| Summary: | Objective: We examined whether different intensities of exercise and/or physical activity (PA) levels affected and/or associated with vaccination efficacy. Methods: A systematic review and meta-analysis was conducted and registered with PROSPERO (CRD42021230108). The PubMed, EMBASE, Cochrane Library (trials), SportDiscus, and CINAHL databases were searched up to January 2022. Results: In total, 38 eligible studies were included. Chronic exercise increased influenza antibodies (standardized mean difference (SMD) = 0.49, confidence interval (CI) = 0.25–0.73, Z = 3.95, I<sup>2</sup> = 90%, <i>p</i> < 0.01), which was mainly driven by aerobic exercise (SMD = 0.39, CI = 0.19–0.58, Z = 3.96, I<sup>2</sup> = 77%, <i>p</i> < 0.01) as opposed to combined (aerobic + resistance; <i>p</i> = 0.07) or other exercise types (i.e., taiji and qigong, unspecified; <i>p</i> > 0.05). PA levels positively affected antibodies in response to influenza vaccination (SMD = 0.18, CI = 0.02–0.34, Z = 2.21, I<sup>2</sup> = 76%, <i>p</i> = 0.03), which was mainly driven by high PA levels compared to moderate PA levels (Chi<sup>2</sup> = 10.35, I<sup>2</sup> = 90.3%, <i>p</i> < 0.01). Physically active individuals developed influenza antibodies in response to vaccination in >4 weeks (SMD = 0.64, CI = 0.30–0.98, Z = 3.72, I<sup>2</sup> = 83%, <i>p</i> < 0.01) as opposed to <4 weeks (<i>p</i> > 0.05; Chi2 = 13.40, I<sup>2</sup> = 92.5%, <i>p</i> < 0.01) post vaccination. Conclusion: Chronic aerobic exercise or high PA levels increased influenza antibodies in humans more than vaccinated individuals with no participation in exercise/PA. The evidence regarding the effects of exercise/PA levels on antibodies in response to vaccines other than influenza is extremely limited.
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