Health benefits of electrically-assisted cycling: a systematic review

Development of a multifactorial prediction model for commute mode choice in 10 983 Finnish public sector employees: a cross-sectional study

OBJECTIVE

The objective of this study is to examine the feasibility of using survey data to identify factors that predict commute mode choice.

DESIGN

The study design is cross-sectional.

SETTING

Survey data from the Finnish Public Sector study (2020) were used.

PARTICIPANTS

42 574 public sector employees, of whom 10 983 were selected for the final sample. These included employees with 5 km or less commuting distances and those working full-time onsite or partly remotely. The mean age was 46 (SD 11) years, and 84% were women.

PRIMARY OUTCOMES

Commute by (1) bike or foot (an active mode) during summer and winter weather and (2) by car (a passive mode) during summer and winter weather.

METHODS

Using logistic Lasso (least-absolute-shrinkage-and-selection-operator) regression, we developed and tested a prediction model for short commutes of 5 km or less to identify the characteristics of employees most likely to commute actively during summer and winter weather and passively during summer and winter weather.

RESULTS

All models had a good predictive ability with a C-index of 0.82, 0.77, 0.72 and 0.71. Cycling and walking during summer weather were predicted by shorter commutes, higher physical activity, lower body mass index (BMI), female sex and higher team psychological safety. Predictors of cycling and walking during winter weather were shorter commute length, higher physical activity, lower BMI and higher age. Commuting by car during summer weather was predicted by longer journey length, higher BMI, lower physical activity, male sex and having children 7-18 years old living at home. Predictors of driving during winter weather were almost identical, but the male sex was replaced by having a spouse.

CONCLUSIONS

We identified the correlates of active and passive commute choice in different weather conditions with eight variables. This information can be used to develop and target interventions to promote sustainable and healthy commuting modes.

A Theory and Evidence-Informed e-Cycling Intervention for Individuals Diagnosed With Cancer: Development Study

BACKGROUND

Physical activity engagement following a cancer diagnosis is positively associated with survival, reduced risk of disease recurrence, and reduced cancer-specific and all-cause mortality. However, rates of physical activity engagement are low among individuals diagnosed with and being treated for breast cancer or prostate cancer.

OBJECTIVE

The purpose of this study was to describe the systematic process of developing an e-cycling intervention aimed at increasing physical activity among individuals living with prostate cancer or breast cancer and outline the key components to be implemented.

METHODS

The Medical Research Council guidance for developing complex interventions and the Behaviour Change Wheel were used to guide intervention development. Information was gathered from the literature and through discussions with end users to understand factors influencing e-cycling. These factors were mapped onto the Theoretical Domains Framework to identify potential mechanisms of action. Behavior change techniques were selected from theory and evidence to develop intervention content. Interested parties, including cycling instructors, end users, and behavior change experts, reviewed and refined the intervention.

RESULTS

Anticipated barriers and facilitators to e-cycling engagement were mapped onto 11 of the 14 domains of the Theoretical Domains Framework. A total of 23 behavior change techniques were selected to target these domains over 4 one-to-one e-cycling sessions delivered by trained cycling instructors in the community. Cycling instructors were provided a 3-hour classroom training session on delivering the intervention and a 3-hour practical session with feedback. The outcome of this work is a theory and evidence-informed intervention aimed at promoting e-cycling behavior among individuals being treated for breast cancer or prostate cancer, which is currently being implemented and evaluated.

CONCLUSIONS

Transparent intervention development and reporting of content is important for comprehensively examining intervention implementation. The implementation of this intervention package is currently being evaluated in a pilot randomized controlled trial. If the intervention is found to be effective and the content and delivery are acceptable, this intervention will form a basis for the development of e-cycling interventions in other survivors of cancer.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN39112034 https://www.isrctn.com/ISRCTN39112034; and IRSCTN Registry ISRCTN42852156; https://www.isrctn.com/ISRCTN42852156.

Measuring Active Transportation on National Health Surveys in Canada From 1994 to 2020

BACKGROUND

Active transportation (AT), described as self-powered modes of travel (eg, walking and cycling), is an important source of health-promoting physical activity. While AT behaviors have been measured on national health surveys in Canada for over 2 decades, historic prevalence has not been previously reported. We aimed to document the measures of AT on Canada's various national health surveys, examine AT over time, and interpret them within the context of evolving methods of assessment.

METHODS

We compiled and summarized the questions used to measure AT among Canadians on 4 national health surveys: National Population Health Survey (1994-1998), Canadian Community Health Survey (2000-2020), Canadian Health Measures Survey (2007-2019), and the Health Behaviour in School-aged Children Study (2010-2018). Among youth and adults (12+ y), we summarized over time: (1) the prevalence of AT participation and (2) time spent in AT (in hours per week) among those who report any AT participation. Where possible, we reported separate estimates of walking and cycling and produced an aggregate estimate of total AT. We stratified results by age group and sex.

RESULTS

Changes in AT survey questions over time and between surveys limit the interpretation and comparability of temporal trends. Nevertheless, a consistently higher proportion of females report walking, while a higher proportion of males report cycling. Irrespective of mode, males report spending more total time in AT. Participation in AT tends to decrease with age, with youth reporting the highest rates of AT and young adults often spending the most time in AT.

CONCLUSIONS

Monitoring trends in AT can help assess patterns of behavior and identify whether promotion strategies are needed or whether population interventions are effective. Our evaluation of AT over time is limited by questions surveyed; however, consistent differences in AT by age and sex are evident over time. Moving forward, ensuring consistency of AT measurement over time is essential to monitoring this important behavior.

Sustainable Lifestyle Among Office Workers (the SOFIA Study): Protocol for a Cluster Randomized Controlled Trial

BACKGROUND

Society is facing multiple challenges, including lifestyle- and age-related diseases of major public health relevance, and this is of particular importance when the general population, as well as the workforce, is getting older. In addition, we are facing global climate change due to extensive emissions of greenhouse gases and negative environmental effects. A lifestyle that promotes healthy life choices as well as climate and environmentally friendly decisions is considered a sustainable lifestyle.

OBJECTIVE

This study aims to evaluate if providing information about a sustainable lifestyle encourages individuals to adopt more nutritious dietary habits and increase physical activity, as compared to receiving information solely centered around health-related recommendations for dietary intake and physical activity by the Nordic Nutrition Recommendations and the World Health Organization. Novel features of this study include the use of the workplace as an arena for health promotion, particularly among office workers-a group known to be often sedentary at work and making up 60% of all employees in Sweden.

METHODS

The Sustainable Office Intervention (SOFIA) study is a 2-arm, participant-blinded, cluster randomized controlled trial that includes a multilevel sustainable lifestyle arm (intervention arm, n=19) and a healthy lifestyle arm (control arm, n=14). The eligibility criteria were being aged 18-65 years and doing office work ≥20 hours per week. Both intervention arms are embedded in the theoretically based behavioral change wheel method. The intervention study runs for approximately 8 weeks and contains 6 workshops. The study focuses on individual behavior change as well as environmental and policy features at an organizational level to facilitate or hinder a sustainable lifestyle at work. Through implementing a citizen science methodology within the trial, the participants (citizen scientists) collect data using the Stanford Our Voice Discovery Tool app and are involved in analyzing the data, formulating a list of potential actions to bring about feasible changes in the workplace.

