21/01/2014 Sports and health issues in an urban environment Luc Int Panis. Is it smart to cycle in the city?

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1 21/01/2014 Sports and health issues in an urban environment Luc Int Panis Is it smart to cycle in the city?

2 21/01/2014 2

3 21/01/2014 3

4 There is a lot that we still don t know» PHYSICAL ACTIVITY THROUGH SUSTAINABLE TRANSPORT APPROACHES (We just call it PASTA)» New 7FP project » Focus on Active Mobility to promote Physical Activity» Objectives:» Health promotion» evaluate ongoing initiatives and interventions in cities to better understand effects on Physical Activity, injury risk and exposure to air pollution.» improved user-friendly HEAT tool for the WHO» apply HEAT to the case study cities & assess health and economic impacts of measures» compendium of good practices aimed at decision makers, implementing authorities, businesses, civil society organizations and end users. 21/01/2014 4

5 PASTA in Antwerp and London et al. 21/01/2014 5

6 There is no doubt that urban cycling is healthy 21/01/2014 6

7 But perhaps not always, everyware or for everyone? 21/01/2014 7

8 There are (three) health impacts for cyclists - Physical activity: - Accidents - Air pollution 21/01/2014 8

9 Health impact of: PHYSICAL ACTIVITY 21/01/2014 9

10 Physical activity» Good for respiratory and cardiovascular health Well known..but Goa et al AE in press Elevated cardiorespiratory fitness observed in physically activate children could be negated by increased amount of inhaled pollutants during exercise Cutrufello et al Sports Medicine healthy athletes. exercising in urban areas in close proximity to major roadways should consider ambient air pollution.prior to engaging in vigorous exercise» Good for memory, brain plasticity, cognition and mental health» Aerobic training improves cognitive and visuospatial memory» WHY?» mechanism for benefits of exercise remains to be elucidated.» Better blood transport to brain? (<> air pollution; Louwies et al EHP in prep)» exercise stimulates neurogenesis and synaptic plasticity» Even short bouts of exercise induce production and release of neurotrophines such as BDNF and SYN1 in blood and in the brain. (Brain Derived Neurotrophic Factor)» Our research hypothesis: Air pollution exposure cancels the neurological benefits of exercise 21/01/

11 Health impact of: ACCIDENTS 21/01/

12 The accident and injury risk of (urban) cycling is underestimated (Aertsen et al. (2010) Accident Analysis and Prevention) # Accidents per km cycled material damage only injuries limited to a bruise or cramp more serious injuries (ABI) Total /01/

13 The (health) cost of minor cycling accidents is underestimated minor accidents weight Avg. cost ( ) CI_low ( ) CI_high ( ) No injury 22.4% Light injury 47.5% Injury 25.7% LT-injury 4.4% % Minor accident risk is 155 per million kilometres (1 accident each 6500 km) Injury risk is 121 per million kilometres (1 injury each 8264 km) Average cost is 841 euro per accident (0.125 / km cycled) Total cost of minor cycling accidents (Belgium) is million / y 21/01/

14 Health impact of: AIR POLLUTION 21/01/

15 Concentrations: car vs bike - Bike > car - On same route!! 21/01/

16 Lower concentrations for cyclists on their self-chosen routes Urbanization Road type Instantaneous traffic intensity (veh h -1 ) Source: PhD by Evi Dons (Ng BC/m 3 ) 21/01/

17 Black Carbon exposure (ng/m³) Dose Exposure Black Carbon dose (ng/min) Higher doses for cyclists /01/ Source: PhD by Evi Dons

18 But does it have any health effects? Walking in Oxford street vs Hyde park 21/01/ McCreanor et al. New Engl J Med. 2007

