Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study

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How to cite this study

Celis-Morales, C.A., Lyall, D.M., Welsh, P., Anderson, J., Steell, L., Guo, Y., Maldonado, R., Mackay, D.F., Pell, J.P., Sattar, N. and Gill, J.M., 2017. Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study. BMJ 357:j1456.

Overview

This large study of U.K. residents finds that those who walk or bike to work have significantly lower incidence of and mortality from cancer and cardiovascular disease. Those who incorporate cycling into their commute had the greatest reduction in risk of disease incidence and mortality.

Relevance

This study is relevant to people looking to promote commuting by walking or cycling in their community. This research demonstrates that increased active commuting has measurable health benefits for participants and may help justify community programs or infrastructure investments to promote active commuting.

This study’s strength comes from a large sample (263,450 adults) followed for five years. Participants in the study volunteered for the program, and the authors acknowledge this may bias the sample toward people who are, on average, healthier than the general population. It is unclear whether this biases the findings.

Location

The study participants are from England, Scotland, and Wales. Participant data are from the U.K. Biobank database, which recruited more than 500,000 volunteers to have their health status and outcomes monitored (for this and other projects).

Trail Type

The study covers commuting to work, so is largely on urban trails, pathways, and roads.

Purpose

The purpose of this study is to evaluate whether bicycle and/or pedestrian commuting is associated with a lower risk of death or incidence of cardiovascular disease and cancer.

This study was supported by the U.K. Biobank, which was funded by the Wellcome Trust, Medical Research Council, Department of Health, Scottish government, Northwest Regional Development Agency, Welsh Assembly government, and the British Heart Foundation.

Findings

  • Active commuting is associated with significantly lower risk of overall mortality and incidence of cancer and cardiovascular disease.
  • Cycling, in particular, is associated with much lower morbidity and mortality rates. People who bike for their commute have a 52% lower risk of mortality from cardiovascular disease and 40% lower risk of mortality from cancer.
  • People who walk for their commute have a 36% lower risk of mortality from cardiovascular disease and no significant difference in mortality from cancer.
  • Cardiovascular disease incidence and mortality lowers the farther individuals cycle or walk.

Methods

Of the more than 500,000 volunteers in the U.K. Biobank database, the authors used data from 263,450 adults aged 40-69 who were in paid employment or self-employment and did not always work from home. The authors controlled for sex, age, material poverty (“Townsend deprivation index”), ethnicity, smoking status, body mass index, sedentary behavior, and dietary intake. Respondents provided information about their typical means of traveling to work and distance traveled. All respondent data were self-reported.

The authors matched individual data to mortality and hospital admission records to identify cardiovascular disease and cancer. They then used a Cox proportional hazard model to measure the differences in risk of cardiovascular disease and cancer incidence and death between commuting modes.

Added to library on April 4, 2019