Patients with bronchiectasis who exercise have reduced risk of cardiovascular diseases, with the lowest risk in those who exercise regularly, according to study findings published in Respiratory Research.
Investigators in Korea sought to assess whether changes in exercise habits are related to reduced cardiovascular disease risk and to determine optimal exercise amounts. The primary endpoint was the incidence of stroke or myocardial infarction (MI). The secondary endpoint was evaluation of the relationship between exercise and risk of cardiovascular diseases.
The researchers conducted a review and analysis of the National Health Insurance Service (NHIS) database of Korea that included 165,842 patients at least 20 years of age (mean age, 59.8 years). Included patients had initial diagnosis of bronchiectasis from January 2010 through December 2016, with 2 health examinations and follow-up until December 2020. Change in weekly habits of moderate- or vigorous-intensity physical activity between the 2 examinations represented exposure. Patients (51.6% women) were stratified into groups defined as “non-exercisers” (n=110,499) or “exercisers” (n=55,343). Those who exercised were further stratified according to changes in exercise habits into the following groups: “new exercisers” (n=21,056); “exercise dropouts” (n=19,377), and “maintainers” (n=14,910). Exercise amounts were measured using metabolic equivalents of task (MET).
Investigators noted exercisers were more likely to be non-smoking, male, of older age, and from low-income groups, and to have higher systolic blood pressure, fasting blood sugar, body mass index, and greater waist circumference than those who did not exercise. Exercisers vs non-exercisers also had a lower proportion of central obesity, estimated glomerular filtration rate, and total cholesterol levels (all P <.001).
The researchers found that exercisers showed higher comorbidity rates of diabetes mellitus, dyslipidemia, hypertension, and asthma or COPD vs non-exercisers.
Investigators found 4233 (2.6%) patients with bronchiectasis had MI during a mean (SD) 6.2 (2.1) years of follow-up. During this follow-up, 3745 (2.3%) patients had a stroke. Exercisers faced a significantly reduced risk of MI (18-28%) or stroke (9-28%) compared with non-exercisers (P <.001 for both). Maintainers showed the lowest risk of MI among the exercisers (adjusted hazard ratio [aHR] 0.72; 95% CI, 0.64-0.81) and the lowest risk of stroke (aHR 0.72; 95% CI, 0.64-0.82) compared with non-exercisers.
Only patients who exercised at least 500 MET-minutes per week saw a significant risk reduction. Investigators noted sex and age had no significant interaction with the association between exercise and cardiovascular outcomes in stratified analysis. The risk-reducing effect of exercise by age for MI and stroke was only significant in patients 40 years of age and older (ie, in those 40-64 years of age and ≥65 years; P <.001). No significant difference in risk reduction with exercise was found between men and women (MI, P <.001 for both; stroke, P <.001 for men, P =.002 for women).
Study limitations include recall bias in self-reported physical activity intensity and frequency; exercise intensity evaluated without peak heart rate and oxygen uptake measurements; lack of accounting for severity of bronchiectasis; the participants’ limited ethnic diversity, which prevented results from being generalized to the broader population; and the unaccounted for effect of energy consumption.
“Our study provides evidence of exercise prescription for patients with bronchiectasis to prevent cardiovascular diseases,” the investigators concluded. The study found an association between exercise and reduced risk of cardiovascular diseases, and that “cardiovascular risk reduction was significant when exercising more than 500 MET-min/wk.”
Choi H, Kim SH, Han K, et al. Association between exercise and risk of cardiovascular diseases in patients with non-cystic fibrosis bronchiectasis. Respir Res. Published online October 18, 2022. doi:10.1186/s12931-022-02202-7