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      A Study of the Combined Effects of Physical Activity and Air Pollution on Mortality in Elderly Urban Residents: The Danish Diet, Cancer, and Health Cohort

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          Abstract

          Background

          Physical activity reduces, whereas exposure to air pollution increases, the risk of premature mortality. Physical activity amplifies respiratory uptake and deposition of air pollutants in the lung, which may augment acute harmful effects of air pollution during exercise.

          Objectives

          We aimed to examine whether benefits of physical activity on mortality are moderated by long-term exposure to high air pollution levels in an urban setting.

          Methods

          A total of 52,061 subjects (50–65 years of age) from the Danish Diet, Cancer, and Health cohort, living in Aarhus and Copenhagen, reported data on physical activity in 1993–1997 and were followed until 2010. High exposure to air pollution was defined as the upper 25th percentile of modeled nitrogen dioxide (NO 2) levels at residential addresses. We associated participation in sports, cycling, gardening, and walking with total and cause-specific mortality by Cox regression, and introduced NO 2 as an interaction term.

          Results

          In total, 5,534 subjects died: 2,864 from cancer, 1,285 from cardiovascular disease, 354 from respiratory disease, and 122 from diabetes. Significant inverse associations of participation in sports, cycling, and gardening with total, cardiovascular, and diabetes mortality were not modified by NO 2. Reductions in respiratory mortality associated with cycling and gardening were more pronounced among participants with moderate/low NO 2 [hazard ratio (HR) = 0.55; 95% CI: 0.42, 0.72 and 0.55; 95% CI: 0.41, 0.73, respectively] than with high NO 2 exposure (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).

          Conclusions

          In general, exposure to high levels of traffic-related air pollution did not modify associations, indicating beneficial effects of physical activity on mortality. These novel findings require replication in other study populations.

          Citation

          Andersen ZJ, de Nazelle A, Mendez MA, Garcia-Aymerich J, Hertel O, Tjønneland A, Overvad K, Raaschou-Nielsen O, Nieuwenhuijsen MJ. 2015. A study of the combined effects of physical activity and air pollution on mortality in elderly urban residents: the Danish Diet, Cancer, and Health cohort. Environ Health Perspect 123:557–563;  http://dx.doi.org/10.1289/ehp.1408698

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          Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project

          Rob Beelen, Ole Raaschou-Nielsen, Massimo Stafoggia … (2014)
          Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. We used data from 22 European cohort studies, which created a total study population of 367,251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and between 10 μm and 2.5 μm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis. The total study population consisted of 367,251 participants who contributed 5,118,039 person-years at risk (average follow-up 13.9 years), of whom 29,076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 μg/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I(2) p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 μg/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 μg/m(3) (1.07, 1.01-1.13). Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value. European Community's Seventh Framework Program (FP7/2007-2011). Copyright © 2014 Elsevier Ltd. All rights reserved.
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            Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies.

            James Woodcock, Oscar Franco, Nicola Orsini … (2011)
            Although previous studies have found physical activity to be associated with lower mortality, the dose-response relationship remains unclear. In this systematic review and meta-analysis we quantify the dose-response relationship of non-vigorous physical activity and all-cause mortality. We aimed to include all cohort studies in adult populations with a sample size of more than 10 000 participants that estimated the effect of different levels of light or moderate physical activity on all-cause mortality. We searched Medline, Embase, Cochrane (DARE), Web of Science and Global Health (June 2009). We used dose-response meta-regression models to estimate the relation between non-vigorous physical activity and mortality. We identified 22 studies that met our inclusion criteria, containing 977 925 (334 738 men and 643 187 women) people. There was considerable variation between the studies in their categorization of physical activity and adjustment for potential confounders. We found that 2.5 h/week (equivalent to 30 min daily of moderate intensity activity on 5 days a week) compared with no activity was associated with a reduction in mortality risk of 19% [95% confidence interval (CI) 15-24], while 7 h/week of moderate activity compared with no activity reduced the mortality risk by 24% (95% CI 19-29). We found a smaller effect in studies that looked at walking alone. Being physically active reduces the risk of all-cause mortality. The largest benefit was found from moving from no activity to low levels of activity, but even at high levels of activity benefits accrue from additional activity.
            Article 0 comments Cited 188 times – based on 0 reviews     Review now
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              The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study

              David Rojas-Rueda, Audrey de Nazelle, Marko Tainio … (2011)
              Objective To estimate the risks and benefits to health of travel by bicycle, using a bicycle sharing scheme, compared with travel by car in an urban environment. Design Health impact assessment study. Setting Public bicycle sharing initiative, Bicing, in Barcelona, Spain. Participants 181 982 Bicing subscribers. Main outcomes measures The primary outcome measure was all cause mortality for the three domains of physical activity, air pollution (exposure to particulate matter <2.5 µm), and road traffic incidents. The secondary outcome was change in levels of carbon dioxide emissions. Results Compared with car users the estimated annual change in mortality of the Barcelona residents using Bicing (n=181 982) was 0.03 deaths from road traffic incidents and 0.13 deaths from air pollution. As a result of physical activity, 12.46 deaths were avoided (benefit:risk ratio 77). The annual number of deaths avoided was 12.28. As a result of journeys by Bicing, annual carbon dioxide emissions were reduced by an estimated 9 062 344 kg. Conclusions Public bicycle sharing initiatives such as Bicing in Barcelona have greater benefits than risks to health and reduce carbon dioxide emissions.
              Article 0 comments Cited 150 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Environ Health Perspect
                Journal ID (iso-abbrev): Environ. Health Perspect
                Journal ID (publisher-id): EHP
                Title: Environmental Health Perspectives
                Publisher: NLM-Export
                ISSN (Print): 0091-6765
                ISSN (Electronic): 1552-9924
                Publication date (Electronic): 27 January 2015
                Publication date (Print): June 2015
                Volume: 123
                Issue: 6
                Pages: 557-563
                Affiliations
                [1 ]Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
                [2 ]Danish Cancer Research Center, Danish Cancer Society, Copenhagen, Denmark
                [3 ]Centre for Environmental Policy, Imperial College London, London, United Kingdom
                [4 ]Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
                [5 ]Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
                [6 ]Universitat Pompeu Fabra, Barcelona, Spain
                [7 ]CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
                [8 ]Department of Environmental Science, Aarhus University, Roskilde, Denmark
                [9 ]Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
                [10 ]Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
                Author notes
                Address correspondence to Z.J. Andersen, Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K 1014, Denmark. Telephone: 45 35327669. E-mail: Zorana.Andersen@ 123456sund.ku.dk
                Article
                Publisher ID: ehp.1408698
                DOI: 10.1289/ehp.1408698
                PMC ID: 4455593
                PubMed ID: 25625237
                SO-VID: 0999a412-2540-4c9b-aff0-ccf6cce3a1f8
                License:

                Publication of EHP lies in the public domain and is therefore without copyright. All text from EHP may be reprinted freely. Use of materials published in EHP should be acknowledged (for example, “Reproduced with permission from Environmental Health Perspectives”); pertinent reference information should be provided for the article from which the material was reproduced. Articles from EHP, especially the News section, may contain photographs or illustrations copyrighted by other commercial organizations or individuals that may not be used without obtaining prior approval from the holder of the copyright.

                History
                Date received : 15 May 2014
                Date accepted : 26 January 2015
                Date: 27 January 2015
                Date: 01 June 2015
                Categories
                Subject: Research

                ScienceOpen disciplines: Public health
                Data availability:
                ScienceOpen disciplines: Public health

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