Physical Activity through Sustainable Transport Approaches (PASTA): a study protocol for a multicentre project

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

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

The impact of black carbon (BC) on mode-specific galvanic skin response (GSR) as a measure of stress in urban environments

Previous research has shown that walking and cycling could help alleviate stress in cities, however there is poor knowledge on how specific microenvironmental conditions encountered during daily journeys may lead to varying degrees of stress experienced at that moment. We use objectively measured data and a robust causal inference framework to address this gap. Using a Bayesian Doubly Robust (BDR) approach, we find that black carbon exposure statistically significantly increases stress, as measured by Galvanic Skin Response (GSR), while cycling and while walking. Augmented Outcome Regression (AOR) models indicate that greenspace exposure and the presence of walking or cycling infrastructure could reduce stress. None of these effects are statistically significant for people in motorized transport. These findings add to a growing evidence-base on health benefits of policies aimed at decreasing air pollution, improving active travel infrastructure and increasing greenspace in cities.

Day-to-day intrapersonal variability in mobility patterns and association with perceived stress: A cross-sectional study using GPS from 122 individuals in three European cities

Many aspects of our life are related to our mobility patterns and individuals can exhibit strong tendencies towards routine in their daily lives. Intrapersonal day-to-day variability in mobility patterns has been associated with mental health outcomes. The study aims were: (a) calculate intrapersonal day-to-day variability in mobility metrics for three cities; (b) explore interpersonal variability in mobility metrics by sex, season and city, and (c) describe intrapersonal variability in mobility and their association with perceived stress. Data came from the Physical Activity through Sustainable Transport Approaches (PASTA) project, 122 eligible adults wore location measurement devices over 7-consecutive days, on three occasions during 2015 (Antwerp: 41, Barcelona: 41, London: 40). Participants completed the Short Form Perceived Stress Scale (PSS-4). Day-to-day variability in mobility was explored via six mobility metrics using distance of GPS point from home (meters:m), distance travelled between consecutive GPS points (m) and energy expenditure (metabolic equivalents:METs) of each GPS point collected (n = 3,372,919). A Kruskal-Wallis H test determined whether the median daily mobility metrics differed by city, sex and season. Variance in correlation quantified day-to-day intrapersonal variability in mobility. Levene's tests or Kruskal-Wallis tests were applied to assess intrapersonal variability in mobility and perceived stress. There were differences in daily distance travelled, maximum distance from home and METS between individuals by sex, season and, for proportion of time at home also, by city. Intrapersonal variability across all mobility metrics were highly correlated; individuals had daily routines and largely stuck to them. We did not observe any association between stress and mobility. Individuals are habitual in their daily mobility patterns. This is useful for estimating environmental exposures and in fuelling simulation studies.

Trends, Issues and Future Directions of Urban Health Impact Assessment Research: A Systematic Review and Bibliometric Analysis

Health impact assessment (HIA) has been regarded as an important means and tool for urban planning to promote public health and further promote the integration of health concept. This paper aimed to help scientifically to understand the current situation of urban HIA research, analyze its discipline co-occurrence, publication characteristics, partnership, influence, keyword co-occurrence, co-citation, and structural variation. Based on the ISI Web database, this paper used a bibliometric method to analyze 2215 articles related to urban HIA published from 2012 to 2021. We found that the main research directions in the field were Environmental Sciences and Public Environmental Occupational Health; China contributed most articles, the Tehran University of Medical Sciences was the most influential institution, Science of the Total Environment was the most influential journal, Yousefi M was the most influential author. The main hotspots include health risk assessment, source appointment, contamination, exposure, particulate matter, heavy metals and urban soils in 2012–2021; road dust, source apposition, polycyclic aromatic hydrocarbons, air pollution, urban topsoil and the north China plain were always hot research topics in 2012–2021, drinking water and water quality became research topics of great concern in 2017–2021. There were 25 articles with strong transformation potential during 2020–2021, but most papers carried out research on the health risk assessment of toxic elements in soil and dust. Finally, we also discussed the limitations of this paper and the direction of bibliometric analysis of urban HIA in the future.

Impact of Seasonality on Physical Activity: A Systematic Review

BACKGROUND

The purpose of this study was to collect and analyze the available scientific evidence of the impact of seasonality on physical activity (PA). PA refers to walking, biking, sports and/or active recreation.

METHODS

The search was performed in the following databases: PubMed, PEDro, Cochrane and Embase. All publications from January 2015 to September 2020 assessing seasonal variations on physical activity development in adults were selected.

RESULTS

A total of 1159 articles were identified, of which 26 fulfilled the selection criteria involving 9300 participants from 18 different countries. The results obtained suggest that seasonality affects PA independently of the countries, pathologies of the participants and the tool to collect PA information.

CONCLUSIONS

PA level varies across the seasons, with higher PA level in summer compared with other seasons, especially in winter. Sedentary behavior follows the opposite trend. Impact of seasonality variations should be considered in clinical research involving PA as a primary outcome as well as in interventions on PA promotion.

The effects of traveling in different transport modes on galvanic skin response (GSR) as a measure of stress: An observational study

BACKGROUND

Stress is one of many ailments associated with urban living, with daily travel a potential major source. Active travel, nevertheless, has been associated with lower levels of stress compared to other modes. Earlier work has relied on self-reported measures of stress, and on study designs that limit our ability to establish causation.

OBJECTIVES

To evaluate effects of daily travel in different modes on an objective proxy measure of stress, the galvanic skin response (GSR).

METHODS

We collected data from 122 participants across 3 European cities as part of the Physical Activity through Sustainable Transport Approaches (PASTA) study, including: GSR measured every minute alongside confounders (physical activity, near-body temperature) during three separate weeks covering 3 seasons; sociodemographic and travel information through questionnaires. Causal relationships between travel in different modes (the "treatment") and stress were established by using a propensity score matching (PSM) approach to adjust for potential confounding and estimating linear mixed models (LMM) with individuals as random effects to account for repeated measurements. In three separate analyses, we compared GSR while cycling to not cycling, then walking to not walking then motorized (public or private) travel to any activity other than motorized travel.

