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

Changes in Step-Defined Physical Activity by Occupation: The National Health and Nutrition Survey of Japan 2001-2019

BACKGROUND

Accumulating more steps/day provides considerable health benefits; however, studies of steps/day trends among a working population are quite limited. Moreover, steps/day trends may differ among occupations. We aimed to assess changes in steps/day by occupations in the Japanese working population.

METHODS

Workers aged 20-65 years were identified from the Japanese National Health and Nutrition Examination Survey conducted between 2001 and 2019. Steps/day were assessed using a pedometer. Occupations with or without income were categorized as professionals, managers, and clerks; sales workers, service workers, protective service workers, and agricultural/forestry/fishery workers; transport/machine operators; manufacturing/construction/cleaning laborers; homemakers; and unemployed individuals. Steps/day per decade were compiled for 2001-2010 and 2011-2019, and differences in age-adjusted steps/day between 2001-2010 and 2011-2019 were evaluated by an analysis of covariance.

RESULTS

A total of 105,492 workers among occupational categories were analyzed. Changes in age-adjusted steps/day (95% CI) per decade among occupations with income ranged from -873 (-1426 to -321) to 352 (-19 to 722) while those for homemakers and the unemployed ranged from -766 (-875 to -677) to -659 (-890 to -429). Only transport/machine operators did not reduce their steps/day (Δ = 352 [-19 to 722]); all other occupations significantly decreased their steps/day. Among occupations with income, the largest decrease was observed in protective service workers, followed by clerks. Moreover, clerks remained the occupational group with the lowest amount of steps/day in both periods.

CONCLUSIONS

Most included occupations reduced their steps/day, and the degree of change varied widely among occupations. Further promotion of steps/day is warranted, especially for clerks.

Physical Activity, Air Pollution, and Mortality: A Systematic Review and Meta-analysis

BACKGROUND

As whether the positive effects of physical activity on mortality outweigh the negative effects of exposure to pollution is still under debate, we conducted a systematic review and meta-analysis on the risk of mortality for combined exposure to physical activity and air pollution.

METHODS

PubMed, Cochrane, Embase and ScienceDirect databases were searched for studies assessing the risk of mortality for combined exposure to physical activity and air pollution.

RESULTS

We included eight studies for a total of 1,417,945 individuals (mean 57.7 years old, 39% men) - 54,131 died. We confirmed that air pollution increased the risk of mortality by 36% (OR 1.36, 95CI 1.05-1.52), whereas physical activity in a non-polluted environment decreased the risk of mortality by 31% (OR 0.69, 95CI 0.42-0.95). Our meta-analysis demonstrated that combined exposure to physical activity and air pollution decreased the risk of mortality by 26% (OR 0.74, 95CI 0.63-0.85). This risk decreased whatever the level of physical activity: by 19% (OR 0.81, 95CI 0.69-0.93) for low, by 32% (OR 0.68, 95CI 0.44-0.93) for moderate, and by 30% (OR 0.70, 95CI 0.49-0.91) for high physical activity in air pollution.

CONCLUSION

We confirmed that air pollution increased mortality by 36% in our meta-analysis. Despite the controversial benefit-risk, we demonstrated a reduction of mortality by 26% for combined exposure to physical activity and air pollution - nearly comparable to the reduction of mortality when practicing physical activity without air pollution (- 31%). However, the limited number of included studies precluded the demonstration of a dose-response relationship between levels of physical activity and air pollution, and reduction of mortality.

Association of active commuting with incidence of depression and anxiety: prospective cohort study

Evidence is limited on the incidence of depression and anxiety in relation to active commuting. Our study aimed to explore their association and examine the mediating role of inflammatory. This study included 240,547 workers in the UK Biobank. The exposure variable was the mode of transport used to get to and from work including active (walking, cycling, mixed mode) and non-active commuting (car or public transport). The incidence of depression and anxiety was defined using ICD-10 codes. Cox proportional hazard regression models were used to explore the hazard ratios (HRs) of active commuting with depression and anxiety, and mediation analyses were used to test the mediating role of inflammatory in this association. There were 10,862 depression and 9407 anxiety events. Active commuting was associated with lower risk of depression [cycling: HR 0.775, 95% confidence interval (0.674-0.890); mixed mode walking: 0.858 (0.800-0.919); mixed mode cycling: 0.821 (0.744-0.907)] and anxiety [cycling: 0.781 (0.675-0.904); mixed mode walking: 0.867 (0.805-0.934); mixed mode cycling 0.810 (0.728-0.902)], and there were distinct dose-response trends between commuting distance and incidence of depression or anxiety. Inflammatory explained 19.75% of the association between cycling with depression, and 18.05% with anxiety. There were interactions between commuting and occupation type. Cycle and mix mode commuting were associated with lower risk of depression and anxiety, and inflammation partially mediated these association. Implementing initiatives that facilitate active commuting may help alleviate the poor mental health.

