Association between physical activity and immunogenicity of an inactivated virus vaccine against SARS-CoV-2 in patients with autoimmune rheumatic diseases

Bruno Gualano, Italo R. Lemes, Rafael P. Silva, Ana J. Pinto, Bruna C. Mazzolani, Fabiana I. Smaira, Sofia M. Sieczkowska, Nadia E. Aikawa, Sandra G. Pasoto, Ana C. Medeiros-Ribeiro, Carla G.S. Saad, Emily F.N. Yuki, Clovis A. Silva, Paul Swinton, Pedro C. Hallal, Hamilton Roschel, Eloisa Bonfa

Research output: Contribution to journalArticlepeer-review


Objectives: To investigate whether physical activity is associated with enhanced immunogenicity of a SARS-CoV-2 inactivated vaccine (Coronavac) in patients with autoimmune rheumatic diseases (ARD) (n = 898) and in non-ARD (n = 197) individuals without pre-existing immunogenicity to SARS-CoV-2. Methods: This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial. Immunogenicity was assessed after vaccination by measuring seroconversion rates of total anti-SARS-CoV-2 S1/S2 IgG (SC), geometric mean titers of anti-S1/S2 IgG (GMT), factor-increase in GMT (FI-GMT), frequency of neutralizing antibody (NAb), and median neutralizing activity. Physical activity (active being defined as ≥ 150 min/week) and sedentary behavior (>8h/day) were assessed by questionnaire. Results: Physically active ARD patients (n = 494) were younger and less frequently used prednisone/biologics than inactive patients (n = 404). After controlling for covariates, active patients exhibited greater SC (OR: 1.4 [95%CI: 1.1–2.0]), GMT (32% [95%CI: 8.8–60) and FI-GMT (33% [95%CI: 9.6–63%]) vs. inactive. Cluster analysis (physical activity/sedentary status) revealed greater GMT (43.0% [95% CI: 11.0–84.0%) and FI-GMT (48.0% [95%CI: 14.0–92.0%]) in active/non-sedentary vs. inactive/sedentary ARD patients. A dose–response was observed, with greater benefits for the group of patients performing ≥ 350 min/week of physical activity (OR: 1.6 [95%CI: 1.1–2.4]; 41% [95%CI: 10–80%]; 35% [95%CI: 4.3–74], for SC, GMT, and FI-GMT, respectively) vs. the least active group (≤30 min/week). Greater SC (OR: 9.9 [95%CI: 1.1–89.0]) and GMT (26% [95%CI: 2.2–56.0%]) were observed in active vs. inactive non-ARD. Conclusions: A physically active lifestyle may enhance SARS-CoV-2 vaccine immunogenicity, a finding of particular clinical relevance for immunocompromised patients. Trial Registration: #NCT04754698.

Original languageEnglish (US)
Pages (from-to)49-56
Number of pages8
JournalBrain, Behavior, and Immunity
StatePublished - Mar 2022
Externally publishedYes


  • Coronavirus
  • Exercise
  • Lifestyle
  • SARS-CoV-2
  • Sedentary behavior

ASJC Scopus subject areas

  • Immunology
  • Endocrine and Autonomic Systems
  • Behavioral Neuroscience


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