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Strengths of our study include a large prospective cohort, with well-defined and validated information on physical activity and air pollution exposure, both of which have been linked to mortality (; , ). We furthermore benefited from the state-of-the art information on individual exposure to NO2 with high spatial (address-specific) and temporal (annual mean) resolution, assessed over 35 years. Another strength of this cohort is the very high prevalence of cycling (68%), both leisure and utilitarian (e.g., to work, shopping); this provided the data for evaluation of an interaction of air pollution with this type of physical activity, in contrast to existing studies on cycling to work (; ; , ). Furthermore, this is the first cohort study to evaluate individual-level benefits of physical activity in an urban cohort while also considering individual exposure to air pollution. A study of short-term effects of air pollution on mortality in Hong Kong, which has several-fold higher levels of air pollution than in Copenhagen, found that those who exercised regularly had reduced susceptibility to acute effects of air pollution and lower mortality than those who did not exercise (). Our study provides a novel approach in contrast to existing health impact assessment studies. Our study estimated benefits versus risks of increased physical activity, typically by evaluating active travel policies targeted to shift commuters from car use to cycling, on a population level, based on derivation of risk estimates from different studies and hypothetical scenarios (; ; , , ).

Physical activity plays a key role in improving the physiologic mechanisms and health outcomes that exposure to air pollution may exacerbate. This presents a challenge in understanding and balancing the beneficial effects of physical activity in the urban environment with the detrimental effects of air pollution on human health. Our findings suggest that beneficial effects of physical activity on mortality in an urban area with relatively low levels of air pollution are not moderated in subjects residing in areas with the highest levels of air pollution. Estimated benefits of cycling and gardening on respiratory mortality were marginally reduced, but not annulled, for those living in areas with high NO2 levels, but these novel results need confirmation. Overall, the long-term benefits of physical activity in terms of reduced mortality outweigh the risk associated with enhanced exposure to air pollution during physical activity.

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Our results—that long-term benefits of physical activity on all major types of mortality were not moderated by exposure to high levels of NO2—are novel. This may imply that acute stress and damage to the cardiovascular system induced by short-term exposure to air pollution during exercise, in terms of vascular impairment, arterial stiffness, and reduced blood flow, as shown in earlier studies (; ; ), seem to be transient and reversible and do not abate long-term benefits of physical activity on mortality. Our results may furthermore be explained by the short duration of the physical activities, with mean of 2–3 hr/week for most activities (); this implies that extra inhaled dose of air pollution during physical activity, which is a function of increased inhalation and duration, is only a small fraction of total inhaled dose of air pollution (), and is therefore not sufficient to increase the risk of premature mortality. Our results are furthermore in line with a study finding significantly lower levels of physical activity on days with poor air quality among respiratory disease patients, but not in cardiovascular patients, who do not seem immediately enough bothered by air pollution to change their outdoor physical activity habits (; ). Our study thus may imply that effects of long-term exposure to NO2 and physical activity on overall and cardiovascular mortality are independent of each other, with benefits of outdoor physical activity not being reduced by exposure to NO2.

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A handicraft, sometimes more precisely expressed as artisanal handicraft, is any of a wide variety of types of work where useful and decorative objects are made completely by hand or by using only simple tools. It is a traditional main sector of craft, and applies to a wide range of creative and design activities that are related to making things with one’s hands and skill, including work with textiles, moldable and rigid materials, paper, plant fibers, etc. Usually the term is applied to traditional techniques of creating items (whether for personal use or as products) that are both practical and aesthetic. – Wikipedia

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