RESULTS

Participant recruitment and data collection began in August 2022. As of June 2024, a total of 37 participants have been recruited. The results of the pilot phase are expected to be published in 2024 or 2025.

CONCLUSIONS

Given the ongoing climate change, negative environmental effects, and the global epidemic of metabolic diseases, a sustainable lifestyle among office workers holds important potential to help in counteracting this trend. Thus, there is an urgent unmet need to test the impact of a sustainable lifestyle on food intake, physical activity, and environmental and climate impacts in a worksite-based randomized controlled trial. This study protocol responds to a societal need by addressing multilevel aspects, including individual behavior changes as well as environmental and organizational changes of importance for the successful implementation of sustainable lifestyle habits in an office setting.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57777.

Short term e-bicycle riding results in favorable cardiometabolic shifts in moderately active adults

PURPOSE

Electric bikes (EB) are a form of active transportation with demonstrated health benefits. The purpose of this study was to determine the influence of riding an EB for one week on indices of cardiometabolic health in middle-aged adults.

METHODS

Adults (n = 22; age = 57.1 ± 11.3 year; BMI = 27.7 ± 4.9) participated in a 2 week study. During Week 1, participants were instructed to continue regular activities. Starting Week 2 participants were provided an EB to ride at least 3 days for a minimum of 30 min·day-1. Physical activity (PA) and glucose were measured continuously. Body composition, blood lipids, glucose, insulin, hemoglobin A1c (HbA1c), plasma endothelin-1 (ET-1), and carotid-femoral pulse wave velocity (cf-PWV) were measured on days 1 and 14.Data and Statistical analyses or Statistics. Each participant served as their own control. Paired t-tests compared dependent variables between week 1 (without EB) and week 2 (with EB).

RESULTS

When provided an EB for one week, moderate to vigorous PA increased by 6-9 min·day-1 (P < 0.05) and sedentary time decreased by ~ 77 min·day-1 (P < 0.05). Data from 24 h continuous glucose monitoring showed the percentage of time in healthy range (70-120 mg·dl-1 glucose) increased (P < 0.05) from week 1 to week 2. Compared to day 1, cf-PWV was lower at day 14 (P < 0.05) following one week of riding an EB.

CONCLUSION

Moderately-active, middleaged adults showed improved continuous glucose regulation and lower central arterial stiffness following one week of riding an EB.

Sex Differences in Mountain Bike Accidents in Austria from 2006 to 2018: A Retrospective Analysis

Woyke, Simon, Anja Hütter, Christopher Rugg, Willi Tröger, Bernd Wallner, Mathias Ströhle, and Peter Paal. Sex differences in mountain bike accidents in Austria from 2006 to 2018: a retrospective analysis. High Alt Med Biol. 25:89-93, 2024. Introduction: Mountain biking is becoming increasingly popular, and mountain bike (MTB) accidents are on the rise. The aim of this study was to assess sex differences in mountain biking accidents in the Austrian Alps. Methods: This retrospective study includes all MTB accidents in Austria from 2006 to 2018. Data were collected by Alpine Police officers and recorded in a national digital registry. Results: The accidents involved 5,095 mountain bikers (81% men and 19% women). The number of MTB accidents rose markedly from 208 in 2006 to 725 in 2018. Men wore a helmet more often than did women (95% vs. 92%; p = 0.001). The most common injury category was "wound/bleeding" for both sexes (men 40% and women 41%). Women were more frequently transported by helicopter or terrestrially (p > 0.001). Conclusion: In the Austrian Alps, the number of MTB accidents more than tripled between 2006 and 2018. Women were involved in only one fifth of all accidents. Sex differences in MTB accidents include (1) women wearing helmets less often, (2) women being less frequently injured, (3) women suffering fewer serious injuries, and (4) women being more frequently transported by helicopter or terrestrially, while men more often did not require transportation.

Effects of Cycling on Spine: A Case-Control Study Using a 3D Scanning Method

BACKGROUND

Few studies have investigated the effects of adopting a specific and prolonged posture on cyclists. This study aimed to evaluate the upright spine in a sample of recreational cyclists and compare it with a sample of non-cyclists, though still athletes, through a 3D scanning method.

METHODS

Forty-eight participants were enrolled in this observational study. The sample consisted of 25 cyclists for the cycling group and 23 non-cyclist athletes for the control group. The Spine3D device (Sensor Medica, Guidonia Montecelio, Rome, Italy) was used to evaluate the spine of the participants in both groups.

RESULTS

The results showed significantly greater spine inclination in the cycling group compared to the control group (p < 0.01). Furthermore, there was a significant decrease in lumbar lordosis in the cycling group compared to the control group (p < 0.01).

CONCLUSIONS

This case-control study raises the possibility that the onset of lower back pain in cyclists may be due to a reduction in lumbar lordosis. Furthermore, this study demonstrated that the Spine3D device can be used in sports to monitor the spine of athletes to prevent and reduce musculoskeletal deficits.

''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.

Physical activity when riding an electric-assisted bicycle with and without cargo

Background

Regular physical activity provides several health benefits, and active transport is a convenient way to implement physical activity in everyday life. However, bikes' lack of possibilities to carry cargo is a limitation. E-cargo bikes can help overcome barriers to cycling and increase levels of active transport while still providing the option to carry cargo such as groceries and children. As such, E-cargo bikes have a greater potential for being a substitute for cars, but relevance is not known as no study has assessed the energy expenditure and time used using E-cargo bikes with considerable cargo.

Objectives

The aim of this study is to compare time spent riding and exercise intensity when (1) riding an electric-assisted bicycle with cargo (30 kg) and without cargo and (2) driving a car.

Method

This study has a randomised crossover design. Eleven participants (six women) were recruited through convenience sampling. The participants traversed through a 4.5 km route with three different forms of transportation: an electric-assisted bicycle (E-bike) with 30 kg cargo, an E-bike without cargo, and a car. Oxygen uptake was measured with a portable oxygen analyser (Metamax 3B), and time spent cycling was measured on site by the test leader using a stopwatch.

Results

Riding an E-bike with cargo was slightly slower than riding an E-bike without cargo (11.8 vs. 11.1 min, p = 0.017) and driving a car (8.8 min, p = 0.002). There was no significant difference in exercise intensity between E-bikes with and without cargo but riding an E-bike with cargo entailed significantly higher exercise intensity compared to driving a car [4.9 metabolic equivalents of task (METs) vs. 1.4 METs, p ≤ 0.001].

Conclusions

E-biking with cargo was rather similar in time spent and exercise intensity to E-biking without cargo, and not much slower than driving a car. Using E-cargo bikes, therefore, appears a good alternative to driving a car when in need of carrying things such as grocery bags and children, resulting in increasing physical activity and, at the same time, decreasing greenhouse gas emissions.

