. 2022 Sep;21(4):32–52.

Table S8.

Physical Resilience, Activity & Exercise Modulation of Vaccine Efficacy

	Dosage	Timing (before/after vaccination)	Control	Population	Vaccine Type	Outcome	Citation
Frailty phenotype	n/a	n/a	n/a	72-95 years; mean age 84.5 n=71	TIV	Non-frail phenotype associated with improved antibody response^a	Yao et al⁷²
Frailty phenotype	n/a	n/a	n/a	50+ years+, mean age 62.3 n=106	TIV	No significant improvement in vaccine response for non-frail phenotype^b Frail phenotype associated with improved antibody response in 50-64 year group only.	Moehling et al⁷³
Frailty phenotype	n/a	n/a	n/a	65-83 years; mean age 71.5 n=168	TIV	Non-frail phenotype not associated with improved antibody response (but there were differences in PBMCs)^b	Moehling et al⁷⁴
Physical activity levels (as component of frailty phenotype)	n/a	n/a	n/a	70-93 years n=76	TIV	Participants in the normal (compared to low) physical activity subgroup had significantly better vaccine response to H3N2 and B strains^a	Bauer et al⁷⁵
Physical activity levels	n/a	n/a	n/a	62+ years n=56	TIV	High activity levels (regular, vigorous exercise at least 20 mins. 3 times per week) associated with improved antibody response and PBMCs^a	Kohut et al⁷⁶
Physical activity levels	n/a	n/a	n/a	67-91 years; mean age 81 n=30	TIV	Highest level of physical activity associated with improved antibody response (H3N2 strain only)^a	Schuler et al⁷⁷
Physical activity levels	n/a	Vaccination at month 0 and month 20 with activity levels monitored for 2 weeks post vaccination	n/a	Females 65+ years n=56	TIV	Higher rates of walking associated with higher influenza B antibodies and H1N1 HAI titers^a	Wong et al⁷⁸
Fitness levels	n/a	n/a	n/a	Males 65-85 years n=61	TIV	Both moderate and intense fitness levels (VO2 max) associated with significantly improved antibody response at both 6 weeks and 6 months^a	de Araújo et al⁷⁹
Fitness levels	n/a	n/a	n/a	60-76 years n=26 ‘	TIV Tetanus toxoid	High fitness (VO2 max) associated with significantly higher influenza H1N1 and B strain antibodies, and Th2-skewed IgG2 tetanus toxocoid at 6 weeks, plus a trend towards higher infleunza B strain antibodies at 6 months.^a	Keylock et al⁸⁰
Regular moderate aerobic exercise	Building up to 45-60 mins cardiovascular exercise (60-70% maximal oxygen uptake) three times per week (supervised)	4 months prior to vaccination and continuing for a total of 10 months	Flexibility exercise program	Sedentary adults; 69.9 mean age n=144	TIV	Significantly improved seroprotection in the cardiovascular exercise intervention group (30-100% depending on variant), compared to flexibility exercise group^a	Woods et al⁸²
Regular moderate aerobic exercise	Building up to 25-30 mins aerobic exercise (65-75% of heart rate reserve) three times per week (supervised)	4 weeks post first vaccination and continued for 13 months, with a second vaccination at 10 months	Control participants instructed to continue current level of physical activity/inactivity	64+ years;, mean age 70 (intervention), 73 (control) n=28	TIV	Significantly improved antibody response for H1N1 and H3N2 strains^a	Kohut et al⁸³
Regular moderate aerobic exercise	45 mins. per/day (independent) + 2.5 hour/wk group sessions Moderate intensity (Borg’s Rating of Perceived Exertion)	6 weeks before and 2 weeks after vaccination	Assigned to wait-list	50+ years; mean age 59 n=149	TIV	No significant change in vaccine response^b	Hayney et al⁸⁴
Acute moderate aerobic exercise	40 mins 55-65% max. heart rate	Immediately prior to vaccination	No exercise	55-75 years; mean age 67 n=55 (32 women and 23 men)	TIV	Significantly improved antibody response at 4 weeks to H1N1 strain only in women (even after covarying for baseline value differences)^a No significant change in vaccine response in men. No significant change in seroprotection (40+ HI titre) in either group.	Ranadive et al⁶⁷
Acute brisk walking	45 mins at least 55% max. heart rate	Immediately prior to vaccination	No exercise (site quietly for 45 mins prior to vaccination)	50-64 years; mean age 57.5 n=60	Pneumococcal (full dose) TIV (half dose)	No significant change in TIV response^b Pneumococcal IgM strains (pn1, pn4, pn18c) were significantly lower in the intervention group compared to controls.	Long et al⁶⁹
Acute resistance training	45 mins. 5 sets; 8 reps; 2 minutes rest in between sets Moderate intensity (60% one repetition max)	Immediately prior to vaccination	No exercise (30 min. seated rest)	65+ years; mean age 73.4 n=46	TIV	No significant change in vaccine response^b Control participants higher rates of mild symptoms (48h post vaccination).	Bohn-Goldbaum et al⁶⁸
Acute resistance training	Upper and lower body resistance exercises (60% one repetition max)	Immediately prior to vaccination	No exercise	Mean age 73 n=46	TIV	No significant change in vaccine response^b Control participants higher rates of adverse events (48h post vaccination).	Edwards et al⁷⁰

^aSignificant effect on/association with vaccine response for at least one vaccine strain/subgroup

^bNo significant effect on/association with vaccine response