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Walking and cycling: latest evidence to support policy-making and practice
Abstract
Active travel modes, especially walking and cycling, are now recognized by many as modes that are fully equal to other urban transport modes, integrated in planning frameworks, and adopted as part of the mainstream – not just in trailblazer countries, but worldwide. An ever-growing body of science underpins the gains society can reap from active travel in terms of transport, health and environmental benefits. Planning practice has accumulated a rich portfolio of measures ready to be considered for inspiration, adaptation and possible application in every city. This publication presents a comprehensive case for why and how to promote walking and cycling, based on the latest evidence from scientific research and planning practice.
Background
Cycling has been suggested to be related to risk of all-cause and cardiovascular disease (CVD) mortality. However, a quantitative comprehensive assessment of the dose–response association of cycling with risk of all-cause and CVD mortality has not been reported. We performed a meta-analysis of cohort studies assessing the risk of all-cause and CVD mortality with cycling.Methods
PubMed and Embase databases were searched for relevant articles published up to December 13, 2019. Random-effects models were used to estimate the summary relative risk (RR) of all-cause and CVD mortality with cycling. Restricted cubic splines were used to evaluate the dose–response association.ResultsWe included 9 articles (17 studies) with 478,847 participants and 27,860 cases (22,415 from all-cause mortality and 5445 from CVD mortality) in the meta-analysis. Risk of all-cause mortality was reduced 23% with the highest versus lowest cycling level [RR 0.77, 95% confidence interval (CI) 0.67–0.88], and CVD mortality was reduced 24% (RR 0.76, 95% CI 0.65–0.89). We found a linear association between cycling and all-cause mortality (Pnon-linearity = 0.208); the risk was reduced by 9% (RR 0.91, 95% CI 0.86–0.96) with each five metabolic equivalent of task (MET)-h/week increase in cycling. We found an approximately U-shaped association between cycling and CVD mortality (Pnon-linearity = 0.034), with the lowest risk at approximately 15 MET-h/week of cycling.Conclusions
Our findings based on quantitative data suggest that any level of cycling is better than none for all-cause mortality. However, for CVD mortality, one must choose an appropriate level of cycling, with an approximate optimum of 15 MET-h/week (equal to 130 min/week at 6.8 MET).
E-bikes are bicycles with a battery-powered motor assisting the rider. With sales rising rapidly in many countries, e-bikes are likely to become a key component of a transition towards a low-carbon mobility. However, there is a scarcity of research into either the similarities or the differences between the practice of e-cycling and conventional cycling. The paper proposes a theoretical framework to address (e-)cycling based on the notions of motility (individuals’ cycling potential) and bikeability (spaces’ hosting potential). The framework is applied to a large-scale survey (14,000 bike commuters in Switzerland). The analysis shows that the e-bike makes it possible to overcome some of the barriers faced by conventional cyclists, such as distance, gradient and physical effort. The e-bike empowers more people to cycle, across social groups (women, couples with children, people over 40, people with a lower physical condition) and spatial contexts (suburban and rural areas). By reaching groups and spaces that are more motorised than average, the e-bike expands the practice of cycling as a complement or alternative to automobility. However, both e-cycling and conventional cycling share many characteristics (e.g. motivations) and face similar challenges (in terms of a lack of infrastructures, etc.).
In Switzerland, strict measures as a response to the Covid-19 pandemic were imposed on March 16, 2020, before being gradually relaxed from May 11 onwards. We report the impact of these measures on mobility behaviour based on a GPS tracking panel of 1,439 Swiss residents. The participants were also exposed to online questionnaires. The impact of both the lockdown and the relaxation of the measures up until the middle of August, 2020 are presented. Reductions of around 60% in the average daily distance were observed, with decreases of over 90% for public transport. Cycling increased in mode share drastically. Behavioural shifts can even be observed in response to the announcement of the measures and relaxation, a week before they came in to place. Long-term implications for policy are discussed, in particular the increased preference for cycling as a result of the pandemic.
Background
Exposure to air pollution and physical inactivity are both significant risk factors for non-communicable diseases (NCDs). These risk factors are also linked so that the change in exposure in one will impact risks and benefits of the other. These links are well captured in the active transport (walking, cycling) health impact models, in which the increases in active transport leading to increased inhaled dose of air pollution. However, these links are more complex and go beyond the active transport research field. Hence, in this study, we aimed to summarize the empirical evidence on the links between air pollution and physical activity, and their combined effect on individual and population health.