Public Health-Led Insights on Electric Micro-mobility Adoption and Use: a Scoping Review

The advent of electric micro-mobility (EMM) has transformed the urban mobility landscape, with projections indicating a 5-10% increase in its modal share in European cities by 2030. In this scoping review, we aimed to comprehensively examine the key determinants of EMM adoption and usage from a public health perspective. Sixty-seven articles were included in the analysis, primarily covering e-bikes and e-scooters. The determinants were categorised into two broad categories: (1) contextual determinants that encompass enabling and hindering factors related to legal frameworks, transportation systems and infrastructure, and technology, and (2) individual-level determinants that pertain to intrinsic motivations and deterrents of individuals. Our findings reveal that EMM vehicles are widely perceived as a cost-effective, flexible, ad hoc, and fast mode of transportation within urban areas, augmenting accessibility and connectivity. Additionally, the lightweight, foldable, and transportable nature of these vehicles is highly appreciated by users. However, several barriers have also been identified, including inadequate infrastructure and end-of-trip facilities, limited capability to traverse diverse terrains and trip scenarios, acquisition and maintenance costs, limited carrying capacities, technical failures, and accident risks. Our results suggest that the interplay of contextual enablers and barriers and personal motivations and deterrents drive the emergence, adoption, and usage of EMM. Hence, a comprehensive understanding of both contextual and individual-level determinants is crucial for ensuring a sustainable and healthy uptake of EMM.

Study protocol for two pilot randomised controlled trials aimed at increasing physical activity using electrically assisted bicycles to enhance prostate or breast cancer survival

BACKGROUND

In 2020, 1.4 and 2.3 million new cases of prostate cancer and breast cancer respectively were diagnosed globally. In the UK, prostate cancer is the most common male cancer, while breast cancer is the most common female cancer. Engaging in physical activity (PA) is a key component of treatment. However, rates of PA are low in these clinical populations. This paper describes the protocol of CRANK-P and CRANK-B, two pilot randomised controlled trials, involving an e-cycling intervention aimed at increasing PA in individuals with prostate cancer or breast cancer respectively.

METHODS

These two trials are single-centre, stratified, parallel-group, two-arm randomised waitlist-controlled pilot trials in which forty individuals with prostate cancer (CRANK-P) and forty individuals with breast cancer (CRANK-B) will be randomly assigned, in a 1:1 allocation ratio, to an e-cycling intervention or waitlist control. The intervention consists of e-bike training with a certified cycle instructor, followed by the provision of an e-bike for 12 weeks. Following the intervention period, participants in the e-bike condition will be directed to community-based initiatives through which they can access an e-bike. Data will be collected at baseline (T0), immediately post intervention (T1) and at 3-month follow-up (T2). In addition, in the intervention group, data will be collected during the intervention and follow-up periods. Quantitative and qualitative methods will be used. The primary objectives are to determine effective recruitment strategies, establish recruitment and consent rates, adherence and retention in the study, and determine the feasibility and acceptability of the study procedures and intervention. The potential impact of the intervention on clinical, physiological and behavioural outcomes will be assessed to examine intervention promise. Data analyses will be descriptive.

DISCUSSION

The findings from these trials will provide information on trial feasibility and highlight the potential of e-cycling as a strategy to positively impact the health and behaviour of individuals with prostate cancer and breast cancer. If appropriate, this information can be used to design and deliver a fully powered definitive trial.

TRIAL REGISTRATION

CRANK-B: [ISRCTN39112034]. CRANK-P [ISRCTN42852156]. Registered [08/04/2022] https://www.isrctn.com .

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.

"I'm Hooked on e-cycling, I Can Finally Be Active Again": Perceptions of e-cycling as a Physical Activity Intervention during Breast Cancer Treatment

Electrically-assisted bicycles (e-bikes) are a means through which to increase individual physical activity (PA) and overcome some commonly reported barriers to engaging in conventional cycling. Fatigue is a common side effect to breast cancer treatment, and the rate of PA engagement drops significantly following a breast cancer diagnosis. The aim of this qualitative study was to examine perceptions of e-cycling as a means of increasing PA in this population. Twenty-four participants (mean age = 57.88 (standard deviation 10.8), 100% female) who have had a breast cancer diagnosis, completed two semi-structured interviews via Zoom. One interview was conducted prior to an e-bike taster session and a second, after the session. Taster sessions were conducted by certified cycling instructors in the community. Interviews were conducted between December 2021 and May 2022. Data were transcribed verbatim and analyzed thematically using NVivo 12 software. An inductive and deductive approach to analysis was adopted. Five themes were generated: (1) Perceived role of e-bikes during treatment, (2) The relationship between e-bikes and fatigue, (3) Cancer-specific considerations, (4) Is e-cycling 'enough'?, and (5) Optimizing the intervention. Negative perceptions of e-bikes noted before the taster session were altered following riding an e-bike. The multiple levels of assistance made cycling manageable and less impacted by fatigue, thereby enabling individuals to re-establish previous cycling habits. E-cycling may be a suitable option to increase PA behavior amongst individuals being treated for breast cancer, with the potential to overcome many of the barriers of conventional cycling. Enabling this population to trial an e-bike elicits positive physical and psychological responses that may help to promote future engagement.

Fractures of the Lower Extremity after E-Bike, Bicycle, and Motorcycle Accidents: A Retrospective Cohort Study of 624 Patients

Electric bicycles (e-bikes) have gained enormous popularity in recent years, and as a result, they have successively become more involved in traffic accidents. The aim of the present study was to assess differences in severity and localization of injuries to the lower extremities after accidents with e-bikes, conventional bicycles, and motorcycles. A retrospective cohort-analysis of patients who sustained traumatic accidents with two-wheeled vehicles transferred to a level 1 trauma center in Switzerland was performed. We assessed patient demographics, injury pattern, and trauma severity (ISS), with a subgroup analysis of outcomes stratified by vehicle. In total, 624 patients (71% male) with injuries to the lower extremities after bicycle (n = 279), electric bike (n = 19), and motorcycle (n = 326) accident were included. The mean age of all assessed patients was 42.4 years (SD 15.8), with a significantly higher age in the e-bike cohort (p = 0.0001). High-velocity injuries were found significantly more often in the motorcycle and e-bike group. The motorcycle group had a significantly higher mean ISS (17.6) than the other groups (p = 0.0001). E-bike accidents produce a different injury profile to the lower extremities compared to motorcycle or bicycle accidents. Higher age, higher velocity, and different protective equipment seem to have an impact on these fracture patterns.

E-Bicycle as a Green and Physically Active Mode of Transport from the Aspect of Students: TPB and Financial Incentives

The positive effects of e-bikes on physical activity, health, and the environment have been confirmed in many studies. Their choice, as well as of cycling in general, was previously considered from, among others, the socio-psychological aspect (often by use of the theory of planned behavior (TPB)) or the financial aspect (in the context of financial incentives). In addition, the question of physical activity can be especially relevant for the student population, since their level of physical activity usually declines. Starting from the previous framework, the aim of this research was to consider the intention to use e-bikes by the student population in the context of their attitudes, subjective norms, perceived behavioral control, and financial incentives. It is, according to the authors' knowledge, the first research that combines all those variables when studying e-bikes. The research was conducted in 2022 on a convenience sample of 332 students from the University of Novi Sad (Republic of Serbia). The results show that the strongest predictor of the intention to use e-bikes can be attributed to financial incentives, followed by attitudes and subjective norms, while perceived behavioral control is not significant. Besides considerations in the context of previous research, additional recommendations for increasing e-bikes' use were provided.

