23 JPJO 7 (1) (2022) 23-28 Jurnal Pendidikan Jasmani dan Olahraga Available online at: https://ejournal.upi.edu/index.php/penjas/article/view/45037 DOI: https://doi.org/10.17509/jpjo.v7i1.45037 The Effect of Performing Exercise in Air Polluted Environments on Blood Pressure Response Samsul Bahri*, Yudhi Teguh Pambudi, Imam Safei, Dadan Resmana, Ilham Hindawan Sport Science, School of Pharmacy, Bandung Institute of Technology, Bandung, Indonesia Article Info Article History : Received February 2022 Revised March 2022 Accepted March 2022 Available online April 2022 Keywords : Air Pollution, Blood Pressure, Exercise, PM2.5 Abstract Exercise has a positive impact on a person's health and fitness level. However, the ben- efits could be obtained if the exercise is conducted properly by avoiding the risk in- volved. One of the risks during exercise, especially for those in urban communities, is the difficulty in avoiding air pollution. Air pollution, especially particles with a size less than 2.5 microns (PM2.5), can be inhaled into the lungs and enter the bloodstream. The amount of air pollution inhaled will increase in the people doing exercise because the rate of breathing increases along with the increasing intensity and duration of the exercise. This may impact the blood pressure response due to the presence of foreign particles in the bloodstream. This study used a quasi-experimental method with a post- test-only comparison group approach. The research was conducted in Karawang Re- gency, West Java, Indonesia, and included two sites, a higher PM2.5 Concentration site, and a lower PM2.5 Concentration site. The research subjects included 22 under- graduate students with a healthy status divided into two research groups. Each group performed exercise, including 5 minutes of warm-up and 15 minutes of running at sub- maximal intensity (80–85% of HR Max) at 07.00 for five days consecutively. Blood pressure response measurements were taken immediately after exercise. This study aimed to determine the effect of regular exercise in high and low air pollution condi- tions (PM2.5) on the blood pressure response. The study found that regular exercise for five days in an environment with high air pollution resulted in higher systolic and dias- tolic arterial pressures than a regular exercise in low air pollution conditions. Thus, performing exercise in high PM2.5 air pollution conditions affects the blood pressure response. For this reason, vulnerable groups should pay attention to air pollution levels when doing exercise. Correspondence Address : Jl. Ganesha No. 10, Bandung, Indonesia E-mail : samsul@fa.itb.ac.id https://ejournal.upi.edu/index.php/penjas/index 24 INTRODUCTION Physical activity or exercising regularly can posi- tively impact increasing the level of health and fitness (Bahri et al., 2020; Brusseau et al., 2016; Ward et al., 2017). In addition, exercise can also reduce the risks of death, such as from hypertension or obesity (Galleguillos et al., 2014; Leonardo Alves Pasqua et al., 2018). Therefore, exercising regularly is recommended. The American College of Sports Medicine recommends that every person perform an exercise for at least 30 min at moderate intensity (65% of maximum pulse) two to five days a week (Riebe et al., 2015). In addition, a positive impact can be obtained if it is done correctly and avoids the risks involved (Vancini et al., 2019). When doing exercises, they should be started by warm- ing up and avoiding movements that can cause injury. In addition, environmental conditions are a concern (Racinais et al., 2017). One environmental condition that increases the risks during exercise is air pollution (Watanabe et al., 2019). Bad air pollution conditions are challenging to avoid, especially in urban communi- ties or near industrial areas. One air pollution type is fine particles with a di- ameter of less than 2.5 microns (PM2.5). PM2.5 is a mixture of solid and liquid particles suspended in the air, mostly from burning fossil fuels made from the pro- cess of heating, generating electricity, or operating mo- torized vehicles (Miao et al., 2019). PM2.5 can be in- haled into the alveoli in the lungs and enter the blood- stream, causing health problems (Giles & Koehle, 2014). Therefore, PM2.5 is a type of pollution that is currently of concern to several researchers, especially in the field of sports physiology. The amount of air pollu- tion inhaled will increase in people who do exercise because the rate of breathing increases with increasing intensity and duration of exercise (Filomena Mazzeo & Alessandro Liccardo, 2019; Giles & Koehle, 2014). This may impact the blood pressure response due to the presence of foreign particles in the bloodstream. Poor air pollution conditions can be found in sev- eral cities and occupied residential areas in Indonesia. The dominant use of energy in Indonesia is still envi- ronmentally unfriendly energy. Based on the 2019 Na- tional Energy Balance, 45% of energy use is in the