The effectiveness of community-based cycling promotion: findings from the Cycling Connecting Communities project in Sydney, Australia

''I felt marvellous e-cycling. If I had long hair I would have flicked it": a qualitative investigation of the factors associated with e-cycling engagement among adults with type 2 diabetes

Background

Physical activity (PA) is a key component in the management of type 2 diabetes. However, this population have low rates of PA engagement. Electrically assisted cycling has been identified as a means through which to increase PA by incorporating activity into daily life, while overcoming some of the barriers to conventional cycling. The determinants of e-cycling among people living with chronic disease are largely unknown. The aim of this research was to explore the determinants of e-cycling among individuals with type 2 diabetes using the Theoretical Domains Framework (TDF) and the Capability, Opportunity and Motivation for Behaviour change model (COM-B). This information is important for determining the suitability of future e-cycling initiatives and, if appropriate, inform future e-cycling interventions.

Method

One-to-one semi structured interviews were conducted with 16 participants from the e-cycling arm of a pilot randomised controlled trial between September 2019 and April 2020. The TDF was used to develop the interview guide. The framework method of analysis was used, incorporating both deductive and inductive reasoning. A conceptual model of the factors that influence e-cycling in this population was created.

Results

The most commonly reported TDF domains were skills, knowledge, belief about capabilities, belief about consequences and environmental context and resources. Specifically, e-bike training facilitated e-cycling engagement by providing participants with the skills, knowledge, and confidence needed to ride the e-bike and ride on the road. In addition, the enjoyment of e-cycling was a key facilitator to engagement. Participants engaged in e-cycling to improve their health rather than for environmental reasons. Most barriers to e-cycling related to the natural or physical environment.

Conclusion

This study provides insight into the personal, social, and environmental factors associated with e-cycling in this population. The findings of this study can be used to develop a more refined e-cycling intervention targeting the factors identified as influencing e-cycling engagement. In addition, this information will help in the selection of mechanistic outcome measures for evaluation.

Electrically assisted cycling for individuals with type 2 diabetes mellitus: a pilot randomized controlled trial

BACKGROUND

Type 2 diabetes mellitus (T2DM) and its associated complications puts considerable strain on healthcare systems. With the global incidence of T2DM increasing, effective disease management is essential. Physical activity (PA) is a key component of T2DM management; however, rates of PA engagement are low in this population. Developing effective and sustainable interventions that encourage PA is a high priority. Electrically assisted bicycles are becoming increasingly popular and may increase PA in healthy adults. This study aimed to provide evidence of the feasibility of conducting a randomized controlled trial to evaluate the efficacy of an e-cycling intervention to increase PA and improve health in individuals with T2DM.

METHODS

A parallel-group two-arm randomized, waitlist-controlled pilot study was conducted. Individuals were randomized to either an e-bike intervention or standard care. The intervention incorporated two one-to-one e-bike skills training and behavioural counselling sessions delivered by a community-based cycling charity, followed by a 12-week e-bike loan with two further sessions with the instructors. Feasibility was assessed via measures related to recruitment, retention and intervention implementation. Post-intervention interviews with instructors and participants explored the acceptability of the study procedures and intervention. Clinical, physiological and behavioural outcomes were collected at baseline and post-intervention to evaluate the intervention's potential.

RESULTS

Forty participants (M_age = 57) were randomized, of which 34 were recruited from primary care practices. Thirty-five participants were retained in the trial. The intervention was conducted with high fidelity (> 80% content delivered). E-bike training provided participants with the skills, knowledge and confidence needed to e-bike independently. Instructors reported being more confident delivering the skills training than behavioural counselling, despite acknowledging its importance. The study procedures were found to be acceptable to participants. Between-group differences in change during the intervention were indicative of the interventions potential for improving glucose control, health-related quality of life and cardiorespiratory fitness. Increases in overall device measured moderate-to-vigorous PA behaviour following the intervention were found, and there was evidence that this population self-selected to e-cycle at a moderate intensity.

CONCLUSIONS

The study's recruitment, retention, acceptability and potential efficacy support the development of a definitive trial subject to identified refinements.

TRIAL REGISTRATION

ISRCTN, ISRCTN67421464 . Registered 17/12/2018.

