Change in commute mode and body-mass index: prospective, longitudinal evidence from UK Biobank

Adipose Tissue Dysfunction Related to Climate Change and Air Pollution: Understanding the Metabolic Consequences

Obesity, a global pandemic, poses a major threat to healthcare systems worldwide. Adipose tissue, the energy-storing organ during excessive energy intake, functions as a thermoregulator, interacting with other tissues to regulate systemic metabolism. Specifically, brown adipose tissue (BAT) is positively associated with an increased resistance to obesity, due to its thermogenic function in the presence of uncoupled protein 1 (UCP1). Recently, studies on climate change and the influence of environmental pollutants on energy homeostasis and obesity have drawn increasing attention. The reciprocal relationship between increasing adiposity and increasing temperatures results in reduced adaptive thermogenesis, decreased physical activity, and increased carbon footprint production. In addition, the impact of climate change makes obese individuals more prone to developing type 2 diabetes mellitus (T2DM). An impaired response to heat stress, compromised vasodilation, and sweating increase the risk of diabetes-related comorbidities. This comprehensive review provides information about the effects of climate change on obesity and adipose tissue, the risk of T2DM development, and insights into the environmental pollutants causing adipose tissue dysfunction and obesity. The effects of altered dietary patterns on adiposity and adaptation strategies to mitigate the detrimental effects of climate change are also discussed.

Active Commuting as a Factor of Cardiovascular Disease Prevention: A Systematic Review with Meta-Analysis

Active commuting (AC) may have the potential to prevent the incidence of cardiovascular disease (CVD). However, the evidence for a correlation between AC and the risk of CVD remains uncertain. The current study thoroughly and qualitatively summarized research on the relationship between AC and the risk of CVD disease. From conception through December 2022, researchers explored four databases (PubMed, PEDro, Cochrane, and Bibliothèque Nationale of Luxembourg [BnL]) for observational studies. The initial findings of the search yielded 1042 references. This systematic review includes five papers with 491,352 participants between 16 and 85 years old, with 5 to 20 years of follow-up period. The exposure variable was the mode of transportation used to commute on a typical day (walking, cycling, mixed mode, driving, or taking public transportation). The primary outcome measures were incident CVD, fatal and non-fatal (e.g., ischemic heart disease (IHD), ischemic stroke (IS), hemorrhagic stroke (HS) events, and coronary heart disease (CHD). Despite methodological variability, the current evidence supports AC as a preventive measure for the development of CVD. Future research is needed to standardize methodologies and promote policies for public health and environmental sustainability.

The Impact of Removing the 10-Minute Bout Requirement and of Different Survey Administration Methods on National Physical Activity Estimates in Austria

BACKGROUND

Monitoring survey methods, as well as movement recommendations, evolves over time. These changes can make trend observations over time difficult. The aim of this study was to examine the differences between 2 computer-assisted survey administration methods and the effect of the omission of the 10-minute minimum bout requirement in physical activity (PA) questions on PA outcomes.

METHODS

We used data from the second Austrian PA Surveillance System for 2998 adults (18-64 y), applying computer-assisted personal interviewing and computer-assisted web interviewing. Within the computer-assisted web interviewing sample only, we added PA questions without the 10-minute requirement. Quantile and logistic regressions were applied.

RESULTS

Between computer-assisted web interviewing and computer-assisted personal interviewing, within the computer-assisted personal interviewing sample, we found lower PA estimates in the leisure domain and work and household domain, but not in the travel domain, and no significant difference in the proportion of people meeting the PA recommendations. In all 3 PA domains, the median minutes did not differ when assessed with or without the 10-minute requirement. However, the percentage participation in the travel domain and work and household domain performing >0 minutes per week PA was higher when there was no 10-minute requirement. The proportion of people meeting the Austrian aerobic recommendation for adults when computed with or without the 10-minute requirement did not differ.

CONCLUSION

Our findings suggest that the omission of the 10-minute requirement does not seem to result in marked differences in PA estimates or the proportion of adults meeting the recommendations.

Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association

Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion or >70% of the world's population by 2050. Given that cardiometabolic diseases are the leading causes of morbidity and mortality in people living in urban areas, transforming cities and urban provisioning systems (or urban systems) toward health, equity, and economic productivity can enable the dual attainment of climate and health goals. Seven urban provisioning systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water management, and waste management lie at the core of human health, well-being, and sustainability. These provisioning systems transcend city boundaries (eg, demand for food, water, or energy is met by transboundary supply); thus, transforming the entire system is a larger construct than local urban environments. Poorly designed urban provisioning systems are starkly evident worldwide, resulting in unprecedented exposures to adverse cardiometabolic risk factors, including limited physical activity, lack of access to heart-healthy diets, and reduced access to greenery and beneficial social interactions. Transforming urban systems with a cardiometabolic health-first approach could be accomplished through integrated spatial planning, along with addressing current gaps in key urban provisioning systems. Such an approach will help mitigate undesirable environmental exposures and improve cardiovascular and metabolic health while improving planetary health. The purposes of this American Heart Association policy statement are to present a conceptual framework, summarize the evidence base, and outline policy principles for transforming key urban provisioning systems to heart-health and sustainability outcomes.

Walking to work: The role of walkability around the workplace in a Dutch adult commuting population

Current evidence on neighborhood walkability and active commuting focuses on residential rather than workplace environment. This cross-sectional study investigated whether higher workplace walkability (WW) was associated with commute walking, both independently and together with residential walkability, using data from 6769 respondents of the 2017 Dutch national travel survey. In a fully adjusted logistic regression model, 10% increase in WW was associated with 32% higher odds of commute walking (Odds ratio (OR): 1.31, 95% Confidence Interval (CI: 1.27-1.36). The estimates were stronger in rural dwellers than urban residents, (ORrural 1.49, 95%CI: 1.34-1.64 vs ORhighly.urban 1.19, 95%CI: 1.13-1.26). In participants with both high residential walkability and WW, we observed 215% higher odds (OR 3.15, 95% CI: 2.48-3.99) of commute walking compared to those with low walkability in both. Our study indicated the importance and complementary nature of walkable residence and workplace in contribution to physical activity of working individuals through active commuting.

Impact of cycling and walking on adiposity and healthcare costs among adults: longitudinal study

Leisure-time physical activity seems relevant to prevent the development of chronic diseases and obesity. However, not much is known about the economic burden of these healthy behaviors, mainly in longitudinal designs. This study aimed to analyze the impact of walking and cycling on leisure-time on adiposity and healthcare costs among adults. This longitudinal study was conducted at a medium-size Brazilian city and included 198 participants with no missing data attended in the Brazilian Unified National Health System. Cycling and walking were assessed by a questionnaire with a face-to-face interview at four time-points (baseline, 6-month, 12-month, and 18-month). Healthcare costs were assessed using medical records. Adiposity markers included waist circumference and body fatness. Over the follow-up period, participants who were more engaged in cycling presented lower body fatness (p-value = 0.028) and healthcare costs (p-value = 0.038). However, in the multivariate model, the impact of cycling on costs was not significant (p-value = 0.507) due to the impact of number of chronic diseases (p-value = 0.001). Cycling on leisure-time is inversely related to adiposity in adults, whereas its role on preventing chronic diseases seems the main pathway linking it to cost mitigation.

Impact of changes in commuting mode on body weight among Japanese workers: a longitudinal study

OBJECTIVE

The health benefits of active commuting have been reported. However, few studies have assessed commuting modes using objective methods. This study clarified the association between changes in objectively measured commuting modes and body weight among Japanese workers.

METHODS

This longitudinal study used data from the annual health examinations and personnel records of a company with branches in all prefectures of Japan. Data from 2018 and 2019 were used as the baseline and follow-up data, respectively. The commuting mode was assessed using the commuting mode code included in the personnel records and classified into 3 types: walking, public transport, and car or motorcycle. The participants were classified into 9 categories based on the combination of their commuting modes in 2018 and 2019. Body weight was measured objectively during health examinations. The 1-year changes in body weight were calculated for the 9 categories and assessed using an analysis of covariance with adjustments for covariates.

RESULTS

The analysis included 6551 workers (men: 86.8%; mean age: 42.8 years). Overall, body weights tended to increase (+0.40 kg/y). The participants who switched to more active commuting, such as from car or motorcycle to walking (-0.13 kg/y), from car or motorcycle to public transport (+0.10 kg/y), and from public transport to walking (-0.07 kg/y), exhibited small weight gains or losses. A similar trend was observed even after adjustment.

