Exploring the role of sex and gender at the intersection of physical activity and air pollution: the INCLUDE project

Abstract

In 2019, climate change and air pollution in combination with non-communicable diseases were the two top threats to health, with 70% of non-communicable diseases caused by air pollution and affecting the lungs. Chronic respiratory disease (CRD) thus was placed fourth as a global cause for mortality in 2021. While physical activity is the most efficient and cost-effective tool to manage CRDs through reduction in the risk of hospital admissions, all-cause mortality, and increases in the quality of life (Garcia-Aymerich et al. 2006; Schrempft et al., 2019), two critical research gaps hinder the optimal integration of physical activity into the management of CRDs. First, the interaction between physical activity and air-pollution, and their downstream health effects are still largely unknown. When exposed to both concomitantly, the inhaled volume of pollutants is increased, thus physical activity could catalyze the risks from air pollution. Second, sex- and gender-based differences in the phenotypes of CRD and physical activity behaviors exist. Women report lower quality of life, more severe feelings of breathlessness and cough, and participate in less physical activity than men (Clougherty., 2010). The objective of INCLUDE is thus to comprehensively study the effects and implications of sex and gender on the combined effects of physical activity and air pollution exposure in older individuals with and without CRD. Methodologically, the project is multi-centric, where 180 participants over the age of 60, both sexes, and broad gender characteristics will participate in the study in either Basel, Zurich, or Barcelona (60 participants at each site). We will identify how sex and gender affect physical activity experiences and responses (1) qualitatively though semi-structured interviews; (2) quantitatively through real-world walking in higher and lower air pollution wherein cardiopulmonary responses and gait characteristics will be measured with field-based and wearable devices; and (3) with an advisory board. The expected results and impact of the INCLUDE project are to understand and quantify how sex and gender affect acute and long-term respiratory health when older individuals are concomitantly exposed to both air pollution and physical activity. Our mixed-methods research approach in combination with our advisory board will guide urban planning, policy, clinicians, and future research.

References:

Clougherty, J. E. (2010). A growing role for gender analysis in air pollution epidemiology. Environmental Health Perspectives, 118(2), 167–176. https://doi.org/10.1289/ehp.0900994

Garcia-Aymerich, J., Lange, P., Benet, M., Schnohr, P., & Antó, J. M. (2006). Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: A population based cohort study. Thorax, 61(9), 772–778. https://doi.org/10.1136/thx.2006.060145

Schrempft, S., Jackowska, M., Hamer, M., & Steptoe, A. (2019). Associations between social isolation, loneliness, and objective physical activity in older men and women. BMC Public Health, 19(1), 74. https://doi.org/10.1186/s12889-019-6424-y