RESULTS

Depending on LMM formulations used, cycling reduces 1-minute GSR by 5.7% [95% CI: 2.0-16.9%] to 11.1% [95% CI: 5.0-24.4%] compared to any other activity. Repeating the analysis for other modes we find that: walking is also beneficial, reducing GSR by 3.9% [95% CI: 1.4-10.7%] to 5.7% [95% CI: 2.6-12.3%] compared to any other activity; motorized mode (private or public) in reverse increases GSR by up to 1.1% [95% CI: 0.5-2.9%].

DISCUSSION

Active travel offers a welcome way to reduce stress in urban dwellers' daily lives. Stress can be added to the growing number of evidence-based reasons for promoting active travel in cities.

Assessing the Policy Environment for Active Mobility in Cities-Development and Feasibility of the PASTA Cycling and Walking Policy Environment Score

The importance of setting a policy focus on promoting cycling and walking as sustainable and healthy modes of transport is increasingly recognized. However, to date a science-driven scoring system to assess the policy environment for cycling and walking is lacking. In this study, spreadsheet-based scoring systems for cycling and walking were developed, including six dimensions (cycling/walking culture, social acceptance, perception of traffic safety, advocacy, politics and urban planning). Feasibility was tested using qualitative data from pre-specified sections of semi-standardized interview and workshop reports from a European research project in seven cities, assessed independently by two experts. Disagreements were resolved by discussions of no more than 75 minutes per city. On the dimension "perception of traffic safety", quantitative panel data were used. While the interrater agreement was fair, feasibility was confirmed in general. Validity testing against social norms towards active travel, modal split and network length was encouraging for the policy area of cycling. Rating the policy friendliness for cycling and walking separately was found to be appropriate, as different cities received the highest scores for each. Replicating this approach in a more standardized way would pave the way towards a transparent, evidence-based system for benchmarking policy approaches of cities towards cycling and walking.

Assessment of personal exposure to particulate air pollution in different microenvironments and traveling by several modes of transportation in Bogotá, Colombia: protocol for a mixed-methods study. (Preprint)

Background

Air pollution in most countries exceeds the levels recommended by the World Health Organization, causing up to one-third of deaths due to noncommunicable diseases. Fine particulate matter (PM_2.5) and black carbon (BC) from mobile sources are the main contaminants.

Objective

The aim of this study is to assess the relationship of exposure to air pollutants (PM_2.5 and BC) in microenvironments according to respiratory health and physical activity in users traveling by different types of transportation in Bogotá, Colombia.

Methods

A mixed methods study based on a convergent parallel design will be performed with workers and students. The sample will include 350 healthy transport users traveling by different urban transportation modes in three main routes in Bogotá. The study is broken down into two components: (1) a descriptive qualitative component focused on assessing the individual perception of air pollution using semistructured interviews; and (2) a cross-sectional study measuring the individual exposure to PM_2.5 and BC using portable instruments (DustTrak and microAeth, respectively), pulmonary function by spirometry, and physical activity with accelerometry. The analysis will include concurrent triangulation and logistic regression.

Results

The findings will be useful for the conception, design, and decision-making process in the sectors of health and mobility from public, academy, and private perspectives. This study includes personal measurements of PM_2.5 and BC during typical trips in the city to assess the exposure to these contaminants in the major roadways in real time. The study further compares the performance of two different lung tests to identify possible short-term respiratory effects. As a limitation, the protocol will include participants from different institutions in the city, which are not necessarily representative of all healthy populations in Bogotá. In this sense, it is not possible to draw causation conclusions. Moreover, a convergent parallel design could be especially problematic concerning integration because such a design often lacks a clear plan for making a connection between the two sets of results, which may not be well connected. Nevertheless, this study adopts a procedure for how to integrate qualitative and quantitative data in the interpretation of the results and a multilevel regression. The time that participants must live in the city will be considered; this will be controlled in the stratified analysis. Another limitation is the wide age range and working status of the participants. Regional pollution levels and episodes (PM_2.5) will be handled as confounding variables. The study is currently in the enrollment phase of the participants. Measurements have been made on 300 participants. Pandemic conditions affected the study schedule; however, the results are likely to be obtained by late 2022.

Conclusions

This study investigates the exposure to air pollutants in microenvironments in Bogotá, Colombia. To our knowledge, this is the first mixed methods study focusing on PM_2.5, BC, and respiratory health effects in a city over 2 meters above sea level. This study will provide an integration of air pollution exposure variables and respiratory health effects in different microenvironments.

International Registered Report Identifier (IRRID)

PRR1-10.2196/25690

Cyclists' exposure to air pollution: in situ evaluation with a cargo bike platform

Cyclists' exposure to air pollutants near roadways has been associated with numerous health effects. While the adverse health effects concerning aerosols have traditionally been assessed with data of particle mass concentrations, it appears that the number concentration is also another important indicator of toxicity. Thus, to holistically evaluate one's exposure to aerosol particles, assessments should be based on mass concentrations and number concentrations. In order to assess individual cyclists' exposure as they move through space and time, spatiotemporal high-resolution approaches are needed. Therefore, a mobile, fast-response monitoring platform was developed that uses a cargo bicycle as a base. Data of particle mass concentrations (PM₁, PM_2.5, PM₁₀) and particle number concentrations (PN₁₀) were collected along two different routes, one characterized by high-intensity vehicle traffic and one by low-intensity vehicle traffic. While high spatiotemporal heterogeneity was observed for all measured quantities, the PN₁₀ concentrations fluctuated the most. High concentrations of PN₁₀ could be clearly associated with vehicle traffic. For PM_2.5, this relation was less pronounced. Mean particle concentrations of all measures were significantly higher along the high-traffic route. Comparing route exposures, the inhalation of PM_2.5 was similar between both routes, whereas along the high-traffic route, cyclists were exposed to twice the particle number. We conclude that the cargo bike, featuring high-frequency mobile measurements, was useful to characterize the spatial distribution of mass concentrations and number concentrations across an urban environment. Overall, our results suggest that the choice of route is a key factor in reducing cyclists' exposure to air pollution.