CONCLUSIONS

Changing to a more active commuting mode may prevent weight gain among workers.

The Weight of Place: Built Environment Correlates of Obesity and Diabetes

In recent decades, the prevalence of obesity and diabetes has risen substantially in North America and worldwide. To address these dual epidemics, researchers and policymakers alike have been searching for effective means to promote healthy lifestyles at a population level. As a consequence, there has been a proliferation of research examining how the "built" environment in which we live influences physical activity levels, by promoting active forms of transportation, such as walking and cycling, over passive ones, such as car use. Shifting the transportation choices of local residents may mean that more members of the population can participate in physical activity during their daily routine without structured exercise programs. Increasingly, this line of research has considered the downstream metabolic consequences of the environment in which we live, raising the possibility that "healthier" community designs could help mitigate the rise in obesity and diabetes prevalence. This review discusses the evidence examining the relationship between the built environment, physical activity, and obesity-related diseases. We also consider how other environmental factors may interact with the built environment to influence metabolic health, highlighting challenges in understanding causal relationships in this area of research.

Built Environments and Cardiovascular Health: REVIEW AND IMPLICATIONS

PURPOSE

This review presents a general overview of the state of evidence on the relationships between neighborhood built environments and cardiovascular health outcomes among adults. We also summarize relevant literature on the associations of built environments with active living behaviors (physical activity [PA] and sedentary behavior), as they are considered as key behavioral pathways.

REVIEW METHODS

We identified recently published systematic reviews assessing associations of built environment attributes with cardiovascular health outcomes or active living behaviors. We summarized findings of the key systematic reviews and presented findings of pertinent empirical studies, where appropriate.

SUMMARY

Increasing evidence suggests that living in a place supportive of engaging in PA for transportation (eg, walkability features) and recreation (eg, parks) can be protective against cardiovascular disease (CVD) risk. Places conducive to higher levels of sedentary travel (ie, prolonged sitting in cars) may have adverse effects on cardiovascular health. The built environment of where people live can affect how active they are and subsequently their cardiovascular health. Clinical professionals are encouraged to consider the built environment features of where their patients live in counseling, as this may assist them to understand potential opportunities or barriers to active living and to propose a suitable CVD prevention strategy.

Perspectives on exercise intensity, volume, step characteristics and health outcomes in walking for transport

Background

Quantification of movement intensity and energy utilization, together with frequency of trips, duration, distance, step counts and cadence, is essential for interpreting the character of habitual walking for transport, and its potential support of health. The purpose of the study is to illuminate this with valid methods and novel perspectives, and to thereby provide a new basis for characterizing and interpreting walking in relation to health outcomes.

Methods

Habitual middle-aged commuting pedestrians (males = 10, females = 10) were investigated in the laboratory at rest and with maximal treadmill and cycle ergometer tests. Thereafter, levels of oxygen uptake, energy expenditure, ventilation, heart rate, blood lactate, rated perceived exertion, cadence, number of steps, duration, distance, and speed were recorded during the normal walking commute of each participant in Greater Stockholm, Sweden. The number of commutes per week over the year was self-reported.

Results

Walking in the field demanded about 30% more energy per km compared to level treadmill walking. For both sexes, the walking intensity in field was about 46% of maximal oxygen uptake, and energy expenditure amounted to 0.96 kcal · kg- 1 · km- 1. The MET values (males: 6.2; females: 6.5) mirrored similar levels of walking speed (males: 5.7; females: 5.9 km · h- 1) and levels of oxygen uptake (males: 18.6; females: 19.5 mL · kg- 1 · min- 1). The average number of MET-hours per week in a typical month was 22 for males and 20 for females. This resulted in a total weekly energy expenditure of ~1,570 and 1,040 kcal for males and females, respectively. Over the year, the number of walking commutes and their accumulated distance was ~385 trips and 800 km for both sexes.

Conclusion

Walking in naturalistic field settings demands its own studies. When males and females walk to work, their relative aerobic intensities and absolute energy demands for a given distance are similar. It is equivalent to the lower part of the moderate relative intensity domain. The combination of oxygen uptake, trip duration and frequency leads to high and sustained levels of MET-hours as well as energy expenditure per week over the year, with a clear health enhancing potential. Based on this study we recommend 6000 transport steps per day, or equivalent, during five weekdays, over the year, in order to reach optimal health gains.

Holistic approach to assess the association between the synergistic effect of physical activity, exposure to greenspace, and fruits and vegetable intake on health and wellbeing: Cross-sectional analysis of UK Biobank

Background

Urban agriculture has been shown to contribute to healthy lifestyle behaviors, such as increased fruit and vegetable intake and greater exposure to greenspaces and there is plenty of evidence linking these lifestyle behaviors to better health and wellbeing. However, most evidence relates to assessing one behavior at a time despite available epidemiological research showing how the combined effects of multiple behaviors are associated with health and wellbeing. This research aims to examine the association of the interactions between various lifestyle behaviors and exposures related to urban agriculture and health and wellbeing.

Methods

We used data from the UK Biobank baseline questionnaire (N~500, 000) to assess the association of two lifestyle behaviors (fruit and vegetable intake and physical activity) and greenspace exposure, with four health and wellbeing markers (blood pressure, BMI, self-health assessment, and self-reported loneliness) independently, and in combination. Associations between lifestyle behaviors, greenspace exposure, and the possible interactions with health and wellbeing were explored using general linear models (GLMs), adjusted for socio-demographic confounders including age, sex, educational qualifications, index of multiple deprivation, and ethnicity, and a lifestyle confounder: smoking status.

Results

After removing missing data, as well as participants who did not meet the inclusion criteria, the final study sample was n = 204,478. The results indicate that meeting recommended levels of the World Health Organization (WHO) for fruits and vegetable intake, and the advice from the UK Chief Medical Officer for physical activity, is linked to better health and wellbeing markers. We found that UK Biobank participants who lived in greener areas and were physically active were more likely to feel alone and think their health was poor. Participants who were physically active and met the recommended intake of fruits and vegetables were more likely to have healthy blood pressure, feel less lonely, and rate their health as good. Evidence of three-way interactions was weak, and mostly was not associated with the health and wellbeing markers assessed here.

Conclusion

Taken in combination, healthy diets, physical activity and exposure to greenspaces are associated with health and wellbeing. In some cases, these effects are synergistic, indicating associations above and beyond the mere additive effect of the behaviors considered independently. Promoting such behaviors together, for example, through urban agriculture, is therefore more likely to generate greater public health changes than if they are promoted through independent policies and programs. Inter-relationships between these pathways and different health and wellbeing markers, however, are complex, and require further investigation to understand optimal environments and conditions for urban health promotion.

How Can We Act to Mitigate the Global Syndemic of Obesity, Undernutrition, and Climate Change?

PURPOSE OF REVIEW

The goal of this manuscript is to identify dietary and active transport strategies that reduce greenhouse gases and obesity, and thereby mitigate the effects of climate change on crop yields and micronutrient content.

RECENT FINDINGS

This report builds on our earlier publication that described the Global Syndemic of Obesity, Undernutrition, and Climate Change. We focus here on the contributions that the USA makes to the Global Syndemic and the policy solutions necessary to reduce the effects of the transport and food and agriculture systems on greenhouse gas emissions and environmental degradation. A recent study suggests that people are interested and ready to address local solutions to climate change. Changing the individual behaviors that sustain the US transport and food and agriculture systems is the first step to the broader engagement necessary to build the political will that to achieve institutional, municipal, state, and federal policy.

Physical Activity Behavior, Motivation and Active Commuting: Relationships with the Use of Green Spaces in Italy

Many benefits of physical activity (PA) are observed with weekly average volumes of 150–300 min at moderate intensity. Public parks may be an attraction for many people living in the city and could help to achieve the recommended dose of PA. The present study aims to understand the motivation that drives people to a park and evaluate the amount of PA practiced by park-goers. A questionnaire was anonymously administered to 383 voluntary visitors to the Arcoveggio park (Bologna), aged 18–70 years. Sixty-one percent of participants practiced outdoor PA. Differences in park use between sexes and age groups were found. PA was higher in men than in women and in the 18–30 age group than in other age groups. Most participants travelled to the park in an active way (86.4%), resulting in easier attainment of the recommended amount of PA (64.5%). The main motivations for using the park were related to relaxation, performing PA, or both. According to a multiple regression model, the time per week spent at the park, the method of getting there, and the kind of PA were significant explanatory variables of the amount of PA practiced. In particular, the highest number of minutes of PA was achieved by those who travelled to the park by running, while those using vehicles presented the lowest number. All initiatives to promote active commuting and activities in the urban park represent an important strategy to improve health, supporting adults to lead an active lifestyle.

