Frédéric Dutheil1,2, Séverine Pélangeon3, Martine Duclos4, Philippe Vorilhon5, Martial Mermillod6,7, Julien S Baker8, Bruno Pereira9, Valentin Navel10. 1. CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Université Clermont Auvergne, Witty Fit, 63000, Clermont-Ferrand, France. frederic.dutheil@acu.edu.au. 2. Faculty of Health, School of Exercise Science, Melbourne, Australia2 General Medicine, AMUAC, Australian Catholic University, 63000, Clermont-Ferrand, France. frederic.dutheil@acu.edu.au. 3. General Medicine, AMUAC, 63000, Clermont-Ferrand, France. 4. INRA, UMR 1019, CRNH-Auvergne, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Sport Medicine and Functional Explorations, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. 5. Université Clermont Auvergne, UPU ACCePPT, 63000, Clermont-Ferrand, France. 6. Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France. 7. Institut Universitaire de France, Paris, France. 8. Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong. 9. CHU Clermont-Ferrand, Clinical Research and Innovation Direction, University Hospital of Clermont Ferrand, 63000, Clermont-Ferrand, France. 10. CNRS, INSERM, GReD, Translational Approach To Epithelial Injury and Repair, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Ophthalmology, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
Abstract
BACKGROUND: Sedentary behaviour is a major risk of mortality. However, data are contradictory regarding the effects of active commuting on mortality. OBJECTIVES: To perform a systematic review and meta-analysis on the effects of active commuting on mortality. METHODS: The PubMed, Cochrane Library, Embase, and Science Direct databases were searched for studies reporting mortality data and active commuting (walking or cycling) to or from work. We computed meta-analysis stratified on type of mortality, type of commuting, and level of commuting, each with two models (based on fully adjusted estimates of risks, and on crude or less adjusted estimates). RESULTS: 17 studies representing 829,098 workers were included. Using the fully adjusted estimates of risks, active commuting decreased all-cause mortality by 9% (95% confidence intervals 3-15%), and cardiovascular mortality by 15% (3-27%) (p < 0.001). For stratification by type of commuting, walking decreased significantly all-cause mortality by 13% (1-25%), and cycling decreased significantly both all-cause mortality by 21% (11-31%) and cardiovascular mortality by 33% (10-55%) (p < 0.001). For stratification by level of active commuting, only high level decreased all-cause mortality by 11% (3-19%) and both intermediate and high level decreased cardiovascular mortality. Low level did not decrease any type of mortality. Cancer mortality did not decrease with walking or cycling, and the level of active commuting had no effect. Low level walking did not decrease any type of mortality, intermediate level of walking decreased only all-cause mortality by 15% (2-28%), and high level of walking decreased both all-cause and cardiovascular mortality by 19% (8-30%) and by 31% (9-52%), respectively. Both low, intermediate and high intensities of cycling decreased all-cause mortality. Meta-analysis based on crude or less fully adjusted estimates retrieved similar results, with also significant reductions of cancer mortality with cycling (23%, 5-42%), high level of active commuting (14%, 4-24%), and high level of active commuting by walking (16%, 0-32%). CONCLUSION: Active commuting decreases mainly all-cause and cardiovascular mortality, with a dose-response relationship, especially for walking. Preventive strategies should focus on the benefits of active commuting.
BACKGROUND: Sedentary behaviour is a major risk of mortality. However, data are contradictory regarding the effects of active commuting on mortality. OBJECTIVES: To perform a systematic review and meta-analysis on the effects of active commuting on mortality. METHODS: The PubMed, Cochrane Library, Embase, and Science Direct databases were searched for studies reporting mortality data and active commuting (walking or cycling) to or from work. We computed meta-analysis stratified on type of mortality, type of commuting, and level of commuting, each with two models (based on fully adjusted estimates of risks, and on crude or less adjusted estimates). RESULTS: 17 studies representing 829,098 workers were included. Using the fully adjusted estimates of risks, active commuting decreased all-cause mortality by 9% (95% confidence intervals 3-15%), and cardiovascular mortality by 15% (3-27%) (p < 0.001). For stratification by type of commuting, walking decreased significantly all-cause mortality by 13% (1-25%), and cycling decreased significantly both all-cause mortality by 21% (11-31%) and cardiovascular mortality by 33% (10-55%) (p < 0.001). For stratification by level of active commuting, only high level decreased all-cause mortality by 11% (3-19%) and both intermediate and high level decreased cardiovascular mortality. Low level did not decrease any type of mortality. Cancer mortality did not decrease with walking or cycling, and the level of active commuting had no effect. Low level walking did not decrease any type of mortality, intermediate level of walking decreased only all-cause mortality by 15% (2-28%), and high level of walking decreased both all-cause and cardiovascular mortality by 19% (8-30%) and by 31% (9-52%), respectively. Both low, intermediate and high intensities of cycling decreased all-cause mortality. Meta-analysis based on crude or less fully adjusted estimates retrieved similar results, with also significant reductions of cancer mortality with cycling (23%, 5-42%), high level of active commuting (14%, 4-24%), and high level of active commuting by walking (16%, 0-32%). CONCLUSION: Active commuting decreases mainly all-cause and cardiovascular mortality, with a dose-response relationship, especially for walking. Preventive strategies should focus on the benefits of active commuting.
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