Research Review: Does exercise boost your vaccination response?

With flu season approaching and ongoing covid boosters on many people’s calendars, some newly published research looks at whether post-jab workouts can enhance vaccine response. Review by Assoc Prof Mike Climstein, PhD & Dr Joe Walsh, PhD.

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Title: Exercise after influenza or COVID-19 vaccination increases serum antibody without an increase in side effects

Authors: J Hallam and colleagues (Department of Kinesiology, Iowa State University)

Source: Brain, Behavior, and Immunity, Vol 102, May 2022, pp1-10. Read journal article free online here.

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Introduction: This Research Review is deja vu from two years ago when a mysterious new sickness was starting to get a grip on the world. Little did we know what a devastating impact COVID-19 would have on our lives and our daily living. There was mention of some type of virus having originated in Wuhan, China, but nothing was certain, and it was hard to separate facts and genuine risk factors from speculation. Besides, we had a Bali surf trip booked, so the optimist in me was sure the whole thing would blow over in a couple of weeks. How naïve I was! It’s over two years later now, and no Bali, Hawaii or any other surf trip has happened yet.

A bit of history to put vaccinations into perspective. In the 1960’s, the fastest vaccine development occurred when the vaccine for mumps was developed in just four years. Jump forward approximately 60 years and COVID-19 struck.  The leading epidemiologists, virologists and scientists had a realisation that they were facing a pandemic of seismic proportions.

The last pandemic was in 1918 when the H1N1 virus (the first of three H1N1 pandemics in slightly over a century, the most recent being 2009 swine flu), the deadliest pandemic of the 20^th century, infected approximately 500 million people worldwide and resulted in approximately 20-50 million deaths. This was a time when the world’s population was around a quarter of what it is today.

It shows what can be accomplished when a global emergency is met with adequate resources.

One hundred years later, in early 2020, scientists began seeking a vaccine for the SARS-CoV-2 coronavirus with the hopes of having one developed within one and a half years. Within just a few months several vaccines were undergoing trials, and within a year governments around the world had approved a number of these and started rolling out their vaccination programs. It shows what can be accomplished when a global emergency is met with adequate resources.

We are all aware of the COVID-19 vaccines available within Australia; Pfizer, Moderna, AstraZeneca and Novovax. The issue of COVID-19 vaccinations (and other vaccinations) is quite contentious (and that is putting it mildly – at the NSW and Queensland border thousands of locals protested mandatory COVID-19 vaccinations).

On top of all this, the issue of vaccination and exercise has again resurfaced. This leads us to the topic of this Research Review. Justus Hallam (a graduate assistant) and colleagues from Iowa State University in the USA examined the effects of exercise on the serum antibody response to three different vaccinations; the 2009 pandemic influenza H1N1, a seasonal influenza (i.e., flu shot); and the Pfizer COVID-19 vaccination.

Background: It is believed that, when completed near the time of receiving the immunisation, physical activity in the form of exercise may positively affect the body’s antibody response to the vaccination.

The mechanism for the benefit is postulated to be that the exercise acts as an acute stressor.

Although a number of studies have demonstrated that exercise resulted in an improved antibody response, others have not shown any such outcome. In brief, an antibody response is an immune reaction where the body defends itself against foreign invaders, meaning the virus. The mechanism for the benefit is postulated to be that the exercise acts as an acute stressor. It has also been shown that progressive resistance training, specifically the eccentric (i.e., negative) component of lifting, produces a local inflammatory response which results in greater cell activity. In fact, eccentric exercise before receiving the vaccination was shown to increase the antibody response. However, the exact mechanism of benefit from exercise is still undetermined and only speculative.

Methods: Healthy, active individuals received either the H1N1 vaccine, seasonal influenza vaccine or the Pfizer COVID-19 vaccine. Participants, prior to participating in this study, were exercising on a regular basis for at least the previous six months. The H1N1 exercise consisted of light-moderate intensity exercise initiated within 30 minutes of receiving the vaccine. Control participants (those that did not receive a vaccine) remained sedentary, watching television and videos. The exercise was 60 to 70% of age predicted heart rate max completed on a cycle ergometer for 90 minutes. Where the flu vaccine was administered, the participants completed either 45 minutes or 90 minutes of exercise at 60 to 70% of age predicted max heart rate on a cycle ergometer. Those participants who received the Pfizer COVID-19 vaccine also exercised at 60 to 70% of age predicted heart rate max.

Heart rate and rating of perceived exertion were assessed every 10 minutes of the exercise session. Additionally, the authors assessed type I interferon, which is a well-known stimulator of antiviral genes which target virus replication within cells (i.e. improved antiviral response).   

It has also been shown that progressive resistance training …produces a local inflammatory response which results in greater cell activity

Results: The authors reported that 90-minutes of light-moderate intensity cycling exercise consistently increased the serum antibody response to all of the vaccines four weeks post-vaccination. Additionally, the exercise did not result in any observed increase in side effects following the COVID-19 vaccination for the small sample of study participants. The authors concluded that adults who complete light-moderate aerobic exercise on a regular basis may increase the antibody response to both the influenza vaccine and COVID-19 vaccine by completing a single bout of light to moderate exercise after receiving the immunisation.

To make things interesting, the authors repeated the same study, however using the animal model (mice) and swapping the cycle ergometer for a treadmill.  

Pros: This is a timely study. The authors added that their findings could directly benefit individuals with a wide range of fitness levels, which makes the findings from this study applicable to a large segment of the population. Although the participants in this study were healthy and active, approximately one-half were classified as being overweight or obese (based upon their body mass index (BMI)).

Cons: This was a difficult study to conduct, given that participants did not receive the same vaccinations. However, it would have been advantageous if the groups within each vaccination were separated into aerobic exercise, resistance training exercise and a group that completed combined aerobic and resistance exercise. Although rare, a number of potentially fatal side effects have been documented following COVID-19 vaccinations. It is not impossible that the probability of fatal or non-fatal side effects might be influenced by exercise after vaccination. The reader should take a cautious approach to engaging in exercise directly after vaccination and speak with the general practitioner first.

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REFERENCES

• Hallam, J., Jones, T., Alley, J., & Kohut, M. (2022).  Exercise after influenza or COVID-19 vaccination increases serum antibody without an increase in side effects.  Brain Behaviour and Immunity.  102: 1-10.
• Kohut, M., Arnston, B., Lee, W., Rozeboom, K., Yoon, K., Cunnick, J., & McElhaney, J. (2004).  Moderate exercise improves antibody response to influenza immunization in older adults.  Vaccine. 2(17-18): 2298-2306.

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Assoc Prof Mike Climstein, PhD FASMF FACSM FAAESS AEP

Dr Climstein is one of Australia’s leading Accredited Exercise Physiologists. He is a faculty member in Clinical Exercise Physiology, Sport & Exercise Science at Southern Cross University (Gold Coast). michael.climstein@scu.edu.au

Dr Joe Walsh, PhD

Joe has worked in a number of large international research teams with study findings presented around the world. In addition to working in the university sector, he is a director of Sport Science Institute. sportscienceinstitute.com