Active transport and obesity prevention - A transportation sector obesity impact scoping review and assessment for Melbourne, Australia

Health comparisons between active and inactive transport modes in urban adults with chronic conditions: A cross-sectional study

An active transport mode provides an opportunity for integrating physical activity into one's daily life through walking, cycling, and the use of public transportation. The purpose of this study was to compare urban adults with chronic conditions who used active and inactive transport modes and to find differences in their health outcomes. A cross-sectional study was conducted from September 2019 to May 2020. Participants were urban adults who self-reported being overweight or obese, or having a diagnosis of chronic disease. Anonymous structured self-reported questionnaires were used for data collection, including the World Health Organization Quality-of-Life Scale, International Physical Activity Questionnaire Short-Form, and the frequency of eight modes of transportation. According to differences between the frequency score of weekly active and inactive transportation, participants were categorized into inactive, balanced, and active transport modes. In total, 617 valid responses were obtained. Participants who engaged in an active transport mode were found to have significantly less sedentary time, and better comprehensive, social, and environmental aspects of quality of life than those with an inactive transport mode. Engaging in active transportation and avoiding inactive transportation are recommended for urban adults with chronic diseases.

Effects of Socioeconomic Environment on Physical Activity Levels and Sleep Quality in Basque Schoolchildren

The socioeconomic and built environment of an area are interrelated with health data and have a direct influence on children’s development. There are facilitators and barriers for schools to promote physical activity depending on the socioeconomic status of the school. The aim of this study was to analyse the relationship between physical activity and sleep and the socioeconomic level of children in the Basque Country. The sample consisted of 1139 schoolchildren between the ages of six and seventeen (566 boys and 573 girls) from 75 schools (43 public and 32 private). Differences between groups were compared using the Mann–Whitney U test (two samples), Kruskal–Wallis one-factor ANOVA (k samples), and Spearman’s Rho correlation. There are sex differences in light (200.8 ± 62.5 vs. 215.9 ± 54.7) and moderate (69.0 ± 34.3 vs. 79.9 ± 32.1) physical activity in favour of the female group of higher socioeconomic status compared to male group of higher socioeconomic status. In the case of vigorous physical activity, the female group performed less than the male group across all socioeconomic statuses, which was statistically significant in the groups of high socioeconomic status (11.6 ± 9.3 vs. 6.9 ± 5.7) in group 2 and medium socioeconomic status (11.1 ± 9.3 vs. 7.7 ± 6.1) in group 3. There is an inverse relationship between sedentary behaviour and BMI, total bed time, total sleep time, and night-time awakenings. There is also an inverse relationship between all levels of physical activity performed with respect to BMI and total sleep efficiency. These data point towards notable inequalities in physical activity and daily sleep in Basque schoolchildren, which in turn may be marginalised in our current school system due to the effects of the socioeconomic environment.

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

Aim

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

Subjects and methods

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

Results

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

Conclusion

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

Walking and cycling for health: A multi-group analysis of path models between genders

AIMS

Walking and cycling are beneficial for urban adults' health. Transport and recreation are modifiable domains of major physical activity resources. The purposes of this study were to explore associations among psychological and environmental factors, walking and cycling behaviours and quality of life by developing a path model and comparing gender differences.

DESIGN

A cross-sectional study.

METHODS

Participants were community-dwelling healthy urban adults aged 20-65 years. Data were collected between September 2019 and June 2020 by self-reported questionnaires, including health beliefs, the neighbourhood environment, walking and cycling behaviours and the World Health Organization Quality-of-Life Scale. An ANCOVA, chi-squared tests, partial least squares-path model and a multi-group analysis were performed for statistical analyses.

RESULTS

In total, 1294 valid responses were received, which included 41.27% men and 58.73% women. Men had lower walking behaviours and better self-efficacy than women. The developed path model indicated an acceptable model fit. Significant path coefficients were found among psychological and environmental factors, walking and cycling behaviours and quality of life. The path model between men and women found no significant differences in any path coefficients. Significant path coefficients of environmental factors with cycling behaviour and of walking behaviour with quality of life were found in men but not in women.

