Effects of active commuting on health-related quality of life and sickness-related absence

Mobility Infrastructures and Health: Scoping Review of studies in Europe

Objectives

Movement-friendly environments with infrastructure favouring active mobility are important for promoting physical activity. This scoping literature review aims at identifying the current evidence for links between mobility infrastructures and (a) behaviour regarding active mobility, (b) health outcomes and (c) co-benefits.

Method

This review was conducted in accordance with the PRISMA scoping review guidelines using PubMed and EMBASE databases. Studies included in this review were conducted in Europe, and published between 2000 and March 2023.

Results

146 scientific articles and grey literature reports were identified. Connectivity of sidewalks, walkability, and accessibility of shops, services and work are associated with walking. Cycling is positively associated with cycle-paths, separation of cycling from traffic and proximity to greenspaces, and negatively associated with traffic danger. Increased active transportation has a protective effect on cardiovascular and respiratory health, obesity, fitness, and quality of life. Co-benefits result from the reduction of individual motorized transportation including reduced environmental pollution and projected healthcare expenditure.

Conclusion

Mobility infrastructure combined with social and educational incentives are effective in promoting active travel and reducing future healthcare expenses. A shift to active transportation would increase both individual and community health and decrease greenhouse gas emissions.

Effectiveness of an eHealth-Delivered Program to Empower People With Musculoskeletal Pain in Rural Australia: A Randomized Controlled Trial

OBJECTIVE

Our objective was to evaluate the effectiveness of a three-month physiotherapist-delivered eHealth physical activity program compared with usual care to improve function in adults with low back pain or knee osteoarthritis in rural Australia.

METHODS

This was a parallel, two-group, pragmatic, superiority, randomized controlled trial involving three- and six-month posttreatment follow-ups. There was a total of 156 adults with chronic nonspecific low back pain (n = 97) or knee osteoarthritis (n = 59) from rural Australia. The intervention involved an eHealth physical activity and an exercise program that included five to eight teleconsultations with a physiotherapist (primary time point three months) or usual care (eg, general practitioner, physiotherapy, and pain medication). The primary outcome was the Patient-Specific Functional Scale (0-30), with a three-point difference between groups being considered the minimum clinically important difference.

RESULTS

Participants receiving the eHealth intervention (n = 78) reported significantly greater and clinically worthwhile improvements in function (mean between-group difference 3.6; 95% confidence interval [CI] 1.3-5.9) compared to participants receiving usual care (n = 78). Small but statistically significantly greater improvements in disability (7.2 of 100; 95% CI 2.1-12.3) and quality of life (4.5 of 100; 95% CI 0.0-9.0) also favored the eHealth group. No clinical or statistical differences between groups were found for the secondary outcomes of pain, coping skills, and physical activity levels.

CONCLUSION

A physiotherapist-delivered eHealth intervention is effective and provides clinically meaningful improvements in function compared to usual care for people with musculoskeletal pain in rural communities. These findings highlight the potential for eHealth-based programs to improve access to evidence-based exercise interventions for people with musculoskeletal pain in rural communities.

Does cycle commuting reduce the risk of mental ill-health? An instrumental variable analysis using distance to nearest cycle path

BACKGROUND

Previous studies have linked cycling with improved mental wellbeing but these studies tend to use cross-sectional survey data that have small sample sizes and self-reported health measures, and are potentially susceptible to omitted-variable bias and reverse causation. We use an instrumental variable approach and an objective measure of mental ill-health taken from linked administrative data to ask: 'Does cycle commuting reduce the risk of mental ill-health?'

METHODS

Our study links data on commuting in Edinburgh and Glasgow from the Scottish population census with mental health prescriptions from the National Health Service Prescribing Information System records. We use road distance from home to nearest cycle path as an instrumental variable for cycle commuting.

