Regular Walking Benefits People with COPD, Even in Areas with Higher Air Pollution
A study published in 'ERJ Open Research' finds that each 1,000 daily steps was associated with around a 5% lower likelihood of flare-ups
The research involved 262 people with COPD from five European countries
Regular walking was associated with fewer symptom flare-ups among people with chronic obstructive pulmonary disease (COPD), even in areas with poor air quality, according to a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation and published in ERJ Open Research.
COPD is a common, long-term lung condition. Although it cannot be cured, a large body of research shows that regular physical activity, such as walking, can help manage symptoms including coughing, wheezing and shortness of breath.
It has been unclear whether walking should be recommended to people with COPD who live in areas with high levels of air pollution. The new research suggests that walking is beneficial regardless of air quality.
“In people who already have COPD, walking in a traffic-polluted area may increase daily respiratory symptoms. However, until now, no research has examined whether physical activity performed in polluted settings could have harmful effects over the longer term,” said Judith Garcia-Aymerich, senior author of the study and deputy director at ISGlobal.
“The purpose of this research was to answer a simple question that health professionals face every day: can we recommend physical activity to people with COPD who live in polluted environments?” she added.
262 people with COPD from five European countries
To answer this question, the researchers studied 262 people with COPD from five European countries: the UK, Spain, Belgium, Switzerland and Greece. All participants wore a movement sensor for seven days to monitor how many steps they took, how long they walked and how fast they walked.
The researchers also estimated air pollution levels at the participants’ home addresses during the previous two years. The pollutants assessed were fine particulate matter (PM₂.₅), black carbon, nitrogen dioxide (NO₂) and ozone (O₃).
Finally, they asked participants to keep a diary of flare-ups and reviewed their medical records over two years to identify moderate or severe flare-ups, known as COPD exacerbations.
Each 1,000 daily steps associated with a 5% lower likelihood of flare-ups
The researchers found that regular walking was associated with fewer flare-ups, regardless of air pollution levels at the participants’ home addresses. Each 1,000 daily steps was associated with around a 5% lower likelihood of flare-ups. Walking regularly at a faster pace—above the participants’ average speed of one metre per second—was associated with greater benefits.
“We found no differences according to COPD severity. Our study included air pollution concentrations above World Health Organization guidelines. However, our findings may not apply to areas with extremely high levels of air pollution,” said Alícia Josa-Culleré, an ISGlobal researcher and first author of the study.
“The take-home message from our study is not that we should stop worrying about air pollution. Exposure to air pollution has been linked to multiple health outcomes, and reducing exposure should still be recommended. Our findings suggest that walking is still better than being regularly inactive, even for people living in relatively polluted areas. Whenever possible, however, people should try to walk in areas with lower pollution,” she added.
A study with a modest sample conducted in Western Europe
The researchers acknowledge that the study was modest in size, which may have limited its ability to detect small differences in the relationship between physical activity, air pollution and COPD exacerbations. They plan to conduct a similar study with more participants, including people living in areas with very high pollution levels.
Marc Miravitlles, President of the European Respiratory Society and a senior researcher and consultant at Vall d’Hebron University Hospital, who was not involved in the research, said: “We know that walking and being active can really help people with COPD. We also know that breathing polluted air is bad for our lungs and can be especially damaging for people living with long-term lung conditions such as COPD.
“This study can give people living with COPD some reassurance, as it suggests that walking is still beneficial, whether they live in the countryside or in the centre of a city. However, the study examined different pollution levels in Western European countries, while levels can be much higher in other parts of the world. We still need more research involving patients living in those areas.”
Reference
Alícia Josa-Culleré, Sarah Koch, Heleen Demeyer, Thierry Troosters, Nicholas S. Hopkinson, Ioannis Vogiatzis, Anja Frei, Elena Gimeno-Santos, Victoria Alcaraz-Serrano, Joren Buekers, Laura Delgado-Ortiz, Paula Álvarez, Marta Cirach, Antònia Valentín, Ignasi Garcia-Olivé, Diego A. Rodriguez-Chiaradia, Walter Maetzler, Clint Hansen, Carl-Philipp Jansen, Lynn Rochester, Silvia Del Din, Andrea Cereatti, Brian Caulfield, David Singleton, Alison Yarnall, Heiko Gassner and Judith Garcia-Aymerich. Interaction of walking activity and long-term air pollution on exacerbation rate in COPD. ERJ Open Research 2026; 00813-2026. DOI: https://doi.org/10.1183/23120541.00813-2026
