence of acupuncture treatment for the athletes of this study.
In the present study, we determined the effect of acupuncture treatment on physical and mental condition of elite female soccer players during sports competition. The following are the main results:
These data suggest that acupuncture treatment may improve the physical well-being of female athletes through changes in the immune and endocrine systems.
We thank Keisuke Akimoto (Mitsubishi Heavy Industries, Ltd.) and Dr. Dawei Yang (Tissue Engineering Research Center, National Institute of Advanced Industrial Science and Technology) for critical comment and review of the manuscript.
This study was supported in part by a Grant-in Aid for Scientific Research from the Ministry of Education, Science and Culture of Japan (13558003).
1. Akimoto, T., Y. Kumai, T. Akama, et al. Effects of 12 months of exercise training on salivary secretory IgA levels in elderly subjects. Br. J. Sports Med. 37: 76–79, 2003.
2. Allen, P. I., K. A. Batty, C. A. Dodd, et al. Dissociation between emotional and endocrine responses preceding an academic examination in male medical students. J. Endocrinol. 107: 163–170, 1985.
3. Barlas, P., J. Robinson, J. Allen, and G. D. Baxter. Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness. Clin. Physiol. 20: 449–456, 2000.
4. Cook, C. J. Rapid noninvasive measurement of hormones in transdermal exudate and saliva. Physiol. Behav. 75: 169–181, 2002.
5. Cumming, D. C., L. A. Brunsting III, G. Strich, A. L. Ries, and R. W. Rebar. Reproductive hormone increases in response to acute exercise in men. Med. Sci. Sports Exerc. 18: 369–373, 1986.
6. Filaire, E., X. Bernain, M. Sagnol, and G. Lac. Preliminary results on mood state, salivary testosterone: cortisol ratio and team performance in a professional soccer team. Eur. J. Appl. Physiol. 86: 179–184, 2001.
7. Fry, A. C., and W. J. Kraemer. Resistance exercise overtraining and overreaching: neuroendocrine responses. Sports Med. 23: 106–129, 1997.
8. Gleeson, M., W. A. Mcdonald, D. B. Pyne, et al. Salivary IgA levels and infection risk in elite swimmers. Med. Sci. Sports Exerc. 31: 67–73, 1999.
9. Hooper, S. L., L. T. Mackinnon, and S. J. Hanrahan. Mood states as an indication of staleness and recovery. Int. J. Sport Psychol. 23: 1–12, 1997.
10. Karvelas, B. R., M. D. Hoffman, and A. I. Zeni. Acute effects of acupuncture on physiological and psychological responses to cycle ergometry. Arch. Phys. Med. Rehabil. 77: 1256–1259, 1996.
11. Keizer, H., G. M. Janssen, P. Menheere, and G. Kranenburg. Changes in basal plasma testosterone, cortisol, and dehydroepiandrosterone sulfate in previously untrained males and females preparing for a marathon. Int. J. Sports Med. 10: S139–S145, 1989.
12. Kirwan, J. P., D. L. Costill, M. G. Flynn, et al. Physiological responses to successive days of intense training in competitive swimmers. Med. Sci. Sports Exerc. 20: 255–259, 1988.
13. Knardahl, S., M. Elam, B. Olausson, and B. G. Wallin. Sympathetic nerve activity after acupuncture in humans. Pain 75: 19–25, 1998.
14. Kotani, N., H. Hashimoto, Y. Sato, et al. Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses. Anesthesiology 95: 349–356, 2001.
15. Lac, G., N. Lac, and A. Robert. Steroid assays in saliva: a method to detect plasmatic contaminations. Arch. Int. Physiol. Biochim. Biophys. 101: 257–262, 1993.
16. Mackinnon, L. T., and D. G. Jenkins. Decreased salivary immunoglobulins after intense interval exercise before and after training. Med. Sci. Sports Exerc. 25: 678–683, 1993.
17. Mcnair, D. M., M. Lorr, and L. F. Droppelman. EDITS Manual for the Profile of Mood States. San Diego: Educational and Industrial Testing Service, 1971.
18. Miyamoto, T. Acupuncture treatment for muscle injury [in Japanese]. Jpn. J. Phys. Fitness Sports Med. 43: 39–41, 1997.
19. Morgan, W. P., D. R. Brown, J. S. Raglin, P. J. O’Connor, and K. A. Ellickson. Psychological monitoring of overtraining and staleness. Br. J. Sports Med. 21: 107–114, 1987.
20. O’Connor, P. J., W. P. Morgan, J. S. Raglin, C. M. Barksdale, and N. H. Kalin. Mood state and salivary cortisol levels following overtraining in female swimmers. Psychoneuroendocrinology 14: 303–310, 1989.
21. O’Connor, P. J., W. P. Morgan, and J. S. Raglin. Psychobiologic effects of 3 d of increased training in female and male swimmers. Med. Sci. Sports Exerc. 23: 1055–1061, 1991.
22. Passelergue, P., and G. Lac. Saliva cortisol, testosterone and T/C ratio variations during a wrestling competition and during the post-competitive recovery period. Int. J. Sports Med. 20: 109–113, 1999.
23. Pedersen, B. K., and D. C. Nieman. Exercise immunology: integration and regulation. Immunol. Today 19: 204–206, 1998.
24. Peltham, T. W., L. E. Holt, and R. Stalker. Acupuncture in human performance. J. Strength Cond. Res. 15: 266–271, 2001.
25. Petrovsky, N. Towards a unified model of neuroendocrine-immune interaction. Immunol. Cell Biol. 79: 350–357, 2001.
26. Snegovskaya, V., and A. Viru. Elevation of cortisol and growth hormone levels in the course of further improvement of performance capacity in trained rowers. Int. J. Sports Med. 14: 202–206, 1993.
27. Stupnicki, R., and Z. Obminski. Glucocorticoid response to exercise as measured by serum and salivary cortisol. Eur. J. Appl. Physiol. 65: 546–549, 1992.
28. Sugiyama, Y., Y.-E. Xue, and T. Mano. Transient increase in human muscle sympathetic nerve activity during manual acupuncture. Jpn. J. Physiol. 45: 337–345, 1995.
29. Urhausen, A., and W. Kindermann. Behaviour of testosterone, sex hormone binding globulin (SHBG), and cortisol before and after a triathlon competition. Int. J. Sports Med. 8: 305–308, 1987.
30. Yang, M. M., K. K. Ng, H. L. Zeng, and J. S. Kwork. Effect of acupuncture on immuno globulins of serum, saliva and gingival sulcus fluid. Am. J. Clin. Med. 17: 89–94, 1989.