Active commuting, commuting modes, and the risk of diabetes: 14-year follow-up data from the Hisayama Study

Aims/Introduction

We aimed to investigate the association of active commuting (cycling or walking to work), as well as the association of the individual commuting modes, with the risk of diabetes in a prospective cohort of community‐dwelling adults in Japan.

Material and Methods

A total of 1,270 residents aged 40–79 years were followed up for a median of 14 years. Active commuting was defined as either cycling or walking to work. A Cox proportional hazards model was used to examine the association of active commuting with the risk of diabetes. Associations for different forms of active commuting (cycling, walking and mixed modes of cycling or walking with non‐active components) were also examined.

Results

During the follow‐up period, 191 participants developed diabetes. Active commuting was associated with a lower risk of diabetes than non‐active commuting after adjustment for potential confounders (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.31–0.92). With regard to the commuting modes, the risk of diabetes was significantly lower in individuals who commuted by cycling alone (HR 0.46, 95% CI 0.22–0.98), and tended to be lower in individuals who commuted by walking alone (HR 0.14, 95% CI 0.02–1.02) compared with that in individuals with non‐active commuting. Meanwhile, no significant associations were observed for the mixed mode of walking and non‐active commuting (HR 1.69, 95% CI 0.77–3.71).

Conclusions

Active commuting, particularly that consisting exclusively of cycling or walking, was associated with a reduced risk of diabetes. Our findings support a public health policy that promotes the choice of active commuting for the prevention of diabetes.

Green Walkability and Physical Activity in UK Biobank: A Cross-Sectional Analysis of Adults in Greater London

Urban greenspace provides opportunities for outdoor exercise and may increase physical activity, with accompanying health benefits. Areas suitable for walking (walkability) are also associated with increased physical activity, but interactions with greenspace are poorly understood. We investigated associations of walkability and green walkability with physical activity in an urban adult cohort. We used cross-sectional data from Greater London UK Biobank participants (n = 57,726) and assessed walkability along roads and footpaths within 1000 m of their residential addresses. Additionally, we assessed green walkability by integrating trees and low-lying vegetation into the walkability index. Physical activity outcomes included self-reported and accelerometer-measured physical activity and active transport. We assessed associations using log-linear, logistic and linear regression models, adjusted for individual- and area-level confounders. Higher green walkability was associated with favourable International Physical Activity Questionnaire responses and achievement of weekly UK government physical activity guideline recommendations. Participants living in the highest versus lowest quintile of green walkability participated in 2.41 min (95% confidence intervals: 0.22, 4.60) additional minutes of moderate-and-vigorous physical activity per day. Higher walkability and green walkability scores were also associated with choosing active transport modes such as walking and cycling. Our green walkability approach demonstrates the utility in accounting for walkability and greenspace simultaneously to understand the role of the built environment on physical activity.

A foresight whole systems obesity classification for the English UK biobank cohort

Background

The number of people living with obesity or who are overweight presents a global challenge, and the development of effective interventions is hampered by a lack of research which takes a joined up, whole system, approach that considers multiple elements of the complex obesity system together. We need to better understand the collective characteristics and behaviours of those who are overweight or have obesity and how these differ from those who maintain a healthy weight.

Methods

Using the UK Biobank cohort we develop an obesity classification system using k-means clustering. Variable selection from the UK Biobank cohort is informed by the Foresight obesity system map across key domains (Societal Influences, Individual Psychology, Individual Physiology, Individual Physical Activity, Physical Activity Environment).

Results

Our classification identifies eight groups of people, similar in respect to their exposure to known drivers of obesity: ‘Younger, urban hard-pressed’, ‘Comfortable, fit families’, ‘Healthy, active and retirees’, ‘Content, rural and retirees’, ‘Comfortable professionals’, ‘Stressed and not in work’, ‘Deprived with less healthy lifestyles’ and ‘Active manual workers’. Pen portraits are developed to describe the characteristics of these different groups. Multinomial logistic regression is used to demonstrate that the classification can effectively detect groups of individuals more likely to be living with overweight or obesity. The group identified as ‘Comfortable, fit families’ are observed to have a higher proportion of healthy weight, while three groups have increased relative risk of being overweight or having obesity: ‘Active manual workers’, ‘Stressed and not in work’ and ‘Deprived with less healthy lifestyles’.

Conclusions

This paper presents the first study of UK Biobank participants to adopt this obesity system approach to characterising participants. It provides an innovative new approach to better understand the complex drivers of obesity which has the potential to produce meaningful tools for policy makers to better target interventions across the whole system to reduce overweight and obesity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12650-x.

Drivers to Obesity-A Study of the Association between Time Spent Commuting Daily and Obesity in the Nepean Blue Mountains Area

Obesity has become a public health challenge in every country on this planet, with a substantial contribution to global mortality and morbidity. Studies of the built environment have shown some promise in understanding the drivers of this obesity pandemic. This paper contributes to this knowledge, by focusing on one aspect of the urban environment and asking whether there is an association between commuting and obesity in residents of the Nepean Blue Mountains area on the fringes of Sydney. This is a cross-sectional study with obesity being the dependent variable, and commuting the independent variable, where 45 min or less was defined as local and distant commute was more than 45 min. In the sample of 158 respondents, the risk of obesity was twice as likely in the distant commuters than in the local commuters (OR 2.04, 95% CI 1.051 to 3.962, p = 0.034). Investigation of possible mediators of this association was limited by sample size; however, mode of transport was found to be a significant mediator. The results support the design of cities to provide health supporting environments for all residents, including equitable access to employment at a reasonable distance and effective public transport.

Poor Dietary Quality and Patterns Are Associated with Higher Perceived Stress among Women of Reproductive Age in the UK

The aim of this study was to investigate the association between stress and diet quality/patterns among women of reproductive age in UK. In total, 244 reproductive aged women participated in an online survey consisting of the European Prospective into Cancer and Nutrition food frequency questionnaire in addition to stress, depression, physical-activity, adiposity, and socioeconomic questions. An a-priori diet quality index was derived by assessing the adherence to Alternate Mediterranean Diet (aMD). A-posteriori dietary-patterns (DPs) were explored through factor analysis. Regression models were used to assess the predictors of the DPs. Participants mainly had medium (n = 113) aMD adherence. Higher stress levels were reported by participants with low aMD adherence. Participants with high aMD adherence were of normal BMI. Factor analysis revealed three DPs: fats and oils, sugars, snacks, alcoholic-beverages, red/processed meat, and cereals (DP-1), fish and seafood, eggs, milk and milk-products (DP-2), and fruits, vegetables, nuts and seeds (DP-3). Regression models showed that DP-1 was positively associated with stress (p = 0.005) and negatively with age (p = 0.004) and smoking (p = 0.005). DP-2 was negatively associated with maternal educational-level (p = 0.01) while DP-3 was negatively associated with stress (p < 0.001), BMI (p = 0.001), and white ethnicity (p = 0.01). Stress was negatively associated with healthy diet quality/patterns among reproductive aged women.

Climate Change, Air Pollution, and Physical Inactivity: Is Active Transportation Part of the Solution?

Active transportation is defined as self-propelled, human-powered transportation modes, such as walking and bicycling. In this article, we review the evidence that reliance on gasoline-powered transportation is contributing to global climate change, air pollution, and physical inactivity and that this is harmful to human health. Global climate change poses a major threat to human health and in the future could offset the health gains achieved over the last 100 yr. Based on hundreds of scientific studies, there is strong evidence that human-caused greenhouse gas emissions are contributing to global climate change. Climate change is associated with increased severity of storms, flooding, rising sea levels, hotter climates, and drought, all leading to increased morbidity and mortality. Along with increases in atmospheric CO2, other pollutants such as nitrogen dioxide, ozone, and particulate matter (e.g., PM2.5) are released by combustion engines and industry, which can lead to pulmonary and cardiovascular diseases. Also, as car ownership and vehicle miles traveled have increased, the shift toward motorized transport has contributed to physical inactivity. Each of these global challenges has resulted in, or is projected to result in, millions of premature deaths each year. One of the ways that nations can mitigate the health consequences of climate change, air pollution, and chronic diseases is through the use of active transportation. Research indicates that populations that rely heavily on active transportation enjoy better health and increased longevity. In summary, active transportation has tremendous potential to simultaneously address three global public health challenges of the 21st century.