Cyclist crash rates and risk factors in a prospective cohort in seven European cities

Increased cycling uptake can improve population health, but barriers include real and perceived risks. Crash risk factors are important to understand in order to improve safety and increase cycling uptake. Many studies of cycling crash risk are based on combining diverse sources of crash and exposure data, such as police databases (crashes) and travel surveys (exposure), based on shared geography and time. When conflating crash and exposure data from different sources, the risk factors that can be quantified are only those variables common to both datasets, which tend to be limited to geography (e.g. countries, provinces, municipalities) and a few general road user characteristics (e.g. gender and age strata). The Physical Activity through Sustainable Transport Approaches (PASTA) project was a prospective cohort study that collected both crash and exposure data from seven European cities (Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zürich). The goal of this research was to use data from the PASTA project to quantify exposure-adjusted crash rates and model adjusted crash risk factors, including detailed sociodemographic characteristics, attitudes about transportation, neighbourhood built environment features and location by city. We used negative binomial regression to model the influence of risk factors independent of exposure. Of the 4,180 cyclists, 10.2 % reported 535 crashes. We found that overall crash rates were 6.7 times higher in London, the city with the highest crash rate, relative to Örebro, the city with the lowest rate. Differences in overall crash rates between cities are driven largely by crashes that did not require medical treatment and that involved motor-vehicles. In a parsimonious crash risk model, we found higher crash risks for less frequent cyclists, men, those who perceive cycling to not be well regarded in their neighbourhood, and those who live in areas of very high building density. Longitudinal collection of crash and exposure data can provide important insights into individual differences in crash risk. Substantial differences in crash risks between cities, neighbourhoods and population groups suggest there is great potential for improvement in cycling safety.

Is a liveable city a healthy city? Health impacts of urban and transport planning in Vienna, Austria

Each year, The Economist Intelligence Unit (EIU) computes the Global Liveability Index and determines the most liveable cities around the world. Vienna, Austria, was ranked by the EIU as the most liveable city worldwide in 2018 and 2019. However, the relationship between a liveable as well as healthy and environmentally-just city has not been previously explored. To explore whether the most liveable city is also a healthy and environmentally-just one, we estimated the premature mortality burden related to non-compliance with international exposure level recommendations for physical activity (PA), air pollution (PM_2.5 and NO₂), road traffic noise, green space and heat for Vienna, as well as its distribution by socioeconomic status (SES). We applied the Urban and TranspOrt Planning Health Impact Assessment (UTOPHIA) methodology and estimated the annual mortality, life expectancy (LE) and economic impact of non-compliance with exposure guidelines for the Viennese adult population ≥ 20 years. We compared current with recommended exposure levels, quantified the association between exposures and mortality and calculated attributable health impact fractions. Eight percent of premature mortality (i.e. 1239 deaths, 95% CI: 679-1784) was estimated to be attributable to non-compliance with the recommended exposure levels. Seventy-six percent of the attributable premature mortality was due to PM_2.5 exposure and insufficient PA. Non-compliance also resulted in an average of 199 days of LE lost for the adult population (95% CI: 111-280) and an economic impact of 4.6 (95% CI: 2.5-6.7) billion 2015€ annually. Overall, residents of lower SES neighbourhoods faced higher risk of premature mortality due to higher exposure to NO₂, road traffic noise, heat and less green space. Despite high liveability standards according to EIU definition, a considerable premature mortality burden was attributable to non-compliance with exposure recommendations, and socioeconomic inequalities were estimated. Although the exposure attributable mortality burden was lower than in other European cities and local Viennese policies favour the reduction of motorized traffic, alongside the promotion of active and public transport and urban greening, there is room for further alignment of liveability, environmental health and justice objectives.

Health impact assessment by the implementation of Madrid City air-quality plan in 2020

OBJECTIVES

Air pollutant concentrations in many urban areas are still above the legal and recommended limits that are set to protect the citizens' health. Madrid is one of the cities where traffic causes high NO₂ levels. In this context, Madrid City Council launched the Air Quality and Climate Change Plan for the city of Madrid (Plan A), a local strategy approved by the previous government in 2017. The aim of this study was to conduct a quantitative health impact assessment to evaluate the number of premature deaths that could potentially be prevented by the implementation of Plan A in Madrid in 2020, at both citywide and within-city level. The main purpose was to support decision-making processes in order to maximize the positive health impacts from the implementation of Plan A measures.

METHODS

The Regional Statistical Office provided information on population and daily mortality in Madrid. For exposure assessment, we estimated PM_2.5, NO₂ and O₃ concentration levels for Madrid city in 2012 (baseline air-quality scenario) and 2020 (projected air-quality scenario based on the implementation of Plan A), by means of an Eulerian chemical-transport model with a spatial resolution of 1 km × 1 km and 30 vertical levels. We used the concentration-response functions proposed by two relevant WHO projects to calculate the number of attributable annual deaths corresponding to all non-accidental causes (ICD-10: A00-R99) among all-ages and the adult population (>30 years old) for each district and for Madrid city overall. This health impact assessment was conducted dependant on health-data availability.

