Cycling or walking to work or study and back may be healthier – both physically and mentally – than other commuting options, according to a large long-term study published today (17 July) in BMJ Public Health, an open access journal.
While both forms of ‘active commuting’ bring health benefits, the strongest ones were accrued by cyclists – for whom the risk of death from any cause was 47 per cent lower, the findings show.
Experts agree that active travel is one of the most practical and sustainable ways to increase daily physical activity levels, and there is mounting evidence in favour of its associated health benefits, the Scotland-based research team notes.
The article’s first author is Bruce Whyte, from the Glasgow Centre for Population Health. Mr Whyte and his colleagues suggest that the existing body of evidence has been hampered by short monitoring periods, narrow age groups and limited health outcomes.
In order to redress these shortcomings, the researchers drew on nationally representative data from the Scottish Longitudinal Study (SLS), which is based on 5 per cent of the Scottish population derived from Census returns in 1991, 2001 and 2011.
Findings based on more than 80,000 people
Mr Whyte and his colleagues focused on people aged from 16 to 74 in 2001 who travelled to work or study in the UK. After exclusions for incomplete data, the final analysis was based on 82,297 people.
Census respondents were asked to select which mode of travel they used for the longest part, by distance, of their usual commute. Active travel was defined as either walking or cycling. All other commuting methods were defined as ‘inactive’.
The responses were linked to national hospital admissions for all causes, cardiovascular disease, cancer, and road traffic collisions; deaths from all of these; and prescriptions for mental health issues (sedatives, anti-anxiety drugs, and antidepressants) from 2001 to 2018 inclusive.
Various potentially influential factors were taken into consideration. These included age, sex, pre-existing health conditions, as well as socioeconomic factors and distance to work/study.
In the years from 2001 to 2018, 4,276 participants died (just over 5 per cent of the study group), almost half of whom died of cancer (2023; 2.5 per cent). Some 52,804 (just over 64 per cent) were admitted to hospital, 9,663 (12 per cent) of them for cardiovascular disease, 5,939 (just over 7 per cent) for cancer, and 2,668 (just over 3 per cent) after a road traffic collision.
In all, 31,666 study participants (38.5 per cent) were prescribed a drug associated with cardiovascular disease between 2009 and 2018, and 33,771 (41 per cent) were prescribed a drug for poor mental health over the same period.
This study strengthens the evidence that active commuting has population-level health benefits and can contribute to reduced morbidity and mortality [Bruce Whyte et al]
Compared with inactive commuters, those who walked to work/study were more likely to be female, younger, work shifts, commute shorter distances, and live in a city. They were also less likely to have dependent children and tended to have lower household income and educational attainment. Similarly, cyclist commuters were more likely to be male, younger, shift workers and live in a city. They were also less likely to be homeowners or carers.
After accounting for potentially influential factors, active commuting was associated with lower risks of death and mental and physical ill health compared with ‘inactive’ commuting. Specifically, commuting by bike was associated with a 47 per cent lower risk of death, a 10 per cent lower risk of any hospital admission, and a 24 per cent lower risk of hospital admission for cardiovascular disease.
It was also associated with a 30 per cent lower risk of being prescribed a drug to treat cardiovascular disease, a 51 per cent lower risk of dying from cancer, and a 24 per cent lower risk of being admitted to hospital for the disease, as well as a 20 per cent lower risk of being prescribed drugs for mental health problems.
But cyclist commuters were twice as likely as ‘inactive’ commuters to be admitted to hospital after a road traffic collision.
Pedestrian commuting was associated with an 11 per cent lower risk of hospital admission for any cause and a 10 per cent lower risk of a hospital admission for cardiovascular disease. It was also associated with, respectively, 10 per cent and 7 per cent lower risks of being prescribed drugs to treat cardiovascular disease and mental health issues.
That cyclist and pedestrian commuting is associated with lower risks of being prescribed medication for poor mental health is an important finding [Bruce Whyte et al]
Caveats and conclusions
As their study was observational in nature, no firm conclusions can be drawn about causal factors, the authors point out. They acknowledge that their research has various limitations. For example, the census responses reflect just one point in time and didn’t include general physical activity levels. And prescription data were only available from 2009 onwards.
The census data didn’t capture multimodal trips either, resulting in potential overlap between active and ‘inactive’ commuters, they point out.
But they nevertheless conclude: ‘This study strengthens the evidence that active commuting has population-level health benefits and can contribute to reduced morbidity and mortality. That cyclist and pedestrian commuting is associated with lower risks of being prescribed medication for poor mental health is an important finding.
‘These findings provide direct evidence of the health benefits of active commuting in a Scottish context, supporting current policy. This study has wider global relevance to efforts to reduce carbon emissions and to shift to more active and sustainable travel modes.’
But they caution: ‘Our finding that cyclist commuters have twice the risk of being a road traffic casualty compared with non-active commuters reinforces the need for safer cycling infrastructure.’
Scottish context
- levels of walking to work in Scotland have reduced significantly in the last 50 years
- levels of active commuting remain relatively low
- while active travel investment is now increasing, there is currently only limited indirect evidence in a Scottish context to assess potential long-term health benefits
To access the full version of the article– titled Health benefits of pedestrian and cyclist commuting: evidence from the Scottish Longitudinal Study Doi: 10.1136/bmjph-2024-001295 – click