Acute Aerobic Exercise and Vaccine Efficacy in Older Adults
The most effective way of avoiding influenza is through influenza vaccination. However, the vaccine is ineffective in about 25% of the older population. Immunosenescence with advancing age results in inadequate protection from disease because of ineffective responses to vaccination. Recently, a number of strategies have been tested to improve the efficacy of a vaccine in older adults. An acute bout of moderate aerobic exercise may increase the efficacy of the vaccine in young individuals, but there are limited efficacy data in older adults who would benefit most.
Purpose: This study sought to evaluate whether acute moderate-intensity endurance exercise immediately before influenza vaccination would increase the efficacy of the vaccine.
Methods: Fifty-nine healthy volunteers between 55 and 75 yr of age were randomly allocated to an exercise or control group. Antibody titers were measured at baseline before exercise and 4 wk after vaccination. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured at 24 and 48 h after vaccination.
Results: Delta CRP and IL-6 at 24 and 48 h were significantly higher after vaccination as compared to the sham injection. There were no differences in the levels of antibody titers against the H3N2 influenza strain between groups. However, women in the exercise group had a significantly higher antibody response against the H1N1 influenza strain as compared to the men, probably because of lower prevaccine titers. There were no significant differences in seroprotection between groups.
Conclusions: Acute moderate aerobic exercise was not immunostimulatory in healthy older men but may serve as a vaccine adjuvant in older women.
The influenza virus can cause a disproportionate increase in serious illness and deaths in individuals 65 yr of age and older. The most effective way of avoiding influenza is through influenza vaccination. However, the vaccine is ineffective in about 25% of the older population. Numerous reasons may account for the lower influenza vaccine response in older adults including past vaccination history, natural exposure to influenza viruses, living situation, dietary factors, and immunosenescence. Hence, studying the role of exogenous and endogenous adjuvants to increase the efficacy of the vaccine in older populations is important.
It has been shown that high levels of chronic stress (psychological or physical) are detrimental to immune system function. Chronic stress has been shown to reduce influenza vaccine antibody titers in all age groups. However, there is evidence that acute stress can be immunoenhancing. The immunoenhancement has primarily been shown with acute psychological and/or physical stressors in animal models.
An acute psychological stressor and an acute physical stressor in close proximity to the administration of influenza vaccination induced higher antibody titers for A/Panama strain in women compared to an unstressed control group. Edwards et al. reported greater antibody responses 4 and 20 wk after vaccination in young women compared to young men after an acute bout of 45-min aerobic exercise before vaccination, suggesting a sex-specific effect of stress on antibody responses to vaccination. Acute eccentric arm exercise also produced a sex-specific response after influenza vaccination, with women showing a greater antibody response than men. Furthermore, Edwards et al. showed that acute eccentric arm exercise produced a sex-specific enhancement of the antibody response to a half-dose influenza vaccination, whereas exercise intensity did not affect the response. Their study also reported that exercise only affected low-immunogenic antigens. Conversely, Campbell et al. noted that acute eccentric exercise in young healthy adults did not further augment the antibody titer in response to influenza vaccination. Thus, acute exercise may enhance the antibody response to influenza vaccination in a sex-specific manner in young adults, while primarily affecting low-immunogenic antigens.
Most of the studies with acute exercise bout have focused on young healthy adults who typically have a robust antibody response to influenza vaccination. Recently, Long et al. reported that an acute moderate-intensity aerobic bout (45 min of brisk walking with an uphill and downhill component) before pneumonia (Pneumovax II) and half-dose influenza vaccination (Fluarix) did not affect or augment the antibody response to either influenza or pneumonia vaccine in middle-aged adults. Because a reduced dose of influenza vaccination usually elicits an appropriate immune response in young healthy individuals, these data suggest that age may affect how acute exercise influences the antibody response to influenza vaccination. Although several studies have shown that exercise training improved antibody responses to influenza vaccination in older adults, to our knowledge, no data exist on the effect of acute exercise on the potential for sex-specific immune responses after influenza vaccination in older (above the age 65 yr) adults.
Previous work has provided support for interleukin-6 (IL-6) as a potential contributor to the immune enhancement after an acute exercise. It has also been previously reported that higher levels of IL-6 at the time of vaccination may be associated with greater antibody response to vaccination. The IL-6 response after vaccination has been used as a biomarker of subsequent vaccine efficacy, as it has been previously shown in humans that antibody responders to Francisella tularensis have a higher level of IL-6 compared to nonresponders. Because IL-6 was one of the primary cytokines to be elevated, it was hypothesized to be involved with the downstream response. Hence, in the present study, we evaluated the association between inflammatory cytokine (C-reactive protein [CRP] and IL-6) levels and antibody titers.
Therefore, the primary aim of this study was to evaluate the effect of acute moderate aerobic exercise immediately before administration of the influenza vaccine on antibody titers and seroprotective responses in older adults. A second exploratory aim was to investigate whether acute exercise immediately before influenza vaccination produces different effects on antibody response in older men versus older women.