The atmospheric impacts of initiatives advancing shifts towards low-emission mobility: A scoping review

In an urban environment, people's daily traffic choices are reflected in emissions and the resulting local air composition, or air quality. Traffic contributes to the emissions of both carbon dioxide (CO₂), affecting climate, and particulate matter (PM), affecting atmospheric chemistry and human health. While the development of city infrastructure is not in the hands of individuals, it is their transport mode choices that constitute traffic. In this scoping review we analyse 108 initiatives from around the world potentially influencing individual travel behaviour and producing changes in the shares of different transport modes (modal shifts). The targets, types and techniques of initiatives are identified. Examples of economic, regulative, structural and persuasive initiatives are included. Special focus is on whether the impacts on CO₂ emissions, PM emissions and/or PM concentrations have been quantitatively evaluated, and on the quality and results of the evaluations. We observe that a variety of targets can motivate actions that lead to modal shifts and emission reductions. The results indicate that the level of atmospheric evaluations is low: absolute or relative changes in emissions and/or concentrations had been evaluated for only 31% (N = 34) of the reviewed initiatives, with substantial heterogeneity in quality. Sanctions, such as congestion charge and restrictions, have more likely been evaluated in peer reviewed analyses than incentives. Scientific evaluations of impacts on ambient PM concentrations are especially scarce (N = 4), although Air Quality is the primary target of 13% of actions and secondary target for at least 12%. We discuss the determinants of success and failure, when it comes to different types of initiatives, emission reductions and evaluations. A high-quality evaluation of atmospheric impacts captures the following: correct data about the modal shift (rate and direction), exclusion of external factors affecting the shift and emissions, and possible indirect impacts of the shift.

Developing Interventions for Scaling Up UK Upcycling

Upcycling presents one of many opportunities for reducing consumption of materials and energy. Despite recent growth evidenced by increasing numbers of practitioners and businesses based on upcycling, it remains a niche activity and requires scaling up to realise its potential benefits. This paper investigates UK household upcycling in order to develop interventions for scaling up upcycling in the UK. Mixed methods were used in four stages: (a) Interviews to gain insights into UK upcycling; (b) a survey to discover key factors influencing UK upcycling; (c) intervention development based on the synthesis of interviews and survey; and (d) use of a semi-Delphi technique to evaluate and develop initial interventions. The results showed approaches to upcycling (e.g., wood, metal and fabric as frequently used materials, online platforms as frequently used source of materials), context for upcycling (e.g., predominant use of home for upcycling), factors influencing UK upcycling with key determinants (i.e., intention, attitude and subjective norm), important demographic characteristics considering a target audience for interventions (i.e., 30+ females) and prioritised interventions for scaling up (e.g., TV and inspirational media and community workshops as short-term high priority interventions). The paper further discusses implications of the study in terms of development of theory and practice of upcycling.

Controlled before-after intervention study of suburb-wide street changes to increase walking and cycling: Te Ara Mua-Future Streets study design

BACKGROUND

Achieving a shift from car use to walking, cycling and public transport in cities is a crucial part of healthier, more environmentally sustainable human habitats. Creating supportive active travel environments is an important precursor to this shift. The longevity of urban infrastructure necessitates retrofitting existing suburban neighbourhoods. Previous studies of the effects of street changes have generally relied on natural experiments, have included few outcomes, and have seldom attempted to understand the equity impacts of such interventions.

METHODS

In this paper we describe the design of Te Ara Mua - Future Streets, a mixed-methods, controlled before-after intervention study to assess the effect of retrofitting street changes at the suburb scale on multiple health, social and environmental outcomes. The study has a particular focus on identifying factors that improve walking and cycling to local destinations in low-income neighbourhoods and on reducing social and health inequities experienced by Māori (Indigenous New Zealanders) and Pacific people. Qualitative system dynamics modelling was used to develop a causal theory for the relationships between active travel, and walking and cycling infrastructure. On this basis we selected outcomes of interest. Together with the transport funder, we triangulated best evidence from the literature, transport policy makers, urban design professionals and community knowledge to develop interventions that were contextually and culturally appropriate. Using a combination of direct observation and random sample face to face surveys, we are measuring outcomes in these domains of wellbeing: road-user behaviour, changes to travel mode for short trips, physical activity, air quality, road traffic injuries, greenhouse gas emissions, and perceptions of neighbourhood social connection, safety, and walking and cycling infrastructure .

DISCUSSION

While building on previous natural experiments, Te Ara Mua - Future Streets is unique in testing an intervention designed by the research team, community and transport investors together; including a wide range of objective outcome measures; and having an equity focus. When undertaking integrated intervention studies of this kind, a careful balance is needed between epidemiological imperatives, the constraints of transport funding and implementation and community priorities, while retaining the ability to contribute new evidence for healthy, equitable transport policy. The study was retrospectively registered as a clinical trial on 21 June 2018 in the ISCRTN registry: ISRCTN89845334 http://www.isrctn.com/ISRCTN89845334.