RESULTS

In 2020, the implementation of Plan A would imply a reduction in the Madrid citywide annual mean PM_2.5 concentration of 0.6 μg/m³ and 4.0 μg/m³ for NO₂. In contrast, an increase of 1 μg/m³ for O₃ would be expected. The annual number of all-cause deaths from long-term exposure (95% CI) that could be postponed in the adult population by the expected air-pollutant concentration reduction was 88 (57-117) for PM_2.5 and 519 (295-750) for NO₂; short-term exposure accounted for 20 (7-32) for PM_2.5 and 79 (47-111) for NO₂ in the total population. According to the spatial distribution of air pollutants, the highest mortality change estimations were for the city centre - including Madrid Central and mainly within the M-30 ring road -, as compared to peripheral districts. The positive health impacts from the reductions in PM_2.5 and NO₂ far exceeded the adverse mortality effects expected from the increase in O₃.

CONCLUSIONS

Effective implementation of Plan A measures in Madrid city would bring about an appreciable decline in traffic-related air-pollutant concentrations and, in turn, would lead to significant health-related benefits.

Area-level and individual correlates of active transportation among adults in Germany: A population-based multilevel study

This study aimed at estimating the prevalence in adults of complying with the aerobic physical activity (PA) recommendation through transportation-related walking and cycling. Furthermore, potential determinants of transportation-related PA recommendation compliance were investigated. 10,872 men and 13,144 women aged 18 years or older participated in the cross-sectional 'German Health Update 2014/15 - EHIS' in Germany. Transportation-related walking and cycling were assessed using the European Health Interview Survey-Physical Activity Questionnaire. Three outcome indicators were constructed: walking, cycling, and total active transportation (≥600 metabolic equivalent, MET-min/week). Associations were analyzed using multilevel regression analysis. Forty-two percent of men and 39% of women achieved ≥600 MET-min/week with total active transportation. The corresponding percentages for walking were 27% and 28% and for cycling 17% and 13%, respectively. Higher population density, older age, lower income, higher work-related and leisure-time PA, not being obese, and better self-perceived health were positively associated with transportation-related walking and cycling and total active transportation among both men and women. The promotion of walking and cycling among inactive people has great potential to increase PA in the general adult population and to comply with PA recommendations. Several correlates of active transportation were identified which should be considered when planning public health policies and interventions.

Correlates of Walking for Travel in Seven European Cities: The PASTA Project

BACKGROUND

Although walking for travel can help in reaching the daily recommended levels of physical activity, we know relatively little about the correlates of walking for travel in the European context.

OBJECTIVE

Within the framework of the European Physical Activity through Sustainable Transport Approaches (PASTA) project, we aimed to explore the correlates of walking for travel in European cities.

METHODS

The same protocol was applied in seven European cities. Using a web-based questionnaire, we collected information on total minutes of walking per week, individual characteristics, mobility behavior, and attitude (N=7,875). Characteristics of the built environment (the home and the work/study addresses) were determined with geographic information system (GIS)-based techniques. We conducted negative binomial regression analyses, including city as a random effect. Factor and principal component analyses were also conducted to define profiles of the different variables of interest.

RESULTS

Living in high-density residential areas with richness of facilities and density of public transport stations was associated with increased walking for travel, whereas the same characteristics at the work/study area were less strongly associated with the outcome when the residential and work/study environments were entered in the model jointly. A walk-friendly social environment was associated with walking for travel. All three factors describing different opinions about walking (ranging from good to bad) were associated with increased minutes of walking per week, although the importance given to certain criteria to choose a mode of transport provided different results according to the criteria.

DISCUSSION

The present study supports findings from previous research regarding the role of the built environment in the promotion of walking for travel and provides new findings to help in achieving sustainable, healthy, livable, and walkable cities. https://doi.org/10.1289/EHP4603.

Seasonality of physical activity and its association with socioeconomic and health factors among urban-dwelling adults of Kaunas, Lithuania

BACKGROUND

Physical activity (PA) has been declining dramatically over time in many countries worldwide. The decrease of PA levels affects a person's health and quality of life as it is a significant risk factor for many noncommunicable diseases. Understanding the factors that determine PA is particularly important in promoting greater PA in adults and reducing the risk of diseases associated with physical inactivity. This study investigated associations of seasonal PA levels with socioeconomic and health factors among adults.

METHODS

A cross-sectional study included 1111 participants of Kaunas city, Lithuania who completed a questionnaire about PA and mobility behaviour, socioeconomic, health and demographic factors. Commuting PA and sufficient PA (sPA) on weekdays and weekends in the summer and winter seasons was investigated in this study. Data on daily commuting duration and forms of transportation were collected using a questionnaire survey. Daily commuting was categorized into two categories: 1) using motorized transportation or walking or cycling 0 to 29 min, 2) and walking or cycling for 30 min or more.

RESULTS

Our findings showed significant seasonal impact on PA levels. The results revealed that employment status was significantly associated with PA. Unemployed individuals were 2 times more likely to engage in sPA in winter and almost 3 times in summer compared to workers.

CONCLUSIONS

Our findings suggest the importance of considering environmental, socioeconomic and health factors when assessing PA. Promoting PA through active commuting is an important part of a healthy lifestyle and strategies to support the implementation of health-promoting policies and practices are needed.

Effects of physical activity and air pollution on blood pressure

AIM

To assess the main and interaction effects of black carbon and physical activity on arterial blood pressure in a healthy adult population from three European cities using objective personal measurements over short-term (hours and days) and long-term exposure.

METHODS

A panel study of 122 healthy adults was performed in three European cities (Antwerp, Barcelona, and London). In 3 seasons between March 2015 and March 2016, each participant wore sensors for one week to objectively measure their exposure to black carbon and monitor their physical activity continuously. Blood pressure was assessed three times during the week: at the beginning (day 0), in the middle (day 4), and at the end (day 7). Associations of black carbon and physical activity with blood pressure and their interactions were investigated with linear regression models and multiplicative interaction terms, adjusting for all the potential confounders.