CONCLUSION

Improving individuals' health beliefs, self-efficacy and perceived walkability and cyclability is a beneficial strategy for promoting physical activity. Walking and cycling behaviours are recommended to improve the quality of life of urban adult populations.

IMPACTS

What problem did the study address? A large proportion of urban adult populations still have insufficient physical activity globally. It is essential that implications from an overall perspective of psychological and environmental factors and their interactions be integrated to develop efficient strategies for promoting physical activity and quality of life. What were the main findings? The developed path model with an acceptable model fit found that psychological and environmental factors were important in explaining urban adults' walking and cycling behaviours and quality of life. Differences were not found between men's and women's path models. Where and on whom will the research have impact? Improving urban adults' psychological and environmental factors might be an efficient strategy for promoting sufficient physical activity. Men's low engagement in walking behaviours should garner increased attention. Providing equal opportunities for both genders to engage in walking and cycling behaviours are recommended for health promotion in urban regions.

Deep Learning in Human Activity Recognition with Wearable Sensors: A Review on Advances

Mobile and wearable devices have enabled numerous applications, including activity tracking, wellness monitoring, and human-computer interaction, that measure and improve our daily lives. Many of these applications are made possible by leveraging the rich collection of low-power sensors found in many mobile and wearable devices to perform human activity recognition (HAR). Recently, deep learning has greatly pushed the boundaries of HAR on mobile and wearable devices. This paper systematically categorizes and summarizes existing work that introduces deep learning methods for wearables-based HAR and provides a comprehensive analysis of the current advancements, developing trends, and major challenges. We also present cutting-edge frontiers and future directions for deep learning-based HAR.

Active commuting and the risk of obesity, hypertension and diabetes: a systematic review and meta-analysis of observational studies

Active commuting may hold a potential for preventing adverse health outcomes. However, evidence of the association of active commuting and the risk of health outcomes remains debatable. The current study systematically and quantitatively summarised research findings on the association between active commuting and the risk of the mentioned health outcomes. We comprehensively searched four databases (PubMed, EMBASE, Web of Science and Open Grey) from inception to 2 August 2020 for observational studies investigating the associations among adult population. Summary relative risks (RRs) and 95% CIs were estimated for the association. Heterogeneity was investigated using Cochran’s Q test and the I² statistic. Restricted cubic splines were used to evaluate linear and nonlinear relations. The search yielded 7581 initial references. We included 28 articles in the meta-analysis. Compared with inactive commuting, active commuting reduced the risk of obesity (RR=0.88, 95% CI 0.83 to 0.94, I²=69.1%), hypertension (RR=0.95, 95% CI 0.87 to 1.04, I²=82.2%) and diabetes (RR=0.82, 95% CI 0.76 to 0.90, I²=44.5%). Restricted cubic splines showed linear associations between active commuting and obesity, hypertension and diabetes (P_nonlinearity=0.640; P_nonlinearity=0.886; P_nonlinearity=0.099). As compared with the lowest active commuting group, the risk of obesity, hypertension and diabetes in the highest active commuting group were reduced by 13% (95% CI 0.82 to 0.93, I²=65.2%); 6% (95% CI 0.86 to 1.02, I²=75.2%) and 19% (95% CI 0.73 to 0.91, I²=49.8%) respectively. Active commuting seemed to be associated with lower risk of obesity, hypertension and diabetes. However, the results should be interpreted cautiously because this meta-analysis was based solely on observational studies.

PROSPERO registration number

CRD42020202723.

