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Air pollution, physical activity and ischaemic heart disease: a prospective cohort study of interaction effects
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0002-0159-6657
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.ORCID iD: 0000-0002-8854-498x
2021 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 4, article id e040912Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess a possible interaction effect between physical activity and air pollution on first incidence of ischaemic heart disease (IHD).

DESIGN: Prospective cohort study.

SETTING: Umeå, Northern Sweden.

PARTICIPANTS: We studied 34 748 adult participants of Västerbotten Intervention Programme cohort from 1990 to January 2014. Annual particulate matter concentrations (PM2.5 and PM10) at the participants' residential addresses were modelled and a questionnaire on frequency of exercise and active commuting was completed at baseline. Cox proportional hazards modelling was used to estimate (1) association with physical activity at different levels of air pollution and (2) the association with particulate matter at different levels of physical activity.

OUTCOME: First incidence of IHD.

RESULTS: Over a mean follow-up of 12.4 years, there were 1148 IHD cases. Overall, we observed an increased risk of IHD among individuals with higher concentrations of particles at their home address. Exercise at least twice a week was associated with a lower risk of IHD among participants with high residential PM2.5 (hazard ratio (HR) 0.60; 95% CI: 0.44 to 0.82) and PM10 (HR 0.55; 95% CI: 0.4 to 0.76). The same beneficial effect was not observed with low residential PM2.5 (HR 0.94; 95% CI: 0.72 to 1.22) and PM10 (HR 0.99; 95% CI: 0.76 to 1.29). An increased risk associated with higher long-term exposure to particles was only observed among participants that exercised in training clothes at most one a week and among those not performing any active commuting. However, only the interaction effect on HRs for exercise was statistically significant.

CONCLUSION: Exercise was associated with a lower risk of first incidence of IHD among individuals with higher residential particle concentrations. An air pollution-associated risk was only observed among those who exercised less. The findings support the promotion of physical activity and a mitigation of air pollution.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2021. Vol. 11, no 4, article id e040912
Keywords [en]
coronary heart disease, ischaemic heart disease, public health
National Category
Occupational Health and Environmental Health
Identifiers
URN: urn:nbn:se:umu:diva-182321DOI: 10.1136/bmjopen-2020-040912ISI: 000641483900005PubMedID: 33849846Scopus ID: 2-s2.0-85104106625OAI: oai:DiVA.org:umu-182321DiVA, id: diva2:1545297
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-1296Available from: 2021-04-19 Created: 2021-04-19 Last updated: 2023-09-05Bibliographically approved
In thesis
1. Impacts of Active Transport on Health: with a focus on physical activity, air pollution, and cardiovascular disease
Open this publication in new window or tab >>Impacts of Active Transport on Health: with a focus on physical activity, air pollution, and cardiovascular disease
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: There are increasing number of health impact assessment studies investigating the health effects by transferring trips made by motorised transport to active commuting; however, air pollution exposure during active commuting and its impact on health has been less thoroughly assessed. It is furthermore uncertain whether there is any interaction effect between air pollution and physical activity for the risk of cardiovascular diseases. The overall aim of the thesis was to improve the knowledge base for assessments of the total impact on health of a mode shift resulting in both increased physical activity and increased air pollution exposure, especially regarding combined effects on cardiovascular risks.

Methods: The thesis is based on four studies. In Study I, methodological issues related to the assessment of air pollution in previous studies on the health impact of changes in transport mode were critically reviewed. In Study II, the effect of leisure time and active commuting physical activity, on chronic diseases was quantified by conducting a random-effect meta-analysis. In two prospective cohort studies, participants of the Västerbotten Intervention Programme living in the Umeå region were studied to assess the impact as well as interaction effect of physical activity and air pollution on the incidence (Study III) and recurrence (Study IV) of cardiovascular diseases.

Results: In previous studies on the health impact of changes in transport mode, there was a large methodological discrepancy between studies due to different assumptions for air pollution exposure assessments in general populations and commuters as well as methods for estimation of impacts. Randomeffect meta-analyses showed a beneficial effect of leisure time physical activity and active commuting on morbidity among individuals performing these activities at the minimum level of physical activity recommended by WHO, equivalent to 11.25 MET-hours per week. Beneficial effects of exercise on firstincident ischemic heart disease (IHD) were observed among individuals with high residential PM10/PM2.5 concentrations, but not among individuals with low concentrations. Adverse effects associated with high residential PM10 and PM2.5 concentrations were only observed among the individuals whom less frequently exercised. A statistically significant interaction effect was found between air pollution and exercise in training clothes for first-incident IHD but not for recurrence of IHD/stroke.

Conclusions: The results in this thesis strengthen the public health message that physical activity is beneficial for cardiovascular health, even in areas with air pollution. Therefore, public health and transport policies should be designed to improve population health through promotion of active transport and mitigation of air pollution.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2021. p. 86
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2132
Keywords
Health impact assessment, Air pollution, Active commuting, Exercise, Interaction. Cardiovascular diseases, Ischemic heart diseases, Stroke
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Research subject
Public health; Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-183309 (URN)978-91-7855-533-8 (ISBN)978-91-7855-532-1 (ISBN)
Public defence
2021-06-15, Triple Helix, Universitetsledningshuset/Zoom, Umeå, 13:00 (English)
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Supervisors
Note

Zoom: https://umu.zoom.us/j/62645020569

Passcode: 223344

Available from: 2021-05-25 Created: 2021-05-21 Last updated: 2021-06-22Bibliographically approved

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Raza, WasifKrachler, BennoForsberg, BertilNilsson Sommar, Johan

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