Objectives and methods
We conducted a non-systematic mapping review of empirical and modelling evidence of the possible links between exposure to air pollution and physical activity published until Autumn 2019. We reviewed empirical evidence for the (i) impact of exposure to air pollution on physical activity behaviour, (ii) exposure to air pollution while engaged in physical activity and (iii) the short-term and (iv) long-term health effects of air pollution exposure on people engaged in physical activity. In addition, we reviewed (v) public health modelling studies that have quantified the combined effect of air pollution and physical activity. These broad research areas were identified through expert discussions, including two public events performed in health-related conferences.
Results and discussion
The current literature suggests that air pollution may decrease physical activity levels during high air pollution episodes or may prevent people from engaging in physical activity overall in highly polluted environments. Several studies have estimated fine particulate matter (PM2.5) exposure in active transport environment in Europe and North-America, but the concentration in other regions, places for physical activity and for other air pollutants are poorly understood. Observational epidemiological studies provide some evidence for a possible interaction between air pollution and physical activity for acute health outcomes, while results for long-term effects are mixed with several studies suggesting small diminishing health gains from physical activity due to exposure to air pollution for long-term outcomes. Public health modelling studies have estimated that in most situations benefits of physical activity outweigh the risks of air pollution, at least in the active transport environment. However, overall evidence on all examined links is weak for low- and middle-income countries, for sensitive subpopulations (children, elderly, pregnant women, people with pre-existing conditions), and for indoor air pollution.
Conclusions
Physical activity and air pollution are linked through multiple mechanisms, and these relations could have important implications for public health, especially in locations with high air pollution concentrations. Overall, this review calls for international collaboration between air pollution and physical activity research fields to strengthen the evidence base on the links between both and on how policy options could potentially reduce risks and maximise health benefits.
Background
Expansion of designated cycling networks increases cycling for transport that, in turn, increases physical activity, contributing to improvement in public health. This paper aims to determine whether cycle-network construction in a large city is cost-effective when compared to the status-quo. We developed a cycle-network investment model (CIM) for Oslo and explored its impact on overall health and wellbeing resulting from the increased physical activity.
Methods
First, we applied a regression technique on cycling data from 123 major European cities to model the effect of additional cycle-networks on the share of cyclists. Second, we used a Markov model to capture health benefits from increased cycling for people starting to ride cycle at the age of 30 over the next 25 years. All health gains were measured in quality-adjusted life years (QALYs). Costs were estimated in US dollars. Other data to populate the model were derived from a comprehensive literature search of epidemiological and economic evaluation studies. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses.
Results
Our regression analysis reveals that a 100 km new cycle network construction in Oslo city would increase cycling share by 3%. Under the base-case assumptions, where the benefits of the cycle-network investment relating to increased physical activity are sustained over 25 years, the predicted average increases in costs and QALYs per person are 22,350 per QALY gained. This is considered highly cost-effective in a Norwegian setting.
Conclusions
The results support the use of CIM as part of a public health program to improve physical activity and consequently avert morbidity and mortality. CIM is affordable and has a long-term effect on physical activity that in turn has a positive impact on health improvement.
Multi-modality has become a key mantra of transport planning and yet, how people access, egress and transfer (hereafter AET) remains under-investigated. We argue that integrating active travel and public transport is an absolute essential. Multilevelpolicy packages for land-use and transport-system development in the larger Norwegian urban regions, called Urban growth agreements (hereafter UGA), provides the bouncing pad for this study. We highlight the extent to which AET can be strengthened through the UGAs. Methodologically, we apply document studies and qualitative interviews with key actors and our analysis is framed to address the following three rationales identified for policy packages: to facilitate implementation, to create synergies and to improve cooperation. While the UGAs provide opportunities to finance new, large-scale public-transport projects, being partly toll-road financed results in cuts reducing AET-qualities. Even though the UGAs provide several synergies between walking, bicycling and public transport, we identified missed opportunities related to shared mobility. Finally, AET may benefit from horizontal and vertical integration of policy actors, specially concerning multilevel cooperation on designing public transport hubs. To conclude, though there are elements in the UGAs benefiting AET, the overall lack of integration between public transport and active travel needs immediate attention to achieve multi-modality.