Neighbourhood speed limit and childhood obesity

As an important factor for neighbourhood walkability, the speed limit in the neighbourhood may influence children's physical activity (PA) outdoors, especially active transport, and further their weight status. This review aimed to systematically evaluate the association between neighbourhood speed limit and obesity-related behaviours and outcomes among children and adolescents. PubMed, Embase and Web of Science were systematically searched for relevant studies published from the inception of the database to 1 January 2019. Sixteen studies were included, with 13 cross-sectional studies and three longitudinal studies. Speed limit was measured as the percentage/number of high-speed roads, perception of safe driving speed, perception of speeding and use of traffic-calming tools in the neighbourhood. Eleven studies measured the use of active transport as the outcome of interest, and seven studies measured PA directly. Eleven studies revealed an association between a lower speed limit and increased PA, whereas one study showed a negative association, and three studies reported non-significant associations. Only one study associated speed limit with weight status, which reported a non-significant association. This review generally supported a negative association between speed limit and PA among children and adolescents. More studies are needed to examine their causality, as well as the association between speed limit and weight status, in order to increase the impact of this research area on public health policy making.

Assessing schoolchildren's exposure to air pollution during the daily commute - A systematic review

Air pollution is mostly caused by emissions from human activities, and exposure to air pollution is linked with numerous adverse human health outcomes. Recent studies have identified that although people only spend a small proportion of time on their daily commutes, the commuter microenvironment is a significant contributor to their total daily air pollution exposure. Schoolchildren are a particularly vulnerable cohort of the population, and their exposure to air pollution at home or school has been documented in a number of case studies. A few studies have identified that schoolchildren's exposure during commutes is linked with adverse cognitive outcomes and severe wheeze in asthmatic children. However, the determinants of total exposure, such as route choice and commute mode, and their subsequent health impacts on schoolchildren are still not well-understood. The aim of this paper is to review and synthesize recent studies on assessing schoolchildren's exposure to various air pollutants during the daily commute. Through reviewing 31 relevant studies published between 2004 and 2020, we tried to identify consistent patterns, trends, and underlying causal factors in the results. These studies were carried out across 10 commute modes and 12 different air pollutants. Air pollution in cities is highly heterogeneous in time and space, and commuting schoolchildren move through the urban area in complex ways. Measurements from fixed monitoring stations (FMSs), personal monitoring, and air quality modeling are the three most common approaches to determining exposure to ambient air pollutant concentrations. The time-activity diary (TAD), GPS tracker, online route collection app, and GIS-based route simulation are four widely used methods to determine schoolchildren's daily commuting routes. We found that route choices exerted a determining impact on schoolchildren's exposure. It is challenging to rank commute modes in order of exposure, as each scenario has numerous uncontrollable determinants, and there are notable research gaps. We suggest that future studies should concentrate on examining exposure patterns of schoolchildren in developing countries, exposure in the subway and trains, investigating the reliability of current simulation methods, exploring the environmental justice issue, and identifying the health impacts during commuting. It is recommended that three promising tools of smartphones, data fusion, and GIS should be widely used to overcome the challenges encountered in scaling up commuter exposure studies to population scales.

What Is the Best Practice Method for Quantifying the Health and Economic Benefits of Active Transport?

The aim of this study was to identify a best practice method to cost the health benefits of active transport for use in infrastructure planning in New South Wales, Australia. We systematically reviewed the international literature covering the concept areas of active transport and cost and health benefits. Original publications describing a method to cost the health benefits of active transport, published in 2000–2019 were included. Studies meeting the inclusion criteria were assessed against criteria identified in interviews with key government stakeholders. A total of 2993 studies were identified, 53 were assessed for eligibility, and 19 were included in the review. The most commonly studied active transport modes were cycling (n = 8) and walking and cycling (n = 6). Exposures considered were physical activity, road transport related injuries and air pollution. The most often applied economic evaluation method was cost benefit analysis (n = 8), and costs were commonly calculated by monetising health outcomes. Based on evaluation of models against the criteria, a Multistate Life Table model was recommended as the best method currently available. There is strong and increasing interest in quantifying and costing the health benefits of active transport internationally. Incorporating health-related economic benefits into existing regulatory processes such as cost benefit analyses could provide an effective way to encourage the non-health sector to include health impacts in infrastructure measures.

