This data indicates the effectiveness of exercise as a vaccine adjuvant, particularly in weaker responses. responses were similar. This data indicates the effectiveness of exercise as a vaccine adjuvant, particularly in weaker responses. Thus, given the potential public health benefits of no-cost behavioural intervention to enhance response to vaccination, testing in at-risk populations should be pursued. [15], and circulating IL-6 levels have been found to be predictive of enhanced vaccine responses after acute exercise or psychological stress [9]. Other aspects of exercise-induced inflammation can be indirectly quantified by indices of oedema and muscle pain [16], which have also been previously associated with immune responses after eccentric exercise [8]. The current study included markers of the inflammatory response to exercise to assess the association with magnitude of antibody to vaccination. Pneumococcal disease remains a major cause of mortality worldwide, even with several licensed vaccines available. The polysaccharide pneumococcal vaccine (PPV) Pneumovax 23 is recommended for adults and children 2 years, conferring immunity against 23 bacterial strains. PPV is estimated to have a protective efficacy of only 50-70%, a number which is further reduced in immunocompromised groups [17-20]. The limitations of responses to PPV indicate it might benefit from exercise-induced enhancement and was chosen for use in the current study. MATERIALS & METHODS Participants One hundred and thirty-three healthy young adults (75 women) were recruited, of which 129 (72 women) completed the study (see CONSORT flow diagram). Exclusion criteria included regular smoking (reported current smoking 1 occasion / month), a history of immune or cardiovascular disease, current acute infection or illness, current psychiatric treatment or diagnosis or history of psychosis, pregnancy, current use of medication (except birth control), and a history of vaccine-related allergies or side effects. None of the participants had previously received the pneumococcal polysaccharide vaccine in adulthood, however it is expected that the majority of participants will have received the conjugate pneumococcal vaccine during childhood. In addition, none of the participants had performed any regular resistance training in the past six months. All participants were instructed to abstain from vigorous exercise for at least 24 h, alcohol for at least 12 h, and food or caffeine for at least 3 h prior to each session. All participants provided written informed consent, the project was approved by the University of California, San Diego (UCSD) Human Subjects Committee. All participants were paid US$100 for completion of the study. Procedure After consent, participants were randomised to receive either a full-dose (0.5ml) or reduced-dose (0.25ml) PPV and to perform either an exercise or control task, by computerised random allocation with equal numbers for each condition (by sex). Salmeterol Final group sizes were: full dose + exercise (N=30), full dose + control (N=35), half-dose + exercise (N=35) and half-dose + control (N=33). See Figure 1 for participant flow. Laboratory personnel running the assays were blind to Salmeterol condition. Groups did not differ on stressful life events exposure, perceived stress and health behaviours (data not presented here); factors which have been associated with variation in vaccination response [21]. Open in a separate window Figure 1 CONSORT participant flow diagram In the first session, ATF3 participants had their height and weight measured and, following a 20 min rest period, baseline blood samples were taken from an antecubital vein in the dominant arm for baseline antibody and cytokine determination. Next, they Salmeterol Salmeterol completed the exercise task or remained quietly resting for 20 min (control group). Immediately after task completion, a nurse administered the PPV, either full (0.5ml) or half (0.25ml) dose dependent on group (Lot# 12464, Pneumovax 23, Merck, West Point, PA, USA) via intra-muscular injection into the deltoid muscle of the non-dominant arm using a 1 inch needle. Participants rested for 30 min after which a final blood sample was drawn for assessment of cytokine response to vaccination and task. A follow-up visit at 28 days post-vaccination included a blood sample for antibody determination. Exercise Task The exercise task used elastic resistance bands, and was performed in sets of 30 seconds of exercise, followed by.