Moderate to Vigorous Physical Activity and Chronic Rhinosinusitis Risk: A Longitudinal Fitbit Study

INTRODUCTION: Chronic rhinosinusitis (CRS) is an inflammatory condition of the sinonasal mucosa. While physical activity is known to modulate systemic inflammation, its role in CRS prevention remains unclear. This study evaluates the association between moderate to vigorous physical activity (MVPA) and CRS using longitudinal Fitbit data. METHODS: We conducted a retrospective cohort study within the All of Us Research Program using Fitbit-derived activity data linked to electronic health records. Adults with ≥ 1 year of valid data were eligible. MVPA was averaged across "strict weeks" (7 valid days, > 100 steps/day) and categorized as < 75, 75-150, 150-225, 225-300, or > 300 min. CRS was defined using ICD-10 coding. Propensity score matching was performed on demographics, obesity, and smoking status. Kaplan-Meier curves, Cochran-Mantel-Haenszel odds ratios, and fixed-effects models assessed associations between MVPA and CRS. RESULTS: The matched cohort included 583 CRSsNP cases and 583 controls. Kaplan-Meier survival analysis demonstrated significant separation across MVPA groups (p = 0.0099), with higher activity associated with lower cumulative incidence. Participants exercising 75-150 min/week had nearly twice the odds of CRS compared with those exercising 150-225 min (OR = 1.95, 95% CI 1.07-3.55). Timing models showed earlier diagnoses among the least active group (- 152 weeks, 95% CI - 169 to - 134) and later diagnoses among those exercising > 300 min/week (+ 260 weeks, 95% CI + 200 to + 320). Continuous modeling revealed an inverse dose-response with a plateau beyond 300 min. CONCLUSION: Regular MVPA is associated with reduced CRS incidence and prolonged disease-free years, supporting physical activity as a possible modifiable risk factor for CRS.