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 diferent 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-efects 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 diference 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 diference 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 frst line of defence of the immune system, and increases the potency of vaccination.
The results from this systematic review and meta-analysis reveal that regular physical activity increases resistance to infectious disease in the general population. Regular physical activity should be promoted in the general population to decrease the risk of community-acquired infection and infectious disease mortality, strengthen the potency of immunisation programmes and help lessen the impact of pandemics such as the recent COVID-19.