People living with chronic obstructive pulmonary disease (COPD) are encouraged to be physically active to help manage their symptoms and prevent flare-ups (exacerbations). Walking is the most common form of physical activity for people with COPD but there are concerns about whether walking in areas of high air pollution could reduce or cancel out the benefits of the activity.
A new study has looked at whether the long-term benefits of walking on COPD flare-ups are reduced for people living in areas with higher air pollution compared to those in less polluted areas.
The study included 262 people with COPD from six cities across five European countries (London and Newcastle in the United Kingdom, Barcelona in Spain, Leuven in Belgium, Zurich in Switzerland and Athens in Greece).
Participants wore a small device on their back to measure their walking activity, including step count, the time spent walking and how fast they walked. Scientists also estimated the levels of four air pollutants in the areas where they lived using data taken from the previous two years. This included fine particles (PM2.5), black carbon, nitrogen dioxide (NO2) and ozone (O3).
Over two years, participants tracked their exacerbations with a paper diary, recording the date, how long symptoms lasted and any hospital admissions. Healthcare professionals checked this with information from medical records. The researchers then analysed whether the combination of walking activity and air pollution affected flare-ups.
The study found that the benefits of regular walking activity in reducing moderate-to-severe flare-ups of COPD are not reduced by air pollution.
The concentrations of the long-term air pollutants at the levels found in Central and Western Europe did not affect the improvement people experienced from walking.
The findings also showed that people who took more steps and walked for longer had fewer flare-ups. Walking at a higher intensity or faster average speed did not directly reduce exacerbation rates. However, faster walking speeds during continuous walking periods lasting more than 30 seconds were linked to an even greater benefit. This applied to all participants, regardless of whether they smoked or how severe their disease was.
The research found no link between step count, the length of time walking or the average walking speed and the levels of any air pollutants. Walking provided the same benefit whether people lived in areas of higher or lower pollution.
The study backs up current recommendations that people living with COPD should maintain regular walking activity even if they live in an area with pollution levels similar to those studied here in Central and Western Europe.
The authors point out that, given the well-known harmful effects of pollution, which may still trigger acute exacerbations, avoiding highly polluted periods and spaces should remain a priority if possible.
The findings also suggest that recommendations for people with COPD should emphasise the amount of regular walking, rather than its intensity.
Read the full paper from the ERJ Open Research.
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