Take a fresh look at your lifestyle.

Exercise early to avoid potential health issues from poor air quality, experts say 

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Do you enjoy an evening run in the park? Or maybe you’ve joined the growing numbers encouraged by the lighter summer months and the pandemic to trade public transport for a bike ride to work?

While exercise offers a huge range of benefits for mental and physical health, experts are now urgently warning about the potential risks running and cycling in polluted areas can pose to heart health.

Cycling and running are undeniably good for your health. But at high intensity and in polluted areas, there may be more risks from air pollution than we’ve recognized before,” says Dr Adam Cooper, a Wakefield GP, himself an avid runner and cyclist.

While exercise offers a huge range of benefits for mental and physical health, experts are now urgently warning about the potential risks running and cycling in polluted areas can pose to heart health.

Mounting evidence of pollution’s role led The European Society of Cardiology to add it to its official list of risk factors for developing heart disease in 2019.

Air pollution is now the second biggest factor after smoking, says Professor Sanjay Sharma, a cardiologist at London’s St George’s Hospital and medical director of the London Marathon.

“Smoking, air pollution and a sedentary lifestyle are the three big killers when it comes to cardiovascular risk factors — more important than blood pressure and cholesterol,” he says.

‘Air pollution kills about 40,000 deaths a year in the UK – 40 per cent of this is due to heart attack and 8 per cent to stroke.’

Pollution, especially small particles (known as PM2.5, including sources such as diesel fumes and wood smoke), causes inflammation in the body.

It also increases levels of the stress hormones adrenaline and noradrenaline and has direct toxic effects on the heart. “The effect is an increase in blood pressure, systemic inflammation and a tendency to high blood sugar and cholesterol,” says Professor Sharma. “These are important in causing heart attacks.”

Running and cycling at a higher intensity that speeds up and deepens breathing is more important than gentle exercise because the harder we breathe, the more air we inhale and the deeper it goes into the lungs, says Dr. Cooper, who was a primary care physician for athletes at the London Marathon for 29 years.

It seems that the harder and longer you exercise, the greater the risk of damage to the heart from pollution. One small study compared men who exercised while breathing filtered air with those who did who inhaled polluted air.

Pollution, especially small particles (known as PM2.5, including sources such as diesel fumes and wood smoke), causes inflammation in the body

Pollution, especially small particles (known as PM2.5, including sources such as diesel fumes and wood smoke), causes inflammation in the body

There was no difference between the groups for the first hour, “but after 90 minutes of exercise, men who inhaled polluted air had higher blood markers of inflammation and higher blood pressure during exercise,” says Professor Sharma.

Some studies have even shown that pollution negates the short-term benefits of exercise in some people with heart and respiratory disease, he adds.

But individuals may respond differently, he explains: “Just as some people can get lung cancer after smoking as little as four cigarettes a week, and some can smoke 80 a week without developing it.”

While longer-term studies are needed, amateur athlete Steve Wilkinson undoubtedly contributed to the heart attack he had five years ago toward the end of a relay race.

“It was the kind of distance I would normally be able to cover quite easily,” says Steve, 64, a retired engineering university professor who lives in Wakefield with his wife Julie, 61.

Steve, who has run hundreds of races in over 25 years – including three London Marathons – blacked out when he limped across the line. Hospital tests showed he had suffered a heart attack, caused by three blocked arteries.

Steve weighed 11th (he is six feet tall), had a healthy BMI, normal blood pressure and cholesterol levels, did not smoke or drink heavily, and had no family history of the condition. So the first question he asked was, ‘Why would someone like me have a heart attack?’

After learning that Steve’s daily commute involved heavy uphill traffic in the city center in Leeds, his cardiologist said air pollution was likely one of the main contributing factors.

He remembered all the days of ‘literally tasting diesel in my mouth and seeing thick black fumes coming from the taxi exhausts as I cycled next to them’, Steve looked at the air quality readings around Leeds Station, where he cycled from each day. These regularly exceeded World Health Organization limits for air quality.

So how can you exercise safely? Professor Sharma says: ‘The best advice for runners and cyclists is to exercise in parks or cycle paths away from major traffic routes or to exercise indoors.’

Those with established heart disease, meanwhile, should exercise first thing in the morning when they’re outdoors, because that’s when pollution is lowest, or exercise indoors.

dr. Adam Cooper has designed a mask for runners that filters out pollutants – runaire.co.uk

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