EXERCISE AND

AIRPOLLUTION
Erlang Samoedro
 Introduction
AIR POLLUTION
• Global health problem
• 7 million premature death
• 91 % people lived in place with high levels of air pollution

DATA FROM WHO

• 4,2 million death due to air pollution
• Economical loss : 2,9 T usd /year
• Every year air pollution is became worse
• In pandemic situation air pollution is decrease due to lock down

https://www.who.int/health-topics/air-pollution
PHYSICAL ACTIVITY
• Outdoor => One of most effective excercise
• Increase health and quality of life

AMERICAN COLLEGE OF SPORTS MEDICINE

• ACSM recommend : 30 minutes exercise
• People should do the exercise 3 – 5 x/week

Araneda Of, et al. Appl Sci. 2021

Air pollution and exercise
◦ Globally more than a quarter of adults are physically inactive, meaning 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, with adults from high-income countries being more inactive
than adults from low- and middle-income countries (LMICs)

◦ At the same time, 90% of the global population lives in environments that exceed the World
Health Organization (WHO) guideline values for ambient air quality, with LMICs countries
suffering the greatest health burden

Journal of Cardiopulmonary Rehabilitation and Prevention

2016;36:84-95
Ozone (O3)
• !"#$%&'( )#'&*%+, -. /0! 1 20!
• 3,&)#'4# %, 45$$#) -. 65$$#) 4$+7
• 3$8'&* %, "#'(*" -. #98+45)# +:#) ;<= 88>

Particulate matter (PM)

• ?%9*5)# 4+(%@ 1 (%A5%@ &+$8+,#,*4
• /')%+54 4%B#
• 3$8'&* %, "#'(*" -. %,@%&'*+) C+) '%) A5'(%*D

Giorgini P, et al. J Cardiopulm Rehabil Prev. 2016

 Particulate Matter
PM10 => Coarse Particle

PM2.5 => Fine Particle

PM0.1 => Ultrafine particle

Giorgini P, et al. J Cardiopulm Rehabil Prev. 2016

Environment International 147 (2021) 105954
IQAir. World Air Qual Rep. 2020
• Have an influencing effect
• Physical activity => Air pollution
• Air pollution => Physical activity

• Exposure with air pollution

• Increase blood pressure
• Damage epitelial airway
• Reduce lung function

• Exercise => increase exposure with pollutant

Wagner DR,et al. J Exerc Sci Fit. 2018
 Increases minute ventilation during exercise

Large fraction of air inhaled through the airway

during exercise

Increases airflow velocity

Carlisle AJ, Sharp NCC.. Br J Sports Med.2001

Journal of Cardiopulmonary Rehabilitation and Prevention
2016;36:84-95
• Pollutants has an inflamatory reaction in airway
epithel
• Exercise will increases risk o f inflamation

• So m e o n e w h o is o f ten e x po s e d t o pollution will

have high FeNO levels
• Higher levels o f p o llutio n = > higher levels FeNO

Kocot K, et al. Int J Environ Res Public Health. 2020;17(23):1–12

• Time and location are important t o perform
outdoor e x e rcis e
• 30 minutes e x e rcis e in high level pollutio n
will increases the binding o f COHb.
• Exposure with high level o f o z o n e will :
• Decreas e lung function
• Increases risk o f metabolic disorder

Morici G, et al. Front. Public Health.2020

Yu Y, et al. Env Health Perspect 2021
Journal of Cardiopulmonary Rehabilitation and Prevention
2016;36:84-95
WEIGHING THE RISKS OF AIR POLLUTION EXPOSURES VERSUS THE BENEFITS OF
EXERCISE

◦ The long-term CV health benefits of regular aerobic ctivity are

unquestionable. Although intense bouts of activity per se can act as a
significant triggering factor for acute events, the benefits of chronic exercise
Are believed to outweigh these transient risks
◦ European studies found that the benefits of physical activity outweighed the
mortality due to increase air pollution inhalation.

Journal of Cardiopulmonary Rehabilitation and Prevention

2016;36:84-95
 Breakeven Point : Risk from air pollution
starts outweighing
the benefits of PA

Tipping Point : Increase in physical activity

will no longer lead to an increase in health
benefits (max benefits has been reached)

Preventive Medicine 87 (2016) 233–236

Preventive Medicine 87 (2016) 233–236
Cycling :
• Tipping p o int at 30 min : PM 2.5 95 μ g /m 3
• Break-ev en point at 30 m in : PM 2.5 160 μ g / m 3
Walking :
• Tipping point and break-even point at 30 min : PM 2.5
abo v e 200 μ g /m 3

WHO
Tipping point would only be reached after 7 h
of cycling and 16 h of walking per day
(average PM 2.5 22 μ g / m 3 )

Tainio M, et al. Prev Med. 2016

 Air pollution and exercise
◦ For half an hour of cycling every day, the background PM2.5 Concentration would need to be 95 µg/m3
to reach the tipping point.
◦ In environment PM2.5 above 100 should limit exercise for 90 minute
◦ The break-even point for half an hour of cycling every day was at 160 µg/m3
◦ For half an hour of walking the tipping point and break-even point appear at a background concentration
level above 200 µg/m3
◦ Even in areas with high background PM concentrations, such as 100 µg/m3, up to 1 h 15 min of cycling
and 10h 30 min of walking per day will lead to net reduction in all-cause mortality
◦ The benefits from active travel generally outweigh health risks from air pollution and therefore should be
further encouraged. When weighing long-term health benefits from PA against possible risks from
increased exposure to air pollution
◦ most global regions the tipping points for the most polluted cities (44 µg/m3to 153 µg/m3) varied
between 30 and 120 min per day for cycling, and 90 min to 6 h 15 min per day for walking
Preventive Medicine 87 (2016) 233–236
Study in Yogyakarta 2 0 2 1 :
• !"#$%&'%(%)*'+ ,%((-.-'+ /-+0--'#1$- 2*$3 *',#'"
2*$3 %' 45!2*6 *', 7-*.+ .*+-
• 8%&7-. )*9".%-$ %' :-":9- 07" 1$- 2*$3 +7*'#'"#
2*$3
Epstein et al 2 0 1 9 :
• ;-":9- 1$- !<= (". -6-.)%$- %$ 7%&7-.#+7*' 07" 1$-#
$1.&%)*9 2*$3 *',#'"#2*$3 %' >+?5! 9-@-9

Nugraha AD, et.al. Sport J Penelit Pembelajaran. 2021

Epstein et al. Scand J Med Sci Sport. 2020
Jakarta air pollution during mass
isolation (greenpeace data)

No significant reduce in air pollution

 IQAIR
PM 2.5 levels is higher in the morning than in
evening

IQAIR
• PM 2.5 levels in Jakarta higher in the morning
than in e v e ning
• PM 2.5 levels in China higher at 6-8 am than at 6-
8 Pm
IQAir. World Air Qual Rep. 2020
Ni XF, et al. Aerosol Air Qual Res. 2019
Jakarta air pollution timing to exercise
 / Air pollution has a negative impact on health.
/ Inflammatory biomarkers such as FeNO increase in physical activity in air
polluted environments .
A Physical exercise should consider tipping points and break-even points
that can occur.
/ When doing physical activity, you should consider the high and low levels
of PM2.5 in the environment.
The use of masks for exercise can still be used and should be considered
with caution in patients with chronic lung disease