transportation sector. In total, 99% of transportation uses fossil fuels. In addition, 58% of electricity genera- tion comes from burning coal (Suharyati et al., 2019). The high demand and use of conventional energy have made several cities, especially industrial cities, a source of air pollution (Haryanto, 2018; Ji et al., 2018). The areas close to air pollution sources will have worse air pollution conditions than other areas far from air pollu- tion sources (Calderón-Garcidueñas & Villarreal-Ríos, 2017). This phenomenon can be found in the occupied residential areas of West Karawang District, West Java, Indonesia, and this area is the capital of the Regency and close to the Karawang International Industrial Cen- ter. Another area that is far from urban and industrial centres is Rengasdengklok District, West Java, Indone- sia. Theoretically, these two regions should have differ- ent levels of air pollution due to differences in their dis- tances from air pollution sources. The contradiction between the need for regular exercise and PM2.5 exposure presents an interesting challenge to balance the benefits and disadvantages, especially in areas affected by air pollution. Should ex- ercise be limited or should it not be done in bad air pol- lution conditions? This has been debated in recent years. Researchers have been interested in studying the conditions of air pollution, especially in West Kara- wang and Rengasdengklok Districts. Are the air pollu- tion conditions in these two regions significantly differ- ent due to the distance from air pollution sources? What are the impacts of different air pollution conditions, especially on the blood pressure response of individuals who routinely exercise in the area? This research can also be used as a basis for how the air pollution condi- tions in these two different regions affect human physi- ology, thus resulting in further research in other areas. METHODS Participants The participants included 22 undergraduate stu- dents. The study inclusion criteria were healthy with the age of 19-22 years and had a normal body mass index. The study exclusion criteria were those with a history of chronic disease, suffered from cardiovascular dis- ease, cardiorespiratory, including being infected with SARS-CoV-2, smoking, consuming alcohol, supple- ments, or drugs. All participants received direct expla- nations from the researcher verbally and in written form about the study's objectives, procedures, and risks. Par- ticipants were directed to sign the informed consent if Copyright © 2022, authors, e-ISSN : 2580-071X , p-ISSN : 2085-6180 Samsul Bahri et al., / Jurnal Pendidikan Jasmani dan Olahraga 7 (1) (2022) 25 they were willing to participate in this study. Materials and Apparatus The researchers used AirVisual Pro (IQAir, Swit- zerland), which was placed at an altitude of 1.6 m above the ground level of the study area, to measure the amount of PM2.5 air pollution and additional data in the form of CO2 levels, temperature, and relative hu- midity at the time of the study. The AirVisual Pro de- vice was connected to the internet when retrieving data. Bodyweight was measured using an Omron HBF-375 (Omron, Japan) and height using a Metrisis Stadiometer (Solo Abadi, Indonesia). Blood pressure was measured using an Automatic Blood Pressure Monitor EM-7322 (Omron, Japan). Heart rate during exercise was moni- tored by Polar H10 (Polar Electro Oy, Finland). Procedure This study used a quasi-experimental method with a post-test-only comparison group approach. The re- search location is in Karawang Regency, West Java. It consisted of two sites, i.e., the Singaperbangsa Stadium and the Cinta Lake Area, Rengasdengklok. Before the training session, the participants filled out a form related to the age formulas based on their identity cards. Body mass index was calculated by weight in kilograms divided by height squared in me- ters. The participants were divided equally into two groups based on the anthropometry data obtained. The two groups of participants each occupied one of the two research sites. The participants did the exercise with 5 min of warm-up and 15 min of submaximal intensity running (80–85% HR Max) at 07.00 am for five con- secutive days at each site. Researchers monitor and en- sure the heart rate is suitable during exercise. Blood pressure measurements were taken 10 min before exer- cise to determine the baseline blood pressure and imme- diately after training in each training session to deter- mine the blood pressure response. During the measure- ment, participants rested in a seated position, their right arm was placed on the table parallel with the heart, and they did not talk during the measurement. During the study, the participants were asked to avoid places with high air pollution except for the study site, not to per- form other heavy physical activity rather than the treat- ment given by the researchers, not to consume alcohol, supplements, or drugs, and to report their health