Cycling for Transportation in Sao Paulo City: Associations with Bike Paths, Train and Subway Stations

Cities that support cycling for transportation reap many public health benefits. However, the prevalence of this mode of transportation is low in Latin American countries and the association with facilities such as bike paths and train/subway stations have not been clarified. We conducted a cross-sectional analysis of the relationship between bike paths, train/subway stations and cycling for transportation in adults from the city of Sao Paulo. We used data from the Sao Paulo Health Survey (n = 3145). Cycling for transportation was evaluated by a questionnaire and bike paths and train/subway stations were geocoded using the geographic coordinates of the adults' residential addresses in 1500-m buffers. We used multilevel logistic regression, taking account of clustering by census tract and households. The prevalence of cycling for transportation was low (5.1%), and was more prevalent in males, singles, those active in leisure time, and in people with bicycle ownership in their family. Cycling for transportation was associated with bike paths up to a distance of 500 m from residences (OR (Odds Ratio) = 2.54, 95% CI (Confidence interval) 1.16-5.54) and with the presence of train/subway stations for distances >500 m from residences (OR = 2.07, 95% CI 1.10-3.86). These results are important to support policies to improve cycling for transportation in megacities such as Sao Paulo.

The usefulness of GPS bicycle tracking data for evaluating the impact of infrastructure change on cycling behaviour

Issue addressed A key strategy to increase active travel is the construction of bicycle infrastructure. Tools to evaluate this strategy are limited. This study assessed the usefulness of a smartphone GPS tracking system for evaluating the impact of this strategy on cycling behaviour. Methods Cycling usage data were collected from Queenslanders who used a GPS tracking app on their smartphone from 2013-2014. 'Heat' and volume maps of the data were reviewed, and GPS bicycle counts were compared with surveillance data and bicycle counts from automatic traffic-monitoring devices. Results Heat maps broadly indicated that changes in cycling occurred near infrastructure improvements. Volume maps provided changes in counts of cyclists due to these improvements although errors were noted in geographic information system (GIS) geo-coding of some GPS data. Large variations were evident in the number of cyclists using the app in different locations. These variations limited the usefulness of GPS data for assessing differences in cycling across locations. Conclusion Smartphone GPS data are useful in evaluating the impact of improved bicycle infrastructure in one location. Using GPS data to evaluate differential changes in cycling across multiple locations is problematic when there is insufficient traffic-monitoring devices available to triangulate GPS data with bicycle traffic count data. So what? The use of smartphone GPS data with other data sources is recommended for assessing how infrastructure improvements influence cycling behaviour.

Physical activity: a synopsis and comment on "community-wide interventions for increasing physical activity"

In this synopsis, we summarize and comment on Baker and colleagues' Cochrane review of studies on the population-level impact of community-wide physical activity (PA) interventions. Insufficient PA remains a major public health problem. Community-wide interventions offer an opportunity to extend reach by increasing the proportion of the population experiencing the intervention. A previous Cochrane review of community-wide PA interventions concluded that evidence for effectiveness was mixed. Hence, Baker and colleagues incorporated new data about community-based PA interventions. This Cochrane review concluded there is an overall lack of evidence that community-wide interventions improve PA outcomes at the population level. Recommendations are that future research should use high quality research design, more explicitly test ways to increase reach, and utilize objective measurements of PA to increase validity. We suggest that future research should first optimize the intervention by systematically evaluating treatment components and selecting a maximally efficient and effective treatment package.

Transtheoretical Model of Change during Travel Behavior Interventions: An Integrative Review

This study aims to identify the relevant empirical work, to synthesize its findings, and to thus attain a general understanding of the application of the Transtheoretical Model (TTM) in transport behavior research. An integrative literature review was used to determine whether or not the implemented interventions impact the stages and processes of travel behavior change. Data was collected from different databases. English language articles published between 2002 and 2017 were included. After sequentially narrowing the search and removing duplicates, 53 relevant papers remained, 13 of which fulfilled the stated criteria of constituting a transport intervention study using the TTM as a reference frame. The final 13 studies were classified and categorized according to stages and processes in the TTM. Findings showed that none of the interventions met the method requirements for a proper evaluation of design and outcome measurement. Reporting did not follow a standardized structure desirable when enabling comparative analyses. Allowing for these shortcomings, it is inferred that positive travel behavior changes have been obtained during some interventions. Importantly, although it was stated that the empirical studies were based on the TTM, the included interventions were implemented irrespective of the individual’s stage of change. For future research, it will be necessary to conduct evaluations of higher quality.