Lifestyle behaviors predict adolescents bullying victimization in low and middle-income countries

BACKGROUND

In this study we aimed to provide a global perspective of the association between different lifestyle behaviors and bullying in school adolescents and to ascertain whether or not the Human Development Index moderated those associations.

METHODS

Data from the Global school-based Student Health Survey were analyzed in 273 121 from 82 countries. Logistic regression was applied to determine country-specific bullying victimization probability from meeting the recommended guidelines for physical activity, excessive sitting time, physical education attendance and active transport. Meta-analysis was then undertaken to ascertain pooled global effect estimates of the relationship between these behaviors and bullying victimization. Linear regression was used to study the relationship between odds of bullying from meeting the lifestyle guidelines and the Human Development Index.

RESULTS

Our estimates indicate that excessive sitting time [1.38 (1.34,1.41)], attendance to physical education [0.87 (0.85,0.89)], and active transport [0.94 (0.91,0.97)] but not overall physical activity [1.01 (0.99,1.04)] were associated with bullying in the study sample.

LIMITATIONS

The present study is limited by its cross-sectional nature. Also, only two countries were surveyed from the European region CONCLUSIONS: Active commuting and attendance to physical education play a protective role for bullying, while physical activity does not.

Fuelling walking and cycling: human powered locomotion is associated with non-negligible greenhouse gas emissions

Reducing motorized transport and increasing active transport (i.e. transport by walking, cycling and other active modes) may reduce greenhouse gas (GHG) emissions and improve health. But, active modes of transport are not zero emitters. We aimed to quantify GHG emissions from food production required to fuel extra physical activity for walking and cycling. We estimate the emissions (in kgCO₂e) per kilometre travelled for walking and cycling from energy intake required to compensate for increased energy expenditure, and data on food-related GHG emissions. We assume that persons who shift from passive modes of transport (e.g. driving) have increased energy expenditure that may be compensated with increased food consumption. The GHG emissions associated with food intake required to fuel a kilometre of walking range between 0.05 kgCO₂e/km in the least economically developed countries to 0.26 kgCO₂e/km in the most economically developed countries. Emissions for cycling are approximately half those of walking. Emissions from food required for walking and cycling are not negligible in economically developed countries which have high dietary-related emissions. There is high uncertainty about the actual emissions associated with walking and cycling, and high variability based on country economic development. Our study highlights the need to consider emissions from other sectors when estimating net-emissions impacts from transport interventions.

Changes in and the mediating role of physical activity in relation to active school transport, fitness and adiposity among Spanish youth: the UP&DOWN longitudinal study

Background

Longitudinal changes in child and adolescent active school transport (AST), and the mediating role of different intensities of daily physical activity (PA) levels in relation to AST and physical fitness and adiposity indicators is unclear. This study aimed to: 1) describe longitudinal changes in AST, light PA (LPA), moderate- to vigorous-intensity PA (MVPA), physical fitness and adiposity indicators over three time-points; and 2) investigate the mediating role of LPA and MVPA levels on associations between AST and physical fitness and adiposity indicators over three time-points among children and adolescents.

Methods

This longitudinal study comprised 1646 Spanish children and adolescents (48.8% girls, mean age 12.5 years ±2.5) at baseline, recruited from schools in Cádiz and Madrid. Mode of commuting to school was self-reported at baseline (T0, 2011–12), 1-year (T1) and 2-year follow-up (T2). PA was assessed using accelerometers. Handgrip strength, standing long jump and cardiorespiratory fitness (CRF) assessed physical fitness. Height, weight, body mass index, waist circumference, and triceps and subscapular skinfold thickness were measured. Multilevel linear regression analyses assessed changes in AST, PA levels, physical fitness and adiposity indicators over three time-points (T0-T1-T2). Additionally, longitudinal path analysis (n = 453; mean age [years] 12.6 ± 2.4) was used to test the mediating effects of LPA and MVPA levels on the association between AST and physical fitness and adiposity indicators.

