Effects of regular physical activity on the immune system, vaccination and risk of community acquired infectious disease in the general population: systematic review and meta-analysis

Sebastien F.M. Chastin*, Ukachukwu Abaraogu, Jan G. Bourgois, Philippa M. Dall, Jennifer Darnborough, Elaine Duncan, Jasmien Dumortier, David Jiménez Pavón, Joanna McParland, Nicola J. Roberts, Mark Hamer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

157 Citations (Scopus)
173 Downloads (Pure)


BACKGROUND: Regular physical activity is the prime modality for the prevention of numerous non-communicable diseases and has also been advocated for resilience against COVID-19 and other infectious diseases. However, there is currently no systematic and quantitative evidence synthesis of the association between physical activity and the strength of the immune system.

OBJECTIVE: To examine the association between habitual physical activity and (1) the risk of community-acquired infectious disease, (2) laboratory-assessed immune parameters, and (3) immune response to vaccination.

METHODS: We conducted a systemic review and meta-analysis according to PRISMA guidelines. We searched seven databases (MEDLINE, Embase, Cochrane CENTRAL, Web of Science, CINAHL, PsycINFO, and SportDiscus) up to April 2020 for randomised controlled trials and prospective observational studies were included if they compared groups of adults with different levels of physical activity and reported immune system cell count, the concentration of antibody, risk of clinically diagnosed infections, risk of hospitalisation and mortality due to infectious disease. Studies involving elite athletes were excluded. The quality of the selected studies was critically examined following the Cochrane guidelines using ROB2 and ROBINS_E. Data were pooled using an inverse variance random-effects model.

RESULTS: Higher level of habitual physical activity is associated with a 31% risk reduction (hazard ratio 0.69, 95% CI 0.61-0.78, 6 studies, N = 557,487 individuals) of community-acquired infectious disease and 37% risk reduction (hazard ratio 0.64, 95% CI 0.59-0.70, 4 studies, N = 422,813 individuals) of infectious disease mortality. Physical activity interventions resulted in increased CD4 cell counts (32 cells/µL, 95% CI 7-56 cells/µL, 24 studies, N = 1112 individuals) and salivary immunoglobulin IgA concentration (standardised mean difference 0.756, 95% CI 0.146-1.365, 7 studies, N = 435 individuals) and decreased neutrophil counts (704 cells/µL, 95% CI 68-1340, 6 studies, N = 704 individuals) compared to controls. Antibody concentration after vaccination is higher with an adjunct physical activity programme (standardised mean difference 0.142, 95% CI 0.021-0.262, 6 studies, N = 497 individuals).

CONCLUSION: Regular, moderate to vigorous physical activity is associated with reduced risk of community-acquired infectious diseases and infectious disease mortality, enhances the first line of defence of the immune system, and increases the potency of vaccination.

PROTOCOL REGISTRATION: The original protocol was prospectively registered with PROSPERO (CRD42020178825).

Original languageEnglish
Pages (from-to)1673-1686
Number of pages14
JournalSports Medicine
Issue number8
Early online date20 Apr 2021
Publication statusPublished - Aug 2021


  • adult
  • COVID-19
  • exercise
  • humans
  • immune system
  • observational studies as topic
  • SARS-CoV-2
  • vaccination

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Effects of regular physical activity on the immune system, vaccination and risk of community acquired infectious disease in the general population: systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this