"If You Don't Do Parking Management .. Forget Your Behaviour Change, It's Not Going to Work.": Health and Transport Practitioner Perspectives on Workplace Active Travel Promotion

OBJECTIVES

After having conducted two studies of the effectiveness of workplace travel plans for promoting active travel, we investigated health and transport practitioners' perspectives on implementing workplace travel plans to share some of the lessons learnt. The objectives of this study were to describe perceived elements of effective workplace travel plans, barriers and enablers to workplace travel planning, their experiences of working with the other profession on travel plan implementation, their recommendations for workplace travel planning, and also to explore similarities and differences in transport and health practitioner perspectives.

MATERIALS AND METHODS

Fourteen health and ten transport practitioners who had prior involvement in workplace travel plan programs were purposefully selected from workplaces in Australia. We conducted 20 in-depth interviews since data saturation had been reached at this point, and data were subject to framework analysis.

RESULTS

Perceived essential elements of effective workplace travel plans included parking management; leadership, organisational commitment and governance; skills and other resources like a dedicated travel plan coordinator; and, pre-conditions including supportive transport infrastructure in the surrounds. Recommendations for promoting travel plans included supportive government policy, focusing on business benefits and working at different scales of implementation (e.g. single large worksites and business precincts). Health and transport practitioner perspectives differed, with transport practitioners believing that parking management is the key action for managing travel demand at a worksite.

CONCLUSIONS

Health practitioners implementing travel plans may require training including concepts of travel demand management, and support from transport planners on parking management strategies. Promoting an understanding of the shared travel behaviour change skills of transport and health practitioners may assist further collaboration. For take-up by organisations to be of sufficient scale to create meaningful population level reductions in driving and increases in active travel, promotion and travel plans should be focused on the priorities of the organisations. Supportive government policy is also required.

Social marketing interventions aiming to increase physical activity among adults

Purpose

A significant proportion of the world’s adult population is insufficiently active. One approach used to overcome barriers and facilitate participation in physical activity is social marketing. The purpose of this paper are twofold: first, this review seeks to provide a contemporary review of social marketing’s effectiveness in changing physical activity for the better; and second, it seeks to ascertain the extent that Andreasen’s (2002) six social marketing benchmark criteria have been applied in social marketing interventions targeting physical activity.

Design/methodology/approach

In total, 94 articles covering 26 social marketing interventions were identified following systematic literature review procedures.

Findings

None of the interventions gave evidence that they addressed all six social marketing benchmark criteria, and only four interventions addressed five criteria. The results indicate that three of the benchmark criteria, namely, behavioural objectives, formative research, and marketing mix are well utilised in social marketing interventions. Inclusion of market segmentation, exchange and competition offers potential to extend further on social marketing’s effectiveness in increasing physical activity.

Originality/value

The results of the current study indicate that increasing the number of benchmark criteria used in an intervention to at least four increases the chances of achieving positive behavioural outcomes.

Promoting Active Transport in Older Adolescents Before They Obtain Their Driving Licence: A Matched Control Intervention Study

Background

Active transport has great potential to increase physical activity in older adolescents (17–18 years). Therefore, a theory- and evidence-based intervention was developed aiming to promote active transport among older adolescents. The intervention aimed to influence psychosocial factors of active transport since this is the first step in order to achieve a change in behaviour. The present study aimed to examine the effect of the intervention on the following psychosocial factors: intention to use active transport after obtaining a driving licence, perceived benefits, perceived barriers, subjective norm, self-efficacy, habit and awareness towards active transport.

Methods

A matched control three-arm study was conducted and consisted of a pre-test post-test design with intervention and control schools in Flanders (northern part of Belgium). A lesson promoting active transport was implemented as the last lesson in the course ‘Driving Licence at School’ in intervention schools (intervention group 1). Individuals in intervention group 2 received this active transport lesson and, in addition, they were asked to become a member of a Facebook group on active transport. Individuals in the control group only attended the regular course ‘Driving Licence at School’. Participants completed a questionnaire assessing socio-demographics and psychosocial variables at baseline, post (after one week) and follow-up (after eight weeks). To assess intervention effects, multilevel linear mixed models analyses were performed.

Results

A sample of 441 older adolescents (56.8% female; 17.4 (0.7) years) was analysed. For awareness regarding the existence of car sharing schemes, a significant increase in awareness from baseline to post measurement was found within intervention group 1 (p = 0.001) and intervention group 2 (p = 0.030) compared to the control group in which no change was found. In addition, a significant increase in awareness from baseline to follow-up measurement was found within intervention group 1 (p = 0.043) compared to a decrease in awareness from baseline to follow-up measurement within the control group.