Results

Multilevel analyses observed decreases in LPA between T0-T1 (β = − 11.27; p < 0.001) and T0-T2 (β = − 16.27; p < 0.001) and decreases in MVPA between T0-T2 (β = − 4.51; p = 0.011). Moreover, changes over time showed increases in handgrip between T0-T1 (β = 0.78; p = 0.028) and T0-T2 (β = 0.81; p = 0.046).

Path analyses showed that AST was directly positively associated with MVPA at T1 (all, β ≈ 0.33; p < 0.001). MVPA at T1 mediated associations between AST and CRF at T2 (β = 0.20; p = 0.040), but not the other outcomes. LPA did not mediate any associations.

Conclusions

Results from longitudinal path analysis suggest that participation in more AST may help attenuate declines in MVPA that typically occur with age and improve CRF. Therefore, we encourage health authorities to promote AST, as a way to increase MVPA levels and CRF among youth.

Prevalence and correlates of objectively measured weight status among urban and rural Mozambican primary schoolchildren: A cross-sectional study

BACKGROUND

The coexistence of undernutrition (thinness) and overnutrition (overweight/obesity) among children and adolescents is a public health concern in low-middle-income countries. Accurate prevalence estimates of thinness and overweight/obesity among children and adolescents are unavailable in many low-middle-income countries due to lack of data. Here we describe the prevalences and examine correlates of objectively measured weight status among urban and rural schoolchildren in Mozambique.

METHODS

A cross-sectional study design was applied to recruit 9-11-year-old schoolchildren (n = 683) from 17 urban and rural primary schools in Mozambique. Body mass index (BMI) was computed from objectively measured height and weight and participants' weight categories were determined using the World Health Organization cut-points. Actigraph GT3X + accelerometers were worn 24 hours per day for 7 days to assess movement behaviours. Multilevel multivariable modelling was conducted to estimate odds ratios and confidence intervals.

RESULTS

Combined prevalence of overweight/obesity (11.4%) was significantly higher among urban participants compared to rural participants (5.7%; χ2 = 7.1; p = 0.008). Conversely, thinness was more prevalent among rural (6.3%) compared to urban (4.2%) participants. Passive school commute, not meeting daily moderate- to vigorous-intensity physical activity (MVPA) guidelines, and maternal BMI >25 kg/m2 were associated with overweight/obesity while possessing one or more functional cars at home, maternal BMI >25 kg/m2 and being an older participant were associated with thinness in the present sample. The proportion of total variance in the prevalences of obesity and/or thinness occurring at the school level was 8.7% and 8.3%, respectively.

CONCLUSION

Prevalences of thinness, overweight/obesity and other key variables differ between urban and rural schoolchildren in Mozambique. MVPA, active transport and mother's BMI are important modifiable correlates of weight status among Mozambican schoolchildren. Results from this study demonstrate important differences between urban and rural schoolchildren that should not be ignored when designing interventions to manage malnutrition, formulating public health strategies, and interpreting findings.

Better transport accessibility, better health: a health economic impact assessment study for Melbourne, Australia

BACKGROUND

Physical inactivity is a global public health problem, partly due to urbanization and increased use of passive modes of transport such as private motor vehicles. Improving accessibility to public transport could be an effective policy for Governments to promote equity and efficiency within transportation systems, increase population levels of physical activity and reduce the negative externalities of motor vehicle use. Quantitative estimates of the health impacts of improvements to public transport accessibility may be useful for resource allocation and priority-setting, however few studies have been published to inform this decision-making. This paper aims to estimate the physical activity, obesity, injury, health and healthcare cost-saving outcomes of scenario-based improvements to public transport accessibility in Melbourne, Australia.