RESULTS

In multiple exposure models, we did not see any effects of black carbon on blood pressure but did see effects on systolic blood pressure of moderate-to-vigorous physical activity effect that were statistically significant from 1 h to 8 h after exposure and for long-term exposure. For a 1METhour increase of moderate-to-vigorous physical activity, the difference in the expected mean systolic blood pressure varied from -1.46 mmHg (95%CI -2.11, -0.80) for 1 h mean exposure, to -0.29 mmHg (95%CI -0.55, -0.03) for 8 h mean exposure, and -0.05 mmHg (95%CI -0.09, -0.00) for long-term exposure. There were little to no interaction effects.

CONCLUSIONS

Results from this study provide evidence that short-term and long-term exposure to moderate-to-vigorous physical activity is associated with a decrease in systolic blood pressure levels. We did not find evidence for a consistent main effect of black carbon on blood pressure, nor any interaction between black carbon and physical activity levels.

Does Health-Oriented Tourism Contribute to Sustainable Mobility?

Previous research has concentrated on traffic and health-related effects in relation to arrival patterns (e.g., stress in connection with means of transport, travel distance, and time). However, tourist mobility behavior during a vacation and potential health-related associations as well as its correlation with physical activity habits and mobility patterns at home seems to have barely been examined. To address this research gap, the study at hand applied a mixed-method approach in three tourism destinations in Tyrol, Austria. The study examined tourists’ mobility as well as their physical activity at home and at the holiday destination. Results show that the preferred transport mode (arrival and on-site) is the private car, due to its flexibility and comfort. Hotel front desks, as the main information source, determine tourists’ behavioral aspects during a vacation. General mobility routines show differences between everyday life and holiday situations, and physical activity is important for the overall satisfaction of tourists, which proves to be more intense and frequent during a vacation than in everyday life. Seven percent of the tourists participating in the research stated that they had changed their daily mobility behavior after their return, with most of them walking or cycling more often. This study contributes to research in the field of sustainable tourist mobility and physical activity behavior and highlights the necessity for further specific analyses.

Evaluation of Different Recruitment Methods: Longitudinal, Web-Based, Pan-European Physical Activity Through Sustainable Transport Approaches (PASTA) Project

Background

Sufficient sample size and minimal sample bias are core requirements for empirical data analyses. Combining opportunistic recruitment with a Web-based survey and data-collection platform yields new benefits over traditional recruitment approaches.

Objective

This paper aims to report the success of different recruitment methods and obtain data on participants’ characteristics, participation behavior, recruitment rates, and representativeness of the sample.

Methods

A longitudinal, Web-based survey was implemented as part of the European PASTA (Physical Activity through Sustainable Transport Approaches) project, between November 2014 and December 2016. During this period, participants were recruited from 7 European cities on a rolling basis. A standardized guide on recruitment strategy was developed for all cities, to reach a sufficient number of adult participants. To make use of the strengths and minimize weakness, a combination of different opportunistic recruitment methods was applied. In addition, the random sampling approach was applied in the city of Örebro. To reduce the attrition rate and improve real-time monitoring, the Web-based platform featured a participant’s and a researchers’ user interface and dashboard.

Results

Overall, 10,691 participants were recruited; most people found out about the survey through their workplace or employer (2300/10691, 21.51%), outreach promotion (2219/10691, 20.76%), and social media (1859/10691, 17.39%). The average number of questionnaires filled in per participant varied significantly between the cities (P<.001), with the highest number in Zurich (11.0, SE 0.33) and the lowest in Örebro (4.8, SE 0.17). Collaboration with local organizations, the use of Facebook and mailing lists, and direct street recruitment were the most effective approaches in reaching a high share of participants (P<.001). Considering the invested working hours, Facebook was one of the most time-efficient methods. Compared with the cities’ census data, the composition of study participants was broadly representative in terms of gender distribution; however, the study included younger and better-educated participants.

Conclusions

We observed that offering a mixed recruitment approach was highly effective in achieving a high participation rate. The highest attrition rate and the lowest average number of questionnaires filled in per participant were observed in Örebro, which also recruited participants through random sampling. These findings suggest that people who are more interested in the topic are more willing to participate and stay in a survey than those who are selected randomly and may not have a strong connection to the research topic. Although direct face-to-face contacts were very effective with respect to the number of recruited participants, recruiting people through social media was not only effective but also very time efficient. The collected data are based on one of the largest recruited longitudinal samples with a common recruitment strategy in different European cities.

The effects of transport mode use on self-perceived health, mental health, and social contact measures: A cross-sectional and longitudinal study

BACKGROUND

Transport mode choice has been associated with different health risks and benefits depending on which transport mode is used. We aimed to evaluate the association between different transport modes use and several health and social contact measures.

METHODS

We based our analyses on the Physical Activity through Sustainable Transport Approaches (PASTA) longitudinal study, conducted over a period of two years in seven European cities. 8802 participants finished the baseline questionnaire, and 3567 answered the final questionnaire. Participants were 18 years of age or older (16 years of age or older in Zurich) and lived, worked and/or studied in one of the case-study cities. Associations between transport mode use and health/social contact measures were estimated using mixed-effects logistic regression models, linear regression models, and logistic regression models according to the data available. All the associations were assessed with single and multiple transport mode models. All models were adjusted for potential confounders.

RESULTS

In multiple transport mode models, bicycle use was associated with good self-perceived health [OR (CI 95%) = 1.07 (1.05, 1.08)], all the mental health measures [perceived stress: coef (CI 95%) = -0.016 (-0.028, -0.004); mental health: coef (CI 95%) = 0.11 (0.05, 0.18); vitality: coef (CI 95%) = 0.14 (0.07, 0.22)], and with fewer feelings of loneliness [coef (CI 95%) = -0.03 (-0.05, -0.01)]. Walking was associated with good self-perceived health [OR (CI 95%) = 1.02 (1.00, 1.03)], higher vitality [coef (CI 95%) = 0.14 (0.05, 0.23)], and more frequent contact with friends/family [OR (CI 95%) = 1.03 (1.00, 1.05)]. Car use was associated with fewer feelings of loneliness [coef (CI 95%) = -0.04 (-0.06, -0.02)]. The results for e-bike and public transport use were non-significant, and the results for motorbike use were inconclusive.

