INTRODUCTION: Ambient air pollution is a global environmental problem, which causes adverse health effects and premature deaths worldwide. Although regular exercise and physical activity have evident health benefits, the influence of long-term air pollution exposure during regular outdoor running has not been definitively clarified. METHODS AND ANALYSIS: This study protocol describes the physiological and anthropometric perspectives of the 'Healthy Aging in Industrial Environment' Study - Programme 4 (4HAIE). The 4HAIE research project is intended to be a single-centre, prospective, longitudinal and multidisciplinary cohort study. The presented study protocol describes the cross-sectional measurements and analyses. Overall, 1500 adult participants (age 18-65 years), runners and inactive individuals, living in a high or low air-polluted area of the Czech Republic will be recruited. We will measure and analyse biomarkers of oxidative stress and inflammation in the blood, exercise capacity (graded exercise test and spiroergometry), blood pressure, lung function (spirometry), cardiac autonomic regulation and anthropometry (body composition). ETHICS AND DISSEMINATION: The 4HAIE study protocol has already been approved by the Ethics Committee of the University of Ostrava (3/2018). A detailed participant information sheet will be provided to each individual prior to obtaining their written informed consent. The study poses little to no risk to participants. The findings of this study will be disseminated at regional and international conferences, in peer-reviewed journals and via social and broadcast media.

Centre for Epidemiological Research University of Ostrava Ostrava Czech Republic

Department of Epidemiology and Public Health University of Ostrava Ostrava Czech Republic

Department of Genetic Toxicology and Epigenetics Institute of Experimental Medicine Czech Academy of Sciences Prague Czech Republic

Department of Human Movement Science University of Ostrava Ostrava Czech Republic

Institute of Human Movement Science Sport and Health Exercise Physiology Training and Training Therapy Research Group University of Graz Graz Austria

Zobrazit více v PubMed

World Health Organization , 2019. Available: https://www.who.int/health-topics/air-pollution#tab=tab_1

Brook RD, Newby DE, Rajagopalan S. Air pollution and cardiometabolic disease: an update and call for clinical trials. Am J Hypertens 2018;31:1–10. 10.1093/ajh/hpx109 PubMed DOI PMC

Thurston GD, Kipen H, Annesi-Maesano I, et al. . A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? an analytical framework. Eur Respir J 2017;49:1600419. 10.1183/13993003.00419-2016 PubMed DOI PMC

Shepherd A, Mullins JT. Arthritis diagnosis and early-life exposure to air pollution. Environ Pollut 2019;253:1030–7. 10.1016/j.envpol.2019.07.054 PubMed DOI

Wu X, Nethery RC, Sabath BM, et al. . Exposure to air pollution and COVID-19 mortality in the United States: a nationwide cross-sectional study. medRxiv 2020. 10.1101/2020.04.05.20054502. [Epub ahead of print: 07 Apr 2020]. PubMed DOI PMC

Yang Y, Ruan Z, Wang X, et al. . Short-Term and long-term exposures to fine particulate matter constituents and health: a systematic review and meta-analysis. Environ Pollut 2019;247:874–82. 10.1016/j.envpol.2018.12.060 PubMed DOI

Newby DE, Mannucci PM, Tell GS, et al. . Expert position paper on air pollution and cardiovascular disease. Eur Heart J 2015;36:83–93. 10.1093/eurheartj/ehu458 PubMed DOI PMC

Yang D, Yang X, Deng F. Ambient air pollution and biomarkers of health effect : Advances in experimental medicine and biology. Springer New York LLC, 2017: 59–102. PubMed

Bai Y, Sun Q. Fine particulate matter air pollution and atherosclerosis: mechanistic insights. Biochim Biophys Acta 2016;1860:2863–8. 10.1016/j.bbagen.2016.04.030 PubMed DOI

Franklin BA, Brook R, Arden Pope C. Air pollution and cardiovascular disease. Curr Probl Cardiol 2015;40:207–38. 10.1016/j.cpcardiol.2015.01.003 PubMed DOI

Garber CE, Blissmer B, Deschenes MR, et al. . American College of sports medicine position stand. quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011;43:1334–59. 10.1249/MSS.0b013e318213fefb PubMed DOI

Tainio M, de Nazelle AJ, Götschi T, et al. . Can air pollution negate the health benefits of cycling and walking? Prev Med 2016;87:S54. 10.1016/j.jth.2016.05.113 PubMed DOI PMC

Qin F, Yang Y, Wang S-T, tao WS, et al. . Exercise and air pollutants exposure: a systematic review and meta-analysis. Life Sci 2019;218:153–64. 10.1016/j.lfs.2018.12.036 PubMed DOI

Daigle CC, Chalupa DC, Gibb FR, et al. . Ultrafine particle deposition in humans during rest and exercise. Inhal Toxicol 2003;15:539–52. 10.1080/08958370304468 PubMed DOI

Pierson WE, Covert DS, Koenig JQ, et al. . Review: implications of air pollution effects on athletic performance. Atmospheric Environment 1986;20:2033–8. 10.1016/0004-6981(86)90344-6 PubMed DOI

