Thursday, 28 March, 2024
HomeSport and Exercise MedicineSubstantial health benefits from active commuting

Substantial health benefits from active commuting

Active commuting by bicycle is associated with a substantial decrease in the risk of death from all causes, cancer and cardiovascular disease (CVD), compared with non-active commuting by car or public transport, finds a University of Glasgow study.

Walking is also associated with a lower risk of cardiovascular disease, but the risk of death from cancer was no different than non-active commuting, the results show.

Many studies have shown that cycling and walking are linked with health benefits, but there is still some debate about the strength of these associations. So researchers set out to investigate the association between active commuting and incident CVD, cancer, and all-cause mortality.

The study by researchers at the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, involved 264,377 participants (average age 53 years) recruited from the UK Biobank – a database of biological information from half a million British adults. Participants were asked to record the types of transport they used to get to and from work on a typical day. Options included walking, cycling and non-active (car or public transport). During an average five-year follow-up period, information on hospital admissions and deaths were recorded.

After adjusting for several influential factors, commuting by walking was associated with a lower risk of CVD incidence and mortality. However, commuting by cycling was associated with the lowest risk of these – as well as lower risks of all-cause mortality and cancer.

Mixed-mode commuting (a combination of active and non-active transport) was also associated with some benefits, but only if the active component comprised cycling.  Furthermore, a lower risk for CVD incidence was only evident among the walking commuters who covered more than six miles a week (equivalent to two hours of weekly commuting by walking at a typical pace of three miles an hour).

The researchers point out that this is an observational study, so no firm conclusions can be drawn about cause and effect, and they outline some limitations could have introduced bias. Nevertheless, they conclude that “the findings, if causal, suggest population health may be improved by policies that increase active commuting, particularly cycling, such as the creation of cycle lanes, cycle hire or purchase schemes, and better provision for cycles on public transport.”

In a linked editorial, Professor Lars Bo Andersen at the Western Norwegian University of Applied Sciences, says active commuting has the potential to substantially reduce the costs of cardiovascular disease (estimated at £15bn each year in the UK) and to save many lives. He argues that the UK has neglected to build infrastructure to promote cycling for decades and the potential for improvements to increase cycling and the safety of cycling is huge.

“The findings from this study are a clear call for political action on active commuting, which has the potential to improve public health by preventing common (and costly) non-communicable diseases,” he writes. “A shift from car to more active modes of travel will also decrease traffic in congested city centres and help reduce air pollution, with further benefits for health.”

Abstract
Objective: To investigate the association between active commuting and incident cardiovascular disease (CVD), cancer, and all cause mortality.
Design: Prospective population based study.
Setting: UK Biobank.
Participants: 263 450 participants (106 674 (52%) women; mean age 52.6), recruited from 22 sites across the UK. The exposure variable was the mode of transport used (walking, cycling, mixed mode v non-active (car or public transport)) to commute to and from work on a typical day.
Main outcome measures: Incident (fatal and non-fatal) CVD and cancer, and deaths from CVD, cancer, or any causes.
Results: 2430 participants died (496 were related to CVD and 1126 to cancer) over a median of 5.0 years (interquartile range 4.3-5.5) follow-up. There were 3748 cancer and 1110 CVD events. In maximally adjusted models, commuting by cycle and by mixed mode including cycling were associated with lower risk of all cause mortality (cycling hazard ratio 0.59, 95% confidence interval 0.42 to 0.83, P=0.002; mixed mode cycling 0.76, 0.58 to 1.00, P<0.05), cancer incidence (cycling 0.55, 0.44 to 0.69, P<0.001; mixed mode cycling 0.64, 0.45 to 0.91, P=0.01), and cancer mortality (cycling 0.60, 0.40 to 0.90, P=0.01; mixed mode cycling 0.68, 0.57 to 0.81, P<0.001). Commuting by cycling and walking were associated with a lower risk of CVD incidence (cycling 0.54, 0.33 to 0.88, P=0.01; walking 0.73, 0.54 to 0.99, P=0.04) and CVD mortality (cycling 0.48, 0.25 to 0.92, P=0.03; walking 0.64, 0.45 to 0.91, P=0.01). No statistically significant associations were observed for walking commuting and all cause mortality or cancer outcomes. Mixed mode commuting including walking was not noticeably associated with any of the measured outcomes.
Conclusions: Cycle commuting was associated with a lower risk of CVD, cancer, and all cause mortality. Walking commuting was associated with a lower risk of CVD independent of major measured confounding factors. Initiatives to encourage and support active commuting could reduce risk of death and the burden of important chronic conditions.

Authors
Carlos A Celis-Morales, Donald M Lyall, Paul Welsh, Jana Anderson, Lewis Steell, Yibing Guo, Reno Maldonado, Daniel F Mackay, Jill P Pell, Naveed Sattar, Jason M R Gill

[link url="http://www.bmj.com/company/newsroom/cycling-or-walking-to-and-from-work-linked-to-substantial-health-benefits/"]BMJ material[/link]
[link url="http://www.bmj.com/content/357/bmj.j1456"]BMJ abstract[/link]
[link url="http://www.bmj.com/content/357/bmj.j1740"]BMJ editorial[/link]

MedicalBrief — our free weekly e-newsletter

We'd appreciate as much information as possible, however only an email address is required.