Conclusions

Overall, the intervention was not effective to increase psychosocial correlates of active transport. Future intervention studies should search for alternative strategies to motivate and involve this hard to reach target group.

The Added Benefit of Bicycle Commuting on the Regular Amount of Physical Activity Performed

INTRODUCTION

Physical inactivity is a leading cause of death and disability globally. Active transportation such as bicycling may increase physical activity levels. It is currently uncertain whether a shift from motorized transport modes to bicycle commuting leads to increased physical activity overall or substitutes other forms of physical activity. The study aims to disentangle whether bicycle commuting adds to or replaces other physical activities by comparing the physical activity performed by bicycle and motorized commuters.

METHODS

Physical activity, travel behavior, health status, sociodemographic, and built environment characteristics were assessed for 752 adults, between June 2011 and May 2012, in Barcelona, Spain. Statistical analyses, performed in 2013-2014, included linear, non-linear, and mixture models to estimate disparities and the dose-response relationship between physical activity duration and commute mode.

RESULTS

Regular bicycle commuters traveled by bicycle an average of 3.1 (SD=2.5) hours in the previous week. Bicycle commuting contributed positively to physical activity duration across participants (p<0.05). It amounted to 2.1 (95% CI=0.84, 3.55) hours/week extra of physical activity for bicycle commuters versus motorized commuters. Among bicycle travelers, there was a positive dose-response relationship between bicycle commuting and physical activity duration, with an average extra physical activity duration of 0.5 (95% CI=0.4, 0.6) hours/week for every additional 1 hour/week of bicycle commuting.

CONCLUSIONS

Bicycle commuting likely adds to overall physical activity. The extra physical activity performed by bicycle commuters is undertaken as moderate physical activity and follows a sigmoidal dose-response relationship with bicycle duration.

Use of and short-term impacts of new cycling infrastructure in inner-Sydney, Australia: a quasi-experimental design

Background

Given increasing investment in new cycling infrastructure, it is important to understand its impacts. The Sydney Transport and Health Study evaluates a new 2.4 km bi-directional separated bicycle path in inner-Sydney. This paper describes the users of the new bicycle path, and examines its short-term impacts upon cycling behaviour and perceptions of the local environment.

Methods

Data were collected from two bike counts at two intersections on the new bicycle path in the intervention area in 2013 and 2014. On-line surveys collected individual participant data in the intervention area and a similar comparison area before the bicycle path was built (2013), and 12 months later (four months after completion) (n = 512). The data included self-reported cycling behaviour, use of the new bicycle path and perceptions of changes in the local environment.

Results

Bike counts at two sites on the new bicycle path reported an increase of 23 % and 97 % respectively at 12 months. However, among the participants in the cohort, there was no change in the self-reported weekly frequency of cycling. One in six (approximately 15 %) participants reported using the new bicycle path, with most users (76 %) living in the intervention area. Bicycle path users were most likely to be frequent riders (at least weekly) [adjusted odds ratio (AOR) = 7.50, 95 % CI 3.93–14.31], be a high intensity recreational rider (AOR = 4.38, 95 % CI 1.53–12.54) or a low intensity transport rider (AOR = 2.42, 95 % CI 1.17–5.04) and live closer to the bicycle path (AOR = 1.24, 1.13–1.37). Perceptions that the neighbourhood was more pleasant, that there were more people walking and cycling were significantly higher in the intervention area at 12 months (both P values <0.05).

Conclusions

Existing cycling behaviour and proximity to the bicycle path were associated with the use of the new bicycle path. Increased use of the new bicycle path as reported by the participants in the intervention area and increased cycling recorded by the bike counts may be due to existing cyclists changing routes to use the new path, and more cyclists from outside the study area using the new path, as study participants did not increase their frequency of cycling. Increases in cycling frequency in the intervention neighbourhood may require a longer lead time, additional promotional activities and further maturation of the Sydney bicycle path network.

Key message

Understanding how new cycling infrastructure impacts communities can influence the promotion of such infrastructure.

Mechanisms underpinning use of new walking and cycling infrastructure in different contexts: mixed-method analysis

Background

Few studies have evaluated the effects of infrastructural improvements to promote walking and cycling. Even fewer have explored how the context and mechanisms of such interventions may interact to produce their outcomes.