Agile Development of Polymer Power Transmission Systems for e-Mobility-A Novel Methodology Based on an e-Bike Drive Case Study

The market for electric bicycles has grown extremely and developed rapidly in recent years. To enter such a market with a new product, the development process has to be fast, and throughout the process, feedback from future potential customer(s) should be sought in order to achieve the best possible market acceptance. The article presents the design process of a pedelec e-bike central drive system. The authors were members of the development team and the designers of the mechanical transmission, and therefore had a good overview of the whole project. The development process and the set-up of production require a certain amount of time, during which design changes are inevitable due to changes in customer expectations and demands. The development team should respond to these changes and take them into account during development. Only the ability to react to changes and constant communication with the customer will ultimately lead to a product that can be commercially successful. Based on a critical review of the successfully completed project, general guidelines were established for the development of mechatronic products that consider the principles of Agile methodology. Particular attention was paid to the development of polymer gears, as these were the most demanding components in the system. The presented guidelines were based on an overview of the e-bike R&D process presented, but they can be generalized and used in the development process of any technical physical product. Agile methods were developed in the field of software development and therefore cannot be directly transferred to the field of physical product development. The article highlights and discusses individual special features that distinguish agile development of physical products from software development.

Development of a behavioural support intervention for e-bike use in Australia

BACKGROUND

Insufficient physical activity (PA) is a risk factor for the development of many non-communicable diseases. Electric bicycles (e-bikes) offer considerable potential to support people to be physically active, however, no previous e-bike intervention studies have supported e-bike use with behavioural support. The aim of this study was to co-develop theory-based intervention components which can be used to increase physical activity through e-cycling among people who are overweight or obese and physically inactive.

METHODS

We conducted a mixed-methods study using an online survey and virtual co-design workshops. We utilised the Behaviour Change Wheel (BCW) to inform the development of the behavioural support intervention to facilitate day-to-day e-cycling.

RESULTS

One hundred participants completed an online survey and seven participated in the online co-design workshops. The development of the intervention identified five intervention functions (enablement, training, environmental restructuring, education, and persuasion) and 16 behaviour change techniques (BCTs) from 11 BCT groups (goals and planning, feedback and monitoring, social support, shaping knowledge, natural consequences, comparison of behaviour, associations, repetition and substitution, comparison of outcomes, antecedents, and self-belief).

CONCLUSION

To our knowledge, this is the first study to combine co-design and the BCW to develop a comprehensive behavioural support intervention for e-bike use. Theory based intervention options should be considered when providing e-bikes to individuals to help them increase their habitual PA levels.

Patterns of Active Travel and Physical Activity among Adolescents in Israel

Active travel (AT) is a core physical activity (PA) indicator for children and youth; contributing to health and wellbeing, at both the individual and societal levels. This analysis explores patterns of adolescent active school travel (AST) and cycling and associations with different PA measures. Secondary analysis of the cross-sectional 2018-2019 Health Behaviour in School Age Children study in Israel included an extended PA module with walking, cycling and e-cycling modes. The nationally representative sample includes students in grades 6-12 (n = 4407). Analysis of weighted data included descriptive analyses, inferential statistics, and regression analyses. AST was reported by 61.9% of adolescents; 39.3% reported 20 min or more daily AST; 27.1% reported habitual cycling (HC) and 17.4% reported habitual e-cycling (HEC). There are mixed results for socio-economic status and environment. AST and HC were associated with less sedentary hours daily (odds ratio [OR] = 1.190 and 1.397, respectively); HC was associated with positive sports self-rating (OR = 2.394). Stepwise regression analysis found that lower AST duration, time in minutes, was associated with watching television with the family. Promotion of adolescent AT may be associated with increased PA and joint parent-adolescent AT, and was utilized across different socio-demographic groups in Israel.

E-cycling and health benefits: A systematic literature review with meta-analyses

The objective of the present study is to review and meta-analyze the effect of E-cycling on health outcomes. We included longitudinal experimental and cohort studies investigating the effect of E-cycling on health outcomes. The studies were identified from the seven electronic databases: Web of Science, Scopus, Medline, Embase, PsycINFO, Cinahl and SportDiscus and risk of bias was assessed with the revised Cochrane Collaboration Risk of Bias Tool (RoB2). We performed meta-analysis with random effects models on outcomes presented in more than one study. Our study includes one randomized controlled trial, five quasi experimental trials and two longitudinal cohort studies. The trials included 214 subjects of whom 77 were included in control groups, and the cohort studies included 10,222 respondents at baseline. Maximal oxygen consumption and maximal power output were assessed in four and tree trials including 78 and 57 subjects, respectively. E-cycling increased maximal oxygen consumption and maximal power output with 0.48 SMD (95%CI 0.16-0.80) and 0.62 SMD (95%CI 0.24-0.99). One trial reported a decrease in 2-h post plasma glucoses from 5.53 ± 1.18 to 5.03 ± 0.91 mmol L^-1 and one cohort study reported that obese respondents performed 0.21 times more trips on E-bike than respondents with normal weight. All the included studies had a high risk of bias due to flaws in randomization. However, the outcomes investigated in most studies showed that E-cycling can improve health.

Health and well-being benefits of e-bike commuting for inactive, overweight people living in regional Australia

INTRODUCTION

Pedal-assisted electric-bikes (e-bikes) are bicycles fitted with electric motors. Motorised functions on e-bikes only operate when the user pedals, allowing riders a moderate amount of physical activity. This study aimed to explore the mental and physical health and well-being impacts related to ebike usage for inactive overweight or obese individuals living in regional Australia.

METHODS

Twenty inactive, overweight/obese people who seldom cycled were provided with an ebike over a 12-week period. Individual semi-structured interviews conducted at the end of the trial generated data about participants' experiences of using ebikes. Inductive thematic analysis of interview data using Thomas (2006) data analysis framework and NVivo 12 software was undertaken.

RESULTS

Data analysis revealed that e-cycling improved participants' mental and physical well-being and that they felt happier when riding an e-bike.

CONCLUSIONS

Riding an e-bike can improve mental and physical health, happiness and overall sense of well-being. Greater uptake of e-bikes would have positive health implications for the wider community. Results from this study can be used to inform active transport policy. SO WHAT?: Our study demonstrated that encouraging active transport in the form of e-cycling can improve the overall health and well-being of overweight and obese Australians. More specifically, e-cycling demonstrated a positive impact on mental health well-being.

Exploring Use Acceptance of Electric Bicycle-Sharing Systems: An Empirical Study Based on PLS-SEM Analysis

The electric bicycle-sharing system (EBSS) is the fourth-generation urban shared bicycle travel system, which effectively improves the travel efficiency of urban residents and solve the problem of urban congestion. This study attempts to use an extended technology acceptance model (TAM) method to study the acceptance of EBSSs. We had introduced four potential variables, including perceived pleasure (PP), perceived environmental value (PEV), perceived cost (PC), and perceived reliability (PR), into the classic TAM to form a new EBSS-TAM. Data were obtained by using a Likert scale questionnaire from 399 citizens in China. Partial least-squares structural equation modeling (PLS-SEM) with reflective constructs was employed as the analysis method. The results showed that: (1) the EBSS-TAM can explain user behaviors regarding the use of EBSSs. PP has a positive impact on behavior attitude (BA) while having no impact on behavior intention (BI). PEV has no impact on BA and BI. PC has a negative impact on BA and has no impact on BI. PR has a positive impact on BA while having no impact on BI. Perceived ease of use (PEU) has a positive impact on PP and PEV. (2) Younger users (under 35 years old) are more likely to change from liking CBSSs to using EBSSs than older users are. Male users are more satisfied with EBSSs because of their ease of use. The users who never used CBSSs are more likely to perceive the environmental protection value of EBSSs. Some managerial implications were proposed for the EBSSs.