Bos I, De Boever P, Vanparijs J, et al. . Subclinical effects of aerobic training in urban environment. Med Sci Sports Exerc 2013;45:439–47. 10.1249/MSS.0b013e31827767fc PubMed DOI

Blair C, Walls J, Davies NW, et al. . Volatile organic compounds in runners near a roadway: increased blood levels after short-duration exercise. Br J Sports Med 2010;44:731–5. 10.1136/bjsm.2008.051888 PubMed DOI

Cavalcante de Sá M, Nakagawa NK, Saldiva de André CD, et al. . Aerobic exercise in polluted urban environments: effects on airway defense mechanisms in young healthy amateur runners. J Breath Res 2016;10:046018. 10.1088/1752-7163/10/4/046018 PubMed DOI

De Meersman RE, Stein PK. Vagal modulation and aging. Biol Psychol 2007;74:165–73. 10.1016/j.biopsycho.2006.04.008 PubMed DOI

Shutt RH, Kauri LM, Weichenthal S, et al. . Exposure to air pollution near a steel plant is associated with reduced heart rate variability: a randomised crossover study. Environmental Health 2017;16:1–10. 10.1186/s12940-016-0206-0 PubMed DOI PMC

Breitner S, Peters A, Zareba W, et al. . Ambient and controlled exposures to particulate air pollution and acute changes in heart rate variability and repolarization. Sci Rep 2019;9:1–12. 10.1038/s41598-019-38531-9 PubMed DOI PMC

Bind M-A, Peters A, Koutrakis P, et al. . Quantile regression analysis of the distributional effects of air pollution on blood pressure, heart rate variability, blood lipids, and biomarkers of inflammation in elderly American men: the normative aging study. Environ Health Perspect 2016;124:1189–98. 10.1289/ehp.1510044 PubMed DOI PMC

Byun H-M, Colicino E, Trevisi L, et al. . Effects of air pollution and blood mitochondrial DNA methylation on markers of heart rate variability. J Am Heart Assoc 2016;5:1–10. 10.1161/JAHA.116.003218 PubMed DOI PMC

Buteau S, Goldberg MS. A structured review of panel studies used to investigate associations between ambient air pollution and heart rate variability. Environ Res 2016;148:207–47. 10.1016/j.envres.2016.03.013 PubMed DOI

Qiao D, Pan J, Chen G, et al. . Long-term exposure to air pollution might increase prevalence of osteoporosis in Chinese rural population. Environ Res 2020;183:109264. 10.1016/j.envres.2020.109264 PubMed DOI

Taunton JE, Ryan MB, Clement DB, et al. . A prospective study of running injuries: the Vancouver Sun Run "In Training" clinics. Br J Sports Med 2003;37:239–44. 10.1136/bjsm.37.3.239 PubMed DOI PMC

Barrack MT, Fredericson M, Tenforde AS, et al. . Evidence of a cumulative effect for risk factors predicting low bone mass among male adolescent athletes. Br J Sports Med 2017;51:200–5. 10.1136/bjsports-2016-096698 PubMed DOI

Tenforde AS, Parziale AL, Popp KL, et al. . Low bone mineral density in male athletes is associated with bone stress injuries at anatomic sites with greater trabecular composition. Am J Sports Med 2018;46:30–6. 10.1177/0363546517730584 PubMed DOI

Riebe D. Guidelines for exercise testing and prescription (ACSM). 10 edn Philadelphia: Wolters Kluwer Health | Lippincott Williams & Wilkins, 2018.

Francová A, Chrastný V, Vítková M, et al. . Health risk assessment of metal(loid)s in soil and particulate matter from industrialized regions: A multidisciplinary approach. Environ Pollut 2020;260:114057. 10.1016/j.envpol.2020.114057 PubMed DOI

Modrá H, Ulmann V, Caha J, et al. . Socio-Economic and environmental factors related to spatial differences in human non-tuberculous mycobacterial diseases in the Czech Republic. Int J Environ Res Public Health 2019;16. 10.3390/ijerph16203969. [Epub ahead of print: 17 10 2019]. PubMed DOI PMC

Švecová V, Topinka J, Solanský I, et al. . Relation between personal exposure and outdoor concentrations of carcinogenic polycyclic aromatic hydrocarbons during smog episode. Cent Eur J Public Health 2019;27:305–11. 10.21101/cejph.a5475 PubMed DOI

Hůnová I. Ambient air quality in the Czech Republic: past and present. Atmosphere 2020;11:214 10.3390/atmos11020214 DOI

Skachová H, Vlasaková L. Air Pollution in the Czech Republic 2018. Czech Hydrometeorological Institute - Air Quality Division, 2018. Available: http://portal.chmi.cz/files/portal/docs/uoco/isko/grafroc/18groc/gr18cz/KO_rocenka_2018.pdf [Accessed 31 Mar 2020].

