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. 2025 Aug 22;23(1):491.
doi: 10.1186/s12916-025-04338-x.

Physical activity, air pollution, and incident long-term conditions: a prospective cohort study

Minshan Huang  1 , Jonathan R Olsen  1   2 , Stewart G Trost  3 , Carlos Celis-Morales  4   5   6 , Jill P Pell  1 , Frederick K Ho  7
Affiliations

Physical activity, air pollution, and incident long-term conditions: a prospective cohort study

Minshan Huang et al. BMC Med. .

Abstract

Background: Physical activity (PA) is consistently associated with lower risk of long-term conditions. Preliminary evidence suggested the associations could be modified by air pollution. This study aims to examine whether air pollution levels modify the associations of PA with all-cause mortality and incident cancer, major adverse cardiovascular events (MACE), type 2 diabetes, and chronic obstructive pulmonary disease (COPD).

Methods: A total of 414,644 UK Biobank participants were included in the analyses. PA was self-reported and objectively measured using accelerometers. PA was self-reported with IPAQ and objectively measured using accelerometers. Annual PM2.5, PM10, and NO air pollutant concentrations in 2010 were measured using a European land use regression model. Cox proportional hazard models were used to examine the associations of PA and air pollution with health outcomes. Multiplicative and additive interactions were estimated.

Results: During the study period from 2006 to 2022, 31,765 (7.7%) died, 70,299 (17.0%) had incident cancer, 25,130 (8.5%) had type 2 diabetes, 33,284 (8.0%) had MACE, and 18,844 (4.5%) had COPD. Lower PA was associated with higher risk of all health outcomes. Higher concentration of PM2.5 was associated with all outcomes except for cancer. The associations of self-reported PA with mortality and cancer were stronger in areas with higher air pollution with significant additive and multiplicative interactions. There was no evidence of moderation for objectively measured PA.

Conclusions: In the UK, air pollution should not be a factor inhibiting the promotion of PA.

Keywords: Air pollution; Interaction; Physical activity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: UK Biobank received ethical approval by North West Multi-centre Research Ethics Committee (21/NW/0157). Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research. All participants provided written consent to this study. Consent for publication: No individual person’s data. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Association of air pollution level with health outcomes
Fig. 2
Fig. 2
Association of physical activity level and health outcomes
Fig. 3
Fig. 3
Additive interaction of lower self-reported physical activity and air pollution with health outcomes
Fig. 4
Fig. 4
Additive interaction of lower accelerometer-measured physical activity and air pollution with health outcomes
See this image and copyright information in PMC

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