19 Looking for health impacts in 21/01/

20 Cycling next to the Antwerp ring road 21/01/

21 Health-effects attributed to air pollution in Antwerp Differences in clinical endpoints per location Endpoint (next to) Antwerp ring Clean room Difference P-value Difference P-value Log Exhaled NO, ppb -2.9% (-3.0% to -2.7%) % (-3.1% to 3.5%) 0.63 Log PFA closure time, s ( to 0.060) ( to 0.048) 0.11 Log Il-6, pg/ml ( to 0.17) ( to 0.064) 0.71 Clara cell protein, µg/l 2.8% (-8.0% to 13.7%) % (-6.6% to 11.7%) 0.58 Leukocyte counts, per µl 1.3% (-2.0% to 4.6%) % (-1.1% to 6.1%) 0.19 Neutrophil counts, per µl 4.6% (0.51% to 13.1%) % (-2.3% to 7.2%) 0.33 Percentage neutrophils, % 3.9% (1.5% to 6.2%) % (-1.8% to 2.2%) 0.83 Subclinical responses in healthy cyclists briefly exposed to traffic-related air pollution: an intervention study Lotte Jacobs, Tim S Nawrot, Bas de Geus, Romain Meeusen, Bart Degraeuwe, Alfred Bernard, Muhammad Sughis, Benoit Nemery, Luc Int Panis Environmental Health :64 21/01/

22 Neurological effects? 21/01/

23 Brain Derived Neurotrophic Factor 21/01/

24 Sports in the city Our Start to Run experiment» Effects of aerobic training in urban and rural area» Inactive/sedentary volunteers» 12 week Start-2-Run (S2R)» 3 sessions/week» UFP- contrast» S2R in city (Brussels; n=21)» S2R in rural area (Mol; n=13)» Biological effects before & after S2R 21/01/

25 Biological effects studied» Cognitive tests» Exhaled NO» Blood tests» Leucocytes» Serum BDNF» Gene expression 21/01/

26 Difference in white blood cells S2R affects urban (but not rural) runners Normalized UFP accumulation Bos I., Vanparijs J., De Boever P., Pattyn N., Int Panis L., Meeusen R. Urban air pollution exposure during aerobic training: effects on inflammatory markers and cognition. Medicine & Science in Sports & Exercise, 45(3), doi: /MSS.0b013e fc 21/01/

27 Tentative advice to urban policy makers» Increase physical activity levels» Take risks into account when planning cities for active urban citizens» Reduce accidents risks» Reduce motorized traffic» Separating motorized and active traffic» Infrastructure» Estimate the health ( ) benefits with WHO-HEAT» Improve air quality» Reduce motorized traffic» Reduce polluting vehicles, 2-stroke motorbikes» Low-emission zone Einstein in Antwerp. But not cycling 21/01/

28 Points of discussion» Urban cycling / sports is associated with both + and health effects» Active mobility is a good way to increase physical activity levels in cities» Urban Cyclists are healthier and live longer than non-cyclists» The (cardiovascular) benefits of physical activity far outweigh the health risks» The accident risk is the major health risk to tackle (in cities)» Traffic related air pollution affects the health of urban cyclists» Cyclists are exposed to lower concentrations but higher doses» Higher exposure is associated with small physiological effects 21/01/

29 What will PASTA do in Antwerp?» A large longitudinal study (self-reported):» approx subjects» General participants / stratified» Affected by the local measure» in each of seven case study cities (FYI in total)» focussing on» travel patterns» AM» PA behaviour» Injury risk» Add-on modules complement the core module with objective data and on additional health relevant correlates (AQ). 21/01/

30 Accident risk model (SHAPES) 21/01/

31 21/01/

32 The (health) cost of minor cycling accidents is underestimated Type of injury Acute Body Injuries Light injuries No injuries & consequences Cost category Long term Short term Direct Costs Medical costs Non medical costs Indirect costs Productivity loss Leisure time loss Intangible costs Other costs Permanent invalidity WTP to avoid pain WTP to avoid psych. conseq. Costs for 3 rd parties TOTAL /01/

33 Blootstelling langsheen de ring versus clean room 21/01/

34 UFP Dose - effect response for inflammation 21/01/

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