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Abstract
Both exposure to higher levels of polluted air and physical inactivity are crucial risk factors for the development and progression of major noncommunicable diseases and, in particular, of cardiovascular disease. In this context, the World Health Organization estimated 4.2 and 3.2 million global deaths per year in response to ambient air pollution and insufficient physical activity, respectively. While regular physical activity is well known to improve general health, it may also increase the uptake and deposit of air pollutants in the lungs/airways and circulation, due to increased breathing frequency and minute ventilation, thus increasing the risk of cardiovascular disease. Thus, determining the tradeoff between the health benefits of physical activity and the potential harmful effects of increased exposure to air pollution during physical activity has important public health consequences. In the present comprehensive review, we analyzed evidence from human and animal studies on the combined effects of physical activity and air pollution on cardiovascular and other health outcomes. We further report on pathophysiological mechanisms underlying air pollution exposure, as well as the protective effects of physical activity with a focus on oxidative stress and inflammation. Lastly, we provide mitigation strategies and practical recommendations for physical activity in areas with polluted air.
Highlights
More than every fourth adult is insufficiently physically active, which means 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, as indicated by recent data from Guthold et al [2]. Environmental factors, such as air pollution, heavy metals, pesticides, and traffic noise, are increasingly recognized as endocrine disruptors that contribute to cardiometabolic diseases
We describe the pathomechanisms of air pollution, as well as the protective effects of physical activity, with focus on oxidative stress and inflammation
The results revealed that aerobic, anaerobic, as well as combined activities may have the potential to acutely increase oxidative stress and antioxidant responses, with a differential pattern of results related to the intensity and the duration of the physical activity
Summary
Increases in physical activity above 1000 MET-min/week was associated with increased risk of cardiovascular disease among subjects exposed to high levels of PM2.5 or PM10 , indicating that large increases in physical activity may adversely affect cardiovascular health in areas where high air pollution is present (Figure 3). A further study by Raza et al, including 34,748 Swedish adults, confirmed these results by showing that being physically active at least twice a week was associated with decreased risk of incident ischemic heart disease among subjects exposed to high levels of PM2.5 (HR 0.60, 95% CI 0.44–0.82). Quite a few studies have demonstrated the benefits of exercise in reducing cigarette smoke induced cardiopulmonary damage [131,132,133,134]
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