Elsevier

Preventive Medicine

Volume 46, Issue 1, January 2008, Pages 9-13
Preventive Medicine

Review
Active commuting and cardiovascular risk: A meta-analytic review

https://doi.org/10.1016/j.ypmed.2007.03.006Get rights and content

Abstract

Objective.

Leisure time physical activity is inversely associated with cardiovascular risk, although evidence for the protective effects of active commuting is more limited. The present review examines evidence from prospective epidemiological studies of commuting activity and cardiovascular risk.

Methods.

Meta-analytic procedures were performed to examine the association between commuting physical activity and cardiovascular risk. Several cardiovascular endpoints were examined including mortality, incident coronary heart disease, stroke, hypertension and diabetes.

Results.

We included eight studies in the overall analysis (173,146 participants) that yielded 15 separate risk ratios (RR). The overall meta-analysis demonstrated a robust protective effect of active commuting on cardiovascular outcomes (integrated RR = 0.89, 95% confidence interval 0.81–0.98, p = 0.016). However, the protective effects of active commuting were more robust among women (0.87, 0.77–0.98, p = 0.02) than in men (0.91, 0.80–1.04, p = 0.17).

Conclusions.

Active commuting that incorporates walking and cycling was associated with an overall 11% reduction in cardiovascular risk, which was more robust among women. Future studies should investigate the reasons for possible gender effects and also examine the importance of commuting activity intensity.

Introduction

The protective effect of physical activity and cardiorespiratory fitness on cardiovascular disease is well publicised (Wannamethee and Shaper, 2002) and follows a curvilinear dose–response pattern. Important mechanisms include blood pressure control, lipid lowering, anti-inflammatory effects, improved endothelial function and glycaemic control. However, the relative importance of different forms of physical activity, such as active commuting, has not been well established. Active commuting, such as cycling and walking to work, provides a feasible method of integrating regular physical activity into the increasingly sedentary lifestyles of western populations, as well as providing environmental benefits. Accumulated bouts of physical activity such as commuting may also be an effective way to achieve recommended guidelines of a 30-min activity per day. A number of studies have demonstrated benefits for accumulated bouts of short duration exercise over the day as oppose to one continuous session (e.g., Park et al., 2006, Murphy et al., 2002). For example, four 10 min bouts of walking were more effective in lowering daytime ambulatory blood pressure than a continuous 40 min session in pre-hypertensive adults (Park et al., 2006).

The aim of the present paper was to examine the association between commuting physical activity and cardiovascular risk using meta-analytic procedures. We selected prospective epidemiological studies with cardiovascular outcomes, including cardiovascular mortality and incident coronary heart disease, stroke, hypertension and diabetes.

Section snippets

Search strategy

We developed a protocol using a widely recommended method for systematic reviews of observational studies (Stroup et al., 2000). We searched general bibliographic databases including Medline (1966–2007), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ACP Journal Club, Database of Abstracts of Reviews of Effects (1991–2007), Web of Science (1900–2007), PubMed (1950–2007) and scrutiny of reference lists from relevant reviews and articles.

Inclusion criteria

We limited the

Results

Eight studies met the inclusion criteria (see Table 1), which yielded 15 separate risk ratios (RR). Five of the studies included cohorts from Finland (Barengo et al., 2005, Barengo et al., 2004, Hu et al., 2006, Hu et al., 2005, Hu et al., 2003), one study from Sweden (Wennberg et al., 2006), one study a collaborative group from Ireland and France (Wagner et al., 2002) and one from Japan (Hayashi et al., 1999). All studies were prospective cohorts that ranged in follow-up from 5 to 20 years,

Discussion

The present meta-analysis demonstrates a protective effect of active commuting on cardiovascular outcomes, which is apparently more robust among women. These results should however be viewed in light of a relatively limited number of available studies that were mainly drawn from cohorts in Finland. Further studies that examine the association between active commuting and cardiovascular risk are therefore warranted to strengthen the conclusions drawn from the present meta-analysis. Nevertheless,

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