condi- tions to the researchers. Data Analysis The results are displayed in the form of means and standard deviations. The significant analysis involved an independent sample t-test. The level of significance was set at p < 0.05. Statistical analysis of this study was done using statistical software SPSS version 23 (IBM, USA). RESULT Table 1 shows that the means ± standard devia- tions (SD) for age, height, weight, and body mass index shows a significant difference in terms of SD. Table 2 shows that the amount of air pollution with the type of PM2.5 at the Singaperbangsa Stadium site was greater Copyright © 2022, authors, e-ISSN : 2580-071X , p-ISSN : 2085-6180 Pollutant Singaperbangsa Stadium Cinta Lake PM2.5 (μg/m 3 ) 117.90* 52.19* CO2 (ppm) 501.15* 465.73* Temperature (°C) 27.37 27.72 Relative Humidity (%) 76.19 76.98 Altitude (masl) 17.8 9.4 Variable Singaperbangsa Stadium (N=11) Cinta Lake (N=11) Mean ± SD Min Max Mean ± SD Min Max Age (year) 20.45 ± 0.49 19.60 21.20 20.65 ± 0.56 19.80 21.50 Weight (kg) 60.09 ± 4.87 53.00 69.00 59.09 ± 3.14 54.00 63.00 Height (m) 1.68 ± 0.03 1.63 1.73 1.68 ± 0.03 1.64 1.73 BMI (kg/m 2 ) 21.29 ± 1.17 19.49 23.05 21.02 ± 0.88 19.13 21.97 Table 1. Anthropometry Data Table 2. Air Pollution Concentrations of the Two Sites *mean difference significant at p < 0.05 PM2.5: Particulate Matter 2.5 (particulate with diameter <2.5); CO2: Carbon Dioxide Samsul Bahri et al., / Jurnal Pendidikan Jasmani dan Olahraga 7 (1) (2022) 26 when compared to the Cinta Lake site, while other pa- rameters, such as CO2, temperature, relative humidity, and altitude, did not differ significantly. At baseline, there were no significant differences for the systolic (Singaperbangsa Stadium=117.5 ± 3.5 mmHg, Cinta Lake: 116.8 ± 3.5 mmHg; P=0.17) and diastolic (Singaperbangsa Stadium=77.4 ± 0.3 mmHg, Cinta Lake=76.6 ± 0.3 mmHg; P=0.87) blood pres- sures. There was an increase in systolic and diastolic arterial pressure at the Singaperbangsa Stadium and Cinta Lake sites. These changes in systolic and diastolic arterial pressures were significantly different between the two experimental conditions (P<0.05). Figure 1 dis- plays the daily blood pressure delta in the arteries as measured immediately at the end of the exercise. Data are shown as the delta mean ± standard deviation. DISCUSSION There was no significant difference between the two groups of participants in terms of age, weight, height, and body mass index. However, at the two re- search sites, there were significant differences in the concentrations of PM2.5 and CO2. This difference was in the form of a higher concentration at the Singapore Stadium. This was because the Singapore Stadium is relatively closer to several industrial areas, which are sources of air pollution. There were no significant dif- ferences for other parameters such as temperature, hu- midity, and altitude at the two research sites. Our research shows that regular exercise for five days in an environment with higher air pollution result- ed in higher systolic and diastolic arterial pressure than in the lower air pollution conditions. In addition, there was a significant change in the blood pressure response to the two air pollution conditions for each of the five days. However, the results of the blood pressure re- sponse tended to be stable. The results of this study in- dicate a better arterial pressure response while doing physical activity or exercising in areas under lower air pollution conditions. The results of this study are rele- vant to previous studies that showed that air pollution affects an increase in blood pressure during polluted conditions (Dong et al., 2013; Giorgini et al., 2016; Le- onardo A. Pasqua et al., 2020; Zeng et al., 2017). These findings suggest that doing physical activity or exercising in a high PM2.5 air pollution condition affects the blood pressure response, although individu- als with a healthy status are less affected. The negative effect caused by air pollution, especially PM2.5, in oc- cupied residential areas, should not be neglected. It should be expected because exercising can increase the air ventilation rate, which can cause air pollution to be inhaled into the alveoli in the lungs and enter the blood- stream (Marmett et al., 2020; Leonardo A. Pasqua et al., 2020; Leonardo Alves Pasqua et al., 2018; Xie et al., 2021). It is a concern for vulnerable groups. The blood pressure increase caused by PM2.5 maybe even more dangerous. Copyright © 2022, authors, e-ISSN : 2580-071X , p-ISSN : 2085-6180 Fig 1. Daily Systolic Pressure Response Fig 2. Daily Diastolic Pressure Response Samsul Bahri et al., / Jurnal Pendidikan Jasmani dan Olahraga 7 (1) (2022) 27 CONCLUSION Our results indicate a need to control air pollutants globally, especially in Indonesia. In addition, we need to check the air pollution conditions regularly and re- port it to the public as consideration for doing activities or exercising. 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