Note from our friendly lawyers: the below does not constitute medical advice, and everyone needs to refer to their physician to determine their own exercise regimen. Everyone is different (but particularly you).

We recently had the pleasure of asking Dr. William Chickering some questions about air pollution in Beijing. Dr. Chickering is one of four American Board of Emergency Medicine-certified physicians in Beijing (all of whom practice at Beijing United Family Hospital). The good news? Maybe it’s not as bad as we thought. The bad news? We’ve got to find some new excuses to not exercise.

1. Thank you very much for taking the time to talk with us. Perhaps first discuss with us how your thinking about pollution in Beijing has developed?

When my family and I encountered Beijing air for the first time 3 years ago, I was appalled, and set out to find out what irreversible harm 3-5 years of exposure might do to otherwise healthy people. (By irreversible, I mean health problems that will not go away when we do. I do not mean things like worsened asthma or recurrent sinusitis or burning eyes.)

I poured through lots of scientific articles. I even visited the world capital of air-pollution studies, the USC School of Public Heath in Los Angeles.

What I found out was a bit surprising, like a crime novel set in LA.

During 60 years of trying to identify air pollution’s irreversible effects and to nail the culprit(s), USC has been forced to let a lot of unsavory characters go for lack of evidence, including several elements that regularly mug Beijing, e.g., sulfur dioxide and nitrogen dioxide and even ozone. For example, the worst USC has been able to pin on ozone is a higher rate of asthma in athletes who spend a LOT of time on playing fields in bad air. (They had to be three-letter athletes, literally. Two-letter athletes didn’t show this effect!)

They’ve known for years that one family of pollutants is responsible—vehicular-emissions—but the question is which one exactly. In recent years, the environmental detectives have all pretty much come to the same conclusion: it’s the ultra-fine particles (mostly from diesel). They’re still building a case that will hold up, but they know.

2. As you probably know, most expats in Beijing refer to the Twitter feed put out by the US Embassy to determine the day’s Air Quality Index (“AQI”) (the feed is located at http://iphone.bjair.info/). For someone who is interested in exercising outside (and let’s assume that this person does not have a history of respiratory issues and is otherwise in good health), at what level should one forgo aspirations to exercise outside? In other words, at what level is staying at home on the couch the healthy choice?

The AQI is less relevant to potential irreversible health effects than how close you exercise next to a Ring Road or a four-lane city street. Ultimately, anything further than 200 meters away from heavy traffic is probably OK.

3. Does this mean that, as long as you stay away from traffic, you can go running on a day whose AQI exceeds 200?

In theory, yes. But in practice, even if it can’t kill you (assuming you’re healthy), such air certainly can irritate your lungs. (Here I have to ask, why not a bike or treadmill at a health club? Air-conditioning and closed windows do help a bit. “Couch” and “healthy” don’t belong in the same sentence.)

4. So what does the US Embassy Twitter feed measure?

The US Embassy reading measures what’s turning the air brown or gray or yellow or­—my personal favorite—green on any particular day. But it’s the stuff that you can’t see that the AQI doesn’t measure, that’s more important.

5. If you had to pick, is there a time of day that is generally best to exercise outside in Beijing?

Beijing keeps most heavy trucks out of the city between the hours of 11PM and 6AM. Since diesel is the main source of ultra-fine particles, the best times to run are probably 6-7AM and 9-10PM.

6. Does it help to run in a park or down tree-lined streets, or are we just kidding ourselves?

Running down the middle of Chaoyang Park would be ideal, but not because of the greenery.

7. Is there another measurement of air quality which we should also reference before exercising outside?

There certainly is: Google Earth. You can use it to find out how close you (or your health club) are to big roads.

8. For the particularly die-hard who are not afraid to look like Darth Vader running down the street, what type of masks should one wear in order to exercise outside on a particularly polluted day? Can we get those masks in Beijing?

There was a recent article that weakly supports the idea of wearing N-95 masks, the white, round, semi-hard ones (available at Nick’s expat grocery in the Holiday Inn Lido (6437-6828) and probably at many similar venues), although my guess is that most people would find them intolerable while running. (The problem with this study is that it used a surrogate endpoint. We know that something changed because of the mask. We’re just not sure how important it is.)

9. Help us put the air quality issues in perspective: if we (again, “we” being those of us without a history of respiratory issues) exercise outside on polluted days, does that mean that we are going to die from some lung-related condition, or is it still more likely that heart disease or cancer is going to get us in the end?

All that said, most expats really don’t have to worry about serious health effects from Beijing air. I have only been able to identify two groups who run even a small risk: (1) those who do or might have underlying coronary artery disease (in whom acute exposure to traffic fumes rarely triggers a heart attack) and (2) those with immature lungs—in other words, young children (a tiny portion of whom might develop asthma or have diminished lung growth). For both groups, a HEPA air purifier in the bedroom makes sense. For the older folks, all the stuff useful in reducing the likelihood that an arterial plaque might go rogue is recommended, with the highest on the list being exercise, then Omega 3 fatty acids from fish and (if doctor-recommended) aspirin.

Special thanks again to Dr. Chickering for his answers to our questions and for taking us seriously as we attempt something called “journalism”. Pulitzer Prize, here we come.

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