Impaired exercise performance and pulmonary function in elite cyclists during low-level ozone exposure in a hot environment

Ozone exposure limits cardiorespiratory function during maximal cycling exercise in endurance athletes

Ground-level ozone (O3) is a potent air pollutant well recognized to acutely induce adverse respiratory symptoms and impairments in pulmonary function. However, it is unclear how the hyperpnea of exercise may modulate these effects, and the subsequent consequences on exercise performance. We tested the hypothesis that pulmonary function and exercise capability would be diminished, and symptom development would be increased during peak real-world levels of O3 exposure compared with room air. Twenty aerobically trained participants [13 M, 7 F; maximal O2 uptake (V̇o2max), 64.1 ± 7.0 mL·kg-1·min-1] completed a three-visit double-blinded, randomized crossover trial. Following a screening visit, participants were exposed to 170 ppb O3 or room air (<10 ppb O3) on separate visits during exercise trials, consisting of a 25-min moderate-intensity warmup, 30-min heavy-intensity bout, and a subsequent time-to-exhaustion (TTE) performance test. No differences in O2 uptake or ventilation were observed during submaximal exercise between conditions. During the TTE test, we observed significantly lower end-exercise O2 uptake (-3.2 ± 4.3%, P = 0.004), minute ventilation (-3.2 ± 6.5%, P = 0.043), tidal volume (-3.6 ± 5.1%, P = 0.008), and a trend toward lower exercise duration in O3 compared with room air (-10.8 ± 26.5%, P = 0.092). As decreases in O2 uptake and alterations in respiratory pattern were also present at matched time segments between conditions, a limitation of oxygen transport seems likely during maximal exercise. A more comprehensive understanding of the direct mechanisms that limit oxygen transport during exercise in high-pollutant concentrations is key for mitigating performance changes.NEW & NOTEWORTHY We demonstrate that in highly trained endurance athletes, exposure to peak real-world levels of O3 air pollution (170 ppb) significantly diminishes O2 uptake along with corresponding changes in ventilation during maximal exercise. As no differences were observed during extended submaximal exercise, a combined effect of effective dose of pollution and exercise intensity on severity of responses seems likely.

The rationale behind updates to ambient ozone guidelines and standards

Although air quality has gradually improved in recent years, as shown by the decrease in PM2.5 concentration, the problem of rising ambient ozone has become increasingly serious. To reduce hazards to human health and environmental welfare exposure to ozone, scientists and government regulators have developed ozone guidelines and standards. These answer the questions of which levels of exposure are hazardous to human health and the environment, and how can ambient ozone exposure be guaranteed, respectively. So what are the basis for the ozone guidelines and standards? This paper reviews in detail the process of revising ozone guidelines and standards by the World Health Organization (WHO) and the United States Environmental Protection Agency (EPA). The present study attempts to explore and analyze the scientific basis and empirical methods for updating guidelines and standards, in a view to guide the future revision process and provide directions for further scientific research. We found many epidemiological and toxicological studies and exposure-response relationships provided strong support for developing and revising the ozone guidelines. When setting standards, ozone exposure has been effectively considered, and the economic costs, health, and indirect economic benefits of standard compliance were reasonably estimated. Accordingly, epidemiological and toxicological studies and the establishment of exposure-response relationships, as well as exposure and risk assessment and benefit-cost estimates of standards compliance should be strengthened for the further update of guidelines and standards. In addition, with the increasing prominence of combined air pollution led by ozone and PM2.5, more joint exposure scientific research related to ozone guidelines and standards should be undertaken.

Impact of air pollution on running performance

Air pollution exposures during training may impact race preformances. We aggregated data on 334 collegiate male track & field athletes from 46 universities across the United States over 2010-2014. Using distributed lag non-linear models, we analyzed the relationship between race time and PM2.5, ozone, and two versions of the Air Quality Index (AQI) exposures up to 21 days prior to the race. We observed a 12.8 (95% CI: 1.3, 24.2) second and 11.5 (95% CI: 0.8, 22.1) second increase in race times from 21 days of PM2.5 exposure (10.0 versus 5.0 μg/m3) and ozone exposure (54.9 versus 36.9 ppm), respectively. Exposure measured by the two-pollutant threshold (PM2.5 and ozone) AQI was not significantly associated with race time; however, the association for summed two-pollutant AQI (PM2.5 plus ozone) was similar to associations observed for the individual pollutants (12.4, 95% CI: 1.8, 23.0 s). Training and competing at elevated air pollution levels, even at exposures within AQI's good-to-moderate classifications, was associated with slower race times. This work provides an initial characterization of the effect of air pollution on running performance and a justification for why coaches should consider approaches to reduce air pollution exposures while training.