RESULTS

In total, 378 253 people aged 16-74 years living and working in the City of Edinburgh and Glasgow City council areas at the 2011 census were included in our study; 1.85% of commuters in Glasgow and 4.8% of commuters in Edinburgh cycled to work. Amongst cyclists, 9% had a prescription for mental health compared with 14% amongst non-cyclists. Using a bivariate probit model, we estimate a mean average reduction in prescriptions for antidepressants and/or anxiolytics in the 5 years following the census of -15.1% (95% CI: -15.3% to -15.0%) amongst cycle commuters compared with those who use any other mode to commute.

CONCLUSIONS

This work suggests that cycle commuting is causally related to reduced mental ill-health and provides further evidence in support of the promotion of active travel to encourage commuters travelling shorter distances to shift to cycle commutes.

Commuting and sick leave: a retrospective longitudinal study among a Belgian military population

OBJECTIVES

In a military context, people often have to deal with long commuting distance. The aim of the current study is to investigate to what extent commuting distances predict sickness absence among a military population.

METHODS

The present study is based on a dynamic cohort of active-duty military personnel of the Belgian Defence. A proportional hazard Andersen-Gill model was used to determine the effect of commuting distance on the recurrence of sickness absence, considering relevant covariates. In a second model, an interaction term for commuting and traffic congestion was introduced.

RESULTS

Higher commuting distances led to higher risk of recurring sickness absence, which was 9%, 15%, 8% and 11% higher, respectively, for distances of 5-14 km, 15-29 km, 30-59 km or >60 km compared with a distance of <5 km.A commuting distance of 30-59 km increased the risk with 47%, 33%, 35% and 76% if the reported traffic congestion was, respectively, 5-20%, 20-40%, 40-70% and 70-100% compared with a commuting distance of <5 km and a reported traffic congestion of 0-5%. A commuting distance of >60 km increased the risk with 25% and 76%, respectively, for a reported traffic congestion of 5-20% and 70-100% compared with a commuting distance of <5 km and a reported traffic congestion of 0-5%.

CONCLUSIONS

These findings support measures to reduce the distance and frequency of commuting in order to reduce sickness absence, considering for example remote working, a more responsible geographical distribution of the offices or a revision of the employees' job-changing policies.

Active mobility and mental health: A scoping review towards a healthier world

Research has proven that engaging in active mobility (AM), namely walking and cycling for transportation, significantly enhances physical activity levels, leading to better physical health. It is still unclear whether AM could also offer any mental health benefits. This scoping review aims to provide a comprehensive understanding of the current knowledge on the relationship between AM and mental health, given its crucial role in public health. The authors searched online databases to isolate primary studies written in English involving an adult sample (16 or over). AM was the exposure factor. Many mental health elements were included as outcomes (depression, anxiety, self-esteem, self-efficacy, stress, psychological and subjective well-being, resilience, loneliness and social support, quality of life, mood, life satisfaction and sleep). The results were organised in a narrative summary per each outcome selected, graphical syntheses and an overview of gaps to be further examined. The authors identified a total of 55 papers as relevant. The results show inconsistency in study designs, definition and operationalisation of the variables, approach and methodologies used. A cross-sectional design was the dominant choice, primarily examining data from national public health surveys. Nonetheless, there has been improvement in outcomes of interests, initially mainly the quality of life and affect. Lately, authors have focused on a broader range of mental health-related factors (such as travel satisfaction). The experimental studies showed promising mental health improvements in those who used active modes more than those who used motorised vehicles. It creates a rationale for further research towards implementing a unified theoretical and methodological framework to study the link between AM and mental health. The ultimate goal is to generate solid conclusions that could support building societies and cities through public health promotion and sustainable strategies, like walking and cycling as a means of transport.

Does it matter for health if steps are taken during work or leisure? A prospective accelerometer study using register-based long-term sickness absence

BACKGROUND

Walking is known to be good for health. However, it is unknown whether it matters if steps are taken during work or leisure. Therefore, we aimed to examine the prospective association between accelerometer-measured steps taken during work or leisure and register-based long-term sickness absence (LTSA).