Protective Effect on Mortality of Active Commuting to Work: A Systematic Review and Meta-analysis

BACKGROUND

Sedentary behaviour is a major risk of mortality. However, data are contradictory regarding the effects of active commuting on mortality.

OBJECTIVES

To perform a systematic review and meta-analysis on the effects of active commuting on mortality.

METHODS

The PubMed, Cochrane Library, Embase, and Science Direct databases were searched for studies reporting mortality data and active commuting (walking or cycling) to or from work. We computed meta-analysis stratified on type of mortality, type of commuting, and level of commuting, each with two models (based on fully adjusted estimates of risks, and on crude or less adjusted estimates).

RESULTS

17 studies representing 829,098 workers were included. Using the fully adjusted estimates of risks, active commuting decreased all-cause mortality by 9% (95% confidence intervals 3-15%), and cardiovascular mortality by 15% (3-27%) (p < 0.001). For stratification by type of commuting, walking decreased significantly all-cause mortality by 13% (1-25%), and cycling decreased significantly both all-cause mortality by 21% (11-31%) and cardiovascular mortality by 33% (10-55%) (p < 0.001). For stratification by level of active commuting, only high level decreased all-cause mortality by 11% (3-19%) and both intermediate and high level decreased cardiovascular mortality. Low level did not decrease any type of mortality. Cancer mortality did not decrease with walking or cycling, and the level of active commuting had no effect. Low level walking did not decrease any type of mortality, intermediate level of walking decreased only all-cause mortality by 15% (2-28%), and high level of walking decreased both all-cause and cardiovascular mortality by 19% (8-30%) and by 31% (9-52%), respectively. Both low, intermediate and high intensities of cycling decreased all-cause mortality. Meta-analysis based on crude or less fully adjusted estimates retrieved similar results, with also significant reductions of cancer mortality with cycling (23%, 5-42%), high level of active commuting (14%, 4-24%), and high level of active commuting by walking (16%, 0-32%).

CONCLUSION

Active commuting decreases mainly all-cause and cardiovascular mortality, with a dose-response relationship, especially for walking. Preventive strategies should focus on the benefits of active commuting.

Active Transportation and Obesity Indicators in Adults from Latin America: ELANS Multi-Country Study

PURPOSE

The aim of this study was to determine the association between active transportation and obesity indicators in adults from eight Latin American countries.

METHODS

Data from the ELANS study, an observational multi-country study (n: 8336; 18-65 years), were used. Active transportation (walking and cycling) and leisure time physical activity was assessed using the International Physical Activity Questionnaire (long version). The obesity indicators considered were: body mass index, and waist and neck circumference.

RESULTS

In the total sample, the average time dedicated to active transportation was 24.3 min/day, with the highest amount of active transportation being Costa Rica (33.5 min/day), and the lowest being Venezuela (15.7 min/day). The countries with the highest proportion of active transportation were Ecuador (71.9%), and the lowest was Venezuela (40.5%). Results from linear regression analyses suggest that active transportation was significantly and independently associated with a lower body mass index (β: -0.033; 95% CI: -0.064; -0.002), but not with waist circumference (β: -0.037; 95% CI: -1.126; 0.390 and neck circumference (β: -0.007; 95% CI: -0.269; 0.130).

CONCLUSIONS

Active transportation is significantly associated with a lower body mass index. Governments should incentivize this type of transportation as it could help to reduce the obesity pandemic in Latin America.

A Priori and a Posteriori Dietary Patterns in Women of Childbearing Age in the UK

Poor diet quality is a major cause of maternal obesity. We aimed to investigate a priori and a-posteriori derived dietary patterns in childbearing-aged women in UK. An online survey assessed food intake, physical activity (PA), anthropometry and socio-demographics. An a priori defined diet quality was determined via Mediterranean diet (MD) adherence score and Exploratory Factor Analysis (EFA) derived dietary patterns (DPs). Multiple linear regression explored associations between DPs with anthropometric measures, PA and socio-demographics. Participants (n = 123) had low-to-medium MD adherence (average MD-score: 4.0 (2.0)). Age was positively associated with higher MD adherence (X2 (2) = 13.14, p = 0.01). EFA revealed three DPs: 'fruits, nuts, vegetables and legumes' ("Vegetarian-style" DP); 'sweets, cereals, dairy products and potatoes' ("Dairy, sweets and starchy foods" DP); and 'eggs, seafood and meats' ("Protein-rich" DP). "Vegetarian-style" DP was positively associated with higher maternal educational level (p < 0.01) and PA (p = 0.01), but negatively with white ethnicity (p < 0.01). "Dairy, sweets and starchy foods" DP was positively associated with white ethnicity (p = 0.03) and negatively with age (p = 0.03). "Protein-rich" DP was positively associated with age (p < 0.001) and negatively with PA (p = 0.01). A poor diet quality was found among childbearing-aged women; notably in the younger age category, those of white ethnicity, that were more physically inactive and with a lower socioeconomic background.

Automaticity facets applied to screen-time sedentary behaviours and active commuting measured by accelerometers

Background: The time adults spend sitting in front of screens is a health risk factor. In contrast, walking and cycling to and from work, also known as active commuting, could promote physical activity and improve population health.

Objective: This study investigated automatic properties role in explaining active commuting and screen-based sedentary behaviours. The stable, daily conditions for carrying out active commuting and screen-based sedentary behaviour are most likely to develop automatic properties. These characteristics mean performing behaviours via external cues (i.e. lack of intentionality), with an unpleasant emotional experience of not carrying out a set routine (i.e. lack of controllability), and without paying much attention (i.e. efficiency).

Method: This article describes findings of a prospective and correlational study in which 128 people participated. First, participants responded to questions assessed using the Generic Multifaceted Automaticity Scale (GMAS), which measured the automatic properties of screen-based sedentary behaviour and active commuting. The following week, both behaviours were assessed by daily logs to document active commuting and screen-based sedentary behaviour events, and by an accelerometer, worn for seven days, as an objective criterion. Confirmatory factor analyses, bivariate correlations, and multiple linear regressions were computed for the associations between the GMAS scores and objective criterion measures of screen-based sedentary behaviours and active commuting.

Results: Automaticity facets displayed different relationships with screen-based sedentary behaviours and active commuting – people with higher lack of intentionality and lack of controllability for active commuting present higher levels of moderate physical activity. In contrast, the lack of controllability of screen-based sedentary behaviours was a significant predictor of sedentary screen time.

Conclusions: The multidimensional approach to automaticity could be useful in determining more precisely the features that need to be addressed to promote the adoption of active commuting and limit the time spent sitting in front of screens.

Perspectives on Exercise Intensity, Volume and Energy Expenditure in Habitual Cycle Commuting

Background: Knowledge about exercise intensity and energy expenditure combined with trip frequency and duration is necessary for interpreting the character and potential influencing capacity of habitual cycle commuting on e.g., health outcomes. It needs to be investigated with validated methods, which is the purpose of this study. Methods: Ten male and 10 female middle-aged habitual commuter cyclists were studied at rest and with maximal exercise tests on a cycle ergometer and a treadmill in the laboratory. During their normal commute in the Stockholm County, Sweden, their oxygen uptake, heart rate, energy expenditure, ventilation, blood lactate, rated perceived exertion, number of stops, durations, route distances and cycling velocities were monitored with validated methods. The frequency of trips was self-reported. Results: The relative exercise intensity was 65% of maximal oxygen uptake, and the energy expenditure was 0.46 kcal per km and kg body weight for both sexes. Sex differences in MET-values (men, 8.7; women 7.4) mirrored higher levels of cycling speed (20%), body weight (29%), oxygen uptake (54%) and ventilation (51%) in men compared to women. The number of METhours per week during peak cycling season averaged 40 for the men and 28 for the women. It corresponded to a total energy expenditure of about 3,500 and 1,880 kcal for men and women, respectively. The number of trips per year was about 370, and the annual distance cycled was on average 3,500 km for men and 2,300 for women. Conclusion: Cycle commuting is characterized by equal relative aerobic intensity levels and energy requirements for a given distance cycled by men and women. Based on an overall evaluation, it represents a lower range within the vigorous intensity category. The combined levels of oxygen uptake, durations and trip frequencies lead to high levels of METhours and energy expenditure in both men and women during both peak cycling season as well as over the year. Overall, the study presents a novel basis for interpreting cycle commuting in relation to various health outcomes.

