Association between exercise and risk of cardiovascular diseases in patients with non-cystic fibrosis bronchiectasis

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Abstract

Background:

Although cardiovascular comorbidities negatively impact survival in patients with bronchiectasis, there is limited evidence to recommend exercise in this population. We aimed to evaluate whether exercise habit changes are related to reduced cardiovascular disease risk and explore an optimal exercise amount.

Methods:

This study identified 165,842 patients with newly diagnosed bronchiectasis during 2010–2016 who underwent two health examinations and were followed up until December 2020. The exposure was the change in weekly habits of moderate- or vigorous-intensity physical activity between the two examinations, classified into non-exercisers and exercisers (further classified into new exercisers, exercise dropouts, and exercise maintainers). The amount of exercise was measured using metabolic equivalents of task (MET). The outcome was the incidence of myocardial infarction (MI) or stroke.

Results:

During a mean of 6.2 ± 2.1 follow-up years, 4,233 (2.6%) and 3,745 (2.3%) of patients with bronchiectasis had MI or stroke, respectively. Compared to non-exercisers, exercisers had a significantly lower risk of MI or stroke by 9–28% (p < 0.001 for both). Among exercisers, exercise maintainers showed the lowest risk of MI (adjusted hazard ratio [aHR], 0.72; 95% confidence interval [CI], 0.64–0.81) and stroke (aHR, 0.72; 95% CI, 0.64–0.82) compared to non-exercisers. Regarding exercise amount, a significant risk reduction was observed only in patients with bronchiectasis who exercised for ≥ 500 MET-min/wk.

Conclusion:

Exercise was associated with a reduced risk of cardiovascular diseases in patients with bronchiectasis. In particular, the risk was lowest in exercise maintainers, and cardiovascular risk reduction was significant when exercising more than 500 MET-min/wk.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-022-02202-7.

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Most cited references 34

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A new equation to estimate glomerular filtration rate.

Andrew Levey, Lesley Stevens, Christopher H Schmid … (2009)

Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. National Institute of Diabetes and Digestive and Kidney Diseases.

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Is Open Access

World Health Organization 2020 guidelines on physical activity and sedentary behaviour

Fiona Bull, Salih Al-Ansari, Stuart Biddle … (2020)

Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.

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Global physical activity levels: surveillance progress, pitfalls, and prospects

Pedro Hallal, Lars Bo Andersen, Fiona Bull … (2012)

The Lancet, 380(9838), 247-257

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Author and article information

Contributors

Hyun Lee: namuhanayeyo@hanyang.ac.kr

Journal

Journal ID (nlm-ta): Respir Res

Journal ID (iso-abbrev): Respir Res

Title: Respiratory Research

Publisher: BioMed Central (London )

ISSN (Print): 1465-9921

ISSN (Electronic): 1465-993X

Publication date (Electronic): 18 October 2022

Publication date PMC-release: 18 October 2022

Publication date (Print): 2022

Volume: 23

Electronic Location Identifier: 288

Affiliations

[1 ]GRID grid.477505.4, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, , Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, ; Seoul, Korea

[2 ]GRID grid.8241.f, ISNI 0000 0004 0397 2876, Division of Molecular and Clinical Medicine, , University of Dundee, Ninewells Hospital and Medical School, ; Dundee, UK

[3 ]GRID grid.263765.3, ISNI 0000 0004 0533 3568, Department of Statistics and Actuarial Science, , Soongsil University, ; Seoul, Korea

[4 ]GRID grid.49606.3d, ISNI 0000 0001 1364 9317, Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, , Hanyang University College of Medicine, ; Seoul, Korea

[5 ]GRID grid.49606.3d, ISNI 0000 0001 1364 9317, Divsion of Pulmonary Medicine and Allergy, Department of Internal Medicine, , Hanyang University College of Medicine, ; 222 Wangsimni-ro, Seongdong-gu, 04763 Seoul, Korea

Article

Publisher ID: 2202

DOI: 10.1186/s12931-022-02202-7

PMC ID: 9580142

PubMed ID: 36258193

SO-VID: a0d65a59-fa96-45da-87c5-da782951d470

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 7 June 2022

Date accepted : 29 September 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100002701, Ministry of Education;

Award ID: 2021R1I1A3052416

Funded by: FundRef http://dx.doi.org/10.13039/501100003725, National Research Foundation of Korea;

Award ID: 2020R1F1A1070468

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ScienceOpen disciplines: Respiratory medicine

Keywords: bronchiectasis,exercise,cardiovascular diseases,disease prevention, sedentary behavior

Data availability:

ScienceOpen disciplines: Respiratory medicine

Keywords: bronchiectasis, exercise, cardiovascular diseases, disease prevention, sedentary behavior

Association between exercise and risk of cardiovascular diseases in patients with non-cystic fibrosis bronchiectasis

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Abstract

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Supplementary Information

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Cardiovascular Innovations and Applications

Most cited references 34

A new equation to estimate glomerular filtration rate.

World Health Organization 2020 guidelines on physical activity and sedentary behaviour

Global physical activity levels: surveillance progress, pitfalls, and prospects

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