CONCLUSIONS

Similarity of findings across cities suggested that active transport, especially bicycle use, should be encouraged to improve population health and social outcomes.

Short-term effects of physical activity, air pollution and their interaction on the cardiovascular and respiratory system

Physical activity (PA) in urban environments may lead to increased inhalation of air pollutants. As PA and air pollution (AP) have respectively beneficial and detrimental effects on the cardiorespiratory system, the responses to these exposures can interact. Therefore, we assessed the short-term effects of PA, AP and their interaction on a set of subclinical cardiovascular and respiratory outcomes in a panel of healthy adults: heart rate variability (HRV), retinal vessel diameters, lung function and fractional exhaled nitric oxide (FeNO). One hundred twenty two participants measured their PA level and exposure to black carbon (BC), a marker of AP exposure, with wearable sensors during an unscripted week in three different seasons. The study was part of the PASTA project in three European cities (Antwerp: 41 participants, Barcelona: 41 participants, London: 40 participants). At the end of each measurement week, the health outcomes were evaluated. Responses to PA, BC and their interaction were assessed with mixed effect regression models. Separate models were used to account for a 2-h and 24-h time window. During the 2-h time window, HRV and lung function changed statistically significantly in response to PA (METhours) and logarithmic BC (%change). Changes in HRV marked an increased sympathetic tone with both PA (logarithmic LF/HF: +7%; p < 0.01) and BC (logarithmic HF: -19%; p < 0.05). In addition, PA provoked bronchodilation which was illustrated by a significant increase in lung function (FEV₁: +15.63 mL; p < 0.05). While a BC %increase was associated with a significant lung function decrease (PEF: -0.10 mL; p < 0.05), the interaction indicated a potential protective effect of PA (p < 0.05). We did not observe a response of the retinal vessel diameters. Most subclinical outcomes did not change in the 24-h time window (except for a few minor changes in LF/HF, FeNO and PEF). Our results on the separate and combined effects of short-term PA and AP exposure on subclinical markers of the cardiorespiratory system are relevant for public health. We provide insights on the physiological responses of multiple, complementary markers. This may move further research towards elucidating potential pathways to disease and the long-term clinical impact of the observed physiological changes.

The Smart City Active Mobile Phone Intervention (SCAMPI) study to promote physical activity through active transportation in healthy adults: a study protocol for a randomised controlled trial

Background

The global pandemic of physical inactivity represents a considerable public health challenge. Active transportation (i.e., walking or cycling for transport) can contribute to greater total physical activity levels. Mobile phone-based programs can promote behaviour change, but no study has evaluated whether such a program can promote active transportation in adults. This study protocol presents the design and methodology of The Smart City Active Mobile Phone Intervention (SCAMPI), a randomised controlled trial to promote active transportation via a smartphone application (app) with the aim to increase physical activity.

Methods/design

A two-arm parallel randomised controlled trial will be conducted in Stockholm County, Sweden. Two hundred fifty adults aged 20–65 years will be randomised to either monitoring of active transport via the TRavelVU app (control), or to a 3-month evidence-based behaviour change program to promote active transport and monitoring of active travel via the TRavelVU Plus app (intervention). The primary outcome is moderate-to-vigorous intensity physical activity (MVPA in minutes/day) (ActiGraph wGT3x-BT) measured post intervention. Secondary outcomes include: time spent in active transportation measured via the TRavelVU app, perceptions about active transportation (the Transport and Physical Activity Questionnaire (TPAQ)) and health related quality of life (RAND-36). Assessments are conducted at baseline, after the completed intervention (after 3 months) and 6 months post randomisation.

Discussion

SCAMPI will determine the effectiveness of a smartphone app to promote active transportation and physical activity in an adult population. If effective, the app has potential to be a low-cost intervention that can be delivered at scale.

Trial registration

ClinicalTrials.gov NCT03086837; 22 March, 2017.

Cycling in Warsaw, Poland - Perceived enablers and barriers according to cyclists and non-cyclists

Cycling in urban environments provides many benefits to people. However, planning of cycling infrastructures in large cities faces numerous challenges and requires better understanding of both the factors enabling cycling as well as barriers to it, determined by particular local context. While there is a growing body of research that tackle the bike transport related questions in Western Europe and the USA, there is relatively little research on that in Central Eastern Europe (CEE), in post-communist countries. In this study we used qualitative and quantitative methods to explore urban cyclists and non-cyclists opinions about the cycling, the perceived problems and obstacles, and perception of the on-going changes in bicycle transportation system in Warsaw, Poland. Although many people see potential advantages of cycling, it is mostly perceived as a leisure time activity. Those who do utilitarian cycling are more acutely aware of the benefits, such as rapidity and flexibility of this mean of transport. The main perceived barriers are linked to lack of good cycling infrastructure in the city, the feeling of insecurity linked to the behaviour of drivers, and to maintenance during winter. In conclusion, our research highlights both the opportunities and challenges linked to the development of improved cycle transportation system, suggesting the need for a range of policies, from the infrastructure improvements and comprehensive planning of the whole transportation system, to improving the driving culture that would support feeling of security of the cyclists.

