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Coxsackie B virus
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== Exercise == Several studies of a mouse model of [[#Coxsackie B3|Coxsackie B3]] [[myocarditis]] have found that [[exercise]] increases the virulence of the infection and results in poorer outcomes.<ref name=":4">Cabinian AE, Kiel RJ, Smith F, Ho KL, Khatib R, Reyes MR. Modification of exercise-aggravated coxsackie virus B3 murine myocarditis by T-lymphocyte suppression in an inbred model. J. Lab. Clin. Med. 1990; 115: 454β 62.</ref><ref name=":5">Kiel RJ, Smith FE, Chason J, Khatib R, Reyes MD. Coxsackie B3 myocarditis in C3H/HeJ mice: Description of an inbred model and the effect of exercise on the virulence. Eur. J. Epidemiol. 1989; 5: 248β 67.</ref><ref name=":6">{{Cite journal | last = IlbΓ€ck|first = NG | date = June 1989 | title = Exercise in coxsackie B3 myocarditis: Effects on heart lymphocyte subpopulations and the inflammatory reaction | url =https://www.ncbi.nlm.nih.gov/pubmed/2543197|journal=American Heart Journal|volume=117 | pages = 1298-302|via=}}</ref><ref name=":7">{{Cite journal | last = Gatmaitan | first = Bienvenido | date = June 1, 1970 | title = Augmentation of the Virulence of Murine Coxsackie Virus B-3 Myocardiopathy by Exercise | url =http://jem.rupress.org/content/131/6/1121|journal=Journal of Experimental Medicine|volume=131 | pages = 1121|via=}}</ref><ref name=":8">{{Cite journal | last = Reyes | first = MP | date = February 1976 | title = Interferon and neutralizing antibody in sera of exercised mice with coxsackievirus B-3 myocarditis |url =https://www.ncbi.nlm.nih.gov/pubmed/1250870|journal=Proceedings of the Society for Experimental Biology and Medicine|volume=151 | pages = 333-8|via=}}</ref> These studies compare two groups of mice, both infected with CVB3, one that is exercised and the other, sedentary. They found: * Exercised mice died of congestive heart failure (the majority while swimming) and had 530X the amount of virus.<ref name=":7" /> * Exercised mice had increased viral titers, mortality and fiber necrosis.<ref name=":5" /> * Exercised mice had higher viremia and virus in the hearts and no circulating interferon; non-exercised mice had detectable interferon activity, higher levels of neutralizing antibodies<ref name=":8" /> * Exercised mice died at much higher rates (52% v. 0 sedentary mice), but not if they were immunosuppressed.<ref name=":4" /> * Increased [[Cytotoxic T cell|T cytotoxic]], [[Regulatory T cell|T suppressor]], and T cytotoxic, suppressor/T helper cell ratio, and myocardial inflammatory and necrotic lesions with exercise at 48 hours after infection. "Failure to restrict physical activity in the acute phase of this infection may well contribute to the progression of the disease."<ref name=":6" />
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