Physical activity accrued as part of public transport use in England

BACKGROUND

Walking and cycling for transport (active travel) is an important source of physical activity with established health benefits. However, levels of physical activity accrued during public transport journeys in England are unknown.

METHODS

Using the English National Travel Survey 2010-14 we quantified active travel as part of public transport journeys. Linear regression models compared levels of physical activity across public transport modes, and logistic regression models compared the odds of undertaking 30 min a day of physical activity.

RESULTS

Public transport users accumulated 20.5 min (95% confidence interval=19.8, 21.2) a day of physical activity as part of public transport journeys. Train users accumulated 28.1 min (26.3, 30.0) with bus users 16.0 min (15.3, 16.8). Overall, 34% (32%, 36%) of public transport users achieved 30 min a day of physical activity in the course of their journeys; 21% (19%, 24%) of bus users and 52% (47%, 56%) of train users.

CONCLUSION

Public transport use is an effective way to incorporate physical activity into daily life. One in three public transport users meet physical activity guidelines suggesting that shifts from sedentary travel modes to public transport could dramatically raise the proportion of populations achieving recommended levels of physical activity.

Association between Different Modes of Travelling and Adiposity in Chilean Population: Findings from the Chilean National Health Survey 2016-2017

BACKGROUND

Active travel has been suggested as a feasible way of increasing physical activity levels. Although international studies have demonstrated its effect over different health outcomes and adiposity, there is still limited evidence on this topic in developing countries, such as Chile.

AIM

To investigate the associations between different types of travelling and markers of obesity in the Chilean adult population.

METHODS

5411 participants from the Chilean National Health Survey 2016-2017 (CNHS) were included in this study. Active travel was assessed using a questionnaire. Car commuters, public transport (PT), walking and cycling were the four forms of travelling assessed. Bodyweight, body mass index and waist circumference were used as markers of adiposity.

RESULTS

Compared to car travellers, body weight, WC and BMI levels were lower for PT walking and cycling travellers. The odds for obesity (Odds ratio (OR): 0.41 (95% CI: 0.28; 0.61 p ≤ 0.001) were lower for walking and the odds (OR: 0.56 (95%CI: 0.35; 0.89 p = 0.014) for central obesity were significantly lower for cyclist in comparison to car travellers. Additionally, participation in any form of active travel (walking or cycling) was low, with only 20.9% of the population reporting being active travellers.

CONCLUSION

Active travel, such as walking and cycling, was associated with lower adiposity levels in the Chilean adult population. Promoting active travel could be a feasible strategy to tackle the high prevalence of obesity and physical inactivity in the Chilean population.

Effects of active commuting to work for 12 months on cardiovascular risk factors and body composition

Active commuting has the potential to decrease cardiovascular risk by increasing physical activity. We aimed to investigate the effects of active commuting to work for 12 months on body composition and cardiovascular risk factors. Therefore, 73 hospital employees (age: 46 ± 9 years, 36% males), with a predominantly passive way of commuting, were randomly assigned to an intervention group (IG) and a control group (CG) in a 2:1 fashion. The IG was further divided into a public transportation plus active commuting group (IG‐PT) and a cycling group (IG‐C). Both IGs were prompted to reach 150 min/wk of moderate intensity exercise. Daily self‐reported commuting details were verified by GPS tracking. All subjects underwent assessment of body composition, resting blood pressure, glycemic control, and lipid profile at the beginning and end of the study. Data for final analyses were available in 62 subjects. Commuting details indicated that the subjects randomized to IG changed their commuting habits. HbA1c decreased by 0.2% [95%CI: −0.3, −0.2] in IG‐PT but was not statistically different between groups (P = .06). LDL cholesterol decreased in IG‐C by 0.8 mmol/L [−1.1, −0.4] and by 0.6 mmol/L [−1.2, 0.1] in IG‐PT which can be considered biologically relevant but did not yield statistical significance. Body composition and blood pressure did not differ between groups. Active commuting to work for 12 months did not change body composition but yielded relevant changes in lipid profile and glycemic control. Health benefits of active commuting should be addressed by healthcare professionals when counseling individuals that seek to improve their cardiovascular risk profile.

Cycling but not walking to work or study is associated with physical fitness, body composition and clustered cardiometabolic risk in young men

Introduction

Active commuting is an inexpensive and accessible form of physical activity and may be beneficial to health. The aim of this study was to investigate the association of active commuting and its subcomponents, cycling and walking, with cardiometabolic risk factors, physical fitness and body composition in young men.

Methods

Participants were 776 Finnish young (26±7 years), healthy adult men. Active commuting was measured with self-report. Waist circumference was measured and body mass index (BMI) calculated. Aerobic fitness was measured with bicycle ergometer and muscular fitness with maximal leg and bench press, sit-ups, push-ups and standing long jump. Cardiometabolic risk factors were analysed from blood samples and selected variables (glucose, insulin, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, as well as systolic and diastolic blood pressure) were further converted to z-score to form clustered cardiometabolic risk.

Results

A total of 24% used active commuting consisting of 10% of walkers and 14% of cyclists. After adjustments for age, smoking, time of year, leisure-time and occupational physical activities, cycling was inversely associated with the clustered cardiometabolic risk (β=−0.11, 95% CI −0.22 to −0.01), while walking was not (β=−0.04, 95% CI −0.16 to 0.08). However, further adjustment for waist circumference attenuated the associations to non-significant. Moreover, cycling but not walking was inversely associated with BMI, waist circumference and maximal strength, while a positive association was observed with aerobic fitness (p<0.05).

Conclusion

This study shows that cycling to work or study has beneficial associations to clustered cardiometabolic risk, body composition and aerobic fitness in young, healthy adult men.

Area-Wide Traffic-Calming Zone 30 Policy of Japan and Incidence of Road Traffic Injuries Among Cyclists and Pedestrians

Objectives. To quantify the impact of the "Zone 30" policy introduced in September 2011 on the incidence of cyclist and pedestrian injuries in Japan.Methods. This was an interrupted time-series study. We used the data of cyclist and pedestrian injuries recorded by the Japanese police between 2005 and 2016. We evaluated the monthly number of deaths and serious injuries per person-time on narrow roads (width < 5.5 m, subjected to the policy) compared with that on wide roads (≥ 5.5 m) to control for secular trends. We regressed the injury rate ratio on 2 predictors: the numbers of months after January 2005 and after September 2011. Using the regression results, we estimated the number of deaths and serious injuries prevented.Results. There were 266 939 deaths and serious injuries. By 2016, the cumulative changes in the rate ratio spanned from -0.26 to -0.046, depending on sex and age, and an estimated number of 1704 (95% confidence interval = 1293, 2198) injuries were prevented.Conclusions. The policy had a large preventive impact on cyclist and pedestrian deaths and serious injuries at the national level.

Physical activity and weight following car ownership in Beijing, China: quasi-experimental cross sectional study

OBJECTIVE

To determine the implications of car ownership for physical activity and weight in a global city.

DESIGN

Quasi-experimental cross sectional study.

SETTING

Beijing, China, 2011-15.

PARTICIPANTS

People aged 18 and older from a random sample of households who had entered a permit lottery to purchase a vehicle between January 2011 and November 2015.

INTERVENTIONS

Permit allowing purchase of a vehicle within six months of permit issuance.

MAIN OUTCOME MEASURES

Transit use (number of subway and bus rides each week), physical activity (minutes of walking or bicycling each day), and weight, measured once in early 2016.

RESULTS

Of 937 people analysed in total, 180 had won a permit to purchase a new vehicle. Winning the permit lottery resulted in the purchase of an additional vehicle 91% of the time (95% confidence interval 89% to 94%; P<0.001). About five years after winning, winners took significantly fewer weekly transit rides (-2.9 rides (-5.1 to -0.7); P=0.01) and walked and cycled significantly less (-24.2 minutes (-40.3 to -8.1); P=0.003) than those who did not win the lottery. Average weight did not change significantly between lottery winners and losers. Among those aged 50 and older, however, winners' weight had increased relative to that of losers (10.3 kg (0.5 to 20.2); P=0.04) 5.1 years after winning.