The Acute Effects of Exercising in Air Pollution: A Systematic Review of Randomized Controlled Trials

BACKGROUND

The acute effects of air pollution (AP) exposure during physical activity have been studied. However, comprehensive systematic reviews are lacking, particularly regarding moderate-to-vigorous physical activity (MVPA).

OBJECTIVE

Our objective was to determine the acute health- and exercise-related effects of AP exposure during a bout of MVPA in healthy individuals.

METHODS

We searched for randomized controlled trials in MEDLINE, Embase, Cochrane CENTRAL, SPORTDiscus, Agricultural and Environmental Science Database, ClinicalTrials.gov, International Standard Randomised Controlled Trial Number Registry, and the World Health Organization (WHO) International Clinical Trials Registry Platform up to July 2020 without language or date restrictions. Studies including healthy subjects engaging in a bout of MVPA while exposed to one or more of the following air pollutants were eligible: particulate matter, black carbon, carbon monoxide, nitrogen dioxide, ozone, diesel exhaust, and traffic-related air pollution (TRAP). Main outcome measures were markers of pulmonary function, symptoms, cardiovascular function, cognitive function, systemic inflammation, and exercise response. The evidence was synthesized by vote counting based on direction of effect.

RESULTS

In total, 53 studies were included in the systematic review. Studies employed a heterogeneous mix of exercise protocols, AP interventions, and measured outcomes. Pooled results suggest ozone exposure during MVPA has an adverse effect on pulmonary function (100% [95% confidence interval (CI) 88-100], p < 0.001; high-certainty evidence) and reported symptoms (88% [95% CI 69-96], p < 0.001; low-certainty evidence). The effect of exposure to carbon monoxide, nitrogen dioxide, small engine exhaust, or diesel exhaust during MVPA on health- and exercise-related outcomes is uncertain because of insufficient evidence and the low to very low certainty of available evidence.

DISCUSSION

The evidence is strongest for ozone, exposure to which generally induced a reduction in pulmonary function and increased symptoms during MVPA. The research related to other outcome domains remains inconclusive. Although long-term exposure to AP is proven to be hazardous, the evidence for healthy individuals to forgo MVPA during periods of high (non-ozone) pollution remains weak.

TRIAL REGISTRATION

Retrospectively registered in PROSPERO (CRD42020188280) on 10 July 2020.

Air Pollution and Noncommunicable Diseases: A Review by the Forum of International Respiratory Societies' Environmental Committee, Part 1: The Damaging Effects of Air Pollution

Air pollution poses a great environmental risk to health. Outdoor fine particulate matter (particulate matter with an aerodynamic diameter < 2.5 μm) exposure is the fifth leading risk factor for death in the world, accounting for 4.2 million deaths and > 103 million disability-adjusted life years lost according to the Global Burden of Disease Report. The World Health Organization attributes 3.8 million additional deaths to indoor air pollution. Air pollution can harm acutely, usually manifested by respiratory or cardiac symptoms, as well as chronically, potentially affecting every organ in the body. It can cause, complicate, or exacerbate many adverse health conditions. Tissue damage may result directly from pollutant toxicity because fine and ultrafine particles can gain access to organs, or indirectly through systemic inflammatory processes. Susceptibility is partly under genetic and epigenetic regulation. Although air pollution affects people of all regions, ages, and social groups, it is likely to cause greater illness in those with heavy exposure and greater susceptibility. Persons are more vulnerable to air pollution if they have other illnesses or less social support. Harmful effects occur on a continuum of dosage and even at levels below air quality standards previously considered to be safe.

Influence of weather and atmospheric pollution on physical activity in patients with COPD

Rationale

Information concerning how climate and atmospheric pollutants affects physical activity in COPD patients is lacking and might be valuable in determining when physical activity should be encouraged.

Methods

Seventy-three stable COPD patients recorded on daily diary cards worsening of respiratory symptoms, peak expiratory flow rate, hours spent outside the home and the number of steps taken per day. Pedometry data was recorded on 16,478 days, an average of 267 days per patient (range 29-658). Daily data for atmospheric PM₁₀ and ozone (O₃) were obtained for Bloomsbury Square, Central London from the Air Quality Information Archive databases. Daily weather data were obtained for London Heathrow from the British Atmospheric Data Archive.

