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Bohn-Goldbaum E, Owen KB, Lee VYJ, Booy R, Edwards KM. Physical activity and acute exercise benefit influenza vaccination response: A systematic review with individual participant data meta-analysis. PLoS One 2022; 17:e0268625. [PMID: 35704557 PMCID: PMC9200169 DOI: 10.1371/journal.pone.0268625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
Whether the vaccine adjuvant potential of acute exercise is uniform among different populations, e.g., inactive persons, is unknown. This meta-analysis examines influenza vaccine antibody responses and the effect of physical activity, acute exercise, and their interaction. Inclusion criteria comprised randomized controlled trials with acute exercise intervention and influenza vaccination antibody measurements at baseline and 4-6 weeks, and participant baseline physical activity measurement; there were no exclusion criteria. Searching via six databases (Medline, Embase, CINAHL, Scopus, Web of Science, and Physiotherapy Evidence) and two clinical registries (WHO and NIH), nine studies were identified and assessed with the Cochrane revised risk-of-bias tool. Data analysis comprised one-stage random-effects generalized linear mixed-effects models with random intercept. Seven of nine identified studies, all of high risk of bias, provided data for 550 included participants. Clinical measures of antibody response tended to be higher in the acute-exercised participants compared to rested controls and physically active compared to inactive. Physical activity significantly increased H1 strain seroconversion (adjusted odds ratio (aOR) 1.69, 95%CI: 1.02-2.82) among all participants and titer response (aOR 1.20, 95%CI: 1.03-1.39) among the acute exercise group. Increasing age frequently reduced immunogenic responses whereas body mass index and sex had little-to-no effect. Adjuvant effects were more pronounced with interventions exercising the same arm in which the vaccination was administered. H1 response was increased by both physical activity and the acute exercise-physical activity interaction. Given the observed modifications by age and the subset analysis suggesting the benefit is more pronounced in older populations, future attention is due for acute exercise-PA interactions to impact vaccination response in the at-risk population of older adults. Further, we identify localized exercise as the likely most-effective protocol and encourage its use to augment the available evidence.
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Affiliation(s)
- Erika Bohn-Goldbaum
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Katherine B. Owen
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Vivian Y. J. Lee
- School of Sport, Exercise & Rehabilitation Sciences, College of Life & Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, England
| | - Robert Booy
- The Children’s Hospital at Westmead, Sydney Medical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Kate M. Edwards
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Dinas PC, Koutedakis Y, Ioannou LG, Metsios G, Kitas GD. Effects of Exercise and Physical Activity Levels on Vaccination Efficacy: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:769. [PMID: 35632525 PMCID: PMC9146578 DOI: 10.3390/vaccines10050769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 01/27/2023] Open
Abstract
Objective: We examined whether different intensities of exercise and/or physical activity (PA) levels affected and/or associated with vaccination efficacy. Methods: A systematic review and meta-analysis was conducted and registered with PROSPERO (CRD42021230108). The PubMed, EMBASE, Cochrane Library (trials), SportDiscus, and CINAHL databases were searched up to January 2022. Results: In total, 38 eligible studies were included. Chronic exercise increased influenza antibodies (standardized mean difference (SMD) = 0.49, confidence interval (CI) = 0.25−0.73, Z = 3.95, I2 = 90%, p < 0.01), which was mainly driven by aerobic exercise (SMD = 0.39, CI = 0.19−0.58, Z = 3.96, I2 = 77%, p < 0.01) as opposed to combined (aerobic + resistance; p = 0.07) or other exercise types (i.e., taiji and qigong, unspecified; p > 0.05). PA levels positively affected antibodies in response to influenza vaccination (SMD = 0.18, CI = 0.02−0.34, Z = 2.21, I2 = 76%, p = 0.03), which was mainly driven by high PA levels compared to moderate PA levels (Chi2 = 10.35, I2 = 90.3%, p < 0.01). Physically active individuals developed influenza antibodies in response to vaccination in >4 weeks (SMD = 0.64, CI = 0.30−0.98, Z = 3.72, I2 = 83%, p < 0.01) as opposed to <4 weeks (p > 0.05; Chi2 = 13.40, I2 = 92.5%, p < 0.01) post vaccination. Conclusion: Chronic aerobic exercise or high PA levels increased influenza antibodies in humans more than vaccinated individuals with no participation in exercise/PA. The evidence regarding the effects of exercise/PA levels on antibodies in response to vaccines other than influenza is extremely limited.