CONCLUSIONS

These data indicate that vehicle ownership in a rapidly growing global city led to long term reductions in physical activity and increase in weight. Continuing increases in car use and ownership in developing and middle income countries could adversely affect physical health and obesity rates.

Association of changes in commute mode with body mass index and visceral adiposity: a longitudinal study

BACKGROUND

Prospective data are sparse for active commuting to work and body weight in Asia. We assessed the association of 5-year changes in commuting mode with body mass index (BMI) and the indicators of abdominal obesity in Japanese working adults.

METHODS

In this longitudinal study, we studied 29,758 participants (25,808 men and 3950 women) in Japan aged 30 to 64 years at baseline who underwent further health examination 5 years after the baseline examination. Changes in BMI were calculated from objectively measured body height and weight at baseline and follow-up examination. Visceral and subcutaneous fat areas and waist circumference measured by computed tomography scans were used as indicators for abdominal adiposity. Linear regression was applied to estimate the association of changes in commuting mode with the obesity outcomes.

RESULTS

Within the 5-year study period, adults who maintained inactive commuting gained weight, and compared with this group, adults who switched to inactive commuting had higher weight gain; conversely, adults who switched to active or public transportation commuting and especially those who maintained active or public transportation commuting experienced less weight gain. Subgroup analysis showed similar tendency across the different transitions of leisure-time exercise or occupational physical activity. For example, among adults who maintained no exercise (n = 16,087), the adjusted mean (95% confidence intervals) of the BMI change over 5 years in kg/m² were 0.27 (0.24 to 0.30) for maintained inactive commuting group (reference), 0.34 (0.30 to 0.38) for switching to inactive commuting group (P = 0.046), 0.20 (0.18 to 0.22) for switching to active commuting or public transportation group (P = 0.001), and 0.09 (0.06 to 0.13) for maintained active commuting or public transportation group (P < 0.001). Maintained inactive commuting tended to be associated with larger gain in abdominal adiposity indicators.

CONCLUSION

Switching from inactive commuting mode to more physically active commuting mode and maintaining active commuting can promote body weight control among working adults across different levels of occupational or leisure-time physical activity.

Acceptability and perceived feasibility of strategies to increase public transport use for physical activity gain - A mixed methods study

ISSUE ADDRESSED

Public transport (PT) users typically accumulate more physical activity (PA) than motor vehicle users. This mixed methods study aimed to determine acceptability and perceived effectiveness of strategies to increase bus use for PA gain in a regional Australian setting.

METHODS

In a 2017 online survey, Tasmanian adults (n = 1091) rated the likelihood of increasing their bus use according to ten hypothetical strategies (fare-, incentives-, information- or infrastructure-based). Three focus groups and five interviews (n = 31) included infrequent bus users from the survey to determine reasons for strategy preferences and potential impact on PA.

RESULTS

The top three strategies in the survey, with supporting rationale from qualitative data, were: provision of real-time bus information ("…because I can better plan…"); bus-only lanes ("…it just speeds the whole thing up…") and employee incentives/rewards for example bus fare credits ("…it really comes down to money…"). Full-time students favoured cost-saving strategies most and residents in outer suburbs favoured infrastructure-based strategies most. Qualitative data indicated that potential for enhanced certainty, efficiency or cost-savings drove strategy preferences and some strategies may lead to PA gain (eg through the location of Park and Ride facilities).

CONCLUSIONS

Real-time information, bus-only lanes and employee incentives/rewards appear most promising for increasing bus use in this population, but tailoring strategies may be required. Discrete PT enhancement strategies may result in PA gain. SO WHAT?: Increasing PA through transport behaviour has been underexplored. The potential for PA gain through greater PT use and discrete PT use enhancement strategies is an important public health consideration.

Potential impact on prevalence of obesity in the UK of a 20% price increase in high sugar snacks: modelling study

OBJECTIVE

To estimate the potential impact on body mass index (BMI) and prevalence of obesity of a 20% price increase in high sugar snacks.

DESIGN

Modelling study.

SETTING

General adult population of the United Kingdom.

PARTICIPANTS

36 324 households with data on product level household expenditure from UK Kantar FMCG (fast moving consumer goods) panel for January 2012 to December 2013. Data were used to estimate changes in energy (kcal, 1 kcal=4.18 kJ=0.00418 MJ) purchase associated with a 20% price increase in high sugar snacks. Data for 2544 adults from waves 5 to 8 of the National Diet and Nutrition Survey (2012-16) were used to estimate resulting changes in BMI and prevalence of obesity.

MAIN OUTCOME MEASURES

The effect on per person take home energy purchases of a 20% price increase for three categories of high sugar snacks: confectionery (including chocolate), biscuits, and cakes. Health outcomes resulting from the price increase were measured as changes in weight, BMI (not overweight (BMI <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30)), and prevalence of obesity. Results were stratified by household income and BMI.

RESULTS

For income groups combined, the average reduction in energy consumption for a 20% price increase in high sugar snacks was estimated to be 8.9×10³ kcal (95% confidence interval -13.1×10³ to -4.2×10³ kcal). Using a static weight loss model, BMI was estimated to decrease by 0.53 (95% confidence interval -1.01 to -0.06) on average across all categories and income groups. This change could reduce the UK prevalence of obesity by 2.7 percentage points (95% confidence interval -3.7 to -1.7 percentage points) after one year. The impact of a 20% price increase in high sugar snacks on energy purchase was largest in low income households classified as obese and smallest in high income households classified as not overweight.

CONCLUSIONS

Increasing the price of high sugar snacks by 20% could reduce energy intake, BMI, and prevalence of obesity. This finding was in a UK context and was double that modelled for a similar price increase in sugar sweetened beverages.

Cross-sectional and longitudinal associations between active commuting and patterns of movement behaviour during discretionary time: A compositional data analysis

Background

Active living approaches seek to promote physical activity and reduce sedentary time across different domains, including through active travel. However, there is little information on how movement behaviours in different domains relate to each other. We used compositional data analysis to explore associations between active commuting and patterns of movement behaviour during discretionary time.

Methods and findings

We analysed cross-sectional and longitudinal data from the UK Biobank study. At baseline (2006–2010) and follow up (2009–2013) participants reported their mode of travel to work, dichotomised as active (walking, cycling or public transport) or inactive (car). Participants also reported activities performed during discretionary time, categorised as (i) screen time; (ii) walking for pleasure; and (iii) sport and do-it-yourself (DIY) activities, summed to produce a total. We applied compositional data analysis to test for associations between active commuting and the composition and total amount of discretionary time, using linear regression models adjusted for covariates. Adverse events were not investigated in this observational analysis. The survey response rate was 5.5%. In the cross-sectional analysis (n = 182,406; mean age = 52 years; 51% female), active commuters engaged in relatively less screen time than those who used inactive modes (coefficient -0.12, 95% confidence interval [CI] -0.13 to -0.11), equating to approximately 60 minutes less screen time per week. Similarly, in the longitudinal analysis (n = 4,323; mean age = 51 years; 49% female) there were relative reductions in screen time in those who used active modes at both time points compared with those who used inactive modes at both time points (coefficient -0.15, 95% confidence interval [CI] -0.24 to -0.06), equating to a difference between these commute groups of approximately 30 minutes per week at follow up. However, as exposures and outcomes were measured concurrently, reverse causation is possible.

Conclusions

Active commuting was associated with a more favourable pattern of movement behaviour during discretionary time. Active commuters accumulated 30–60 minutes less screen time per week than those using inactive modes. Though modest, this could have a cumulative effect on health over time.

Potential of active transport to improve health, reduce healthcare costs, and reduce greenhouse gas emissions: A modelling study

Background

Physical inactivity contributes substantively to disease burden, especially in highly car dependent countries such as New Zealand (NZ). We aimed to quantify the future health gain, health-sector cost-savings, and change in greenhouse gas emissions that could be achieved by switching short vehicle trips to walking and cycling in New Zealand.

Methods

We used unit-level survey data to estimate changes in physical activity, distance travelled by mode, and air pollution for: (a) switching car trips under 1km to walking and (b) switching car trips under 5km to a mix of walking and cycling. We modelled uptake levels of 25%, 50%, and 100%, and assumed changes in transport behaviour were permanent. We then used multi-state life table modelling to quantify health impacts as quality adjusted life years (QALYs) gained and changes in health system costs over the rest of the life course of the NZ population alive in 2011 (n = 4.4 million), with 3% discounting.