Fecal microbiota transplantation, a tool to transfer healthy longevity

The complex gut microbiome influences host aging and plays an important role in the manifestation of age-related diseases. Restoring a healthy gut microbiome via Fecal Microbiota Transplantation (FMT) is receiving extensive consideration to therapeutically transfer healthy longevity. Herein, we comprehensively review the benefits of gut microbial rejuvenation - via FMT - to promote healthy aging, with few studies documenting life length properties. This review explores how preconditioning donors via standard - lifestyle and pharmacological - antiaging interventions reshape gut microbiome, with the resulting benefits being also FMT-transferable. Finally, we expose the current clinical uses of FMT in the context of aging therapy and address FMT challenges - regulatory landscape, protocol standardization, and health risks - that require refinement to effectively utilize microbiome interventions in the elderly.

Walking for transport and all-cause mortality: a prospective cohort study of Australian community-dwelling older adults

Background

Walking for transport may prolong survival in younger and middle-aged adults; however, evidence for older adults is scarce. We examined a prospective relationship between transport-related walking and all-cause mortality among adults aged 70 years and over.

Methods

Community-dwelling, apparently healthy older adults (n=11 539; mean age 75.1 years, 53.1% females), participants of the ASPirin in Reducing Events in the Elderly Longitudinal Study of Older Persons, reported their frequency of transport-related walking (never, rarely/once a week, more than once a week or every day). All-cause mortality was verified by two independent sources. Cox proportional-hazards models (HR and 95% CI) assessed the association between transport-related walking and all-cause mortality.

Results

Of participants, 44.1% reported walking every day, 31.5% more than once a week, 21.7% rarely or once a week and 2.7% never engaged in transport-related walking. During the median follow-up of 8.6 years (IQR: 7.4-10.1), 1599 participants (13.9%) died. Compared with those who reported never walking for transport, the risk of all-cause mortality was lower for those walking rarely or once a week (HR 0.73, 95% CI 0.56 to 0.96); more than once a week (HR 0.76, 95% CI 0.59 to 0.99) and every day (HR 0.74, 95% CI 0.57 to 0.96). Analyses were adjusted for age, sex, education, smoking, alcohol consumption, living status, rurality, household income, socioeconomic status, chronic conditions, body mass index and overall physical activity levels.

Conclusions

Engaging in any weekly transport-related walking helps older adults prolong survival. Public health campaigns and urban planning should promote and support transport-related walking to boost physical activity levels of older adults and support healthier ageing.

The influence of burnout on cardiovascular disease: a systematic review and meta-analysis

Background

Burnout is a public health problem with various health consequences, among which cardiovascular disease is the most investigated but still under debate. Our objective was to conduct a systematic review and meta-analysis on the influence of burnout on cardiovascular disease.

Methods

Studies reporting risk (odds ratio, relative risk, and hazard ratio) of cardiovascular disease following burnout were searched in PubMed, PsycINFO, Cochrane, Embase, and ScienceDirect. We performed a random-effect meta-analysis stratified by type of cardiovascular disease and searched for putative influencing variables. We performed sensitivity analyses using the most adjusted models and crude risks.

Results

We included 25 studies in the systematic review and 9 studies in the meta-analysis (4 cross-sectional, 4 cohort, and 1 case-control study) for a total of 26,916 participants. Burnout increased the risk of cardiovascular disease by 21% (OR = 1.21, 95% CI 1.03 to 1.39) using the most adjusted risks and by 27% (OR = 1.27, 95% CI 1.10 to 1.43) using crude risks. Using stratification by type of cardiovascular disease and the most adjusted risks, having experienced burnout significantly increased the risk of prehypertension by 85% (OR = 1.85, 95% CI 1.00 to 2.70) and cardiovascular disease-related hospitalization by 10% (OR = 1.10, 95% CI 1.02 to 1.18), whereas the risk increase for coronary heart disease (OR = 1.79, 95% CI 0.79 to 2.79) and myocardial infarction (OR = 1.78, 95% CI 0.85 to 2.71) was not significant. Results were also similar using crude odds ratio. The risk of cardiovascular disease after a burnout was not influenced by gender. Insufficient data precluded other meta-regressions.

Conclusions

Burnout seems to increase the risk of cardiovascular disease, despite the few retrieved studies and a causality weakened by cross-sectional studies. However, numerous studies focused on the pathophysiology of cardiovascular risk linked to burnout, which may help to build a preventive strategy in the workplace.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

[Work-related sedentary behavior]

Background

Sedentary behavior is associated with an increased risk of chronic diseases, such as metabolic syndrome and type 2 diabetes and all-cause mortality. Occupational sitting time contributes to large amounts of daily sedentary behavior, especially in office workers.

Objective

This study investigated the amount of time spent in sedentary behavior during different tasks at work and while commuting of administrative personnel of a university hospital in Germany.

