Research ArticleActive Travel to Work and Cardiovascular Risk Factors in the United Kingdom
Introduction
Physical inactivity and the growing prevalence of obesity and diabetes threaten ongoing reductions in cardiovascular disease (CVD) burden in middle- and high-income countries. Data from the Health Survey for England have shown that 62% of the adult English population were overweight or obese in 2011,1 with similar levels in Scotland,2 Wales,3 and Northern Ireland.4 The prevalence of hypertension was estimated at 30% using direct measurement in national surveys in England,5 with similar figures in Scotland,6 and at 20% in Wales, using self-reported data.7 The prevalence of diabetes ranges from 3.8% in Northern Ireland to 5.5% in England.8
Active travel (walking, cycling, public transport) is increasingly being seen as a way to promote physical activity, and has substantial environmental benefits.9, 10 There is growing evidence that active travel is associated with reduced risk of being overweight, having diabetes, and having hypertension. A meta-analysis of all studies prior to 2007 found that active travel to work is associated with an 11% reduction in cardiovascular risk.11
A U.S. study found that people who use public transport to commute walk an average of 19 minutes as part of their journey, and that minority groups may be more likely to attain levels of recommended activity as part of these journeys alone.12 A recent systematic review concluded that people who are physically active in their journey to work were less likely to be overweight, even after accounting for leisure-time activity.13 Use of private transport remains the most common mode of travel to work in most high-income countries. For example, data from the National Travel Survey for England for 2011 suggest that only 15% of people walk or cycle to work.14 Levels of any walking or any cycling are also known to be low in the U.S., at 19% and 2%, respectively.15
There are currently few nationally representative data examining the link between active travel and cardiovascular risk factors. Further, despite known inequalities in the distribution of obesity, diabetes, and hypertension, less is known about how sociodemographic patterning of active travel may relate to CVD risk factors. Using data from Understanding Society, a nationally representative survey of United Kingdom (UK) residents in 2009/2011, the current study investigates differences among sociodemographic groups in their use of active travel in the four countries of the UK. It also investigates whether active travel to work is associated with being overweight/obese, or with having diabetes or hypertension.
Section snippets
Study Population and Design
Data for this study come from Understanding Society, a study of the socioeconomic circumstances, attitudes, and behaviors of members of a representative sample of 40,000 households in the UK.16, 17 The design is a longitudinal household panel survey that includes an ethnic boost to sample around 1000 participants from Indian, Pakistani, Bangladeshi, Caribbean, and African backgrounds. For these groups, numbers participating in nationally representative samples are typically small. The overall
Results
The total household response rate to Wave 1 of Understanding Society was 56.5% and was similar for the ethnic boost and the general population sample.20 In all, 69% of participants used private forms of transport to get to work, 16% used public transport, 12% walked, and 3% cycled (Table 1). A total of 19,380 (95%) participants had a valid BMI based on reported height and weight; 47% had a BMI of <25. Overweight participants totaled 36%, and 17% were obese. Participants who reported being
Discussion
This study found that use of public transport to work was associated with a lower likelihood of being overweight than use of private transport. Walking or cycling were associated with a lower likelihood of having diabetes; and walking with a lower likelihood of having hypertension than private transport. There were large differences in active travel across sociodemographic groups and regions in the UK.
This study adds to a growing body of evidence that active travel is associated with a decrease
Acknowledgements
The Department of Primary Care and Public Health at Imperial College is grateful for support from the National Institute for Health Research Biomedical Research Centre Funding scheme, the NIHR Collaboration for Leadership in Applied Health Research and Care scheme, and the Imperial Centre for Patient Safety and Service Quality. The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the paper. CM is funded by the Higher Education Funding
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