Results

Colder weather below 22.5 °C, reduced daily step count by 43.3 steps day per°C (95 % CI 2.14 to 84.4; p = 0.039) and activity was lower on rainy than dry days (p = 0.002) and on overcast compared to sunny days (p < 0.001). Daily step count was 434 steps per day lower on Sunday than Saturday (p < 0.001) and 353 steps per day lower on Saturday than Friday (p < 0.001). After allowance for these effects, higher O₃ levels decreased activity during the whole week (-8 steps/ug/m3; p = 0.005) and at weekends (-7.8 steps/ug/m3; p = 0.032). Whilst, during the week PM₁₀ reduced activity (p = 0.018) but not during the weekend.

Conclusions

Inactivity of COPD patients is greatest on cold, wet and overcast days and at the weekends. This study also provides evidence of an independent effect of atmospheric pollution at high levels.

Electronic supplementary material

The online version of this article (doi:10.1186/s12931-015-0229-z) contains supplementary material, which is available to authorized users.

The health effects of exercising in air pollution

The health benefits of exercise are well known. Many of the most accessible forms of exercise, such as walking, cycling, and running often occur outdoors. This means that exercising outdoors may increase exposure to urban air pollution. Regular exercise plays a key role in improving some of the physiologic mechanisms and health outcomes that air pollution exposure may exacerbate. This problem presents an interesting challenge of balancing the beneficial effects of exercise along with the detrimental effects of air pollution upon health. This article summarizes the pulmonary, cardiovascular, cognitive, and systemic health effects of exposure to particulate matter, ozone, and carbon monoxide during exercise. It also summarizes how air pollution exposure affects maximal oxygen consumption and exercise performance. This article highlights ways in which exercisers could mitigate the adverse health effects of air pollution exposure during exercise and draws attention to the potential importance of land use planning in selecting exercise facilities.

Investigating performance and lung function in a hot, humid and ozone-polluted environment

Large urbanized areas, where sports events take place, have a polluted environment and can also reach high temperatures and humidity levels. The aim of this study was to investigate the impact of a hot, humid and ozone-polluted (O(3)) environment on (1) performance of an 8 km time trial run, (2) pulmonary function, and (3) subjective respiratory symptoms in endurance-trained runners. Using crossover randomized design, 10 male participants (mean V(O)₂(max)= 64.4 mlO(2) kg(-1) min(-1), SD = 4.4) took part in a time trial run under four different conditions: 20 degrees C + 50% relative humidity (rh) (Control), 20 degrees C + 50% rh + 0.10 ppm O(3) (Control + O(3)), 31 degrees C + 70% rh (Heat), 31 degrees C + 70% rh + 0.10 ppm O(3) (Heat + O(3)). Heart rate, ratings of perceived exertion and minute ventilation were collected during the run. Lung function was measured pre and post-exercise. The runners completed a respiratory symptoms questionnaire after each trial. The completion time of both the Heat (32 min 35 s) and Heat + O(3) (33 min 09 s) trials were significantly higher (P < 0.0001) when compared to the Control + O(3) (30 min 27 s) and Control (30 min 15 s) trials. There were no significant changes between pre/post lung function measures or between trials. The effective dose of ozone simulated in the present study did not affect the performance and therefore, ozone-pollution, at an environmentally relevant concentration, did not compound the impairment in performance beyond that induced by a hot, humid environment.

Acute effects of ozone on pulmonary function of cyclists receiving antioxidant supplements

OBJECTIVES

To identify whether acute lung function effects of ozone can be modulated by antioxidant vitamin supplementation.

METHODS

Amateur cyclists (n = 26) were studied in the summer of 1994 in The Netherlands. Repeated lung function measurements were performed with a rolling seal spirometer after training sessions or competitive races on four to 14 occasions. The cyclists were assigned to two study groups. The supplementation group (n = 12) received antioxidant supplements (15 mg beta-carotene, 75 mg vitamin E, and 650 mg vitamin C) once a day for three months. The control group did not receive supplementation. For each subject, lung function after exercise was regressed on the previous eight hour mean ozone concentration. The individual regression coefficients were pooled for each study group and weighted with the inverse of the variance.

RESULTS

The eight hour mean ozone concentration was 101 micrograms/m3 (30 to 205 micrograms/m3). For the supplementation group, there was no effect of ozone on FVC, FEV1, peak expiratory flow (PEF), and maximal mid-expiratory flow (MMEF). For the control group the mean coefficients were negative, except for MMEF. The difference between the groups was 2.08 (95% confidence interval (95% CI) 1.31 to 2.85) ml/microgram/m3 for FVC, 1.66 (95% CI 0.62 to 2.70) for FEV1, 6.83 (95% CI 3.17 to 10.49) for PEF, and 0.42 (95% CI -1.38 to 2.22) for MMEF.

CONCLUSION

The results suggest that antioxidant vitamin supplementation protects against acute effects of ozone on lung function in heavily exercising amateur cyclists.