Material and methods

A cross-sectional questionnaire-based study of administrative employees at the University Hospital Regensburg, Germany was carried out to assess work-related sedentary behavior. Descriptive and exploratory statistical analyses were performed.

Results

The study population consisted of 159 participants (54.1% women, 51.6% older than 40 years), which corresponds to a response rate of 26%. The median daily sitting time in the office was 7.0 h (interquartile range, IQR 6.0-7.5 h) and mostly occurred during computer work (57.3%), telephone calls (13.2%) and meetings (11.7%). Median standing time at work was 0.8 h (IQR 0.3-1.4 h). Administrative staff spent a median of 0.7 h (IQR 0.3-1.0 h) per day sedentary while commuting, with 67.3% of respondents commuting by car, motorbike or scooter. The participants were of the opinion that sitting for long uninterrupted periods had negative (69.6%) or relatively negative (29.7%) effects on health.

Conclusion

Administrative staff in hospitals spend large amounts of the daily working time with sedentary behavior. Interventions that enable working both in sitting and standing positions can lead to reduced work-related sitting time and thereby could improve occupational and, in a broader sense, public health.

Perceived Neighborhood Safety and Active Transportation in Adults from Eight Latin American Countries

Neighborhood built environment is associated with domain-specific physical activity. However, few studies with representative samples have examined the association between perceived neighborhood safety indicators and domain-specific active transportation in Latin America. This study aimed to examine the associations of perceived neighborhood safety with domain-specific active transportation in adults from eight Latin American countries. Data were obtained from the Latin American Study of Nutrition and Health (n = 8547, aged 18-65). Active transportation (walking and cycling) was assessed using the long form of the International Physical Activity Questionnaire. Specifically, traffic density and speed as well as street lightening, visibility of residents regarding pedestrians and bicyclists, traffic lights and crosswalks, safety of public spaces during the day and at night, crime rate during the day and at night were used to evaluate perceived neighborhood safety. Slow traffic speeds, unsafe public spaces during the day, and crime during the day were associated with ≥10 min/week vs. <10 min/week of walking. Furthermore, drivers exceeding the speed limit and crime rate during the day were associated with reporting ≥10 min/week vs. <10 min/week of cycling. These results indicate a stronger association of the perceived neighborhood safety with walking compared to cycling.

Association of Habitual Physical Activity With the Risk of All-Cause Mortality Among Chinese Adults: A Prospective Cohort Study

Objective

This study was conducted to evaluate the association of the risk of all-cause mortality with habitual physical activity (HPA) and its different domains among Chinese adults.

Methods

A total of 11,994 participants from the Guangzhou Heart Study were followed up until 1 January 2020. Information on HPA, including leisure-time physical activity (LTPA) and commute activity, was collected using a modified Global Physical Activity Questionnaire. Individual cause of death was obtained from the National Death Registry of China. Cox proportional hazards regression model was used to estimate hazard ratio (HR) and 95% confidence interval (CI) after adjustment for covariates.

Results

During 37,715 person-years of follow-up, 208 deaths (1.73%) were observed. When compared with the highest with the lowest exposure tertiles, HPA and LTPA were associated with 34% (HR: 0.66, 95% CI: 0.46–0.95) and 30% (HR: 0.70, 95% CI: 0.49–0.99) reduced risk of all-cause mortality after adjustment for covariates. Commute activity was not associated with mortality risk. For the specific component of LTPA, we found that every 1 MET-h/week increment of the housework was associated with a 1% (HR: 0.99, 95% CI: 0.98–0.99) decreased mortality risk, and performing brisk walking/health exercises/Yangko was associated with a 46% reduced mortality risk (HR: 0.54, 95% CI: 0.29–0.99).

Conclusion

This study suggests that a higher level of HPA and LTPA was associated with a lower risk of all-cause mortality. Our findings suggest people to perform HPA, especially LTPA, as a strategy for mortality reduction and health promotion.

Cycling for health: Improving health and mitigating the climate crisis

OBJECTIVE

To review the literature about cycling and health, and to provide an overview and discussion of the available evidence.

SOURCES OF INFORMATION

The MeSH terms bicycle and transportation were searched in PubMed. Clinical trials, practice reviews, and systematic reviews were included. All reference lists were reviewed for additional articles.

MAIN MESSAGE

Climate change is a threat to health. In Canada alone, transportation is the second largest source of greenhouse gas emissions. Active transportation, which is any form of human-powered transportation, can mitigate the health effects of the climate crisis while simultaneously improving the health of people. Physical activity improves overall well-being, as well as physical and mental health. Active transportation, particularly cycling, is a convenient way to meet physical activity targets, reduce risk of disease and all-cause mortality, and derive mental health and social benefits. Family physician advocacy for active transportation has been shown to increase cycling levels in patients compared with no physician advocacy.

CONCLUSION

Family physicians can help to increase the level of active transportation at the individual patient level through patient education and behaviour change counseling; at the community level through community education and political advocacy; and at the policy level through partnerships with larger organizations.