Introduction
The rising use of e-bikes (EBs) presents an opportunity to increase active transportation but may compromise road safety due to increased travel speed and weight compared to conventional bicycle (CBs). Evidence comparing the safety of EBs and CBs is limited while the influence of cyclists’ health status has been neglected.
Methods
This cross-sectional case-control study compared EB and CB users in the Netherlands. Data were gathered 1) through a survey among crash casualties treated at emergency departments aged >16 (N = 2383) and 2) control group data were collected among cyclists without any known crash experience, randomly drawn from a panel of the Dutch population (N = 1860). Using logistic regressions, we assessed the likelihood of crashes and crash severity while adjusting for bicycle use and health status.
Results
EB users had poorer health than CB users, but they were not more likely to be involved in a crash or to sustain more severe injuries. However, older female cyclists did have an elevated risk on EBs and sustained more severe injuries. Health-related factors such as the presence of morbid conditions, medication use, and the body mass index were neither associated with crash likelihood nor associated with injury severity and accordingly did not explain the findings for older females. However, balance and coordination problems, and the use of anti-epileptic drugs were associated with crashes.
Conclusion
Our findings provide support that EB users have a poorer health status than CB users, while general health status is unrelated to the likelihood and severity of bicycle crashes. EBs enable more vulnerable groups to cycle or keep cycling but, after controlling for bicycle use, EB users are not more likely to be involved in a crash or to sustain severe injuries. As older females run a higher risk on an EB and are more likely to fall while (dis)mounting, we recommend to promote EBs enabling safer (dis)mounting such as by reduced saddle height.
While there has been sustained growth in cycling as an urban mean of transport over the last two decades, it has often been accompanied by an increase in traffic crashes and deaths involving cyclists (Broe et al., 2017; Loreta et al., 2016). Many of the recommendations proposed to reduce such negative consequences rely primarily on individual behavioural changes or segregating infrastructure; however, the positive impacts of such actions are not yet proven (Dozza, 2017; Shinar et al., 2018). While these actions are certainly necessary, it has been proposed that more collective and long-standing changes in policy, education and law can be even more beneficial for cycling safety (Jacobsen, 2003; Marqués and Hernández-Herrador, 2017). Research considering social, spatial and economic disparities and their relation to urban cycling is very scarce within cycling studies and has the potential to benefit cycling safety by expanding its underlying understanding (Brown, 2016). Additionally, qualitative approaches such as the analysis of media representations of cycling safety events have only recently started attracting attention from researchers (Macmillan et al., 2016). Furthermore, there is a clear disproportion between research about cycling safety undertaken in Europe, Oceania and North America when compared to the rest of the world – in particular, Latin America. While debates around transport and inequalities are prevalent in Latin American cities, limited attention has been paid to cycling. In this study, through the analysis of secondary data and media coverage of traffic crashes involving cyclists in Bogotá, Colombia, it is proposed that cycling safety research can benefit from including analysis of social, economic and spatial inequalities as well as media representation. Preliminary results show that spatial inequality in cycling safety is expressed in at least three ways: disparities in cycling infrastructure allocation by city planners; concentration of traffic crashes resulting in cyclists' deaths in low income areas; and disproportion in media coverage of cyclists' deaths in traffic according to their locations.
Cycling and walking have gained a prominent role in the mobility policy agenda as awareness has risen over the growing unsustainability of the current transport system and the multiple co-benefits of active mobility. As interest and investments for cycling and walking increase, how active mobility can be appraised becomes a crucial question, which has been tackled over the years through different methods and tools. The aim of this chapter is to provide a structured review of the methods and the practices of appraisal of walking and cycling policies and projects, focusing on both traditional and emerging assessment techniques. At present, much attention has been paid to the application of four main traditional methods: Balance Sheet Calculations, Cost-Benefit Analysis, Cost-Effectiveness Analysis and Multi-Criteria Analysis. We compare and discuss these methods to identify strengths and weaknesses for each of them, as well as their main limitations and knowledge gaps in their application. We conclude that over the last decades much effort has been undertaken to further expand and develop these tools thanks to an increased attention to walking and cycling. However, much research is still needed, particularly in the quantification and valuation of specific effects within Cost-Benefit Analysis and in better integrating different appraisal techniques. Finally, the impact of appraisals on decision-making outcomes is still underexplored.