Methods

This mixed-method analysis forms part of the UK iConnect study, which aims to evaluate new walking and cycling routes at three sites — Cardiff, Kenilworth and Southampton. Applying a complementary follow-up approach, we first identified differences in awareness and patterns of use of the infrastructure in survey data from a cohort of adult residents at baseline in spring 2010 (n = 3516) and again one (n = 1849) and two (n = 1510) years later following completion of the infrastructural projects (Analysis 1). We subsequently analysed data from 17 semi-structured interviews with key informants to understand how the new schemes might influence walking and cycling (Analysis 2a). In parallel, we analysed cohort survey data on environmental perceptions (Analysis 2b). We integrated these two datasets to interpret differences across the sites consistent with a theoretical framework that hypothesised that the schemes would improve connectivity and the social environment.

Results

After two years, 52% of Cardiff respondents reported using the infrastructure compared with 37% in Kenilworth and 22% in Southampton. Patterns of use did not vary substantially between sites. 17% reported using the new infrastructure for transport, compared with 39% for recreation. Environmental perceptions at baseline were generally unfavourable, with the greatest improvements in Cardiff. Qualitative data revealed that all schemes had a recreational focus to varying extents, that the visibility of schemes to local people might be an important mechanism driving use and that the scale and design of the schemes and the contrast they presented with existing infrastructure may have influenced their use.

Conclusions

The dominance of recreational uses may have reflected the specific local goals of some of the projects and the discontinuity of the new infrastructure from a satisfactory network of feeder routes. Greater use in Cardiff may have been driven by the mechanisms of greater visibility and superior design features within the context of an existing environment that was conducive neither to walking or cycling nor to car travel.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0185-5) contains supplementary material, which is available to authorized users.

Community wide interventions for increasing physical activity

BACKGROUND

Multi-strategic community wide interventions for physical activity are increasingly popular but their ability to achieve population level improvements is unknown.

OBJECTIVES

To evaluate the effects of community wide, multi-strategic interventions upon population levels of physical activity.

SEARCH METHODS

We searched the Cochrane Public Health Group Segment of the Cochrane Register of Studies,The Cochrane Library, MEDLINE, MEDLINE in Process, EMBASE, CINAHL, LILACS, PsycINFO, ASSIA, the British Nursing Index, Chinese CNKI databases, EPPI Centre (DoPHER, TRoPHI), ERIC, HMIC, Sociological Abstracts, SPORT Discus, Transport Database and Web of Science (Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index). We also scanned websites of the EU Platform on Diet, Physical Activity and Health; Health-Evidence.org; the International Union for Health Promotion and Education; the NIHR Coordinating Centre for Health Technology (NCCHTA); the US Centre for Disease Control and Prevention (CDC) and NICE and SIGN guidelines. Reference lists of all relevant systematic reviews, guidelines and primary studies were searched and we contacted experts in the field. The searches were updated to 16 January 2014, unrestricted by language or publication status.

SELECTION CRITERIA

Cluster randomised controlled trials, randomised controlled trials, quasi-experimental designs which used a control population for comparison, interrupted time-series studies, and prospective controlled cohort studies were included. Only studies with a minimum six-month follow up from the start of the intervention to measurement of outcomes were included. Community wide interventions had to comprise at least two broad strategies aimed at physical activity for the whole population. Studies which randomised individuals from the same community were excluded.

DATA COLLECTION AND ANALYSIS

At least two review authors independently extracted the data and assessed the risk of bias. Each study was assessed for the setting, the number of included components and their intensity. The primary outcome measures were grouped according to whether they were dichotomous (per cent physically active, per cent physically active during leisure time, and per cent physically inactive) or continuous (leisure time physical activity time (time spent)), walking (time spent), energy expenditure (as metabolic equivalents or METS)). For dichotomous measures we calculated the unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. For continuous measures we calculated percentage change from baseline, unadjusted and adjusted.

