Pollution and

Exercise in a Polluted Environment

Exercise
Michael Koehle, MD, PhD
Director, Division of Sport & Exercise Medicine &
Professor, School of Kinesiology,
University of British Columbia, Vancouver, Canada
 Objectives
• Understand the constituents of air pollution

• Be able to compare the bene ts and drawbacks of di erent

types of pollution research

• Summarize the e ects of diesel exhaust and tra c related

air pollution on exercise in healthy people

• Summarize the e ects of ozone during exercise

• Name some key strategies to reduce pollution e ects with

exercise.
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 AIR POLLUTION = BAD

EXERCISE = GOOD
 Statement of the Problem
• Health e ects of exercise are well-documented
• Cancer, heart disease, stroke, cognitive
function, mental health, diabetes…

• Adverse e ects of pollution are well-documented

• Cancer, heart disease, stroke…

• 52% of World is urbanized

• 78% of Developed World is urbanized

• 49% of Slovenia
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Conflicting
Messages
• What guidance do we give
athletes?
• Especially those with
asthma?
 Air Pollution Recipe
Pollution Components
• Gases
– Ozone, carbon monoxide, oxides of nitrogen (NO2, NO), etc.

• Particles
• Solid particles, or liquid droplets like dust, metal, soot
– Gaseous
particles, pollen
– Ozone, carbon monoxide, oxides of nitrogen (NO2, NO)
• Particulate
– Categorized according to aerodynamic size
Tokyo 2020– Anticipated Pollution
• Ozone – highest in OECD
 Research Models
• Real World Epidemiology Studies
– Long-term results
– Meaningful outcomes

• Real World Acute Exposures

– Realistic pollution exposures
– Tough to generate control exposures, with
blinding
 Research Models

• Laboratory Acute Exposures

– Controlled consistent pollution exposure
– Sham condition, blinding crossover design
– Lack of long term results
– Surrogate outcomes
Diesel Exhaust Exposure

Particulate Matter2.5 300 μg/m3

 Sao Paulo Model
The Role of Norepinephrine

• Plasma levels re ect sympathetic nervous system

activity (SNS).
• Increases cardiac output and respiratory rate during
exercise.
• Smoke exposure may increase plasma NE by increasing
SNS activity.

(Nakamura and Hayashida, 1992. Am J Physiol, 262)

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 Intense exercise

• Increased ventilation

• Nasal breathing

• Deposition further down the bronchial tree

• Higher metabolic rate

 The kinds of things we
The outcomes we measure:
measure:
• Lung Function
• Lung Function
• Endothelial Function
• Heart
Blood•Vessel Rate Variability
Function

• Cognitive Function
Heart •Function
• Exercise Performance
• Cognitive Function
• Inflammatory Markers
• Exercise Performance

• Stress Hormones, In ammation Markers

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 Placebo
Lung function
Salbutamol
35
35 Fitlered Air
30

(% change from baseline)

30 Diesel Exhaust (DE)

(% change from baseline)

25
25
20 • No differences in 20
15

spirometry

FEV1
15
FEV1

10
10
5 5

• No
FeNOdifferences in
0 0
-5 -5
-10 -10

1
Baseline 2
20 min 40 3min 60 4min No
1055min 1656min
FeNO
differences
• Multiple inintensities 1
Baseline 20 2min 3
40 min 4
60 min 1055min 6 min
165

35
Seated in Exposure Booth Post Cycle Bout
•• Two
Two models
models 35
Seated in Exposure Booth Post Cycle Bout

30 30
(% change from baseline)

(% change from baseline)

25 25
20 20
15 15
FVC

FVC
10 10
5 5
0 0
-5 -5
-10 -10

Baseline 20 2min 40 min 60 4min 1055 min 1656min Baseline 20 min 40 min 60 4min 105 min 165 min
1 3 1 2 3 5 6
Seated in Exposure Booth Post Cycle Bout Seated in Exposure Booth Post Cycle Bout
 Blood Vessel Function

• Impaired blood vessel function is linked to

poor health comes downstream
• Two models tested
• Three techniques tested
• Multiple intensities tested
• No difference in post-exercise blood vessel
function between pollution condition and
control condition
What about exercise
intensity?
 High Intensity vs. Low
Intensity