Findings

The modelled scenarios resulted in health gains between 1.61 (95% uncertainty interval (UI) 1.35 to 1.89) and 25.43 (UI 20.20 to 30.58) QALYs/1000 people, with total QALYs up to 112,020 (UI 88,969 to 134,725) over the remaining lifespan. Healthcare cost savings ranged between NZ$127million (UI $101m to 157m) and NZ$2.1billion (UI $1.6b to 2.6b). Greenhouse gas emissions were reduced by up to 194kgCO₂e/year, though changes in emissions were not significant under the walking scenario.

Conclusions

Substantial health gains and healthcare cost savings could be achieved by switching short car trips to walking and cycling. Implementing infrastructural improvements and interventions to encourage walking and cycling is likely to be a cost-effective way to improve population health, and may also reduce greenhouse gas emissions.

Do physical activity, commuting mode, cardiorespiratory fitness and sedentary behaviours modify the genetic predisposition to higher BMI? Findings from a UK Biobank study

OBJECTIVE

To investigate whether the association between a genetic profile risk score for obesity (GPRS-obesity) (based on 93 SNPs) and body mass index (BMI) was modified by physical activity (PA), cardiorespiratory fitness, commuting mode, walking pace and sedentary behaviours.

METHODS

For the analyses we used cross-sectional baseline data from 310,652 participants in the UK Biobank study. We investigated interaction effects of GPRS-obesity with objectively measured and self-reported PA, cardiorespiratory fitness, commuting mode, walking pace, TV viewing, playing computer games, PC-screen time and total sedentary behaviour on BMI. Body mass index (BMI) was the main outcome measure.

RESULTS

GPRS-obesity was associated with BMI (β:0.54 kg.m^-2 per standard deviation (SD) increase in GPRS, [95% CI: 0.53; 0.56]; P = 2.1 × 10^-241). There was a significant interaction between GPRS-obesity and objectively measured PA (P_{[interaction]} = 3.3 × 10^-11): among inactive individuals, BMI was higher by 0.58 kg.m^-2 per SD increase in GPRS-obesity (p = 1.3 × 10^-70) whereas among active individuals the relevant BMI difference was less (β:0.33 kg.m^-2, p = 6.4 × 10^-41). We observed similar patterns for fitness (Unfit β:0.72 versus Fit β:0.36 kg.m^-2, P_{[interaction]} = 1.4 × 10^-11), walking pace (Slow β:0.91 versus Brisk β:0.38 kg.m^-2, P_{[interaction]} = 8.1 × 10^-27), discretionary sedentary behaviour (High β:0.64 versus Low β:0.48 kg.m^-2, P_{[interaction]} = 9.1 × 10^-12), TV viewing (High β:0.62 versus Low β:0.47 kg.m^-2, P_{[interaction]} = 1.7 × 10^-11), PC-screen time (High β:0.82 versus Low β:0.54 kg.m^-2, P_{[interaction]} = 0.0004) and playing computer games (Often β:0.69 versus Low β:0.52 kg.m^-2, P_{[interaction]} = 8.9 × 10^-10). No significant interactions were found for commuting mode (car, public transport, active commuters).

CONCLUSIONS

Physical activity, sedentary behaviours and fitness modify the extent to which a set of the most important known adiposity variants affect BMI. This suggests that the adiposity benefits of high PA and low sedentary behaviour may be particularly important in individuals with high genetic risk for obesity.

Transforming Our Cities: Best Practices Towards Clean Air and Active Transportation

PURPOSE OF REVIEW

By 2050, 70% of the global population will live in urban areas, exposing a greater number of people to specific city-related health risks that will only be exacerbated by climate change. Two prominent health risks are poor air quality and physical inactivity. We aim to review the literature and state the best practices for clean air and active transportation in urban areas.

RECENT FINDINGS

Cities have been targeting reductions in air pollution and physical inactivity to improve population health. Oslo, Paris, and Madrid plan on banning cars from their city centers to mitigate climate change, reduce vehicle emissions, and increase walking and cycling. Urban streets are being redesigned to accommodate and integrate various modes of transportation to ensure individuals can become actively mobile and healthy. Investments in pedestrian, cycling, and public transport infrastructure and services can both improve air quality and support active transportation. Emerging technologies like electric and autonomous vehicles are being developed and may reduce air pollution but have limited impact on physical activity. Green spaces too can mitigate air pollution and encourage physical activity. Clean air and active transportation overlap considerably as they are both functions of mobility. The best practices of clean air and active transportation have produced impressive results, which are improved when enacted simultaneously in integrated policy packages. Further research is needed in middle- and low-income countries, using measurements from real-world interventions, tracing air pollution back to the sources responsible, and holistically addressing the entire spectrum of exposures and health outcomes related to transportation.

Cross-sectional and longitudinal analysis of the active commuting behaviors of U.S. Department of the Interior employees

BACKGROUND

Despite evolving evidence of the health and economic benefits of active transportation (AT) to work, few studies have examined the determinants of AT in large organizations with multiple worksites nor how trends in commuting change over time.

METHODS

The data were obtained from the U.S. Department of the Interior Employee Commuting Census of 2010 (n = 23,230), and 2012-2016 (n = 21,725-25,974). The respondents were grouped into four commuting categories: non-active mode, walking, biking, and mixed-mode. Multinomial logistic regression analysis was utilized to examine the correlates of choosing AT to work for the 2010 data. Next, a repeated cross-sectional analysis was completed for all six years of data.

RESULTS

In 2010, AT modes were only chosen by approximately 10% of respondents. Employees who lived farther from work and did not have a public transit station within 0.5 miles from home were generally less likely to choose AT. Respondents working in non-metro workplaces were less likely to bike or take mixed-modes to work, but more likely to walk. Men were more likely to choose AT modes, particularly biking. Respondents aged ≤30 yrs. were less likely to bike than those 31 to 40 yrs., but more likely than those ≥61 yrs. In 2010, the number of respondents that walked was higher, and biked and took mixed-modes was lower when compared to 2016, while the choice to take mixed-modes was higher in 2012 and 2013 when compared to 2016. Daily commuting distances in 2016 tended to be lower than 2010 and 2012, and higher than 2013. However, overall AT choice and commute distance remained reasonably stable over time.

CONCLUSIONS

Respondents who lived close to their workplace and a public transportation station, worked in a metro location, were male and younger were more likely to choose AT modes to work. The results provide insight for the U.S. Department of the Interior and other large organizations to develop intervention strategies that support AT to work. Further research is warranted to understand the concurrent individual, social, and environmental barriers and facilitators for choosing AT to work.

Associations of Public Transportation Use With Cardiometabolic Health: A Systematic Review and Meta-Analysis

Public transportation provides an opportunity to incorporate physical activity into journeys, but potential health impacts have not been systematically examined. We searched the literature for articles on public transportation and health published through December 2017 using Google (Google Inc., Mountain View, California), 5 medical databases, and 1 transportation-related database. We identified longitudinal studies which examined associations between public transportation and cardiometabolic health (including adiposity, type 2 diabetes mellitus, and cardiovascular disease). We assessed study quality using the Newcastle-Ottawa Scale for cohort studies and performed meta-analyses where possible. Ten studies were identified, 7 investigating use of public transportation and 3 examining proximity to public transportation. Seven studies used individual-level data on changes in body mass index (BMI; weight (kg)/height (m)²), with objective outcomes being measured in 6 studies. Study follow-up ranged from 1 year to 10 years, and 3 studies adjusted for nontransportation physical activity. We found a consistent association between use of public transportation and lower BMI. Meta-analysis of data from 5 comparable studies found that switching from automobile use to public transportation was associated with lower BMI (−0.30 units, 95% confidence interval: −0.47, −0.14). Few studies have investigated associations between public transportation use and nonadiposity outcomes. These findings suggest that sustainable urban design which promotes public transportation use may produce modest reductions in population BMI.

Active commuting through natural environments is associated with better mental health: Results from the PHENOTYPE project

BACKGROUND

Commuting routes with natural features could promote walking or cycling for commuting. Commuting through natural environments (NE) could have mental health benefits as exposure to NE can reduce stress and improve mental health, but there is little evidence. This study evaluates the association between NE and commuting, whether active or not, and the association between commuting (through NE), whether active or not, and mental health. We also evaluate the moderating effect of NE quality on the association between NE commuting and mental health.