Exploring built environment factors on e-bike travel behavior in urban China: A case study of Jinan

E-bike, characterized as a low-carbon and health-beneficial active travel mode, is gradually becoming popular in China. Although built environment factors are considered to be key parameters that can facilitate or hinder active transportation, such as cycling or walking, few studies have explored the impact of built environment on e-bikes. To fill this gap, this study was the first to explore the relationship between e-bike usage and built environment factors based on population level travel survey in central Jinan, China. Both macro and micro levels of built environment were measured using multi-source data. We employed ordinary least squares (OLS) and geographically weighted regression (GWR) models to explore the aggregation patterns of e-bike trips. Besides, the local Moran's I was employed to classify the aggregation patterns of e-bike trips into four types. The results from OLS model showed that eye-level greenery, building floor area, road density and public service POI were positive significantly related to e-bike trips, while open sky index and NDVI had negative association with e-bike trips. The usage of GWR model provided more subtle results, which revealed significant spatial heterogeneity on the impacts of different built environment parameters. Road density and public service POI posed positive effects on e-bike travel while NDVI and open sky index were found mainly pose negative impacts on e-bike travel. Moreover, we found similar coefficient distribution patterns of eye-level greenery, building floor area and distance to bus stop. Therefore, tailored planning interventions and policies can be developed to facilitate e-bike travel and promote individual's health level.

COVID-19, commuter territories and the e-bike boom

The appearance and integration of e-bikes in public space is a source of much debate worldwide. This paper offers insights to these debates by reflecting on how Deleuze and Guattari's concept of assemblage as territory helps us to understand the uptake of e-bike commuter cycling during the Covid-19 pandemic through empirical material from a study conducted in Sydney, Australia. Here we conceptualise commuter journeys in terms of processes of deterritorialisation and reterritorialisation; experienced through the affective territories generated by e-bikes. The disclosure of commuter cycling sensations generated by the pandemic disruptions to commuter routines provided an important lens through which to understand the uptake of e-bikes. The paper concludes by showing the utility of the concept of territory as a means of theorising changes to everyday mobility practices.

Systematic review and meta-analysis evaluating the effects electric bikes have on physiological parameters

BACKGROUND

There is a universal need to increase the number of adults meeting physical activity (PA) recommendations to help improve health. In recent years, electrically assisted bicycles (e-bikes) have emerged as a promising method for supporting people to initiate and maintain physical activity levels. To the best of our knowledge, there have been no meta-analyses conducted to quantify the difference in physiological responses between e-cycling with electrical assistance, e-cycling without assistance, conventional cycling, and walking.

METHODS

A systematic review and meta-analysis was conducted following PRISMA guidelines. We identified short-term e-bike studies, which utilized a crossover design comparing physiological outcomes when e-cycling with electrical assistance, e-cycling without electrical assistance, conventional cycling, or walking. Energy expenditure (EE), heart rate (HR), oxygen consumption (VO2 ), power output (PO), and metabolic equivalents (METs) outcomes were included within the meta-analysis.

RESULTS

Fourteen studies met our inclusion criteria (N = 239). E-cycling with electrical assistance resulted in a lower energy expenditure (EE) [SMD = -0.46 (-0.98, 0.06), p = 0.08], heart rate (HR) [MD = -11.41 (-17.15, -5.68), p < 0.000, beats per minute], oxygen uptake (VO2 ) [SMD = -0.57 (-0.96, -0.17), p = 0.005], power output (PO) [MD = -31.19 (-47.19 to -15.18), p = 0.000, Watts], and metabolic equivalent (MET) response [MD = -0.83 (-1.52, -0.14), p = 0.02, METs], compared with conventional cycling. E-cycling with moderate electrical assistance resulted in a greater HR response [MD 10.38 (-1.48, 22.23) p = 0.09, beats per minute], and VO2 response [SMD 0.34 (-0.14, 0.82) p = 0.16] compared with walking.

CONCLUSIONS

E-cycling was associated with increased physiological responses that can confer health benefits.

Effects of Lower Limb Cycling Training on Different Components of Force and Fatigue in Individuals With Parkinson’s Disease

The strength of lower extremity is important for individuals to maintain balance and ambulation functions. The previous studies showed that individuals with Parkinson’s disease suffered from fatigue and strength loss of central origin. The purpose of this study was to investigate the effect of lower extremities’ cycling training on different components of force and fatigue in individuals with Parkinson’s disease. Twenty-four individuals (13 males, 11 females, mean age: 60.58 ± 8.21 years) diagnosed with idiopathic Parkinson’s disease were randomized into training and control groups. The maximum voluntary contraction (MVC) force, voluntary activation level (VA), and twitch force of knee extensors were measured using a custom-made system with surface electrical stimulation. The general, central, and peripheral fatigue indexes (GFI, CFI, and PFI) were calculated after a fatiguing cycling protocol. Subjects received 8 weeks of low resistance cycling training (training group) or self-stretching (control group) programs. Results showed that MVC, VA, and twitch force improved (p < 0.05) only in the training group. Compared to the baseline, central fatigue significantly improved in the training group, whereas peripheral fatigue showed no significant difference in two groups. The cycling training was beneficial for individuals with Parkinson’s disease not only in muscle strengthening but also in central fatigue alleviation. Further in-depth investigation is required to confirm the effect of training and its mechanism on central fatigue.

Smart Electrically Assisted Bicycles as Health Monitoring Systems: A Review

This paper aims to provide a review of the electrically assisted bicycles (also known as e-bikes) used for recovery of the rider's physical and physiological information, monitoring of their health state, and adjusting the "medical" assistance accordingly. E-bikes have proven to be an excellent way to do physical activity while commuting, thus improving the user's health and reducing air pollutant emissions. Such devices can also be seen as the first step to help unhealthy sedentary people to start exercising with reduced strain. Based on this analysis, the need to have e-bikes with artificial intelligence (AI) systems that recover and processe a large amount of data is discussed in depth. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to complete the relevant papers' search and selection in this systematic review.

The 2019 Conference on Health and Active Transportation: Research Needs and Opportunities

Active transportation (AT) is widely viewed as an important target for increasing participation in aerobic physical activity and improving health, while simultaneously addressing pollution and climate change through reductions in motor vehicular emissions. In recent years, progress in increasing AT has stalled in some countries and, furthermore, the coronavirus (COVID-19) pandemic has created new AT opportunities while also exposing the barriers and health inequities related to AT for some populations. This paper describes the results of the December 2019 Conference on Health and Active Transportation (CHAT) which brought together leaders from the transportation and health disciplines. Attendees charted a course for the future around three themes: Reflecting on Innovative Practices, Building Strategic Institutional Relationships, and Identifying Research Needs and Opportunities. This paper focuses on conclusions of the Research Needs and Opportunities theme. We present a conceptual model derived from the conference sessions that considers how economic and systems analysis, evaluation of emerging technologies and policies, efforts to address inclusivity, disparities and equity along with renewed attention to messaging and communication could contribute to overcoming barriers to development and use of AT infrastructure. Specific research gaps concerning these themes are presented. We further discuss the relevance of these themes considering the pandemic. Renewed efforts at research, dissemination and implementation are needed to achieve the potential health and environmental benefits of AT and to preserve positive changes associated with the pandemic while mitigating negative ones.

