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Background <p>This study assessed whether higher levels of fine particulate matter (PM<sub>2.5</sub>) reduce the protective effects of leisure-time physical activity (LTPA) on all-cause, cardiovascular, and cancer mortality, and explored the PM<sub>2.5</sub> threshold beyond which attenuation occurs.</p> Methods <p>We conducted two complementary investigations. First, a systematic review and meta-analysis (per PRISMA guidelines) identified eligible cohort studies from PubMed, Web of Science, Embase, and SPORTDiscus (from inception to 6 January 2025) that examined the independent or joint associations of LTPA and PM₂.₅ with mortality among adults (≥ 18&#xa0;years). Second, an individual-level pooled analysis using harmonized data from three cohorts was performed using Cox regression modeling to assess the associations observed in the meta-analysis.</p> Results <p>In Study One, a total of seven cohort studies (<i>n</i> = 1,515,094; deaths = 115,196) were included in the meta-analysis, revealing that the reduction in all-cause mortality risk diminished with higher PM<sub>2.5</sub> exposure. Meeting the recommended LTPA level (7.5–15 MET-h/week) reduced all-cause mortality risk by approximately 30% at PM<sub>2.5</sub> &lt; 25&#xa0;μg/m<sup>3</sup> but only 12–15% at 25 + μg/m<sup>3</sup>. Study Two (three cohorts; <i>n</i> = 869,038; deaths = 45,080) confirmed this pattern. Individuals meeting the recommended LTPA level (7.5–15 MET-h/week) had a lower risk of all-cause mortality compared to those in the highest-risk group (reference: &lt; 1 MET-h/week and PM<sub>2.5</sub>: 35–50&#xa0;μg/m<sup>3</sup>). Hazard ratios (HRs) varied by PM<sub>2.5</sub> exposure, with lower HRs indicating a greater protective effect: 35–50&#xa0;μg/m<sup>3</sup> (HR = 0.75, 95% CI: 0.61–0.93), 25–35&#xa0;μg/m<sup>3</sup> (HR = 0.67, 95% CI: 0.57–0.79), 15–25&#xa0;μg/m<sup>3</sup> (HR = 0.34, 95% CI: 0.29–0.39), 10–15&#xa0;μg/m<sup>3</sup> (HR = 0.34, 95% CI: 0.28–0.41), and &lt; 10&#xa0;μg/m<sup>3</sup> (HR = 0.30, 95% CI: 0.25–0.37). Higher levels of LTPA were generally associated with lower all-cause and cause-specific mortality across most PM₂.₅ exposure categories, but the protective effects were attenuated at PM₂.₅ levels 25 + μg/m<sup>3</sup> for all outcomes and became non-significant for cancer mortality at 35–50&#xa0;μg/m<sup>3</sup>.</p> Conclusions <p>LTPA is beneficial for all-cause, cardiovascular, and cancer mortality even at relatively high PM<sub>2.5</sub> levels, with greater benefits observed under cleaner air conditions. However, its protective effects are attenuated at 25 + μg/m<sup>3</sup> for all outcomes and become less evident at 35–50&#xa0;μg/m<sup>3</sup>, particularly for cancer mortality.</p> PROSPERO Registration Number <p>CRD42023395364.</p>

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Does ambient PM2.5 reduce the protective association of leisure-time physical activity with mortality? A systematic review, meta-analysis, and individual-level pooled analysis of cohort studies involving 1.5 million adults

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  • 发表日期：

    2025年11月28日

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  • Po-Wen Ku,
  • Andrew Steptoe,
  • Mark Hamer,
  • Paola Zaninotto,
  • Emmanuel Stamatakis,
  • Ching-Heng Lin,
  • Bin Yu,
  • Ulla Arthur Hvidtfeldt,
  • Xiang Qian Lao,
  • Hsien-Ho Lin,
  • Wei-Cheng Lo,
  • Ole Raaschou-Nielsen,
  • Shengzhi Sun,
  • Linwei Tian,
  • Su-Fen Wang,
  • Yiqian Zeng,
  • Yunquan Zhang,
  • Shang-Ti Chen,
  • Chien-Fong Huang,
  • Yang Xia,
  • Li-Jung Chen

摘要

Background

This study assessed whether higher levels of fine particulate matter (PM2.5) reduce the protective effects of leisure-time physical activity (LTPA) on all-cause, cardiovascular, and cancer mortality, and explored the PM2.5 threshold beyond which attenuation occurs.

Methods

We conducted two complementary investigations. First, a systematic review and meta-analysis (per PRISMA guidelines) identified eligible cohort studies from PubMed, Web of Science, Embase, and SPORTDiscus (from inception to 6 January 2025) that examined the independent or joint associations of LTPA and PM₂.₅ with mortality among adults (≥ 18 years). Second, an individual-level pooled analysis using harmonized data from three cohorts was performed using Cox regression modeling to assess the associations observed in the meta-analysis.

Results

In Study One, a total of seven cohort studies (n = 1,515,094; deaths = 115,196) were included in the meta-analysis, revealing that the reduction in all-cause mortality risk diminished with higher PM2.5 exposure. Meeting the recommended LTPA level (7.5–15 MET-h/week) reduced all-cause mortality risk by approximately 30% at PM2.5 < 25 μg/m3 but only 12–15% at 25 + μg/m3. Study Two (three cohorts; n = 869,038; deaths = 45,080) confirmed this pattern. Individuals meeting the recommended LTPA level (7.5–15 MET-h/week) had a lower risk of all-cause mortality compared to those in the highest-risk group (reference: < 1 MET-h/week and PM2.5: 35–50 μg/m3). Hazard ratios (HRs) varied by PM2.5 exposure, with lower HRs indicating a greater protective effect: 35–50 μg/m3 (HR = 0.75, 95% CI: 0.61–0.93), 25–35 μg/m3 (HR = 0.67, 95% CI: 0.57–0.79), 15–25 μg/m3 (HR = 0.34, 95% CI: 0.29–0.39), 10–15 μg/m3 (HR = 0.34, 95% CI: 0.28–0.41), and < 10 μg/m3 (HR = 0.30, 95% CI: 0.25–0.37). Higher levels of LTPA were generally associated with lower all-cause and cause-specific mortality across most PM₂.₅ exposure categories, but the protective effects were attenuated at PM₂.₅ levels 25 + μg/m3 for all outcomes and became non-significant for cancer mortality at 35–50 μg/m3.

Conclusions

LTPA is beneficial for all-cause, cardiovascular, and cancer mortality even at relatively high PM2.5 levels, with greater benefits observed under cleaner air conditions. However, its protective effects are attenuated at 25 + μg/m3 for all outcomes and become less evident at 35–50 μg/m3, particularly for cancer mortality.

PROSPERO Registration Number

CRD42023395364.