METHODS

We included 937 blue- and white-collar workers from the PODESA cohort who wore a thigh-based accelerometer over four days to measure number of steps during work and leisure. Steps were divided into domain based on diary data. First event of LTSA was retrieved from a national register with four years' follow-up. We used Cox proportional hazard models to analyze the association between domain-specific and total daily steps and LTSA, adjusted for age, sex, job type, smoking, and steps in the other domain (e.g., work/leisure).

RESULTS

We found more steps at work to be associated with a higher LTSA risk [Hazard Ratio (HR):1.04; 95% CI: 1.00-1.08 per 1000 steps]. No significant association was found between steps during leisure and LTSA (HR: 0.97; 95% CI: 0.91-1.02), nor between total daily steps and LTSA (HR: 1.01; CI 95% 0.99-1.04).

CONCLUSIONS

More steps at work were associated with higher risk of LTSA, while steps during leisure was not clearly associated with LTSA risk. These findings partly support 'the physical activity paradox' stating that the association between physical activity and health depends on the domain.

The health benefits of bicycling to school among adolescents in China: A propensity score matching study

Background

A large number of high-income countries are now promoting active commuting to school as an opportunity for adolescents to increase physical activity (PA) and improve their health. Few studies have examined the multiple benefits of active travel to school among adolescents in developing countries, especially in China. Hence, this study aims to estimate the effects of bicycling to school on adolescents' subjective health, physical health, and sickness absence.

Methods

Self-reported and cross-sectional data from 6,353 school-aged children (12-19 years old) in the 2014-2015 China Education Panel Survey (CEPS2014-2015) were used. The independent variable was a binary, self-reported indicator of whether children bicycled to school. The dependent variables included subjective health (self-reported health, mental stress), physical health (BMI, kidney disease, lung disease, heart disease, brain disease, upper limb fracture, lower limb fracture, and sickness frequency), and sickness absence. Propensity score matching (PSM) was used to estimate the causal effects of bicycling to school on adolescents' health.

Results

Bicycling to school positively affects both subjective and physical health. Those students who biked to school were associated with a higher self-rated health status, a healthier weight, a lower level of mental stress, and a lower risk of developing brain diseases. No significant relation is found between bicycling and sickness frequency, and sickness absence. Moreover, we separately compared the bicycling group with the walking group and the non-active travel group. There is still evidence that cycling is beneficial for students. Compared with walking to school, cycling to school resulted in a higher self-rated health score and a lower mental stress score. Physically, students who bicycled to school were less likely to be absent from school and suffer from kidney and brain diseases than students who walked to school. However, we do not find a significant difference in health outcomes from cycling compared to non-active modes of transportation. Further, differentiation of the health effects of bicycling across living areas shows that health effects are more pronounced for those living in edge and rural areas.

Conclusion

These findings provide evidence of the value of promoting bicycling to school in improving various adolescents' health outcomes in transitional China.

Active commuting associations with BMI and self-rated health: a cross-sectional analysis of the Healthy Ireland survey

Aim

Active travel is advised to help meet recommended weekly physical activity levels. However limited research has examined active travel associations with health indicators. The aim of this study is to investigate active commuting associations with BMI and self-rated health (SRH) using data from the Healthy Ireland Survey.

Subjects and methods

Cross-sectional analysis of data was conducted from a nationally representative study of the Irish population. Participants who worked or attended education (n = 4038) provided information regarding their most common travel mode to work or education and demographic, lifestyle and health characteristics during an interview. Following comparative analysis, multivariable logistic regression was used to investigate associations between active commuting modes and overweight, obesity and SRH.

