Exercise, physical activity, physical fitness, and humoral responses to influenza vaccination in adults: a systematic review and meta-analysis
7 affiliations
- 1School of Physical Education, Chengdu Vocational University of the Arts
- 2School of Information Technology, Vitebsk State University named after P.M. Masherov
- 3South China Normal University
- 4School of Physical Education, Guangdong Technology College
- 5Department of Basic Medicine, Langfang Health Vocational College
- 6College of Sports Science, Shenyang Normal University
- 7Hebei Sport University
Abstract
Background: Exercise, habitual physical activity, and physical fitness have been proposed as behavioral adjuvants that could improve influenza vaccine immunogenicity, but individual studies are small and inconsistent.
Objective: To evaluate the effects of assigned acute and chronic exercise interventions, and the associations of habitual activity and fitness, with humoral responses to influenza vaccination in adults.
Methods: We searched PubMed, Web of Science, Embase, Cochrane Library, Scopus, and SPORTDiscus from inception to May 1, 2026. Randomized evidence was analyzed separately for acute exercise and chronic training; nonrandomized interventions and observed activity or fitness were considered separately. Risk ratios (RRs) and mean differences (MDs) in log ₂ hemagglutination inhibition (HAI) titers were synthesized when compatible numerical data were available. Design-appropriate risk-of-bias tools and GRADE were applied.
Results: Twenty-two reports were included. Seven randomized reports provided primary quantitative estimates, and five contributed to at least one meta-analysis of two or more trials. Acute exercise did not show a clear effect on H1N1 seroprotection (RR 0.88, 95% CI 0.65–1.21; k = 3) or H3N2 seroprotection (RR 1.04, 0.91–1.20; k = 3), or on H1N1 seroconversion (RR 1.30, 0.58–2.92; k = 2) or H3N2 seroconversion (RR 0.84, 0.50–1.40; k = 2). Chronic-training titer estimates were imprecise for H1N1 (MD 0.50 log ₂ units, −0.64 to 1.64; k = 2), H3N2 (0.27, −0.17 to 0.72; k = 2), and influenza B (−0.14, −0.64 to 0.36; k = 2). Other primary comparisons were supported by single trials. Certainty was low or very low.
Conclusion: The available randomized evidence does not establish an immunogenicity benefit of acute exercise or chronic training, but does not demonstrate equivalence or exclude benefit. Observational associations remain vulnerable to confounding. Larger trials with complete numerical reporting are needed; these antibody findings do not establish effects on clinical influenza.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261425732 , identifier CRD420261425732.
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BibTeX
@article{hao2026exercise,
title = {{Exercise, physical activity, physical fitness, and humoral responses to influenza vaccination in adults: a systematic review and meta-analysis}},
author = {Xiaoman Hao and Tianyuan Yu and Weibao Liang and Yue Zong and Yasong Zhang and Yu Hou and Zhijia Sun},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1950491},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1950491/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Exercise, physical activity, physical fitness, and humoral responses to influenza vaccination in adults: a systematic review and meta-analysis
AU - Xiaoman Hao
AU - Tianyuan Yu
AU - Weibao Liang
AU - Yue Zong
AU - Yasong Zhang
AU - Yu Hou
AU - Zhijia Sun
PY - 2026
DA - 2026/10/08
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1950491
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1950491/full
AB - Background: Exercise, habitual physical activity, and physical fitness have been proposed as behavioral adjuvants that could improve influenza vaccine immunogenicity, but individual studies are small and inconsistent. Objective: To evaluate the effects of assigned acute and chronic exercise interventions, and the associations of habitual activity and fitness, with humoral responses to influenza vaccination in adults. Methods: We searched PubMed, Web of Science, Embase, Cochrane Library, Scopus, and SPORTDiscus from inception to May 1, 2026. Randomized evidence was analyzed separately for acute exercise and chronic training; nonrandomized interventions and observed activity or fitness were considered separately. Risk ratios (RRs) and mean differences (MDs) in log ₂ hemagglutination inhibition (HAI) titers were synthesized when compatible numerical data were available. Design-appropriate risk-of-bias tools and GRADE were applied. Results: Twenty-two reports were included. Seven randomized reports provided primary quantitative estimates, and five contributed to at least one meta-analysis of two or more trials. Acute exercise did not show a clear effect on H1N1 seroprotection (RR 0.88, 95% CI 0.65–1.21; k = 3) or H3N2 seroprotection (RR 1.04, 0.91–1.20; k = 3), or on H1N1 seroconversion (RR 1.30, 0.58–2.92; k = 2) or H3N2 seroconversion (RR 0.84, 0.50–1.40; k = 2). Chronic-training titer estimates were imprecise for H1N1 (MD 0.50 log ₂ units, −0.64 to 1.64; k = 2), H3N2 (0.27, −0.17 to 0.72; k = 2), and influenza B (−0.14, −0.64 to 0.36; k = 2). Other primary comparisons were supported by single trials. Certainty was low or very low. Conclusion: The available randomized evidence does not establish an immunogenicity benefit of acute exercise or chronic training, but does not demonstrate equivalence or exclude benefit. Observational associations remain vulnerable to confounding. Larger trials with complete numerical reporting are needed; these antibody findings do not establish effects on clinical influenza. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261425732 , identifier CRD420261425732.
SN - 1664-3224
ER -