Abstract
BackgroundExposure to air pollution and physical inactivity are both significant risk factors for non-communicable diseases (NCDs). These risk factors are also linked so that the change in exposure in one will impact risks and benefits of the other. These links are well captured in the active transport (walking, cycling) health impact models, in which the increases in active transport leading to increased inhaled dose of air pollution. However, these links are more complex and go beyond the active transport research field. Hence, in this study, we aimed to summarize the empirical evidence on the links between air pollution and physical activity, and their combined effect on individual and population health. Objectives and methodsWe conducted a non-systematic mapping review of empirical and modelling evidence of the possible links between exposure to air pollution and physical activity published until Autumn 2019. We reviewed empirical evidence for the (i) impact of exposure to air pollution on physical activity behaviour, (ii) exposure to air pollution while engaged in physical activity and (iii) the short-term and (iv) long-term health effects of air pollution exposure on people engaged in physical activity. In addition, we reviewed (v) public health modelling studies that have quantified the combined effect of air pollution and physical activity. These broad research areas were identified through expert discussions, including two public events performed in health-related conferences. Results and discussionThe current literature suggests that air pollution may decrease physical activity levels during high air pollution episodes or may prevent people from engaging in physical activity overall in highly polluted environments. Several studies have estimated fine particulate matter (PM2.5) exposure in active transport environment in Europe and North-America, but the concentration in other regions, places for physical activity and for other air pollutants are poorly understood. Observational epidemiological studies provide some evidence for a possible interaction between air pollution and physical activity for acute health outcomes, while results for long-term effects are mixed with several studies suggesting small diminishing health gains from physical activity due to exposure to air pollution for long-term outcomes. Public health modelling studies have estimated that in most situations benefits of physical activity outweigh the risks of air pollution, at least in the active transport environment. However, overall evidence on all examined links is weak for low- and middle-income countries, for sensitive subpopulations (children, elderly, pregnant women, people with pre-existing conditions), and for indoor air pollution. ConclusionsPhysical activity and air pollution are linked through multiple mechanisms, and these relations could have important implications for public health, especially in locations with high air pollution concentrations. Overall, this review calls for international collaboration between air pollution and physical activity research fields to strengthen the evidence base on the links between both and on how policy options could potentially reduce risks and maximise health benefits.
Highlights
More than a quarter of adults are physically inactive, meaning that they do not achieve the minimum recommended level of 150 min of moderate-intensity or 75 min of vigorous-intensity physical activity per week, with adults from high-income countries being more inactive than adults from low- and middle-income countries (LMICs) (Guthold et al, 2018)
They found that reductions in respiratory mortality as sociated with cycling and gardening were significantly higher in sub jects who lived in areas with moderate/low NO2 [hazard ratio (HR) = 0.55; 95% confidence interval (CI): 0.42–0.72 and 0.55; 95% CI: 0.41–0.73, respectively] than in those who lived in areas with high NO2 levels (HR = 0.77; 95% CI: 0.54–1.11 and HR = 0.81; 95% CI: 0.55–1.18, p-interaction = 0.09 and 0.02, respectively)
Strategies to mitigate air pollution while being physically active should be considered when building e.g. sport facilities, parks, schools, kindergartens, and nurseries, especially when the facility is aimed for vulnerable people;
Summary
More than a quarter of adults are physically inactive, meaning that they do not achieve the minimum recommended level of 150 min of moderate-intensity or 75 min of vigorous-intensity physical activity per week, with adults from high-income countries being more inactive than adults from low- and middle-income countries (LMICs) (Guthold et al, 2018). These risk factors are linked so that the change in exposure in one will impact risks and benefits of the other These links are well captured in the active transport (walking, cycling) health impact models, in which the increases in active transport leading to increased inhaled dose of air pollution. In this study, we aimed to summarize the empirical evidence on the links between air pollution and physical activity, and their combined effect on individual and population health. We reviewed (v) public health modelling studies that have quantified the combined effect of air pollution and physical activity. These broad research areas were identified through expert discussions, including two public events performed in health-related conferences. Overall evidence on all examined links is weak for low- and middle-
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