Users

old man looking at the p-step app on his mobile phone

User & Stakeholder Focus Groups

Over the last 18 months a focus group made up of 11 volunteers with long-term health conditions have provided input into the development of the P-STEP app. Providing researchers and developers from the University of Leicester with key insights into the design and function of the app. Two face-to-face workshops have been held where the P-STEP volunteers were able to test and use the app to record walks.

What Is Different About P-STEP?

There are many fitness applications (apps) for use with smartphones and wearables (e.g., Apple Watch, Fitbit) available to people to encourage physical activity. However, these are aimed at healthy people, there are very few apps catering for those who live with long-term conditions (LTCs), where advice on exercise to consider the persons LTC. There are also apps to advice on pollution levels and air quality, but again these do not include advice for people with LTCs.

It is well known that undertaking exercise can be of benefit to people with LTCs but many people with LTCs do not exercise. To address this problem researchers from the University of Leicester and University Hospitals of Leicester NHS Trust are developing an app.

The P-STEP app will provide not only advice on exercising taking into account a person’s LTC but also by linking this to real-time data on pollution provide advice on when and where to exercise. The app will access a person’s location using satellites around Earth (Global Navigation Satellite System or GNSS for short) in order to provide advice on when and where to exercise.

The app will be able to tell the person using it i.e., a user about the pollution levels when they go for a walk. It will alert a user to air pollution risks and highlight “cleaner air” routes, provide user feedback, track progress, and provide encouragement.

Why is Air Quality Important When Walking?

Air pollution has been associated with various health issues, including worsening of heart and pulmonary conditions and increased risk for asthma, heart attacks, stroke, and premature death.

What Can Be The Effects Of Walking In Polluted Air?

Physical activity like walking is key to the prevention and rehabilitation of long-term conditions.

However, there is some evidence that suggests short-term exposure to air pollution while exercising outdoors could have negative effects on health. This includes greater reduction in lung function when walking in polluted places and risk of cardiovascular-related events.

Other negative effects include more cough, sputum, shortness of breath, and wheeze after walking in areas exposed to pollution from cars and buses compared to walking in parks.

Walking exposed to traffic pollution therefore may offset some of the beneficial effects of walking in general.

What if where I live has high air pollution?

Our advice is to aim to exercise in the cleanest areas possible. P-STEP will help you find the cleanest areas. However, where this is not possible, studies have shown that there could be benefits of regular exercise even at moderate air pollution levels.

Therefore, it is very important to follow the exercise and environmental advice found in P-STEP and keep exercising in the cleanest conditions possible.

nurse showing old person how to use the app

Professionals

Health Care Professionals including GPs, Nurses, Pharmacists and Physiotherapists have fed into the information they would like to see included in a website and what might be useful information for a user to share with them.

Why is air quality important when patients go out walking?

Air pollution has been associated with various health issues, including worsening of heart and pulmonary conditions and increased risk for asthma, heart attacks, stroke, and premature mortality. Physical activity (PA) participation is key to the prevention and rehabilitation of chronic conditions. Studies found evidence that short-term exposure to air pollution while exercising could have negative effects on health.

What can be the effects of walking in polluted air have on patients?

A study looking at 60 people with mild to moderate asthma walking on a busy road with high particulate and NO2 air pollution (Oxford Street) and a nearby park (Hyde Park) found evidence that associates the degree of traffic exposure with lung function in asthma (McCreanor et al., 2007).

Small reductions in lung function (<2%) with walking in Hyde Park, but significantly higher reductions (~6%) in walking along Oxford Street, although lung function impacts were asymptomatic. Concomitant increases in biomarkers of neutrophilic inflammation and airway acidification. Changes associated most consistently with exposures to ultrafine particles and elemental carbon.

The study was repeated with patients with COPD, ischaemic heart disease and healthy controls (Sinharay et al., 2018). They found that short-term exposure to traffic pollution may offset some of the beneficial cardiopulmonary effects of walking for healthy individuals and individuals with ischemic heart diseases and COPD. Participants with COPD reported more cough, sputum, shortness of breath, and wheeze after walking down Oxford Street compared with Hyde Park. All participants showed increase in lung function and a decrease in pulse wave velocity and augmentation index up to 26 hr after the walk in the park. However, those benefits were not seen when walking along Oxford Street and in participants with COPD lung function measures actually decreased.

Chen et al., (2017) in a panel study determined that in participants with COPD, reduction in pulmonary function was associated with short-term exposure to PM2.5. Hemmingsen et al., (2015), determined that exposure to real-life levels of PM from urban street air impairs the vasomotor function and heart rate variability in overweight middle-aged and elderly adults.

Warburton et al., (2019), found that people with coronary artery disease (CAD) are at an increased risk for short-term adverse cardiovascular-related events and disturbances in autonomic function when exposed to air pollution in comparison to healthy individuals. Heart rate variability was negatively associated with multiple pollutants including black carbon, carbon dioxide, CO, and NO2 as well as mass concentrations of PM0.3–1.0, PM2.5, PM2.5–10, PM10, and accumulation mode particles (AMP). ST-segment depression was associated with diesel exhaust, black carbon, and particulate air pollution. Other adverse cardiovascular symptoms were reported after higher exposure to air pollution while exercising including an earlier onset of anginal symptoms, and increased number, complexity, and severity of ventricular arrhythmias, pulse wave velocity, and augmentation index.

What if where the patient lives has high air pollution?

Our advice is to aim to exercise in the cleanest areas possible. P-STEP will help patients to find the cleanest areas. Long-term studies suggested that there could be benefits of regular exercise even at moderate air pollution levels (Raza et al, 2021; Andersen et al., 2015, Sun et al., 2019).

Therefore, it is very important patients follow the exercise and environmental advice found in P-STEP and keep exercising in the cleanest conditions possible.

Where can I download the app?

Following 18 months of design and testing, the app is currently being piloted by members of the EXCEED cohort prior to the next phase of release and isn’t yet available to the public.