MAIN RESULTS

After the selection process had been completed, 33 studies were included. A total of 267 communities were included in the review (populations between 500 and 1.9 million). Of the included studies, 25 were set in high income countries and eight were in low income countries. The interventions varied by the number of strategies included and their intensity. Almost all of the interventions included a component of building partnerships with local governments or non-governmental organisations (NGOs) (29 studies). None of the studies provided results by socio-economic disadvantage or other markers of equity. However, of those included studies undertaken in high income countries, 14 studies were described as being provided to deprived, disadvantaged or low socio-economic communities. Nineteen studies were identified as having a high risk of bias, 10 studies were unclear, and four studies had a low risk of bias. Selection bias was a major concern with these studies, with only five studies using randomisation to allocate communities. Four studies were judged as being at low risk of selection bias although 19 studies were considered to have an unclear risk of bias. Twelve studies had a high risk of detection bias, 13 an unclear risk and four a low risk of bias. Generally, the better designed studies showed no improvement in the primary outcome measure of physical activity at a population level.All four of the newly included, and judged to be at low risk of bias, studies (conducted in Japan, United Kingdom and USA) used randomisation to allocate the intervention to the communities. Three studies used a cluster randomised design and one study used a stepped wedge design. The approach to measuring the primary outcome of physical activity was better in these four studies than in many of the earlier studies. One study obtained objective population representative measurements of physical activity by accelerometers, while the remaining three low-risk studies used validated self-reported measures. The study using accelerometry, conducted in low income, high crime communities of USA, emphasised social marketing, partnership with police and environmental improvements. No change in the seven-day average daily minutes of moderate to vigorous physical activity was observed during the two years of operation. Some program level effect was observed with more people walking in the intervention community, however this result was not evident in the whole community. Similarly, the two studies conducted in the United Kingdom (one in rural villages and the other in urban London; both using communication, partnership and environmental strategies) found no improvement in the mean levels of energy expenditure per person per week, measured from one to four years from baseline. None of the three low risk studies reporting a dichotomous outcome of physical activity found improvements associated with the intervention.Overall, there was a noticeable absence of reporting of benefit in physical activity for community wide interventions in the included studies. However, as a group, the interventions undertaken in China appeared to have the greatest possibility of success with high participation rates reported. Reporting bias was evident with two studies failing to report physical activity measured at follow up. No adverse events were reported.The data pertaining to cost and sustainability of the interventions were limited and varied.

AUTHORS' CONCLUSIONS

Although numerous studies have been undertaken, there is a noticeable inconsistency of the findings in the available studies and this is confounded by serious methodological issues within the included studies. The body of evidence in this review does not support the hypothesis that the multi-component community wide interventions studied effectively increased physical activity for the population, although some studies with environmental components observed more people walking.

A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project)

BACKGROUND

This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework.

METHODS

Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions.

RESULTS

Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention.

CONCLUSIONS

Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.

Active commuting and perceptions of the route environment: a longitudinal analysis

OBJECTIVE

To assess associations between changes in perceptions of the environment en route to work and changes in active commuting.

METHODS

655 commuters in Cambridge, UK reported perceptions of their commuting route and past-week commuting trips in postal questionnaires in 2009 and 2010. Associations between changes in route perceptions and changes in time spent walking and cycling, proportion of car trips, and switching to or from the car on the commute were modelled using multivariable regression.

RESULTS

Changes in only a few perceptions were associated with changes in travel behaviour. Commuters who reported that it became less pleasant to walk recorded a 6% (95% CI: 1, 11) net increase in car trips and a 12 min/week (95% CI: -1, -24) net decrease in walking. Increases in the perceived danger of cycling or of crossing the road were also associated with increases in car trips. Increases in the perceived convenience of public transport (OR: 3.31, 95% CI: 1.27, 8.63) or safety of cycling (OR: 3.70, 95% CI: 1.44, 9.50) were associated with taking up alternatives to the car.

CONCLUSIONS

Interventions to improve the safety of routes and convenience of public transport may help promote active commuting and should be evaluated.

New walking and cycling routes and increased physical activity: one- and 2-year findings from the UK iConnect Study

OBJECTIVES

We evaluated the effects of providing new high-quality, traffic-free routes for walking and cycling on overall levels of walking, cycling, and physical activity.

METHODS

1796 adult residents in 3 UK municipalities completed postal questionnaires at baseline (2010) and 1-year follow-up (2011), after the construction of the new infrastructure. 1465 adults completed questionnaires at baseline and 2-year follow-up (2012). Transport network distance from home to infrastructure defined intervention exposure and provided a basis for controlled comparisons.

RESULTS

Living nearer the infrastructure did not predict changes in activity levels at 1-year follow-up but did predict increases in activity at 2 years relative to those living farther away (15.3 additional minutes/week walking and cycling per km nearer; 12.5 additional minutes/week of total physical activity). The effects were larger among participants with no car.

CONCLUSIONS

These new local routes may mainly have displaced walking or cycling trips in the short term but generated new trips in the longer term, particularly among those unable to access more distant destinations by car. These findings support the potential for walking and cycling infrastructure to promote physical activity.

Evaluating the transport, health and economic impacts of new urban cycling infrastructure in Sydney, Australia - protocol paper

Background

There are repeated calls to build better cycling paths in Australian cities if the proportion of people cycling is to increase. Yet the full range of transport, health, environmental and economic impacts of new cycling infrastructure and the extent to which observed changes are sustained is not well understood. The City of Sydney is currently building a new bicycle network, which includes a new bicycle path separated from road traffic in the south Sydney area. This protocol paper describes a comprehensive method to evaluate this new cycling infrastructure.

