A Houston Methodist–led study leveraging wearable device data has found that moderate to vigorous physical activity may significantly reduce the risk of developing chronic rhinosinusitis (CRS), offering new evidence that lifestyle factors can influence upper airway inflammation.

The longitudinal analysis, published in International Forum of Allergy & Rhinology, is the first to use Fitbit-derived activity data to examine CRS risk over time. Drawing from the National Institutes of Health’s All of Us database, investigators linked objective physical activity measurements with electronic health records to evaluate whether exercise patterns could predict disease onset.

The findings suggest that patients who engage in regular, moderate-to-vigorous physical activity (MVPA) — particularly within a defined “sweet spot” — may experience a meaningful reduction in CRS risk, reinforcing exercise as a potentially modifiable factor in a disease not traditionally associated with lifestyle.

A novel look at inflammation and the sinuses

Chronic rhinosinusitis, an inflammatory condition affecting the nasal and sinus mucosa, impacts up to 7% of the U.S. population and is associated with significant quality-of-life burdens and health care costs.

While exercise has long been known to modulate systemic inflammation, its role in upper airway disease has remained largely unexplored.

“That was really the driving question,” says Dr. Omar Ahmed, a Houston Methodist otolaryngologist and senior author of the study. “We wanted to understand whether that same anti-inflammatory effect could extend to the sinuses, which are influenced by a range of environmental and biological triggers.”

He noted that prior research has established physical activity as one of the most important modifiable risk factors across chronic diseases, from cardiovascular conditions to sleep apnea.

Fitbit data reveals a dose-response relationship

The study analyzed more than 1,100 matched participants, including 583 patients with CRS and 583 controls, each with at least one year of valid Fitbit data prior to diagnosis.

Participants were categorized by weekly minutes of MVPA, ranging from less than 75 minutes to more than 300 minutes per week.

Kaplan-Meier survival analysis demonstrated a clear separation between activity groups, with higher levels of exercise associated with lower cumulative incidence of CRS over a 10-year period (p = 0.0099).

Patients who achieved 150–225 minutes of MVPA per week — consistent with current public health guidelines — had significantly lower odds of developing CRS compared with less active individuals. In contrast, those exercising less than 75 minutes per week experienced earlier disease onset, with diagnoses occurring an average of 152 weeks sooner.

Dr. Ahmed describes the findings as both intuitive and striking.

“We saw a very clear signal,” he explains. “Patients who were consistently active — not extreme athletes, but those meeting moderate exercise thresholds — had a noticeably lower risk of developing chronic sinusitis.”

The data also suggested diminishing returns at the highest activity levels. While individuals exceeding 300 minutes per week still benefited, the incremental protective effect plateaued beyond this range.

“It’s not that more exercise is harmful,” Dr. Ahmed says. “It’s just that the biggest benefit seems to occur within that moderate range — around 150 to 225 minutes per week.”

Independent risk factor

Importantly, the association between physical activity and CRS persisted after controlling for a wide range of confounders, including obesity, smoking status, diabetes, hypertension and other comorbidities.

“We accounted for all the usual suspects,” Dr. Ahmed says. “Even after matching for these variables, physical activity still stood out as an independent factor.”

That distinction is critical, he added, as it suggests exercise may influence CRS risk beyond its role in weight management or general health.

“It’s not just about being a healthy weight,” Dr. Ahmed says. “You can be otherwise healthy, but if you’re not physically active, you may not be getting this protective effect.”

Implications for prevention and clinical care

The study adds to a growing body of evidence linking wearable-measured activity to chronic disease outcomes and highlights the potential for integrating lifestyle interventions into otolaryngologic care.

Dr. Masayoshi Takashima, chair of Otolaryngology–Head and Neck Surgery at Houston Methodist and a co-author on the study, emphasized the broader clinical significance.

“For a long time, sinonasal disease has not been viewed through a lifestyle lens. This data helps us start thinking differently — not just about treating symptoms, but about modifying risk.”

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Mas Takashima, MD

The findings also align with emerging concepts in airway inflammation, including the interconnectedness of upper and lower respiratory conditions and the role of systemic immune modulation.

Investigators hypothesize that exercise may reduce CRS risk through multiple mechanisms, including decreased systemic inflammatory mediators, improved mucociliary clearance and enhanced nasal airflow, though further research is needed to confirm these pathways.

A foundation for future research

As a retrospective observational study, the analysis cannot establish causation, and the authors note limitations related to fitness device measurement variability and reliance on diagnostic coding.

Still, the scale, longitudinal design and use of objective activity data represent a significant advance in the field.

To Dr. Ahmed, the implications are straightforward.

“This is one of the first studies to show that something as simple as regular exercise may help reduce the risk of a disease like chronic sinusitis,” he says. “That’s a powerful message because it means there’s something patients can actually do.”

Houston Methodist researchers say the findings should prompt further prospective studies and, potentially, clinical trials exploring whether structured exercise interventions can reduce CRS incidence or severity.

More broadly, the work underscores the institution’s role at the intersection of digital health and clinical research — using real-world data to uncover insights that may reshape how chronic diseases are prevented and managed.