Is your diabetes related to air pollution?

We’ve all heard that air pollution is bad for our health. But most people, myself included, assume that we are talking about respiratory health i.e. asthma or emphysema. The truth is, air pollution can be detrimental to cardiovascular and metabolic health too. In fact, a growing amount of research is finding that there may be an association between air pollution and type 2 diabetes.

Type 2 diabetes is on the rise in western countries and is slowly becoming one of the greatest health concerns worldwide. It is primarily a result of poor lifestyle and is considered a preventable disease. However, there are some risk factors (such as genetics and age) that are not in our control. A recent study published in Diabetes Care (Andersen et al. 2012) and conducted by a group of scientists in Denmark found that air pollution may be another one of those factors. The authors used data from the Danish Diet, Cancer and Health database and from national health registries to determine whether traffic-related air pollution levels and the risk for diabetes in the elderly are related. They found a weak and positive association between diabetes and air pollution. This means that higher levels of air pollution were associated with a higher risk of diabetes, particularly among those who were non-smokers or who were physically active. While the association in this study was weak, there is other evidence to suggest that this association indeed exists. For example, a recent study found that traffic-related air pollution is associated with death from diabetes (Raaschou-Nielsen O et al. Diabetologia 2012), while others have found that those with diabetes have worse outcomes when exposed to higher levels of air pollution (O’Neill et al. Circulation 2005).

It seems then that air pollution may be another risk factor for type 2 diabetes. The question is, is it a risk factor we can control or a risk factor that is out of our control?  Well, I would like to think it is one we can control, not just at the individual level, but one that our governments can do a great deal about as well. If air pollution is leading to an increase in the prevalence of chronic conditions, then it is a public health issue. The government should opt for clean and green energy solutions and make green choices more affordable for the general population. This could lead to significant savings in health care expenditure as well as a significant improvement in our quality of life.

TAKE HOME MESSAGE: Type 2 diabetes is preventable and in some cases, reversible; particularly if you have a HALF. However, there are some factors that may be out of our our control and require action from our government. If you live in an area with high levels of air pollution, write to your local officials and let them know that your health is on the line! While we can all do our part at being green, we need significant changes in air pollution levels to ensure we can all maintain our HALF!


What determines whether a person becomes an exerciser?

You often hear people say they don’t have time or they don’t have access to the appropriate facilities to start an exercise program. Yet, there are many people who are regularly active despite such barriers. So, what allows one person to overcome such barriers while another cannot? The answer is simple yet quite complex. The fact of the matter is, research has identified hundreds of factors that influence regular physical activity.

So the real question then becomes, which of these identified factors truly matters? Which ones are important when trying to make a lifestyle change and trying to engage in regular physical activity? A recent review entitled “Correlates of physical activity: why are some people physically active and others not?” published in the highly reputable journal The Lancet (link) set out to answer these questions. The authors undertook a massive task and reviewed hundreds of articles to determine which correlates/determinants of physical activity show the strongest association with physical activity among children/adolescents and adults. They identified 5 main areas of determinants: demographical, psychological/cognitive, behavioural, social and environmental. Among children/adolescents biological sex (male), ethnic origin (white), self-efficacy (confidence to exercise), family support, perceived behavioural control (whether one thinks they can be active) and environmental  variables such as walkability, traffic speed, access to recreation facilities were all strong determinants of physical activity. For adults health status (i.e. whether one has a chronic disease/limitation or not) and self-efficacy were the strongest determinants of physical activity. Others included personal history of physical activity, intention to exercise and environmental factors such as transportation environment (safety of crossing, side-walks etc), neighbourhood aesthetics (eg. greenery) and access to recreational facilities. The authors also looked at determinants specifically among low-middle income countries and noted that demographic variables such as biological sex, age and socioeconomic status were the strongest determinants. Further, cultural differences in the value of physical activity and social support were noted as being important. Finally, the authors pointed out that genetics MAY play a role in determining whether one is active or not because of the enjoyment or pleasure that physical activity brings for some versus the pain and exertion it brings to others.

It seems then that those who are regular exercisers have the right combination of factors in place. But, the real question is, what can we do for those who do not? Or what can those who do not have the right combination of factors do for themselves? First, as the authors suggest, this data can inform new policies that help overcome barriers. For example, governments can invest in creation of cycling lanes or work to improve neighbourhood sidewalks. Second, individuals who have many barriers but are interested in becoming active can seek out social support to assist them with overcoming the barriers. For example, they can find groups in their geographical area that are interested in similar activities through social media outlets or local facilities. Finally, it is important to find the right type of physical activity/exercise i.e. the type that brings you pleasure. Enjoyment is a great predictor of whether one maintains an active lifestyle, so be sure to search for the right activity/activities, and you’ll be sure to stick with your new HALF!

TAKE HOME MESSAGE: This article was meant to inform people in the field of health promotion and policy development on what can be done to increase physical activity levels among the global population. But we can all learn a little from it. If you work with or have children/adolescents, it seems working on self-efficacy and providing family support will help greatly with their HALF. If you are an adult who hasn’t quite made the habit, or know of someone who needs to create their HALF, then motivate them to become active regardless of their health status and help them boost their self-confidence. Some of the strongest determinants of a HALF are belief in ones’ ability that they can do it. So get out there and tell everyone you know that they can do it, there is no barrier that can’t be overcome when you truly believe in a HALF!