METHODS

Baseline and two hypothetical future scenario estimates of improved public transport accessibility for Melbourne, Australia, were derived using a spatial planning and decision tool designed to simulate accessibility performance (the Spatial Network Analysis for Multimodal Urban Transport Systems (SNAMUTS)). Public transport related physical activity was quantified by strata of age group and sex from Melbourne travel survey data (VISTA survey) and used with the SNAMUTS Composite Index to estimate input data for health impact modelling for the Melbourne population aged 20-74 years. A proportional multi-state, multiple cohort lifetable Markov model quantified the potential health gains and healthcare cost-savings from estimated changes in physical activity, body weight and injuries related to walking to access/egress public transport under two scenarios: (S1) public transport accessibility under current policy directions, and (S2) multi-directional, high-frequency network improvements.

RESULTS

Multi-directional, high-frequency improvements to the public transport network (S2) resulted in significantly greater health and economic gains than current policy directions (S1) in relation to physical activity (mean 6.4 more MET minutes/week), body weight (mean 0.05 kg differential), health-adjusted life years gained (absolute difference of 4878 HALYs gained) and healthcare cost-savings (absolute difference of AUD43M), as compared to business as usual under both scenarios (n = 2,832,241 adults, over the lifecourse).

CONCLUSIONS

Based on our conservative analyses, improving accessibility to public transport will improve population health by facilitating physical activity and lead to healthcare cost savings compared with business-as-usual. These wider health benefits should be better considered in transport planning and policy decisions.

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

Background

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

Methods

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

Findings

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

Conclusions

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

Cycling is associated with a lower incidence of cardiovascular diseases and death: Part 1 – systematic review of cohort studies with meta-analysis

Objectives

Physical inactivity is a risk factor for cardiovascular disease (CVD). Cycling as a physical activity holds great potential to prevent CVD. We aimed to determine whether cycling reduces the risk of CVD and CVD risk factors and to investigate potential dose-response relationships.

Design

Systematic review and meta-analysis of quantitative studies.

Eligibility criteria for selecting studies

We searched four databases (Web of Science, MEDLINE, SPORTDiscus and Scopus). All quantitative studies, published until August 2017, were included when a general population was investigated, cycling was assessed either in total or as a transportation mode, and CVD incidence, mortality or risk factors were reported. Studies were excluded when they reported continuous outcomes or when cycling and walking were combined in them. We pooled adjusted relative risks (RR) and OR. Heterogeneity was investigated using I.

Results

The search yielded 5174 studies; 21 studies which included 1,069,034 individuals. We found a significantly lower association in combined CVD incidence, mortality and physiological risk factors with total effect estimate 0.78 (95% CI (CI): 0.74–0.82; P<0.001; I2=58%). Separate analyses for CVD incidence, mortality and risk factors showed estimates of RR 0.84 (CI, 0.80 to 0.88; P<0.001; I2=29%), RR 0.83 (CI, 0.76 to 0.90; P<0.001; I2=0%), and OR 0.75 (CI, 0.69 to 0.82; P<0.001; I2=66%), respectively. We found no dose-response relationship or sex-specific difference.

Conclusions

Any form of cycling seems to be associated with lower CVD risk, and thus, we recommend cycling as a health-enhancing physical activity.

Systematic review registration

Prospero CRD42016052421.

Cycling and cardiovascular disease risk factors including body composition, blood lipids and cardiorespiratory fitness analysed as continuous variables: Part 2—systematic review with meta-analysis

Objectives

We aimed to examine the relationship between cycling (particularly commuter cycling) and risk factors associated with cardiovascular diseases (CVDs) including body composition, blood lipids and cardiorespiratory fitness. This study differed from our recent (Part 1) systematic review in that risk factors for CVD were analysed as continuous variables rather than being present or absent.

Design

Systematic review and meta-analysis.

Eligibility criteria

We searched four databases (Web of Science, MEDLINE, SPORTDiscus and Scopus). All quantitative studies, published until August 2017, were included when a general population was investigated, cycling was assessed either in total or as a transportation mode, and CVD risk factors were reported.

