Purpose:

To investigate the effects of habitual physical activity (PA) and long-term exposure to particulate matter (PM) with an
aerodynamic diameter less than 2.5 μm (PM2.5).

Methods:

A cohort (yr. 2001—2014) of more than 0.5 million Taiwanese residents ages 18 and older took part in the study. WBC
counts (< 3.5 X 109 / L) and (> 12.5 X 109 / L) were excluded to avoid a potential confusion bias from reduced immune
function or acute systemic infection. The final sample size was (n=158,213) (44.1%) of the initial sample size.

BMI (Kg/m2), BP resting (seated) using an auto-sphygmomanometer (Citizen CH-5000), fasting blood glucose using an ABBOTT
Cell Dyn 3000/3700 hematology analyzer, total cholesterol, HDL and plasma triglycerides using an automatic biochemical
analyzer (Hitachi 7150) were recorded.

Information on habitual PA was collected by questionnaire. Participants classified their weekly PA levels from the last few
months into one of four categories: light (e.g. walking), moderate (e.g. brisk walking), medium-vigorous (e.g. jogging) and
high-vigorous (e.g. rope skipping). The MET values for each of the four categories were: 2.5 for light, 4.5 for moderate, 6.5
for medium-vigorous and 8.5 for high-vigorous. MET-hours were calculated and participants were sorted into one of four
categories of PA: inactive (< 3.75 MET-hour), low (3.75–7.49 MET-hour), moderate (7.50–16.49 MET-hour) and high
(≥16.50 MET-hour).

Air pollution was assessed using a spatio-temporal model with high resolution (1 × 1 km) based on satellite aerosol optical
depth (AOD) data to retrieve ground-level PM2.5 concentrations. The researchers only used data from 2005 and later,
because between 2001 and 2004, only 3 of over 70 data collection stations were functional in Taiwan.

Statistical analysis was performed considering the following variables: age, sex, education level, alcohol use, smoking
status, occupational exposure to dust or organic solvents and calendar season.

Results:

Mean age was 39.9 yr. with 48.5 % fewer males than females. 73.9 % of participants never smoked and 85.8 % were
seldom alcohol drinkers. 51.3 % of participants were physically inactive.

Greater levels of PA were associated with lower WBC counts. Initially, PM2.5 had an insignificant effect on WBC count with
respect to PA.

Chronic exposure to PM2.5 resulted in an increase in WBC count in all PA groups. According to Zhang et al. (2018), after
two years of exposure to PM2.5, in all PA groups, the highest quartile had a higher WBC count than the lowest quartile.
However, the higher WBC values in the PA groups were lower than the WBC values in the inactive group after chronic
exposure to PM2.5. The most favorable WBC values were that of the highest level of PA with the lowest level of PM2.5
exposure.

An additional year of chronic exposure to PM2.5 yielded improvements in WBC values in all PA groups, however these
values were still higher than the initial WBC values prior to chronic exposure to PM2.5.

In summery, prior to exposure to PM2.5, the PA groups had more favorable WBC values compared to the inactive group.
After two years of exposure to PM2.5, WBC values in the PA group increased, but were still more favorable to those of the
inactive participants. As the study progressed, the WBC values in the PA groups improved, however, still remained more
favorable to those of the inactive participants.

Conclusion:

The results obtained by Zhang et al. (2018) show that the benefits of PA and harmful effects of PM2.5 are independent of
each other.

Even though the data showed that chronic exposure to PM2.5 leads to an increase in WBC values, higher levels of physical
activity tend to negate the harmful effects of PM2.5 exposure.
Zhang et al. (2018) explained that exercise increases ventilation rate. And under acute conditions, the inhalation of more air
pollution initially increases WBC values. But over time, the WBC values would show improvement in the PA groups, and
would still be more favorable to those of the inactive group, even though the inactive group would not experience the
increased rate of ventilation.

Strengths:

Zhang et al. (2018) employed a longitudinal cohort design, taking into consideration many participant factors including
socio-economic status, lifestyle factors and metabolic variables. The large sample size allowed for a well-rounded set of
estimates in the data.

Because the researchers developed a MET-hour based protocol, they were able to take into consideration the intensity and
duration of the physical activity in the PA groups.

The spiro-temporal method that Zhang et al. (2018) used allowed them to pin-point the degree of PM2.5 exposure to the
accuracy of 1Km2.. Since the PM2.5 data distribution was stable over time, the two year averages that the researchers used
can be confirmed to be accurate.

Limitations:

First, 159,773 out of 959,280 participants were excluded due to missing information in the questionnaires.

However, this may not be a significant limitation because there is no evidence showing that excluded participants had any
differences in either PM2.5 exposure of PA habits. Zhang et al. (2018) added that the excluded participants did not differ
from the non-excluded participants in age, sex and WBC count, suggesting that the excluded participants were also
randomly distributed.

Second, the researchers had no way of knowing if the reported PA took place indoors or outdoors.

However, Zhang et al. (2018) added that people in Taiwan usually exercise outdoors. The researchers strengthened this
argument by stating that, according to a nation-wide survey done in 2015, only 7.5% of Taiwanese residents reported that
they exercise indoors. Therefore, the weekly MET-hour data that was collected can be a good indicator of outdoor PA.

Third, since the data was self-reported, the accuracy of the data may be questionable.

However, self-administered questioners are the go-to method for collecting data from large groups of participants when
collecting data for epidemiological studies.

Lastly, only data on particle air pollution was collected, leaving out data on gaseous air pollution. The example that Zhang
et al. (2018) used as gaseous air pollution was NO2.

Practical Applications:

The data collected and interpreted by Zhang et al. (2018) may be valuable in the promotion of health through PA under
significantly polluted conditions. If we understand how large groups of individuals physiologically respond to PA under
polluted conditions, we can better promote exercise in areas with high amounts of air pollution.

Additionally, the data provided by the researchers may allow us to employ exercise as a means of mitigating the health risks
associated with the inhalation of air pollution. Zhang et al. (2018) showed that, even though PA and air pollution are
independent of each other, it is better for individuals to exercise under polluted conditions, then not to exercise under
polluted conditions.
Reference:

Zhang, Z., Hoek, G., Chang, L., Chan, T., Guo, C., Chuang, Y.C., Chan, G., Lin, C., Jiang, W.K., Guo, Y., Vermeulen, R.,
Yeoh, E., Tam, T., Lau, L.K.H., Griffiths, S., Lao, X.Q. (2018). Particulate matter air pollution, physical activity
and systemic inflammation in Taiwanese adults. International Journal of Hygiene and Environmental Health (221)
P.41-47.
http://dx.doi.org/10.1016/j.ijheh.2017.10.001