Cyclist exposure to black carbon, ultrafine particles and heavy metals: An experimental study along two commuting routes near Antwerp, Belgium

Urban environments typically exhibit large atmospheric pollution variation, in both space and time. In contrast to traditional monitoring networks suffering from a limited spatial coverage, mobile platforms enable personalized high-resolution monitoring, providing valuable insights into personal atmospheric pollution exposure, and the identification of potential pollution hotspots. This study evaluated personal cyclist exposure to UFPs, BC and heavy metals whilst commuting near Antwerp, Belgium, by performing mobile measurements with wearable black carbon (BC) and ultrafine particle (UFP) instruments. Loaded micro-aethalometer filterstrips were chemically analysed and the inhaled pollutant dose determined from the exhibited heart rate. Considerable spatial pollutant variation was observed along the travelled routes, with distinct contributions from spatial factors (e.g. traffic intersections, urban park and market) and temporary events. On average 300% higher BC, 20% higher UFP and changing elemental concentrations are observed along the road traffic route (RT), when compared to the bicycle highway route (BH). Although the overall background pollution determines a large portion of the experienced personal exposure (in this case 53% for BC and 40% for UFP), cyclists can influence their personal atmospheric pollution exposure, by selecting less exposed commuting routes. Our results, hereby, strengthen the body of evidence in favour of further policy investments in isolated bicycle infrastructure.

Mobile health applications in cardiovascular research

Cardiovascular disease is the leading cause of mortality and morbidity globally. With widespread and growing use of smart phones and mobile devices, the use of mobile health (mHealth) in transmission of physiologic parameters and patient-referred symptoms to healthcare providers and researchers, as well as reminders and care plan applications from providers to patients, has potential to revolutionize both clinical care and the conduct of clinical trials with improved designs, data capture, and potentially lower costs. In randomized early phase proof-of-concept studies, focusing on lifestyle intervention, there is evidence that mHealth technology can improve outcomes. By contrast, results from small randomized controlled trials that tested mHealth interventions in heart failure patients were disappointing with inconsistent findings. These inconclusive results could be partially attributed to a lack of methodological rigor (insufficient sample size, quasi-experimental design, inadequate mHealth equipment). Therefore, there is an urgent need to develop systematic evidence-based guidelines and parameters for mHealth to be effectively utilized in cardiovascular clinical trials.

The Unanticipated Challenges Associated With Implementing an Observational Study Protocol in a Large-Scale Physical Activity and Global Positioning System Data Collection

Background

Large-scale primary data collections are complex, costly, and time-consuming. Study protocols for trial-based research are now commonplace, with a growing number of similar pieces of work being published on observational research. However, useful additions to the literature base are publications that describe the issues and challenges faced while conducting observational studies. These can provide researchers with insightful knowledge that can inform funding proposals or project development work.

Objectives

In this study, we identify and reflectively discuss the unforeseen or often unpublished issues associated with organizing and implementing a large-scale objectively measured physical activity and global positioning system (GPS) data collection.

Methods

The SPACES (Studying Physical Activity in Children’s Environments across Scotland) study was designed to collect objectively measured physical activity and GPS data from 10- to 11-year-old children across Scotland, using a postal delivery method. The 3 main phases of the project (recruitment, delivery of project materials, and data collection and processing) are described within a 2-stage framework: (1) intended design and (2) implementation of the intended design.

Results

Unanticipated challenges arose, which influenced the data collection process; these encompass four main impact categories: (1) cost, budget, and funding; (2) project timeline; (3) participation and engagement; and (4) data challenges. The main unforeseen issues that impacted our timeline included the informed consent process for children under the age of 18 years; the use of, and coordination with, the postal service to deliver study information and equipment; and the variability associated with when participants began data collection and the time taken to send devices and consent forms back (1-12 months). Unanticipated budgetary issues included the identification of some study materials (AC power adapter) not fitting through letterboxes, as well as the employment of fieldworkers to increase recruitment and the return of consent forms. Finally, we encountered data issues when processing physical activity and GPS data that had been initiated across daylight saving time.

Conclusions

We present learning points and recommendations that may benefit future studies of similar methodology in their early stages of development.

Health impact assessment of cycling network expansions in European cities

We conducted a health impact assessment (HIA) of cycling network expansions in seven European cities. We modeled the association between cycling network length and cycling mode share and estimated health impacts of the expansion of cycling networks. First, we performed a non-linear least square regression to assess the relationship between cycling network length and cycling mode share for 167 European cities. Second, we conducted a quantitative HIA for the seven cities of different scenarios (S) assessing how an expansion of the cycling network [i.e. 10% (S1); 50% (S2); 100% (S3), and all-streets (S4)] would lead to an increase in cycling mode share and estimated mortality impacts thereof. We quantified mortality impacts for changes in physical activity, air pollution and traffic incidents. Third, we conducted a cost-benefit analysis. The cycling network length was associated with a cycling mode share of up to 24.7% in European cities. The all-streets scenario (S4) produced greatest benefits through increases in cycling for London with 1,210 premature deaths (95% CI: 447-1,972) avoidable annually, followed by Rome (433; 95% CI: 170-695), Barcelona (248; 95% CI: 86-410), Vienna (146; 95% CI: 40-252), Zurich (58; 95% CI: 16-100) and Antwerp (7; 95% CI: 3-11). The largest cost-benefit ratios were found for the 10% increase in cycling networks (S1). If all 167 European cities achieved a cycling mode share of 24.7% over 10,000 premature deaths could be avoided annually. In European cities, expansions of cycling networks were associated with increases in cycling and estimated to provide health and economic benefits.

Towards a Comprehensive Conceptual Framework of Active Travel Behavior: a Review and Synthesis of Published Frameworks

PURPOSE OF REVIEW

This paper reviews the use of conceptual frameworks in research on active travel, such as walking and cycling. Generic framework features and a wide range of contents are identified and synthesized into a comprehensive framework of active travel behavior, as part of the Physical Activity through Sustainable Transport Approaches project (PASTA). PASTA is a European multinational, interdisciplinary research project on active travel and health.