CHMI Czech Hydrometeorological Institute. Available: http://portal.chmi.cz/?l=en

Binder RK, Wonisch M, Corra U, et al. . Methodological approach to the first and second lactate threshold in incremental cardiopulmonary exercise testing. Eur J Cardiovasc Prev Rehabil 2008;15:726–34. 10.1097/HJR.0b013e328304fed4 PubMed DOI

Casey DE, Thomas RJ, Bhalla V, et al. . 2019 AHA/ACC clinical performance and quality measures for adults with high blood pressure: a report of the American College of Cardiology/American heart association Task force on performance measures. Circ Cardiovasc Qual Outcomes 2019;12:e000057. 10.1161/HCQ.0000000000000057 PubMed DOI PMC

Parati G, Stergiou GS, Asmar R, et al. . European Society of hypertension guidelines for blood pressure monitoring at home: a summary report of the second international consensus conference on home blood pressure monitoring. J Hypertens 2008;26:1505–26. 10.1097/HJH.0b013e328308da66 PubMed DOI

Graham BL, Steenbruggen I, Miller MR, et al. . Standardization of spirometry 2019 update. An official American thoracic Society and European respiratory Society technical statement. Am J Respir Crit Care Med 2019;200:e70–88. 10.1164/rccm.201908-1590ST PubMed DOI PMC

Wu S, Deng F, Hao Y, et al. . Fine particulate matter, temperature, and lung function in healthy adults: findings from the HVNR study. Chemosphere 2014;108:168–74. 10.1016/j.chemosphere.2014.01.032 PubMed DOI

Pan J, Tompkins WJ. A real-time QRS detection algorithm. IEEE Trans Biomed Eng 1985;32:230–6. 10.1109/TBME.1985.325532 PubMed DOI

Malik M, Bigger J, Camm A, et al. . Heart rate variability. standards of measurement, physiological interpretation, and clinical use. Task force of the European Society of cardiology and the North American Society of pacing and electrophysiology. Eur Heart J 1996. PubMed

Lipponen JA, Tarvainen MP. A robust algorithm for heart rate variability time series artefact correction using novel beat classification. J Med Eng Technol 2019;43:173–81. 10.1080/03091902.2019.1640306 PubMed DOI

Tarvainen MP, Ranta-Aho PO, Karjalainen PA. An advanced detrending method with application to HRV analysis. IEEE Trans Biomed Eng 2002;49:172–5. 10.1109/10.979357 PubMed DOI

World Health Organization Ambient (outdoor) air pollution. fact sheets, 2018. Available: https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health [Accessed 17 Feb 2020].

Beelen R, Raaschou-Nielsen O, Stafoggia M, et al. . Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre escape project. Lancet 2014;383:785–95. 10.1016/S0140-6736(13)62158-3 PubMed DOI

Di Q, Wang Y, Zanobetti A, et al. . Air pollution and mortality in the Medicare population. N Engl J Med 2017;376:2513–22. 10.1056/NEJMoa1702747 PubMed DOI PMC

Ehrman JK, Gordon PM, Visich PS, et al. . Clinical exercise physiology. Champaign: Human Kinetics, 2019.

Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015;25 Suppl 3:1–72. 10.1111/sms.12581 PubMed DOI

Pedersen BK, Saltin B. Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports 2006;16:3–63. 10.1111/j.1600-0838.2006.00520.x PubMed DOI

Kim Y, White T, Wijndaele K, et al. . The combination of cardiorespiratory fitness and muscle strength, and mortality risk. Eur J Epidemiol 2018;33:953–64. 10.1007/s10654-018-0384-x PubMed DOI PMC

Lee DAY, Rhee E-J, Cho JH, et al. . Appropriate amount of regular exercise is associated with a reduced mortality risk. Med Sci Sports Exerc 2018;50:2451–8. 10.1249/MSS.0000000000001734 PubMed DOI

Lee J. Associations between handgrip strength and disease-specific mortality including cancer, cardiovascular, and respiratory diseases in older adults: a meta-analysis. J Aging Phys Act 2020;28:320–31. 10.1123/japa.2018-0348 PubMed DOI

Thorpe KE, Joski P. Association of social service spending, environmental quality, and health behaviors on health outcomes. Popul Health Manag 2018;21:291–5. 10.1089/pop.2017.0136 PubMed DOI

Grabow ML, Spak SN, Holloway T, et al. . Air quality and exercise-related health benefits from reduced CAR travel in the midwestern United States. Environ Health Perspect 2012;120:68–76. 10.1289/ehp.1103440 PubMed DOI PMC

Running Distance and Biomechanical Risk Factors for Plantar Fasciitis: A 1-yr Prospective 4HAIE Cohort Study

Association between cardiac autonomic regulation, visceral adipose tissue, cardiorespiratory fitness and ambient air pollution: 4HAIE study (Program-4)

Comparison of bone mineral density of runners with inactive males: A cross-sectional 4HAIE study

Air pollution, cardiorespiratory fitness and biomarkers of oxidative status and inflammation in the 4HAIE study

Physical activity and menopausal symptoms: evaluating the contribution of obesity, fitness, and ambient air pollution status

The effect of regular running on body weight and fat tissue of individuals aged 18 to 65

Pattern of the heart rate performance curve in maximal graded treadmill running from 1100 healthy 18-65 Years old men and women: the 4HAIE study