METHODS

This cross-sectional study was based on adult respondents (n = 3599) of the Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe (PHENOTYPE) project. Data were collected in four European cities in Spain, the Netherlands, Lithuania and the United Kingdom. Data on commuting behavior (active commuting at least one day/week, daily NE commuting) and mental health were collected with questionnaires. Associations were estimated with multilevel analyses including random intercepts at city- and neighborhood level.

RESULTS

Adjusted multilevel analyses showed that daily NE commuters were more often active commuters (OR 1.42; 95% CI 1.19, 1.70). There was no association between active commuting and mental health, but daily NE commuters had on average a 2.74 (95% CI 1.66, 3.82) point higher mental health score than those not commuting through NE. The association with mental health was stronger among active commuters (4.03, 95% CI 2.13, 5.94) compared to non-active commuters (2.21; 95% CI 0.90, 3.51) when daily commuting through NE, but NE quality did not have a moderating effect.

CONCLUSIONS

Daily NE commuting was associated with better mental health, especially for active commuters. Daily NE commuters were likely to be active commuters. Active commuting itself was not associated with mental health. These findings suggest that cities should invest in commuting routes with nature for cycling and walking.

Communicating the benefits of population health interventions: The health effects can be on par with those of medication

How can we communicate to the public that population level health interventions are effective at improving health? Perhaps the most familiar "currency" of effect is that which can be brought about via medication. Comparisons of effect sizes may be effective ways of communicating the benefits of population health interventions if they are seen and understood in the same way that medications are. We developed a series of comparisons to communicate benefits of population health interventions in terms of similar gains to be obtained from statins, metformin and antihypertensive medications for prevention of cardiovascular events, type 2 diabetes, obesity and hypertension. A purposive search identified evidence of population health intervention-related benefits. This evidence ranged from meta-analyses of RCTs to that from observational cohort studies. Population health interventions included implementation of national smoke free legislation, enhanced neighbourhood walkability, increased opportunities for active travel and protection of urban green space. In some cases, the benefits of population health interventions were found to be equivalent to, or even outweighed those of the medications to which they were compared. For example, RCT-based evidence suggested that exercise taken with a view of a green space was associated with 12 mmHg and 6 mmHg reductions in systolic and diastolic blood pressure, respectively, which was at least on par with the reductions associated with antihypertensive medications. Future work will test the effectiveness of these comparisons for increasing the familiarity, credibility and acceptability of population health interventions and, in particular, examine the importance of communicating putative mechanisms and potential co-benefits.

Using alternatives to the car and risk of all-cause, cardiovascular and cancer mortality

OBJECTIVE

To investigate the associations between using alternatives to the car which are more active for commuting and non-commuting purposes, and morbidity and mortality.

METHODS

We conducted a prospective study using data from 3 58 799 participants, aged 37-73 years, from UK Biobank. Commute and non-commute travel were assessed at baseline in 2006-2010. We classified participants according to whether they relied exclusively on the car or used alternative modes of transport that were more active at least some of the time. The main outcome measures were incident cardiovascular disease (CVD) and cancer, and CVD, cancer and all-cause mortality. We excluded events in the first 2 years and conducted analyses separately for those who regularly commuted and those who did not.

RESULTS

In maximally adjusted models, regular commuters with more active patterns of travel on the commute had a lower risk of incident (HR 0.89, 95% CI 0.79 to 1.00) and fatal (HR 0.70, 95% CI 0.51 to 0.95) CVD. Those regular commuters who also had more active patterns of non-commute travel had an even lower risk of fatal CVD (HR 0.57, 95% CI 0.39 to 0.85). Among those who were not regular commuters, more active patterns of travel were associated with a lower risk of all-cause mortality (HR 0.92, 95% CI 0.86 to 0.99).

CONCLUSIONS

More active patterns of travel were associated with a reduced risk of incident and fatal CVD and all-cause mortality in adults. This is an important message for clinicians advising people about how to be physically active and reduce their risk of disease.

Transport mode choice and body mass index: Cross-sectional and longitudinal evidence from a European-wide study

BACKGROUND

In the fight against rising overweight and obesity levels, and unhealthy urban environments, the renaissance of active mobility (cycling and walking as a transport mode) is encouraging. Transport mode has been shown to be associated to body mass index (BMI), yet there is limited longitudinal evidence demonstrating causality. We aimed to associate transport mode and BMI cross-sectionally, but also prospectively in the first ever European-wide longitudinal study on transport and health.

METHODS

Data were from the PASTA project that recruited adults in seven European cities (Antwerp, Barcelona, London, Oerebro, Rome, Vienna, Zurich) to complete a series of questionnaires on travel behavior, physical activity levels, and BMI. To assess the association between transport mode and BMI as well as change in BMI we performed crude and adjusted linear mixed-effects modeling for cross-sectional (n = 7380) and longitudinal (n = 2316) data, respectively.

RESULTS

Cross-sectionally, BMI was 0.027 kg/m² (95%CI 0.015 to 0.040) higher per additional day of car use per month. Inversely, BMI was -0.010 kg/m² (95%CI -0.020 to -0.0002) lower per additional day of cycling per month. Changes in BMI were smaller in the longitudinal within-person assessment, however still statistically significant. BMI decreased in occasional (less than once per week) and non-cyclists who increased cycling (-0.303 kg/m², 95%CI -0.530 to -0.077), while frequent (at least once per week) cyclists who stopped cycling increased their BMI (0.417 kg/m², 95%CI 0.033 to 0.802).

CONCLUSIONS

Our analyses showed that people lower their BMI when starting or increasing cycling, demonstrating the health benefits of active mobility.

Cycling in Warsaw, Poland - Perceived enablers and barriers according to cyclists and non-cyclists

Cycling in urban environments provides many benefits to people. However, planning of cycling infrastructures in large cities faces numerous challenges and requires better understanding of both the factors enabling cycling as well as barriers to it, determined by particular local context. While there is a growing body of research that tackle the bike transport related questions in Western Europe and the USA, there is relatively little research on that in Central Eastern Europe (CEE), in post-communist countries. In this study we used qualitative and quantitative methods to explore urban cyclists and non-cyclists opinions about the cycling, the perceived problems and obstacles, and perception of the on-going changes in bicycle transportation system in Warsaw, Poland. Although many people see potential advantages of cycling, it is mostly perceived as a leisure time activity. Those who do utilitarian cycling are more acutely aware of the benefits, such as rapidity and flexibility of this mean of transport. The main perceived barriers are linked to lack of good cycling infrastructure in the city, the feeling of insecurity linked to the behaviour of drivers, and to maintenance during winter. In conclusion, our research highlights both the opportunities and challenges linked to the development of improved cycle transportation system, suggesting the need for a range of policies, from the infrastructure improvements and comprehensive planning of the whole transportation system, to improving the driving culture that would support feeling of security of the cyclists.

Body dimensions and weight to height indices in rescuers from the State Fire Service of Poland

Few studies have been published in Poland concerning body dimensions of firefighters from the State Fire Service although this knowledge is needed for e.g. development of personal protective equipment. The aim of the study was to evaluate body dimensions and weight-to-height ratio in firefighters from the State Fire Service. Using the anthropological procedures, body mass (BM) and body height (BH) were examined in 178 men at the chronological age (CA) of 19.5 to 53 years who were rescuers from the national rescue and fire brigades of the State Fire Service. The study participants were divided into three categories of CA: up to 25 years, between 24 and 44 years, and over 44 years. The results were compared to population standards. It was found that BH of the youngest rescuers was significantly higher (0.05) than in other study participants. Based on the standardized values of BM and BMI, population of firefighters aged over 25 years was found to be characterized by overweight and, in certain cases, even by obesity. The excess level of body mass index (BMI ≥ 25 kgm2) was found in nearly 60% of study participants, with half of the group classified as overweight (n=31, BMI ranging from 25 to 29.9 kg/m2), and 10% classified as obese. Due to the worrying high percentage of cases of excess body mass in firefighters from the State Fire Service, it was found that it is recommended to evaluate the relationships between body height and mass on regular basis during periodical obligatory tests of physical fitness of rescuers from the State Fire Service and to increase the frequency and duration of training sessions.