Active commuters less likely to suffer from heart disease and cancer, new research shows

By Vijay Kumar MalesuReviewed by Lily Ramsey, LLMJul 17 2024

In a recent study published in the BMJ Public Health, researchers separately examined the prospective associations between active commuting and multiple health outcomes over 18 years for pedestrians and cyclists.

Study: Health benefits of pedestrian and cyclist commuting: evidence from the Scottish Longitudinal Study. Image Credit: PeopleImages.com - Yuri A/Shutterstock.com

Background 

Regular moderate-to-vigorous physical activity, such as walking and cycling, has significant physical and mental health benefits.

Evidence suggests that cyclist commuting, and to a lesser degree, pedestrian commuting, is associated with lower morbidity and mortality risks.

Further research is needed to explore the long-term effects of active commuting on a wider range of health outcomes and to understand the underlying mechanisms.

About the study 

The present study accessed data from the Scottish Longitudinal Study (SLS), representing 5.3% of the Scottish population based on the 1991, 2001, and 2011 Censuses. Data from hospital admissions, death registrations, and prescription records were linked using personal identifiers. The base year of 2001 was chosen due to the unavailability of key covariate measures in 1991 and 2011.

Participants aged 16-74 years in 2001 who traveled to work or study in the United Kingdom (UK) were included, excluding the unemployed, offshore workers, and those working outside the UK, resulting in 114,523 individuals.

Records for 467 active commuters traveling over 40.5 km were excluded, along with 31,759 individuals with missing covariate data. The final sample comprised 82,297 participants.

Anonymized data were used, so patient and public involvement was not applicable. The exposure variable was derived from Census responses about usual travel mode to work or study, with active travel defined as walking or cycling. Covariates included age, sex, pre-existing health conditions, socioeconomic factors, and other potential confounders.

Health outcomes were binary variables for the follow-up period of 2001–2018, including all-cause mortality, hospitalization, cardiovascular disease (CVD), cancer, mental health medication, and traffic casualty hospitalization.

Cox proportional hazard models estimated the association between travel mode and health outcomes, adjusted for covariates. Analyses were conducted using R version 3.6.3 and the ‘survival package’.

Study results 

The study followed 82,297 participants from the 2001 Scottish Longitudinal Study until 2018. During this period, 4,276 participants died i.e. 5.2% of the cohort, with almost half of these deaths attributed to cancer (2,023, 2.5%).

A total of 52,804 participants (64.2%) had a hospital admission; of these, 9,663 (11.7%) were for CVD, 5,939 (7.2%) were for cancer, and 2,668 (3.2%) were due to traffic collisions.

Additionally, 31,666 participants (38.5%) received a CVD-related prescription from 2009 to 2018, and 33,771 participants (41%) had a prescription for mental health conditions during the same period.

Descriptive statistics for covariates by commuting mode showed that pedestrian commuters, compared to non-active commuters, were more likely to be younger, female, shift workers, commute shorter distances, and dwelled in urban areas.

They were less likely to have dependent children and generally had lower socioeconomic status, as indicated by educational qualifications, home ownership, occupation, and likelihood of living in overcrowded households.

Cyclist commuters, compared to non-active commuters, were more likely to be younger, male, shift workers, and city dwellers and were less likely to be homeowners or carers.

Cyclist commuters had a significantly lower risk of all-cause mortality (Hazard ratio (HR) 0.53, 95% CI 0.38 to 0.73), CVD hospitalization (HR 0.76, 95% CI 0.64 to 0.91), any hospitalization (HR 0.90, 95% CI 0.84 to 0.97), receiving a CVD-related prescription (HR 0.70, 95% CI 0.63 to 0.78), cancer hospitalization (HR 0.76, 95% CI 0.59 to 0.98), cancer mortality (HR 0.49, 95% CI 0.30 to 0.82), and having a prescription for a mental health condition (HR 0.80, 95% CI 0.73 to 0.89).

There was no clear association between cyclist commuting and CVD mortality (HR 0.63, 95% CI 0.35 to 1.15). However, cyclist commuters had an increased risk of hospitalization after a traffic collision (HR 1.98, 95% CI 1.59 to 2.48), though this was relatively rare, with 83 hospitalizations over 18 years.

Pedestrian commuters had a lower risk of any hospitalization (HR 0.91, 95% CI 0.88 to 0.93), CVD hospitalization (HR 0.90, 95% CI 0.84 to 0.96), receiving a CVD-related prescription (HR 0.90, 95% CI 0.87 to 0.93), and having a prescription for a mental health condition (HR 0.93, 95% CI 0.90 to 0.97).

There was no clear evidence of an association between pedestrian commuting and all-cause mortality (HR 0.96, 95% CI 0.88 to 1.06), CVD mortality (HR 0.96, 95% CI 0.79 to 1.17), cancer mortality (HR 0.89, 95% CI 0.77 to 1.02), cancer hospitalization (HR 0.98, 95% CI 0.90 to 1.06), or hospitalization after a traffic collision (HR 0.99, 95% CI 0.87 to 1.12).

Conclusions 

To summarize, this study provides long-term evidence of the health benefits of active commuting in Scotland. Cyclists had significantly lower risks of death, hospitalization, CVD, cancer, and mental health issues compared to non-active commuters.

Pedestrians also experienced lower risks of hospitalization, CVD, and mental health issues. Despite a higher risk of traffic collisions for cyclists, the overall health benefits outweigh the risks.

These findings align with previous research and underscore the importance of promoting active travel to improve public health. Increased physical activity from active commuting contributes significantly to these positive health outcomes.