Safer cycling in older age (SiFAr): a protocol of a randomized controlled trial

Background

Cycling has positive effects on health and the proportion of older cyclists is rising. However, the risk for older adults to be injured or killed by a bicycle accident increases. The aim of the ongoing project “Safer Cycling in Older Age (SiFAr)” is to promote safer cycling in community-dwelling older adults with a structured, multi-component exercise training.

Methods

SiFAr is a randomized, controlled trial with a duration of 3 months for the intervention and a 6–9 months follow-up. We address community-dwelling persons aged 65 years and older living in the area Nürnberg-Fürth-Erlangen (Germany) who are either 1) beginners with the e-bike or 2) feeling self-reported unsteadiness when cycling or 3) uptaking cycling after a longer break. Long-term, experienced cyclists without subjectively reported limitations or worries when cycling are excluded. Participants are either randomized 1:1 to an intervention group (IG; receiving multi-component exercise program related to cycling, MEPC) or an active control group (aCG; receiving health and bicycle-related presentations, HRP). The purpose of this study is to investigate if the cycling competence of the IG will improve compared to the aCG. The cycling competence as primary outcome is tested not blinded in a standardized cycle course prior and after the intervention period, which consists of variant tasks requiring motor and cognitive skills related to traffic situations in daily life. Additional assessments such as physical functioning, quality of life, fear of falling, questionnaires regarding cycling behavior are obtained.

To investigate the primary objective, regression analyses with difference of errors in the cycling course as independent variable and group as dichotomous dependent variable adjusted for covariates (sex, bicycle type) will be performed.

The trial design is described in the present manuscript, using the extended CONSORT checklist for reporting pragmatic trials.

Discussion

Since there is a lack of cycling-related interventions for older people, SiFAr aims to evaluate a standardized intervention to enhance cycling safety. The results of the SiFAr trial could contribute to the implementation of an evaluated cycling course concept promoting mobility and independence of older adults.

Trial registration

This study was registered with clinicaltrials.gov: NCT04362514 on April 27, 2020

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02502-5.

The burden of cycling-related trauma to the orthopaedic and trauma department of a level 1 trauma hospital in Adelaide, South Australia

Background

With the fourth largest metropolitan population density, motor vehicle drivers in Adelaide, South Australia, record the most number of motor vehicle insurance claims in Australia. Previous studies have shown a rise in cycling-related emergency department presentations from 2005 to 2010. There is no specific data available specifically related to South Australia. Our institution is the largest level 1 trauma centre in South Australia and Northern Territory and has a local geographic pool of the central metropolitan region of Adelaide.

The aims of this study were to establish the demographics of cycling-related presentations to our institution that involved the admission of a patient under the Orthopaedic and Trauma service. Secondary aims were to investigate whether there were any common variables among these presentations that could be modified to prevent or reduce the morbidity of cycling-related trauma.

Methods

A prospective study was performed at our institution from 1 March 2018 until 31 December 2019 of all inpatient admissions under the Orthopaedics and Trauma department, where the patient was injured as a cyclist. We collated patient-reported information about the accident and their cycling habits.

Results

One hundred and ten patients were included in the study. One hundred and thirty-one injuries were recorded, requiring 89 surgical procedures. Eighty were upper limb injuries (61%), 49 were lower limb (37%), and 2 injuries occurred in either the spine or ribs. The most common reason for the accident was excessive cyclist speed.

Conclusions

The majority of cyclists admitted to our unit with orthopaedic injuries were male patients who assessed themselves as experienced riders, and yet still were involved in accidents that resulted predominantly from episodes of poor judgement. Speed is a common and avoidable factor involved in the presentation of orthopaedic-related trauma to the public system. Involvement of other vehicles was relatively uncommon, as was poor weather; upper limb injuries predominate in this group.

Could smart research ensure healthy people in disrupted cities?

BACKGROUND

Since the late 19th century, city planners have struggled to cope with new types of urban transport and mobility that threatened the existing system, or even rendered it obsolete.

PURPOSE

As city planners confront the range of disruptive urban mobilities currently on the horizon, this paper explores how we can draw on a vast body of evidence to anticipate and avoid unintended consequences to people's health and wellbeing.

METHODS

This commentary involved a rapid review of the literature on transport disruption.

RESULTS

We found that to avoid the unintended consequences of disruption, research, policy and practice must think beyond single issues (such as the risk of chronic disease, injury, or traffic management) and consider the broader consequences of interventions. For example, although autonomous vehicles will probably reduce road trauma, what will be the negative consequences for physical inactivity, sedentary behavior, chronic disease, land use, traffic congestion and commuting patterns? Research is needed that considers and informs how to mitigate the range of potential harms caused by disruptive mobilities.

CONCLUSION

In the face of new disruptive mobilities, we must: (a) draw on existing evidence to shape new regulations that address the 'who, when and where' rules of introducing new mobilities (such as electric assisted bicycles (e-bikes) and scooters (e-scooters)) of which the health repercussions can be easily anticipated; (b) monitor and evaluate the implementation of any interventions through natural experiment studies; and (c) use innovative research methods (such as agent-based simulation and health-impact-assessment modelling) to assess the likely effects of emerging disruptive mobilities (e.g., autonomous vehicles) on health and wellbeing and on the environment.

The impact of e-cycling on travel behaviour: A scoping review

INTRODUCTION

Electrically assisted bicycles (e-bikes) have become increasingly popular in the past decade. This review aimed to scope the literature to identify what is known about the frequency and duration of e-bike use, their impact on travel behaviour, the purposes for which e-bikes are used and factors associated with e-bike use. In addition, the review aimed to identify gaps in the literature and highlight future research priorities.

METHODS

A scoping review of published and unpublished literature in any language. Relevant articles were identified through searching six databases, two grey literature platforms and reference lists. Searches were conducted until August 2019. Data were extracted using a standardised extraction form and descriptive and narrative results are provided.

RESULTS

Seventy-six studies met the inclusion criteria. The volume of research has increased since 2017 and primarily examines personal e-bike use, as opposed to e-bike share/rental schemes or organizational e-bike initiatives. The use of e-bikes increased the frequency and duration of cycling compared to conventional cycling and may help overcome barriers associated with conventional cycling. The uptake in e-cycling largely substitutes for conventional cycling or private car journeys, though the degree of substitution depends on the primary transport mode prior to e-bike acquisition. E-bikes are primarily used for utilitarian reasons, though older adults also engage in recreational e-cycling. Research priorities include quantitatively examining e-bike use, their impact on overall transport behaviour and identifying determinants of e-cycling to inform intervention and policy.