Results

Active commuting was associated with decreased likelihood of obesity (AOR 0.69, 95% CI = 0.52, 0.90) relative to non-active commuting. Examination of active commuting mode revealed further reduced obesity risk among cyclists (AOR 0.23, 95% CI = 0.09, 0.56) relative to non-cyclists and among those actively travelling ≥3 km (AOR 0.54, 95% CI = 0.30, 0.98). No associations between active commuting and overweight or SRH were observed.

Conclusion

Our findings, which indicate an inverse association between active commuting and obesity, represent a significant contribution to the evidence base supporting promotion of active travel for obesity prevention.

Impacts of Commuting Practices on Social Sustainability and Sustainable Mobility

Commuting is an integral part of many people’s everyday life providing a transition between private and working life. It does, however, lead to negative impacts at a personal and social-ecological level (health impacts, lack of time, climate emissions, etc.). This article is based on the transdisciplinary research project “CommuterLab” (PendelLabor), which investigates commuting practices in the German Rhine-Main region. Using a practice-theoretical approach, we conducted a qualitative empirical study to explore how commuters organise the transition between their personal life and job. Through our analysis, we were able to identify different meanings of commuting and its strong interconnection with other everyday practices. This allowed us to gain deep insight into the social (non-)sustainability of commuting. At the core of our results are four different types of commuting practice whose impact on social sustainability differs widely. Furthermore, since the interviews were conducted during the coronavirus pandemic, respondents had their first experience of strongly reduced commuting. This in turn allowed insights into the changing organisation of everyday life and the impact of reconfigured commuting practices on social sustainability. Based on these results, we drew conclusions about the dynamics of commuting in terms of social sustainability.

Health effects of active commuting to work: The available evidence before GISMO

Sedentary lifestyle is a major modifiable risk factor for many chronic diseases. Global guidelines recommend for maintaining health in adults, at least 150 minutes of moderate intensity of physical activity throughout the week, but compliance is insufficient and health problems arise. One obvious way to overcome this is to integrate physical activity into the daily routine for example by active commuting to work. Scientific evidence, however, is scarce and therefore we set out to perform this systematic review of the available literature to improve understanding of the efficiency of active commuting initiatives on health. Literature searches were performed in PubMed and Cochrane database. Altogether, 37 studies were screened. Thereof, eight publications were reviewed, which included 555 participants. The mean study duration of the reviewed research was 36 ± 26 (8-72) weeks. Overall, active commuting in previously untrained subjects of both sexes significantly improved exercise capacity, maximal power, blood pressure, lipid parameters including cholesterol, high-density lipoprotein, and waist circumference. Improvement was independent of the type of active commuting. Despite relatively few studies that were previously performed, this review revealed that active commuting has health beneficial effects comparable to those of moderate exercise training.

Dose-response relationship of active commuting to work: Results of the GISMO study

The positive health benefits of regular exercise, particularly regarding cardiovascular risk and diseases, are well recognized and scientifically evident. However, a sedentary lifestyle is one of the most important cardiovascular risk factors that are still insufficiently addressed. Leisure-time active commuting like walking and biking is an ideal way to improve exercise behavior in the general population. The purpose of this substudy of the GISMO study was to assess dose-response relations in all commuters and the three subgroups of commuters (physically active by bicycle and/or walking, physically active by using public transportation (PT), and the controls using their own vehicles). As such, a positive dose-response relationship could be confirmed in all physically active commuters compared to the control group. Whether the commuters cycled, walked, or traveled by PT -the more the physical exercise they performed (measured in metabolic equivalent [MET]-hours), the larger their gain in physical fitness (measured in gained or "Delta" Watt during a maximal exercise test), and their physical fitness at the end of the study was P = .016 and P = .003, respectively. Health-related quality of life correlated in two out of eight subdomains of the SF-36 questionnaire with MET-hours achieved during the study period (General Health and Physical Functioning). No clearly significant dose-response could be observed regarding HDL(high-density lipoprotein)-cholesterol or body composition. Our results indicate a dose-response pattern of healthy commuting in exercise capacity and health-related quality of life to increase doses of physically active commuting.