Low levels of physical activity and a large amount of time spent in sedentary behavior are associated with an increased risk of being hospitalized for an exacerbation of bronchiectasis. If these findings are validated in the future, it would be appropriate to include physical activity and sedentary behavior as an element to be included in the severity scales of this respiratory disease, according to a new study published in the European Respiratory Journal, in which various members of SEPAR (Spanish Society of Pulmonology and Thoracic Surgery) have participated.
“As far as we know, the importance of this study lies in the fact that it is the first to investigate the association between physical activity, time spent sedentary lifestyle and hospitalization for exacerbation in patients with bronchiectasis. We confirmed that the patients who were hospitalized for an exacerbation of bronchiectasis after one year of follow-up had worse clinical characteristics, greater severity and lower levels of physical activity at the beginning of the study compared to those who were not hospitalized “, he highlights the physiotherapist Victoria Alcaraz, member of SEPAR.
Current situation of bronchiectasis
Bronchiectasis are a disease of the airways characterized by recurrent inflammation and infection. It can debut in childhood or in adulthood. In adults with non-cystic fibrosis bronchiectasis, a vicious cycle in which a pathogen causes neutrophilic inflammation and impaired mucociliary clearance which lead to an increase in bacterial load and repeated exacerbations, which in turn increase the costs of medical care.
In Spain, the annual incidence of hospitalizations for exacerbations of bronchiectasis is around 15.5 cases per 100,000 inhabitants, while in Germany and the United States it is, respectively, 9.4 cases and 16.5 cases per 100,000 inhabitants. These hospitalizations are associated with increased mortality, as well as decreased lung function and poor quality of life. Hospitalizations for exacerbations of bronchiectasis are related to age and severity of the disease.
Furthermore, it has been described that patients with this disease have a less active lifestyle than healthy people of the same age. It has been shown that only 11% of the population with bronchiectasis meet the recommended guidelines of moderate physical activity of at least 150 minutes per week. However, there is still little evidence on the relationship between physical activity and sedentary behavior with hospitalizations for exacerbation of bronchiectasis.
Objectives and results of the study
The main objective of the study was precisely to to analyze the association between physical activity and sedentary time with hospitalization for exacerbation of bronchiectasis after one year. The secondary objective was to establish the cut-off points for steps walked per day and time devoted to sedentary behavior that would indicate the risk of hospitalization the following year.
For this, a prospective observational study was carried out. In the baseline evaluation measured lung function, quality of life, exercise tolerance, as well as the severity of bronchiectasis and physical activity. Physical activity was objectively evaluated for a week, using a sensor (SenseWear accelerometer), the results of which were expressed in steps per day and time in sedentary lifestyle. After one year of follow-up, the number of patients who were hospitalized for exacerbation due to bronchiectasis was collected.
The results of the study show that they were studied a total of 64 patients with bronchiectasis, of which 15 (23%) were hospitalized during follow-up. The hospitalized patients showed, in the baseline evaluation, worse clinical and severity results, walked fewer steps per day and had a more sedentary behavior than the non-hospitalized group.
Furthermore, patients who walked fewer than 6,290 steps per day or who spent more than 7.8 hours per day in sedentary behavior they were at increased risk of being admitted to hospital due to exacerbation from bronchiectasis. Specifically, spending at least or more than 7.8 hours a day with sedentary behavior was associated with a 5.9 times higher risk of hospital admission during the following year (that is, almost 6 times higher).