• We expected to see more pollution e ects

during high intensity exercise

• Very few di erences, but breathing and

metabolic rate were increased with air pollution
in low intensity exercise only?!
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Wait…what?
 Subsequent Studies

• Crossover design study in real world tra c

• Smaller di erence in pollution between exposures
• e.g. PM2.5 30 vs. 80 μg/m3 (contrast 13 vs. 302 μg/m3 )

• Similar outcomes: lung function, FENO, markers of

in ammation
• Signi cant e ect of exercise on all outcomes
• No signi cant e ect of pollution on any outcomes
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 AIR POLLUTION = BAD

EXERCISE = GOOD
End of Video 1
 Interim Summary
• Air pollution has a variety of adverse health eects in terms of
cancer, cognition, lung disease, mental health and
cardiovascular health

• When looking at diesel exhaust and tra c related air pollution

in healthy people, across a variety of study designs
• Minimal if any e ects on:
• Lung function
• Blood vessel function
• Cardiovascular function
• No clear evidence that an increase in intensity is more harmful
• Slightly elevated oxygen consumption and ventilation at
lower vs. Higher intensity
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What about Performance?
 Performance Effects
• Increased
perceived effort
• At low intensity,
increased oxygen
cost
 Respiratory Responses to Exercise in
Diesel Exhaust

• During low-intensity exercise in diesel exhaust:

-VE Significantly greater

than in fresh air

-VO2
-VCO2

• This did not occur during high-intensity exercise.

(Giles et al. 2014 Med Sci Sports Exerc. 46(10):1999-2006)
Soon to be published 50 km Time Trial Data
• Ambient São Paulo pollution vs. filtered air
120
100
80

What about prolonged exercise? 60

40
20
0
Clean Air Polluted Air

• Prof. Rõmulo Bertuzzi and Andre Casanova

• Universidade São Paulo
 Ozone
• secondary gaseous pollutant
• nitrogen dioxide, sunlight, and hydrocarbons
• ozone exposure:
– respiratory irritant that impair pulmonary
function and heart rate variability
– Often concomitant with heat
– Responds to salbutamol/albuterol
 Ozone
• Adaptation may be possible
• Healthy people from high ozone
environments do better at competitions in
high ozone than those from low ozone
environments
• Healthy people exposed to ozone daily,
gradually have less symptoms after about
the third day
Don’t neglect Indoor
Pollution
• Zambonis (ice resurfacing machines)

• Candles, incense (yoga)

• Cleaning solvents, VOCs,

• Wearables?
 Pollution and Stress

• Pollution is associated with other

stressors
• heat, humidity, tra c, NOISE
• Recovery from exercise is delayed
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 Air Pollution and Asthma
• Chronic exposure to high-dose Particulate Matter
reduces lung function (FEV1) in asthmatics
• Greater e ects in moderate vs. Mild asthma
• Acute ozone reduces FEV1 in some studies
• Dose and intensity-dependent
• Chronic ozone increases asthma prevalence in
children
• Acute exposure studies are con icting, pulmonary
e ects of asthmatics and healthy often similar
Giles and Koehle, Sports Medicine 2014 44:223–249
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 Training Recommendations
• Avoid pollution as much as possible
– Separate by time
– Separate by distance

• On high pollution days

– Shorter, more intense workouts
– Move training to better environment
– Extra care in those with respiratory disease
• Salbutamol safe in asthma and EIB
– Minimise non-exercise pollution exposure
 Competition Recommendations
• Reassurance
– Minimal performance effects during competition
• Avoid pollution as much as possible pre-
competition
– Travel to and from competition
– Consider masks in very high pollution environments
• Prepare for heat exposure
– Acclimation & Hydration strategies
• Stabilize asthma and EIB with medications and proper warm-
up – monitor those on corticosteroids
Events
 Summary

•AIR POLLUTION = BAD

•EXERCISE = GOOD
 Acknowledgements
• Sarah Koch PhD
• Luisa Giles PhD
• Ramon Cruz PhD
• Martha Smith MD
• Michael Brauer PhD
• Christie Cole MSc
• Hannah Nelson
• Chris Carlsten MD, MPH
• André Casanova MSc
• Andy Hung
• Cole Plater
• Ana Zelembaba
• Mehrdad Amini
• Rômulo Bertuzzi PhD
• Jordan Guenette PhD
• Raymond Tran