CONCLUSIONS

This review suggests that the personal use of e-bikes is associated with a reduction in motorized vehicle use, which has potential positive impacts on the environment and health. The impacts of e-bike share schemes and workplace initiatives are less well understood. Evidence describing the purposes for which e-bikes are used, and the factors associated with usage, are useful to inform e-cycling promotion policy.

Can a liveable city be a healthy city, now and into the future?

City planning and infrastructure can influence the social determinants of health, the liveability of cities and the physical and mental health of city residents. This article defines these concepts and discusses how city planning can help in mitigating COVID-19 transmission, and support health by accommodating active transport (i.e. walking and cycling) and emerging technologies (i.e. autonomous and electric vehicles).

Exploring the factors influencing the use of electrically assisted bikes (e-bikes) by stroke survivors: a mixed methods multiple case study

PURPOSE

E-bikes have the potential to overcome some of the barriers that stroke survivors face with regards to physical activity. This study aims to explore the factors that affect e-bike usage by stroke survivors.

METHODS

A mixed methods multiple case studies design, using semi-structured interviews and GPS data. Subject to GP approval, participants loaned an e-bike or e-trike for up to three months. Interviews were undertaken pre and post intervention. The COM-B behaviour change model acted as a framework for analysis. GPS data relating to journey duration and distance travelled was collected fortnightly.

RESULTS

Six participants were recruited; only three loaned an e-bike/e-trike (with adaptations as required). Storage, being unable to get GP approval, and safety were withdrawal reasons. Level of impairment was a factor influencing the type of e-bike used, level of support required and the motivation of the participants.

CONCLUSION

Stroke survivors can use e-bikes although barriers exist. Electrical assistance was a positive factor in enabling some of the participants to cycle outdoors. Due to the small sample size and the number of participants who were able to loan an e-bike, further research is required to determine whether e-bikes are a feasible and effective intervention to increase physical activity for stroke survivors.IMPLICATIONS FOR REHABILITATIONThe assistance provided by the e-bike/e-trike could provide stroke survivors the opportunity to cycle outdoors.E-bikes/e-trikes could facilitate participation of activities of everyday living such as shopping, hobbies and increase levels of physical activity.Rehabilitation could focus on physical impairment, its effects on self-confidence, and knowledge surrounding the e-bike to overcome barriers to cycling.Social support, the belief that e-bike was an enjoyable mode of physical activity that was good for their health were reported by the participants as important factors for using the e-bike/e-trike.

Cumbersome but desirable-Breaking the code of everyday cycling

Introduction

Cycling for transport could integrate physical activity (PA) into daily routines and potentially increase total PA levels. However, for parents with young children, most factors affecting transport mode choice tend to facilitate car use. Greater insight is necessary into reasons for (not) using sustainable transport modes in parents with young children. Therefore, the objective of this study was to explore the experiences, including motives, perceptions, attitudes, and norms, of parents of young children by using an e-bike, a longtail bike, and a traditional bike for everyday travel to the workplace, kindergarten, and the grocery store during the autumn, winter, and spring, in nine months.

Methods

Semistructured focus group interviews were conducted with 18 parents of young children residing in southern Norway. Parents were recruited through Facebook announcements and direct contact with kindergartens, selected organisations, and companies in the Kristiansand municipality. Data were analysed by systematic text condensation by using NVivo V.11.

Results

Participants’ experiences were summarised by three main themes: ‘cycling is cumbersome’, ‘cycling reflects the desirable me’, and ‘breaking the cycling code’. Time use, planning, logistics, wet and cold weather, long distances, and no cycling habit were frequently mentioned barriers, and the most notable facilitator was the children’s attitude towards cycling. In general, children loved to cycle and preferred cycling to driving. Additionally, the freedom and independence of cycling were emphasised and valued.

Conclusion

In challenging weather conditions, parents of young children may experience cycling as cumbersome but desirable, and bike access could increase the feasibility of daily cycling.

Everyday Pedelec Use and Its Effect on Meeting Physical Activity Guidelines

Pedelecs (e-bikes with electrical support up to 25 km·h^-1) are important in active transportation. Yet, little is known about physiological responses during their everyday use. We compared daily pedelec (P) and bicycle (B) use to determine if pedelecs are a suitable tool to enhance physical activity. In 101 employees, cycling duration and intensity, heart rate (HR) during P and B were recorded via a smartphone app. Each recording period was a randomized crossover design and lasted two weeks. The ride quantity was higher in P compared to B (5.3 ± 4.3 vs. 3.2 ± 4.0 rides·wk^-1; p < 0.001) resulting in a higher total cycling time per week for P (174 ± 146 min·wk^-1) compared to B (99 ± 109 min·wk^-1; p < 0.001). The mean HR during P was lower than B (109 ± 14 vs. 118 ± 17 bpm; p < 0.001). The perceived exertion was lower in P (11.7 ± 1.8 vs. 12.8 ± 2.1 in B; p < 0.001). The weekly energy expenditure was higher during P than B (717 ± 652 vs. 486 ± 557 metabolic equivalents of the task [MET]·min·wk^-1; p < 0.01). Due to a sufficient HR increase in P, pedelecs offer a more active form of transportation to enhance physical activity.

Urban and transport planning pathways to carbon neutral, liveable and healthy cities; A review of the current evidence

INTRODUCTION

Half the world population lives in cities and this is likely to increase to 70% over the next 20 years. Suboptimal urban and transport planning has led to e.g. high levels of air pollution and noise, heat island effects and lack of green space and physical activity and thereby an increase in morbidity and premature mortality. How can better urban and transport planning improve public health?

METHODS

A narrative meta-review around a number of cutting edge and visionary studies and practices on how to improve public health through better urban and transport planning reported in the literature and from meetings over the past few years.

RESULTS

We describe the latest quantitative evidence of how cities can become healthier through better urban and transport planning. It focuses and provides evidence for important interventions, policies and actions that can improve public health, including the need for land use changes, reduce car dependency and move towards public and active transportation, greening of cities, visioning, citizen involvement, collaboration, leadership and investment and systemic approaches. Health impact assessment studies have recently provided new powerful quantitative evidence on how to make cities healthier and will be used as examples. At the same time these measures make also our cities more sustainable (i.e. carbon neutral) and liveable creating multiple benefits.

CONCLUSION

Better urban and transport planning can lead to carbon neutral, more liveable and healthier cities, particularly through land use changes, a move from private motorised transportation to public and active transportation and greening of cities.

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

Background

The global incidence of type 2 diabetes mellitus (T2DM) is increasing. Given the many complications associated with T2DM, effective management of the disease is crucial. Physical activity is considered to be a key component of T2DM management. However, people with T2DM are generally less physically active than individuals without T2DM and adherence to physical activity is often poor following completion of lifestyle interventions. As such, developing interventions that foster sustainable physical activity is of high priority. Electrically assisted bicycles (e-bikes) have been highlighted as a potential strategy for promoting physical activity in this population. E-bikes provide electrical assistance to the rider only when pedalling and could overcome commonly reported barriers to regular cycling. This paper describes the protocol of the PEDAL-2 pilot randomized controlled trial, an e-cycling intervention aimed at increasing physical activity in individuals with T2DM.