Abstract and Introduction
Abstract
The most effective way of avoiding influenza is through influenza vaccination. However, the vaccine is ineffective in about 25% of the older population. Immunosenescence with advancing age results in inadequate protection from disease because of ineffective responses to vaccination. Recently, a number of strategies have been tested to improve the efficacy of a vaccine in older adults. An acute bout of moderate aerobic exercise may increase the efficacy of the vaccine in young individuals, but there are limited efficacy data in older adults who would benefit most.
Purpose: This study sought to evaluate whether acute moderate-intensity endurance exercise immediately before influenza vaccination would increase the efficacy of the vaccine.
Methods: Fifty-nine healthy volunteers between 55 and 75 yr of age were randomly allocated to an exercise or control group. Antibody titers were measured at baseline before exercise and 4 wk after vaccination. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured at 24 and 48 h after vaccination.
Results: Delta CRP and IL-6 at 24 and 48 h were significantly higher after vaccination as compared to the sham injection. There were no differences in the levels of antibody titers against the H3N2 influenza strain between groups. However, women in the exercise group had a significantly higher antibody response against the H1N1 influenza strain as compared to the men, probably because of lower prevaccine titers. There were no significant differences in seroprotection between groups.
Conclusions: Acute moderate aerobic exercise was not immunostimulatory in healthy older men but may serve as a vaccine adjuvant in older women.
Introduction
The influenza virus can cause a disproportionate increase in serious illness and deaths in individuals 65 yr of age and older. The most effective way of avoiding influenza is through influenza vaccination. However, the vaccine is ineffective in about 25% of the older population. Numerous reasons may account for the lower influenza vaccine response in older adults including past vaccination history, natural exposure to influenza viruses, living situation, dietary factors, and immunosenescence. Hence, studying the role of exogenous and endogenous adjuvants to increase the efficacy of the vaccine in older populations is important.
It has been shown that high levels of chronic stress (psychological or physical) are detrimental to immune system function. Chronic stress has been shown to reduce influenza vaccine antibody titers in all age groups. However, there is evidence that acute stress can be immunoenhancing. The immunoenhancement has primarily been shown with acute psychological and/or physical stressors in animal models.
An acute psychological stressor and an acute physical stressor in close proximity to the administration of influenza vaccination induced higher antibody titers for A/Panama strain in women compared to an unstressed control group. Edwards et al. reported greater antibody responses 4 and 20 wk after vaccination in young women compared to young men after an acute bout of 45-min aerobic exercise before vaccination, suggesting a sex-specific effect of stress on antibody responses to vaccination. Acute eccentric arm exercise also produced a sex-specific response after influenza vaccination, with women showing a greater antibody response than men. Furthermore, Edwards et al. showed that acute eccentric arm exercise produced a sex-specific enhancement of the antibody response to a half-dose influenza vaccination, whereas exercise intensity did not affect the response. Their study also reported that exercise only affected low-immunogenic antigens. Conversely, Campbell et al. noted that acute eccentric exercise in young healthy adults did not further augment the antibody titer in response to influenza vaccination. Thus, acute exercise may enhance the antibody response to influenza vaccination in a sex-specific manner in young adults, while primarily affecting low-immunogenic antigens.
Most of the studies with acute exercise bout have focused on young healthy adults who typically have a robust antibody response to influenza vaccination. Recently, Long et al. reported that an acute moderate-intensity aerobic bout (45 min of brisk walking with an uphill and downhill component) before pneumonia (Pneumovax II) and half-dose influenza vaccination (Fluarix) did not affect or augment the antibody response to either influenza or pneumonia vaccine in middle-aged adults. Because a reduced dose of influenza vaccination usually elicits an appropriate immune response in young healthy individuals, these data suggest that age may affect how acute exercise influences the antibody response to influenza vaccination. Although several studies have shown that exercise training improved antibody responses to influenza vaccination in older adults, to our knowledge, no data exist on the effect of acute exercise on the potential for sex-specific immune responses after influenza vaccination in older (above the age 65 yr) adults.
Previous work has provided support for interleukin-6 (IL-6) as a potential contributor to the immune enhancement after an acute exercise. It has also been previously reported that higher levels of IL-6 at the time of vaccination may be associated with greater antibody response to vaccination. The IL-6 response after vaccination has been used as a biomarker of subsequent vaccine efficacy, as it has been previously shown in humans that antibody responders to Francisella tularensis have a higher level of IL-6 compared to nonresponders. Because IL-6 was one of the primary cytokines to be elevated, it was hypothesized to be involved with the downstream response. Hence, in the present study, we evaluated the association between inflammatory cytokine (C-reactive protein [CRP] and IL-6) levels and antibody titers.
Therefore, the primary aim of this study was to evaluate the effect of acute moderate aerobic exercise immediately before administration of the influenza vaccine on antibody titers and seroprotective responses in older adults. A second exploratory aim was to investigate whether acute exercise immediately before influenza vaccination produces different effects on antibody response in older men versus older women.
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