Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study.
Level 3 - non-randomized controlled study
Prospective observational cohort study
PubMed 28424154 · doi:10.1136/bmj.j1456
What was done
A prospective cohort study evaluated 263,450 UK Biobank participants (106,674 women, 52%; mean age 52.6) recruited from 22 sites across the UK. Mode of transport for commuting on a typical day was categorized into walking, cycling, mixed-mode, or non-active (car or public transport). Participants were followed for a median of 5.0 years (interquartile range 4.3 to 5.5) to track incident (fatal and non-fatal) cardiovascular disease (CVD) and cancer, as well as all-cause, CVD, and cancer mortality using maximally adjusted models.
What was found
Over follow-up, 2,430 participants died (496 from CVD, 1,126 from cancer), with 3,748 incident cancer cases and 1,110 incident CVD events. - Cycling commuting was associated with lower all-cause mortality (HR 0.59, 95% CI 0.42 to 0.83, P=0.002), cancer incidence (HR 0.55, 95% CI 0.44 to 0.69, P<0.001), cancer mortality (HR 0.60, 95% CI 0.40 to 0.90, P=0.01), CVD incidence (HR 0.54, 95% CI 0.33 to 0.88, P=0.01), and CVD mortality (HR 0.48, 95% CI 0.25 to 0.92, P=0.03). - Mixed-mode cycling was associated with lower all-cause mortality (HR 0.76, 95% CI 0.58 to 1.00, P<0.05), cancer incidence (HR 0.64, 95% CI 0.45 to 0.91, P=0.01), and cancer mortality (HR 0.68, 95% CI 0.57 to 0.81, P<0.001). - Walking commuting was associated with lower CVD incidence (HR 0.73, 95% CI 0.54 to 0.99, P=0.04) and CVD mortality (HR 0.64, 95% CI 0.45 to 0.91, P=0.01), but had no statistically significant association with all-cause mortality or cancer outcomes. - Mixed-mode walking was not noticeably associated with any of the measured outcomes.
Why it matters
This study provides large-scale prospective evidence that cycle commuting is associated with substantially lower incidence and mortality from cardiovascular disease and cancer.
Limits
The observational design cannot prove causality or rule out residual confounding. Commute mode was self-reported for a typical day without longitudinal tracking of behavioral changes. Commuting distance, speed, and intensity were not detailed in the abstract, and the median follow-up of 5.0 years is relatively short for cancer latency.
Cited by
- supports A study found that people who engaged in high amounts of cycling had their overall mortality risk reduced by 40% in later decades of life.