Periodic Reporting for period 1 - APPARHU (The Effects of Air Pollution and Physical Activity on Respiratory Health in Children in the Context of Urbanization)
Okres sprawozdawczy: 2020-02-01 do 2022-01-31
The aim of this project was to advance our knowledge of how air pollution exposure, physical activity, and their interactions with one another affect children’s lung health in an urban environment. More specifically, the purpose of this study was to identify factors that support and hinder the healthy development of the lungs in children, and describe their underlying biological mechanisms. Due to the COVID-19 pandemic, the scope of this project was broadened throughout the project period to also assess how physical activity and air pollution exposure during the COVID-19 pandemic affect health in the adult population.
Air pollution levels are often higher, and the opportunities to engage in physical activity fewer in cities compared to rural areas. Physical activity is a must for the healthy development of children. For example, children with higher physical fitness have been shown to have better lung function compared to children who are less fit. What is unclear, however, are the relative risks and rewards of being physically active in an area with poor air quality. Breathing more frequently during physical activity can increase the number of inhaled pollutants and reduce lung function. Currently, only one in three 11 year-olds in meet the physical activity recommendations in Europe. This is, in part, a direct result of our changed living infrastructure. In the continuously growing urban centres in Europe, the number of parks, walking and cycling paths are often sacrificed for apartment complexes, high-rises, roadways, and vehicles. While these human-made changes to our landscape decrease the need and opportunities to be physically active, they also increase air pollution levels. We do not know yet how these human-made constructs in urban areas affect lung health directly, and indirectly by modifying physical activity levels and air pollution exposures.
Chronic respiratory disease continues to be a major burden on society. One in three Europeans will develop asthma between the ages of 5 and 80 years. Interestingly, asthma has become more common in children, especially in urban areas. Low lung function in childhood is viewed as a major risk factor in the development of chronic respiratory disease in adulthood. Air pollution exposure during pregnancy or childhood is thought to impair the development of the lungs. The identification of health risks due to air pollution has been challenging, because the term “air pollution” describes a constantly changing mixture of particles and gases. To better understand how air pollution affects lung health, we need to use advanced research models such as the exposome concept, that provide a broader view, accounting for a multitude of external and internal factors.
Air pollution levels are often higher, and the opportunities to engage in physical activity fewer in cities compared to rural areas. Physical activity is a must for the healthy development of children. For example, children with higher physical fitness have been shown to have better lung function compared to children who are less fit. What is unclear, however, are the relative risks and rewards of being physically active in an area with poor air quality. Breathing more frequently during physical activity can increase the number of inhaled pollutants and reduce lung function. Currently, only one in three 11 year-olds in meet the physical activity recommendations in Europe. This is, in part, a direct result of our changed living infrastructure. In the continuously growing urban centres in Europe, the number of parks, walking and cycling paths are often sacrificed for apartment complexes, high-rises, roadways, and vehicles. While these human-made changes to our landscape decrease the need and opportunities to be physically active, they also increase air pollution levels. We do not know yet how these human-made constructs in urban areas affect lung health directly, and indirectly by modifying physical activity levels and air pollution exposures.
Chronic respiratory disease continues to be a major burden on society. One in three Europeans will develop asthma between the ages of 5 and 80 years. Interestingly, asthma has become more common in children, especially in urban areas. Low lung function in childhood is viewed as a major risk factor in the development of chronic respiratory disease in adulthood. Air pollution exposure during pregnancy or childhood is thought to impair the development of the lungs. The identification of health risks due to air pollution has been challenging, because the term “air pollution” describes a constantly changing mixture of particles and gases. To better understand how air pollution affects lung health, we need to use advanced research models such as the exposome concept, that provide a broader view, accounting for a multitude of external and internal factors.
We performed a total of 6 studies using various methodological angles to address the question of how physical activity and air pollution exposure affect health. In a first study, we used an accelerated study cohort design to build lung function growth trajectories in 6 -18-year-old adolescents, and to identify predictors of those trajectories. We identified a total of four trajectories. Three run in parallel and one shows catch-up growth. Predictors of catch-up up lung function growth are body mass at 4 years and physical activity levels and body mass growth between 4 and 7 years of age. This study emphasizes the importance of physical activity and a healthy diet in early childhood for lung function growth.
Another two projects include a published commentary on the need for multi-disciplinary research using the socio-exposome research concept that includes the integration of research methods from the natural sciences with the social and political sciences to better understand key determinants of health, and a guideline paper on preventive strategies to mitigate adverse effects of air pollution when being physically active in areas with increased air pollution levels.
A health impact assessment on the effects of COVID-19 governmental restrictions put in place in the first wave in Barcelona, Vienna, and Stockholm on environmental exposures and health behaviours and subsequent downstream effects of anticipated cardiovascular and mental health has been accepted for publication. If the observed changes in environmental exposures and health behaviours were maintained for over one year, the greatest health impacts (i.e. anticipated annual heart attack, stroke, depression, and anxiety diagnoses) would occur due to the tremendous decreases in physical activity.
Another two projects include a published commentary on the need for multi-disciplinary research using the socio-exposome research concept that includes the integration of research methods from the natural sciences with the social and political sciences to better understand key determinants of health, and a guideline paper on preventive strategies to mitigate adverse effects of air pollution when being physically active in areas with increased air pollution levels.
A health impact assessment on the effects of COVID-19 governmental restrictions put in place in the first wave in Barcelona, Vienna, and Stockholm on environmental exposures and health behaviours and subsequent downstream effects of anticipated cardiovascular and mental health has been accepted for publication. If the observed changes in environmental exposures and health behaviours were maintained for over one year, the greatest health impacts (i.e. anticipated annual heart attack, stroke, depression, and anxiety diagnoses) would occur due to the tremendous decreases in physical activity.
To date, we have used a multitude of research methods, including trajectory modelling with an accelerated cohort design, exposome analyses, and health impact assessments to investigate how physical activity and air pollution exposures affect (respiratory) health in children and adults. We are currently continuing to work on two projects. One includes the calculation of inhaled dose of multiple pollutants in 6–9-year-old children from the HELIX study. In another study, we assess how the COVID-19 pandemic impacted adults physical activity levels in rural and urban areas using time series data.
The findings of our work have impacts on future research and clinical management. For example, our findings from the lung function trajectory project showed the need for studies using objectively measured physical activity levels in early childhood combined with detailed dietary data on lung function growth. Furthermore, our results show that parents, particularly those of children with low initial lung function, should be encouraged to motivate their child to engage in physical activity and a to adhere to a healthy diet. An estimate of the socio-economic impact is difficult; however, every prevented chronic lung disease in adulthood due to optimal support of lung function growth in childhood, for example through increased physical activity levels, will generate tremendous financial savings.
The findings of our work have impacts on future research and clinical management. For example, our findings from the lung function trajectory project showed the need for studies using objectively measured physical activity levels in early childhood combined with detailed dietary data on lung function growth. Furthermore, our results show that parents, particularly those of children with low initial lung function, should be encouraged to motivate their child to engage in physical activity and a to adhere to a healthy diet. An estimate of the socio-economic impact is difficult; however, every prevented chronic lung disease in adulthood due to optimal support of lung function growth in childhood, for example through increased physical activity levels, will generate tremendous financial savings.