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Impacts of Active Transport on Health: with a focus on physical activity, air pollution, and cardiovascular disease
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
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 [en]
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: urn:nbn:se:umu:diva-183309ISBN: 978-91-7855-533-8 (electronic)ISBN: 978-91-7855-532-1 (print)OAI: oai:DiVA.org:umu-183309DiVA, id: diva2:1556452
Public defence
2021-06-15, Triple Helix, Universitetsledningshuset/Zoom, Umeå, 13:00 (English)
Opponent
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
List of papers
1. Air pollution as a risk factor in health impact assessments of a travel mode shift towards cycling
Open this publication in new window or tab >>Air pollution as a risk factor in health impact assessments of a travel mode shift towards cycling
2018 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1429081Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Promotion of active commuting provides substantial health and environmental benefits by influencing air pollution, physical activity, accidents, and noise. However, studies evaluating intervention and policies on a mode shift from motorized transport to cycling have estimated health impacts with varying validity and precision.

OBJECTIVE: To review and discuss the estimation of air pollution exposure and its impacts in health impact assessment studies of a shift in transport from cars to bicycles in order to guide future assessments.

METHODS: A systematic database search of PubMed was done primarily for articles published from January 2000 to May 2016 according to PRISMA guidelines.

RESULTS: We identified 18 studies of health impact assessment of change in transport mode. Most studies investigated future hypothetical scenarios of increased cycling. The impact on the general population was estimated using a comparative risk assessment approach in the majority of these studies, whereas some used previously published cost estimates. Air pollution exposure during cycling was estimated based on the ventilation rate, the pollutant concentration, and the trip duration. Most studies employed exposure-response functions from studies comparing background levels of fine particles between cities to estimate the health impacts of local traffic emissions. The effect of air pollution associated with increased cycling contributed small health benefits for the general population, and also only slightly increased risks associated with fine particle exposure among those who shifted to cycling. However, studies calculating health impacts based on exposure-response functions for ozone, black carbon or nitrogen oxides found larger effects attributed to changes in air pollution exposure.

CONCLUSION: A large discrepancy between studies was observed due to different health impact assessment approaches, different assumptions for calculation of inhaled dose and different selection of dose-response functions. This kind of assessments would improve from more holistic approaches using more specific exposure-response functions.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Active commuting, mode shift, emission factors, population exposure, commuters’ exposure, exposure response function, comparative risk assessment
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-144660 (URN)10.1080/16549716.2018.1429081 (DOI)000424246900001 ()29400262 (PubMedID)2-s2.0-85053812003 (Scopus ID)
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2023-03-23Bibliographically approved
2. Health benefits of leisure time and commuting physical activity: a meta-analysis of effects on morbidity
Open this publication in new window or tab >>Health benefits of leisure time and commuting physical activity: a meta-analysis of effects on morbidity
2020 (English)In: Journal of Transport and Health, ISSN 2214-1405, E-ISSN 2214-1405, Vol. 18, article id 100873Article in journal (Refereed) Published
Abstract [en]

Introduction: A protective role of leisure time physical activity with regard to non-communicable chronic diseases (NCDs) is well established. However, shapes of dose-response relationships and the extent of BMI mediation between physical activity and disease risk are not well known. Furthermore, the knowledge about risk reductions from active commuting is limited. Methods: Meta-analyses of prospective cohort studies published from January 1990 to June 2019 were conducted, 1) to assess the effect of leisure time and commuting physical activity on cardiovascular disease (CVD), type 2 diabetes, breast cancer and colon cancer, and 2) to quantify the extent to which adjustment for BMI affect these relations. Results: Random effect meta-analyses of 59 prospective cohort studies estimated that individuals who engaged in 11.25 MET-hours/week of active commuting had a decreased risk of myocardial infarction (MI) by 18% (95% CI: 1-33%) and type 2 diabetes by 22% (95% CI: 4-37%) compared with non-commuters. Corresponding risk reductions for leisure-time physical activity (LTPA) were 22% for MI, 26% for CVD, 27% for heart failure, 23% for stroke, 22% for type 2 diabetes, 15% for colon cancer and 7% for breast cancer. Except for breast cancer, adjustment for BMI reduced the benefit of physical activity. Conclusion: Both active commuting and LTPA are associated with lower risk for NCD. Currently, available data is insufficient to establish detail and reliable dose-response curves.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Leisure time physical activity, Active commuting, Non communicable chronic diseases, Meta-analysis, Dose-response relation, Metabolic equivalent of task
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-175846 (URN)10.1016/j.jth.2020.100873 (DOI)000571103400022 ()2-s2.0-85085926435 (Scopus ID)
Available from: 2020-10-14 Created: 2020-10-14 Last updated: 2023-03-24Bibliographically approved
3. Air pollution, physical activity and ischaemic heart disease: a prospective cohort study of interaction effects
Open this publication in new window or tab >>Air pollution, physical activity and ischaemic heart disease: a prospective cohort study of interaction effects
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
Keywords
coronary heart disease, ischaemic heart disease, public health
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-182321 (URN)10.1136/bmjopen-2020-040912 (DOI)000641483900005 ()33849846 (PubMedID)2-s2.0-85104106625 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-1296
Available from: 2021-04-19 Created: 2021-04-19 Last updated: 2023-09-05Bibliographically approved
4. Does physical activity modify the association between air pollution and recurrence of cardiovascular disease?
Open this publication in new window or tab >>Does physical activity modify the association between air pollution and recurrence of cardiovascular disease?
2021 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 5, p. 1-11, article id 2631Article in journal (Refereed) Published
Abstract [en]

We aimed to assess a possible interaction effect between physical activity and particulate air pollution exposure on recurrence of ischemic heart disease (IHD) and stroke. We followed 2221 adult participants comprising first time IHD (1403) and stroke (818) cases from the Västerbotten Intervention Program between 1 January 1990 to 31 December 2013. During mean follow-up times of 5.5 years, 428 and 156 participants developed IHD and stroke recurrence, respectively. PM2.5 concentrations above the median (5.48 µg/m3) were associated with increased risk of IHD and stroke recurrence by 13% (95% CI −17–45%) and 21% (95% CI −19–80%), respectively. These risk increases were however only observed among those that exercised at most once a week at 21% (95% CI −5– 50%) and 25% (95% CI −19–90%) for IHD and stroke recurrence, respectively. Higher frequency of exercise at recruitment was positively associated with IHD and stroke recurrence but only the association with IHD recurrence among participants with low residential PM2.5 was statistically significant (96% increased risk (95%-CI 22–215%)). However, no interaction effect between physical activity and PM2.5 exposure was found. Our findings suggest that physical activity may reduce the air pollution exposure associated risk for recurrent cardiovascular disease, likely by reducing the inflammatory response.

Place, publisher, year, edition, pages
MDPI, 2021
Keywords
Active commuting, Cardiovascular disease prevention, Exercise, Interaction, PM2.5
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-181583 (URN)10.3390/ijerph18052631 (DOI)000628170200001 ()2-s2.0-85101960141 (Scopus ID)
Available from: 2021-03-19 Created: 2021-03-19 Last updated: 2023-09-05Bibliographically approved

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