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Affiliation(s)
- Petros C. Dinas
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
| | - Yiannis Koutedakis
- Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
- Faculty of Education Health & Wellbeing, University of Wolverhampton, Walsall WS1 3BD, UK;
| | - Leonidas G. Ioannou
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
| | - George Metsios
- Faculty of Education Health & Wellbeing, University of Wolverhampton, Walsall WS1 3BD, UK;
- Department of Nutrition and Dietetics, University of Thessaly, 42100 Trikala, Greece
- Dudley Group NHS Foundation Trust and School of Sports and Exercise Science, University of Birmingham, Birmingham B15 2TT, UK;
| | - George D. Kitas
- Dudley Group NHS Foundation Trust and School of Sports and Exercise Science, University of Birmingham, Birmingham B15 2TT, UK;
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Lee VY, Bohn-Goldbaum E, Fong J, Barr IG, Booy R, Edwards KM. Analgesic and adjuvant properties of exercise with vaccinations in healthy young population. Hum Vaccin Immunother 2021; 17:2058-2064. [PMID: 33499711 PMCID: PMC8189097 DOI: 10.1080/21645515.2020.1859322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022] Open
Abstract
Introduction: Exercise holds the potential to be beneficial if used during vaccination processes by 1)exercise-induced analgesia to reduce pain associated with vaccination, 2)immune-enhancing effects, improving antibody responses to the vaccine, and 3)reducing local and systemic adverse reactions to the vaccine. This study examines whether analgesic responses could be enhanced locally in the exercising limb to further benefit the use of exercise during influenza vaccination processes to minimize vaccine-related pain and improve antibody response to inactivated influenza vaccines.Methods: 57 participants (22.6 ± 3.2 years, 33 females) randomized into a control (n = 19) or one of two exercise groups: pre-vaccine arm (n = 19) or pre-vaccine leg (n = 19). Intervention groups performed exercise (15 minutes), prior to administration of the vaccine. Vaccine-related pain and pressure pain threshold (PPT) were measured at baseline and post-vaccination for all groups. Blood samples were taken on the day of vaccination and one month later to measure serum antibody titers to influenza.Results: No significant difference in vaccine-related pain or change in PPT was found with exercise, however, there was a trend in higher reports of vaccine-related pain in females compared to males(p = .06). Significantly higher fold increase (p = .02) of the B/Brisbane/60/2008 strain was found in the exercise group compared to the control group.Conclusion: The current study failed to observe an analgesic effect of exercise to improve vaccine-related pain in young adults. However, immune-enhancing effects in one of four strains suggest potential adjuvant effects of exercise. Importantly, the sex difference in pain sensitivity suggests the need for separate analysis, especially when examining pain perception.Australian New Zealand Clinical Trial Registry (ACTRN:12617000374369).
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Affiliation(s)
- Vivian Y. Lee
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences & Charles Perkins Centre, Sydney, Australia
| | - Erika Bohn-Goldbaum
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences & Charles Perkins Centre, Sydney, Australia
| | - Jacqueline Fong
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Ian G. Barr
- WHO Collaborating Centre for Reference and Research on Influenza, VIDRL, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The University of Sydney, Sydney, Australia
- Discipline of Child & Adolescent Health, Faculty of Health and Medicine, Children’s Hospital Westmead, The University of Sydney, Australia
| | - Kate M. Edwards
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Health Sciences & Charles Perkins Centre, Sydney, Australia
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Bohn-Goldbaum E, Pascoe A, Singh MF, Singh N, Kok J, Dwyer DE, Mathieson E, Booy R, Edwards KM. Acute exercise decreases vaccine reactions following influenza vaccination among older adults. Brain Behav Immun Health 2020; 1:100009. [PMID: 38377422 PMCID: PMC8474530 DOI: 10.1016/j.bbih.2019.100009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/13/2019] [Indexed: 11/30/2022] Open
Abstract
Although valuable and effective in decreasing disease burden, influenza vaccination has low rates of efficacy, especially in those at most risk. Studies have shown that acute exercise can improve vaccine responses, most consistently with weaker antigens. Here we examined the effect of resistance exercise on the acute and longer-term responses to influenza vaccination among healthy older adults. Forty-six participants (47.8% male, mean 73.4 ± 6.6 years) were randomised to perform one 45-min moderate-intensity resistance exercise session or sit quietly prior to the receipt of influenza vaccination. Acute exercise reduced vaccine reactions but had no effect on either antibody responses or development of influenza-like symptoms during six months of follow-up. Psychosocial and behavioural characteristics were examined for potential associations with the responses to vaccination. Participants (n = 36) vaccinated in the previous year had higher baseline antibody titres but not follow-up titres nor more frequent experience of influenza-like symptoms over 6 months compared to those unvaccinated in the previous year. These findings provide further support for the ability of acute exercise to reduce vaccine reactions and suggest risk factors for vaccine responses for future exploration.
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Affiliation(s)
- Erika Bohn-Goldbaum
- The University of Sydney, Faculty of Health Sciences and Charles Perkins Centre, Sydney, Australia
| | - April Pascoe
- The University of Sydney, Faculty of Health Sciences and Charles Perkins Centre, Sydney, Australia
| | - Maria Fiatarone Singh
- The University of Sydney, Faculty of Health Sciences and Charles Perkins Centre, Sydney, Australia
- The University of Sydney, Faculty of Health Sciences, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Lidcombe, Australia
- Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Nalin Singh
- The Centre for STRONG Medicine, Pymble, NSW, Australia
| | - Jen Kok
- Institute for Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital and University of Sydney, Sydney, Australia
| | - Dominic E. Dwyer
- Institute for Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital and University of Sydney, Sydney, Australia
| | | | - Robert Booy
- The University of Sydney, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
| | - Kate M. Edwards
- The University of Sydney, Faculty of Health Sciences and Charles Perkins Centre, Sydney, Australia
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