Methods

We analysed body composition, physical activity (PA), cardiorespiratory fitness (CRF), blood lipids and blood pressure (BP). Skinfold, waist circumference and body mass index were analysed and prioritised in that order when more than one measure were available. PA included measures of counts per minutes, moderate-to-vigorous PA or minutes per week. CRF included results of maximal tests with or without expired air or submaximal test. For blood lipids and BP, separate analyses were run for low-density and high-density lipoprotein, triglycerides, total cholesterol, systolic BP and diastolic BP. Studies were excluded when reporting dichotomous outcomes or when cycling and walking were combined. Heterogeneity was investigated using I2.

Results

Fifteen studies were included; the majority reported commuter cycling. In total, we included 5775 cyclists and 39 273 non-cyclists. Cyclists had more favourable risk factor levels in body composition −0.08 (95% CI −0.13 to −0.04), PA 0.13 (95% CI 0.06 to 0.20), CRF 0.28 (95% CI 0.22 to 0.35) and blood lipids compared with non-cyclists. There was no sex difference in risk reduction.

Conclusion/implication

Cycling mitigated the risk factor profile for CVD. A strength of this systematic review is that all the risk factors were analysed as continuous variables. These data provide evidence for practitioners, stakeholders, policy-makers and city planners to accommodate and promote cycling.

Systematic review registration

PROSPERO CRD42016052421.

Exploring changes in active travel uptake and cessation across the lifespan: Longitudinal evidence from the UK Household Longitudinal Survey

This study aims to explore changes in uptake and cessation of walking, cycling and public transport use across the lifespan in a representative sample of UK adults aged 16 and older. A longitudinal analysis of 11,559 individuals in waves two (2010–2012) and six (2014–2016) of the General Population Sample (GPS) of the UK Household Longitudinal Survey (UKHLS) was performed. The outcome variables were self-reported and categorised as changes to and from 1) walking or cycling and 2) public transport. In adjusted models compared to younger adults (aged 16–34), middle-aged adults (aged 45–55: OR 0.66, p = 0.050) and older adults (aged >55: OR 0.53, p = 0.017) were significantly less likely to initiate walking/cycling during the study period. Middle and older aged adults were also significantly less likely to cease walking/cycling (aged 45–55: OR 0.68, p = 0.019; aged >55: OR 0.46, p < 0.001) and public transport use (aged 45–55: OR 0.33, p < 0.001; aged >55: OR 0.28, p < 0.001). Dose response relationships were observed where increasing age was associated with increased stability in transport mode. Developmental processes in early adulthood may contribute to self-selection and sustainability of active commuting in later life. Active travel programs and policies that target younger adults may be an efficient means to increase and sustain participation in active commuting.

•

In the UK younger adults are more likely to initiate and cease active travel than older adults.

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Advancing age is associated with increased stability in commuting modes.

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A developmental perspective may help to understand drivers of transport behaviour change.

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Potential exists for active travel programs and policies to be tailored to age groups.

Cost-Effectiveness of Product Reformulation in Response to the Health Star Rating Food Labelling System in Australia

The Health Star Rating (HSR) system is a voluntary front-of-pack labelling (FoPL) initiative endorsed by the Australian government in 2014. This study examines the impact of the HSR system on pre-packaged food reformulation measured by changes in energy density between products with and without HSR. The cost-effectiveness of the HSR system was modelled using a proportional multi-state life table Markov model for the 2010 Australian population. We evaluated scenarios in which the HSR system was implemented on a voluntary and mandatory basis (i.e., HSR uptake across 6.7% and 100% of applicable products, respectively). The main outcomes were health-adjusted life years (HALYs), net costs, and incremental cost-effectiveness ratios (ICERs). These were calculated with accompanying 95% uncertainty intervals (95% UI). The model predicted that HSR-attributable reformulation leads to small changes [corrected] in mean population energy intake (voluntary: -0.98 kJ/day; mandatory: -11.81 kJ/day). [corrected]. These are likely to result in changes in mean body weight (voluntary: -0.01 kg [95% UI: -0.012 to -0.006]; mandatory: -0.11 kg [95% UI: -0.14 to -0.07, and HALYs gained [corrected] (voluntary: 4207 HALYs gained [corrected] [95% UI: 2438 to 6081]; mandatory: 49,949 HALYs gained [95% UI: 29,291 to 72,153]). The HSR system [corrected] could be considered cost-effective relative to a willingness-to-pay threshold of A$50,000 per HALY (incremental cost effectiveness ratio for voluntary: [corrected] A$1728 per HALY [95% UI: dominant to 10,445] and mandatory: A$4752 per HALY [95% UI: dominant to 16,236]).