Methods

A parallel-group two-arm randomized waitlist-controlled pilot trial will be conducted. Forty individuals with T2DM will be randomly assigned, in a 1:1 allocation ratio, to an e-cycling intervention or waitlist control. Recruitment and screening will close once 20 participants have been randomized to each study arm. The intervention will involve e-bike training with a certified cycle instructor and provision of an e-bike for 12 weeks. Data will be collected at baseline, during the intervention and immediately post-intervention using both quantitative and qualitative methods. In this trial, the primary interests are determination of effective recruitment strategies, recruitment and consent rates, adherence and retention and delivery and receipt of the intervention. The potential impact of the intervention on a range of clinical, physiological and behaviour outcomes will be assessed to examine intervention promise. Data analyses will be descriptive.

Discussion

This paper describes the protocol for the PEDAL-2 pilot randomized controlled trial. Results from this trial will provide information on trial feasibility and identify the promise of e-cycling as a strategy to positively impact the health and behaviour of individuals with T2DM. If appropriate, this information can be used to design and deliver a fully powered definitive trial.

Trial registration

ISRCTN, ISRCTN67421464. Registered 03/01/2019.

Psychosocial and Physiological Health Outcomes of Green Exercise in Children and Adolescents-A Systematic Review

Both physical activity (PA) and nature exposure are associated with several youth health benefits. However, the health outcomes when being physically active in nature, called Green Exercise (GE), are less clear. Thus, the purpose of this systematic review was to provide an overview of the psychosocial and physiological outcomes of GE in children and adolescents and to outline future GE research directions. The PRISMA statement guided the review. Web of Science, PubMed, ERIC, and APA PsychNET were systematically searched in February 2019, including studies between 2000 and 2019. Fourteen of 1175 identified publications were included, which reported 15 different psychosocial and six different physiological outcomes, with some studies reporting more than one outcome. For 16 outcomes, studies reported either similar or no effects for both GE and comparison groups. For six outcomes, studies reported stronger effects for GE, for three outcomes, studies reported stronger effects in the comparison group. Evidence was rated as weak, using the EPHPP tool. Thus, GE does not have deleterious effects for children and adolescents compared to PA in other settings. GE might be beneficial; however, due to the study's heterogeneity and quality, it is premature to make definite conclusions. Future research should build the quality of evidence for GE, use more rigorous research designs, and investigate the underlying effects and mechanisms of GE.

Engagement in e-cycling and the self-management of type 2 diabetes: a qualitative study in primary care

Background

Physical activity (PA) is important in the management of type 2 diabetes (T2DM), however many people find it difficult to implement and/or sustain in the self-management of the condition. Electrically assisted cycling (e-cycling) may be viewed as a means of self-management in which effort is invested to balance the interplay of lifestyle factors and disease progression.

Aim

To explore engagement with an e-cycling intervention conducted with adults with T2DM.

Design & setting

Prospective qualitative interview study with adults in central Bristol (UK) and surrounding suburbs, in the context of the self-management of T2DM in primary care.

Method

Interviews were conducted with 20 individuals with T2DM (42–70 years, 11 male, 9 female) prior to their participation in a 20-week e-cycling intervention. Post-intervention interviews were conducted with 18 participants (11 male, 7 female). Interviews were transcribed verbatim and inductive thematic analysis was undertaken.

Results

Participants were aware that PA contributed to the management of their diabetes. Engagement with e-cycling was viewed as both an acceptable and a social lifestyle intervention. Furthermore, participants were unhappy with the volume of medication used to manage their diabetes and e-cycling fostered autonomy in the management of T2DM. GPs and practice nurses were regarded as an important source of reliable information, and were considered to be best placed to talk about interventions to increase PA.

Conclusion

E-cycling is viewed as an acceptable form of PA to aid the self-management of T2DM. E-cycling may support people with T2DM to reduce their medication intake and in turn foster greater autonomy in managing the condition. The findings have implications for the role of primary care health professionals in supporting both patients and significant others in adoption of e-cycling.

From cars to bikes - The effect of an intervention providing access to different bike types: A randomized controlled trial

Introduction

We aimed to investigate whether providing parents with children in kindergarten with access to different bicycle types could influence (i) travel behavior and cycling amount, and (ii) intrinsic motivation for cycling and psychological constructs related to car use.

Methods

A randomized, controlled trial was conducted in Southern Norway from September 2017 to June 2018. In total 36 parents were recruited and randomly drawn into an intervention (n = 18) or control group (n = 18). The intervention group was in random order equipped with an e-bike with trailer (n = 6), a cargo (longtail) bike (n = 6) and a traditional bike with trailer (n = 6).

Results

At follow-up, more participants from the intervention group (vs. the control group) were classified as cyclists to the workplace (n = 7 (38.9%) vs. n = 1 (5.9%), p = 0.04), but not to the kindergarten (n = 6 (33.3%) vs. n = 2 (11.8%), p = 0.23) or to the grocery store (n = 2 (11.1%) vs. n = 0 (0%), p = 0.49). A significant (p = ≤0.05) increase in cycling frequency (0.1 to 2.0 days/week) from baseline to follow-up was found in the intervention group for all destinations and seasons, except to the grocery store during winter (p = 0.16). A decrease in frequency of car driving (-0.2 to -1.7 days/week) was found to be apparent in terms of travelling to the workplace and the kindergarten for all seasons, yet not to the grocery store for any season (p = 0.15–0.49). The intervention group (vs. the control group) reported significantly higher “intrinsic regulation” for cycling (p = 0.01) at follow-up.

Conclusion

Access to different bike types for parents with children attending kindergarten resulted in overall increased cycling, decreased car use and higher intrinsic motivation for cycling. E-bikes obtained the greatest cycling amount in total, with the smallest sample variability. Hence, providing parents with children in kindergarten with access to e-bikes might result in increased and sustained cycling, also during the winter season.

Public employees in South-Western Norway using an e-bike or a regular bike for commuting - A cross-sectional comparison on sociodemographic factors, commuting frequency and commuting distance

Large-scale analyses on the travel behavior of e-bikes are scarce, and current knowledge regarding who the e-bike owners are is inconsistent. Also, commuters represent a relevant user group with an unexploited potential. Therefore, the purpose of the present study was to examine (i) associations between type of bike (e-bike vs. regular bike) with place of residence (county), sociodemographic variables (age, sex, educational level, income and ethnicity) and habitual physical activity level, and (ii) if public employees possessing an e-bike cycle more often and longer distances to work. A cross-sectional survey was conducted in 2017 among 1977 (5.2% of eligible subjects) public employees in Southern and Western Norway. Binary and multinomial logistic regression analyses were conducted. Respondents possessing an e-bike were less likely to perform high levels of leisure time physical activity (OR 0.56 (CI 0.39-0.82)), compared to those possessing a regular bike only. For those residing in Agder, the likelihood of possessing an e-bike (vs. regular bike) was almost 4 times higher (OR 3.98 (CI 2.53-6.26)), compared with participants residing in Sogn og Fjordane. Compared with those possessing a regular bike only, e-bike users cycled more frequently to work, both occasionally (OR 3.71 (CI 2.44-5.65)) and most of the time (OR 4.28 (CI 2.79-6.55)), and they had higher odds of cycling medium distances to the workplace (OR 1.74 (CI 1.04-2.90)). In conclusion, e-bike access could result in increased commuter cycling, both in terms of cycling frequency and cycling distance, which in turn could contribute to enhanced physical activity levels.