J Korean Med Sci.  2023 Jun;38(23):e176. 10.3346/jkms.2023.38.e176.

Exercise Frequency Reduction Is Associated With Higher Risk of Infection in Newly Diagnosed Diabetes: A Nationally Representative Cohort Study

• Lim Y
• Kim HJ
• Yoon SS
• Lee SJ
• Lee MH
• Park H
• Park SJ
• Jeong S
• Han HW

• KMID: 2543868
• DOI: http://doi.org/10.3346/jkms.2023.38.e176

Abstract

Background
Exercise is an important method to control the progression of diabetes. Since diabetes compromises immune function and increases the risk of infectious diseases, we hypothesized that exercise may affect the risk of infection by its immunoprotective effects. However, population-based cohort studies regarding the association between exercise and the risk of infection are limited, especially regarding changes in exercise frequency. The aim of this study was to determine the association between the change in exercise frequency and the risk of infection among patients with newly diagnosed diabetes.
Methods
Data of 10,023 patients with newly diagnosed diabetes were extracted from the Korean National Health Insurance Service-Health Screening Cohort. Self-reported questionnaires for moderate-to-vigorous physical activity (MVPA) were used to classify changes in exercise frequency between two consecutive two-year periods of health screenings (2009–2010 and 2011–2012). The association between changes in exercise frequency and the risk of infection was evaluated using multivariable Cox proportional-hazards regression.
Results
Compared with engaging in ≥ 5 times of MVPA/week during both periods, a radical decrease in MVPA (from ≥ 5 times of MVPA/week to physical inactivity) was associated with a higher risk of pneumonia (adjusted hazard ratio [aHR], 1.60; 95% confidence interval [CI], 1.03–2.48) and upper respiratory tract infection (aHR, 1.15; 95% CI, 1.01–1.31). In addition, a reduction of MVPA from ≥ 5 to < 5 times of MVPA/week was associated with a higher risk of pneumonia (aHR, 1.52; 95% CI, 1.02–2.27), whereas the risk of upper respiratory tract infection was not higher.
Conclusion
Among patients with newly diagnosed diabetes, a reduction in exercise frequency was related to an increase in the risk of pneumonia. For patients with diabetes, a modest level of physical activity may need to be maintained to reduce the risk of pneumonia.

Keyword

Diabetes Mellitus; Exercise; Infection; Cohort Study; Pneumonia

Figure

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  Fig. 1 Flow diagram for the inclusion of study population.

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  Fig. 2 Restricted cubic spline evaluating the association of MVPA frequency during period II (2011–2012) with the risk of pneumonia among patients with ≥ 5 times of MVPA/week during period I (2009–2010). aHR was calculated using Cox proportional hazards regression after adjustments for age, sex, household income, body mass index, systolic blood pressure, fasting serum glucose, smoking, alcohol consumption, and Charlson Comorbidity Index. Blue solid line indicates aHR and beige shaded area indicates 95% CIs.MVPA = moderate-to-vigorous physical activity, aHR = adjusted hazard ratio, CI = confidence interval.

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