Obesity-related health impacts of active transport policies in Australia - a policy review and health impact modelling study

OBJECTIVE

To review Australian policies on active transport, defined as walking and cycling for utilitarian purposes. To estimate the potential health impact of achieving four active transport policy scenarios.

METHODS

A policy review was undertaken, using key words to search government websites. Potential health benefits were quantified using a cohort simulation Markov model to estimate obesity and transport injury-related health effects of an increase in active transport. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Budget thresholds to achieve cost-effectiveness were estimated for each scenario.

RESULTS

There is broad recognition of the health-related benefits of active transport from all levels of Australian government. Modelling results suggest significant health-related benefits of achieving increased prevalence of active transport. Total HALYs saved assuming a one-year effect ranged from 565 (95%UI 173-985) to 12,105 (95%UI 4,970-19,707), with total healthcare costs averted ranging from $6.6M (95%UI $1.9M-11.3M) to $141.2M (95%UI $53.8M-227.8M).

CONCLUSION

Effective interventions that improve rates of active transport may result in substantial healthcare-related cost savings through a decrease in conditions related to obesity. Implications for public health: Significant potential exists for effective and cost-effective interventions that result in more walking and cycling.

Obesity-related health impacts of fuel excise taxation- an evidence review and cost-effectiveness study

Background

Reducing automobile dependence and improving rates of active transport may reduce the impact of obesogenic environments, thereby decreasing population prevalence of obesity and other diseases where physical inactivity is a risk factor. Increasing the relative cost of driving by an increase in fuel taxation may therefore be a promising public health intervention for obesity prevention.

Methods

A scoping review of the evidence for obesity or physical activity effect of changes in fuel price or taxation was undertaken. Potential health benefits of an increase in fuel excise taxation in Australia were quantified using Markov modelling to simulate obesity, injury and physical activity related health impacts of a fuel excise taxation intervention for the 2010 Australian population. Health adjusted life years (HALYs) gained and healthcare cost savings from diseases averted were estimated. Incremental cost-effectiveness ratios (ICERs) were reported and results were tested through sensitivity analysis.

Results

Limited evidence on the effect of policies such as fuel taxation on health-related behaviours currently exists. Only three studies were identified reporting associations between fuel price or taxation and obesity, whilst nine studies reported associations specifically with physical activity, walking or cycling. Estimates of the cross price elasticity of demand for public transport with respect to fuel price vary, with limited consensus within the literature on a probable range for the Australian context. Cost-effectiveness modelling of a AUD0.10 per litre increase in fuel excise taxation using a conservative estimate of cross price elasticity for public transport suggests that the intervention would be cost-effective from a limited societal perspective (237 HALYs gained, AUD2.6 M in healthcare cost savings), measured against a comparator of no additional increase in fuel excise. Under “best case” assumptions, the intervention would be more cost-effective (3181 HALYs gained, AUD34.2 M in healthcare cost savings).

Conclusions

Exploratory analysis suggests that an intervention to increase fuel excise taxation may deliver obesity and physical activity related benefits. Whilst such an intervention has significant potential for cost-effectiveness, potential equity and acceptability impacts would need to be minimised. A better understanding of the effectiveness and cost-effectiveness of a range of transport interventions is required in order to achieve more physically active transport environments.