RECENT FINDINGS

Along with an exponential growth in active travel research, a growing number of conceptual frameworks has been published since the early 2000s. Earlier frameworks are simpler and emphasize the distinction of environmental vs. individual factors, while more recently several studies have integrated travel behavior theories more thoroughly. Based on the reviewed frameworks and various behavioral theories, we propose the comprehensive PASTA conceptual framework of active travel behavior. We discuss how it can guide future research, such as data collection, data analysis, and modeling of active travel behavior, and present some examples from the PASTA project.

Physical activity and sedentary behaviour in daily life: A comparative analysis of the Global Physical Activity Questionnaire (GPAQ) and the SenseWear armband

Reduction of sedentary time and an increase in physical activity offer potential to improve public health. However, quantifying physical activity behaviour under real world conditions is a major challenge and no standard of good practice is available. Our aim was to compare the results of physical activity and sedentary behaviour obtained with a self-reported instrument (Global Physical Activity Questionnaire (GPAQ)) and a wearable sensor (SenseWear) in a repeated measures study design. Healthy adults (41 in Antwerp, 41 in Barcelona and 40 in London) wore the SenseWear armband for seven consecutive days and completed the GPAQ on the final day. This was repeated three times. We used the Wilcoxon signed rank sum test, Spearman correlation coefficients, mixed effects regression models and Bland-Altman plots to study agreement between both methods. Mixed models were used to assess the effect of personal characteristics on the absolute and relative difference between estimates obtained with the GPAQ and SenseWear. Moderate to vigorous energy expenditure and duration derived from the GPAQ were significantly lower (p<0.05) compared to the SenseWear, yet these variables showed significant correlations ranging from 0.45 to 0.64. Estimates of vigorous-intensity physical activity in particular showed high similarity (r>0.59). Results for sedentary behaviour did not differ, yet were poorly correlated (r<0.25). The differences between all variables were reproducible across repeated measurements. In addition, we observed a relationship between these differences and BMI, body fat and physical activity domain. Due to the lack of a standardized protocol, results from different studies measuring physical activity and sedentary behaviour are difficult to compare. Therefore, we suggested an easy-to-implement approach for future studies adding the GPAQ to the wearable of choice as a basis for comparisons.

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

Given the alarming prevalence of obesity worldwide and the need for interventions to halt the growing epidemic, more evidence on the role and impact of transport interventions for obesity prevention is required. This study conducts a scoping review of the current evidence of association between modes of transport (motor vehicle, walking, cycling and public transport) and obesity-related outcomes. Eleven reviews and thirty-three primary studies exploring associations between transport behaviours and obesity were identified. Cohort simulation Markov modelling was used to estimate the effects of body mass index (BMI) change on health outcomes and health care costs of diseases causally related to obesity in the Melbourne, Australia population. Results suggest that evidence for an obesity effect of transport behaviours is inconclusive (29% of published studies reported expected associations, 33% mixed associations), and any potential BMI effect is likely to be relatively small. Hypothetical scenario analyses suggest that active transport interventions may contribute small but significant obesity-related health benefits across populations (approximately 65 health adjusted life years gained per year). Therefore active transport interventions that are low cost and targeted to those most amenable to modal switch are the most likely to be effective and cost-effective from an obesity prevention perspective. The uncertain but potentially significant opportunity for health benefits warrants the collection of more and better quality evidence to fully understand the potential relationships between transport behaviours and obesity. Such evidence would contribute to the obesity prevention dialogue and inform policy across the transportation, health and environmental sectors.

Wearable Sensors for Personal Monitoring and Estimation of Inhaled Traffic-Related Air Pollution: Evaluation of Methods

Physical activity and ventilation rates have an effect on an individual's dose and may be important to consider in exposure-response relationships; however, these factors are often ignored in environmental epidemiology studies. The aim of this study was to evaluate methods of estimating the inhaled dose of air pollution and understand variability in the absence of a true gold standard metric. Five types of methods were identified: (1) methods using (physical) activity types, (2) methods based on energy expenditure, METs (metabolic equivalents of task), and oxygen consumption, (3) methods based on heart rate or (4) breathing rate, and (5) methods that combine heart and breathing rate. Methods were compared using a real-life data set of 122 adults who wore devices to track movement, black carbon air pollution, and physiological health markers for 3 weeks in three European cities. Different methods for estimating minute ventilation performed well in relative terms with high correlations among different methods, but in absolute terms, ignoring increased ventilation during day-to-day activities could lead to an underestimation of the daily dose by a factor of 0.08-1.78. There is no single best method, and a multitude of methods are currently being used to approximate the dose. The choice of a suitable method for determining the dose in future studies will depend on both the size and the objectives of the study.

COPD and exercise: does it make a difference?

KEY POINTS

Physiological changes are observed following a structured exercise training programme in patients with COPD, without changes in resting lung function.Exercise training is the cornerstone of a comprehensive pulmonary rehabilitation programme in patients with COPD.Most comorbidities in patients referred for pulmonary rehabilitation remain undiagnosed and untreated.After careful screening, it is safe for COPD patients with comorbidities to obtain significant and clinically relevant improvements in functional exercise capacity and health status after an exercise-based pulmonary rehabilitation programme.

EDUCATIONAL AIMS

To inform readers of the positive effects of exercise-based pulmonary rehabilitation in patients with COPD, even with comorbid conditions.To inform readers of the importance of physical activity in patients with COPD. Exercise training is widely regarded as the cornerstone of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). Indeed, exercise training has been identified as the best available means of improving muscle function and exercise tolerance in patients with COPD. So, exercise training truly makes a difference in the life of patients with COPD. In this review, an overview is provided on the history of exercise training (as standalone intervention or as part of a comprehensive pulmonary rehabilitation programme), exercise training in comorbid patients with COPD, and the impact of physical activity counselling in a clean air environment.