Walking May Help Reduce COPD Flare-Ups, Even in Areas With Air Pollution

Regular walking is often recommended for people with chronic obstructive pulmonary disease (COPD), but doctors have had a lingering question: Is it still a good idea if a patient lives somewhere with poor air quality? Walking increases how much air a person breathes in, which could also increase how much pollution reaches the lungs.

A study published in ERJ Open Research offers some reassurance. Researchers found that people with COPD who walked more had fewer flare-ups, and that air pollution levels near their homes didn’t reduce that benefit.

“The purpose of this research was to find an answer to a very simple question that health professionals face every day: Can we recommend physical activity in people with COPD living in polluted environments?” said Judith Garcia-Aymerich, a professor at the Barcelona Institute for Global Health (ISGlobal) in Spain, who co-led the study.

Tracking steps, pollution and flare-ups

The study included 262 people with COPD in the United Kingdom, Spain, Belgium, Switzerland and Greece. Participants were 69 years old on average, and about one-third were women.

Each person wore a movement sensor on their lower back for seven days to measure how many steps they took, how long they walked and how fast. Researchers then estimated air pollution levels at each participant’s home over the previous two years, including fine particulate matter, black carbon, nitrogen dioxide and ozone.

Over the next two years, participants tracked flare-ups, also known as exacerbations, in a diary, and researchers cross-checked them against medical records. During that time, 62% of participants had at least one moderate or severe flare-up.

More steps, fewer flare-ups

Each additional 1,000 steps per day was associated with about a 5% lower rate of flare-ups. That link held regardless of pollution levels at participants’ homes, and it was similar across smokers and former smokers and across different levels of COPD severity.

Walking speed on its own wasn’t linked to fewer flare-ups. However, the researchers saw a possible pattern suggesting that the benefit of more steps may be greater in people who regularly walk faster. Because this finding was less certain, the authors recommend focusing on the amount of walking rather than the pace.

Air pollution still matters

The researchers stressed that the findings don’t mean people with COPD can ignore air quality.

“Reducing exposure to air pollution should still be recommended,” said Alícia Josa-Culleré, a researcher at ISGlobal and co-leader of the study. “And of course, it’s better if people try to walk in low-pollution areas whenever possible.”

Pollution levels in the study often exceeded World Health Organization guidelines but were typical of Central and Western Europe. The results may not apply to areas with much higher pollution.

The study also had limitations. It was observational, so it shows an association rather than proving that walking prevents flare-ups. Walking was measured over only one week, and researchers didn’t know where participants usually walked.

Marc Miravitlles, M.D., president of the European Respiratory Society, who was not involved in the study, said the results may offer some reassurance to people with COPD, whether they live in the countryside or a city. Still, he noted that more research is needed in parts of the world with higher pollution levels.

If you have COPD, talk with your health care provider about a walking plan that fits your health and abilities.