Method

A cohort of residents within two kilometres of the new bicycle path will be surveyed at baseline before a new section of bicycle path is built, and again 12 and 24 months later to assess changes in travel behaviour, sense of community, quality of life and health behaviours. Residents in a comparable area of Sydney that will not get a new separated bike path will act as a comparison group. At baseline a sub-set of residents who volunteer will also take a small GPS device with them for one week to assess travel behaviour.

Discussion

This research should contribute to the advancement in evaluation and appraisal methods for cycling projects.

"Where have all the bicycles gone?" Are bicycle sales in Australia translated into health-enhancing levels of bicycle usage?

OBJECTIVE

To explore whether the reported increase in bicycle sales in Australia is corroborated by increases in numbers of cyclists.

METHODS

Australian representative data on cycling from annual Exercise, Recreation and Sport Surveys (ERASS) from 2001 to 2008 were used. Based on the weighted proportion of cyclists and 'regular cyclists' each year, the number of 'new' riders each year was calculated. Generous assumptions about the number of new bicycle purchased by new riders plus replacement bicycles by regular riders were compared with industry sales figures.

RESULTS

Any cycling increased from 9.5% of all adults in 2001 to 11.6% in 2008, an increase of 2.1% [95% CI: 1.14 to 2.76]. This 2.1% represents an overall increase in cyclists of around 343,552 (95% CI from 186,500 to 441,710 new cyclists). The difference between the estimated number bought and the actual industry total average number of bicycles sold (n=753,843 per annum) numbered at least 395,000 unused adult bicycles sold each year after sensitivity analyses.

CONCLUSIONS

There appear to be many more bicycles sold in Australia than are used. Further improvements may be needed in the cycling environment before a possible latent desire for cycling translates to participation.

Interventions to promote cycling: systematic review

OBJECTIVES

To determine what interventions are effective in promoting cycling, the size of the effects of interventions, and evidence of any associated benefits on overall physical activity or anthropometric measures.

DESIGN

Systematic review.

DATA SOURCES

Published and unpublished reports in any language identified by searching 13 electronic databases, websites, reference lists, and existing systematic reviews, and papers identified by experts in the field. Review methods Controlled "before and after" experimental or observational studies of the effect of any type of intervention on cycling behaviour measured at either individual or population level.

RESULTS

Twenty five studies (of which two were randomised controlled trials) from seven countries were included. Six studies examined interventions aimed specifically at promoting cycling, of which four (an intensive individual intervention in obese women, high quality improvements to a cycle route network, and two multifaceted cycle promotion initiatives at town or city level) were found to be associated with increases in cycling. Those studies that evaluated interventions at population level reported net increases of up to 3.4 percentage points in the population prevalence of cycling or the proportion of trips made by bicycle. Sixteen studies assessing individualised marketing of "environmentally friendly" modes of transport to interested households reported modest but consistent net effects equating to an average of eight additional cycling trips per person per year in the local population. Other interventions that targeted travel behaviour in general were not associated with a clear increase in cycling. Only two studies assessed effects of interventions on physical activity; one reported a positive shift in the population distribution of overall physical activity during the intervention.

CONCLUSIONS

Community-wide promotional activities and improving infrastructure for cycling have the potential to increase cycling by modest amounts, but further controlled evaluative studies incorporating more precise measures are required, particularly in areas without an established cycling culture. Studies of individualised marketing report consistent positive effects of interventions on cycling behaviour, but these findings should be confirmed using more robust study designs. Future research should also examine how best to promote cycling in children and adolescents and through workplaces. Whether interventions to promote cycling result in an increase in overall physical activity or changes in anthropometric measures is unclear.

Walking and cycling to health: a comparative analysis of city, state, and international data

OBJECTIVES

We sought to determine the magnitude, direction, and statistical significance of the relationship between active travel and rates of physical activity, obesity, and diabetes.

METHODS

We examined aggregate cross-sectional health and travel data for 14 countries, all 50 US states, and 47 of the 50 largest US cities through graphical, correlation, and bivariate regression analysis on the country, state, and city levels.

RESULTS

At all 3 geographic levels, we found statistically significant negative relationships between active travel and self-reported obesity. At the state and city levels, we found statistically significant positive relationships between active travel and physical activity and statistically significant negative relationships between active travel and diabetes.

CONCLUSIONS

Together with many other studies, our analysis provides evidence of the population-level health benefits of active travel. Policies on transport, land-use, and urban development should be designed to encourage walking and cycling for daily travel.