What is already known on this topic
Our finding, that active commuting is associated with lower likelihood of obesity, is consistent with findings from other studies (Gordon-Larsen et al.
2009; Lindström
2008). A systematic review by Brown and colleagues suggested small but important benefits of active travel for obesity management (Brown et al.
2017). The results from the current study support the proposed framework that active travel use results in higher energy expenditure than inactive travel modes which may result in healthy weight maintenance provided no significant increase in energy intake occurs in active travel users (Brown et al.
2017). When cycling and walking were investigated separately, cycling had a strong inverse association with obesity. This was in concordance with findings from other studies (Laverty et al.
2013; Millett et al.
2013; Mytton et al.
2016a; Nordengen et al.
2019a; Rissel et al.
2014; Wen and Rissel
2008). Results from another systematic review indicate that cyclists have lower BMI and decreased cardiovascular disease risk factors than non-cyclists (Nordengen et al.
2019b). Contrary to other studies which reported associations between active travel on foot and reduced obesity risk (Laverty et al.
2013; Millett et al.
2013; Rissel et al.
2014), we did not find any association between walking and obesity. Of note we used objective BMI measurements whereas some of the previous studies used self-reported BMI data which may affect the accuracy of results (Laverty et al.
2013; Rissel et al.
2014). However, our findings are plausible as cycling is often considered a more intense activity. Oja and colleagues reported that commuting by bicycle was associated with higher cardiorespiratory and metabolic improvements than walking in a 10-week RCT of sedentary commuters (Oja et al.
1991).
There was no association detected between active commute modes and overweight. This is inconsistent with findings from other cross-sectional studies (Barengo et al.
2006; Hu et al.
2002; Mendoza et al.
2011), all of which used objective BMI measurements. Eriksson and colleagues reported lower CVD risk for overweight participants who actively commuted (Eriksson et al.
2020). A possible explanation for the lack of an association between active commuting and overweight in the current study may be that active travel is generally of lower intensity than leisure time physical activity while regular higher intensity physical activity may be needed for prevention of overweight.
Higher SRH is hypothesised to be associated with active travel use, given the established links between physical activity and better health-related quality of life (Bize et al.
2007). No association was found between high SRH and active commute modes. This contrasts with findings from a study of 1196 commuters by Norgenen and colleagues (Nordengen et al.
2019a). It should be noted that in that study 40% of the study population cycled and 88% reported high SRH, whereas in the current study 3% of participants cycled and 92% reported high SRH, which may account for the lack of an association with active commuting. In a longitudinal study by Mytton and colleagues, higher physical well-being was associated with maintenance of cycling commuting in Cambridge, UK, using the Physical Component Summary (PCS-8), which includes an SRH component (Mytton et al.
2016b). It has been suggested that those who participate in healthy lifestyle behaviours can be more negative about their health (Layes et al.
2012). Therefore, it is important to appreciate the complex nature of SRH as a representation of overall health as it can be influenced by many underlying social and individual factors. Residual confounding factors such as job strain and sleep may also affect the association between SRH and active commuting in this study.
Interestingly we report a stronger inverse association with obesity in those who actively travelled at least 3 km which may suggest a dose-response relationship. This is consistent with previous studies which indicated similar exposure-response findings (Laverty et al.
2013; Martin et al.
2015). Those engaging in longer active journeys are more likely to achieve the 30-minute recommended physical activity threshold which is linked to a decreased disease risk (Department of Health and Children, Health Service Executive
2009).
Active travel specifically to work or education accounts for 27% of all trips in Ireland with the largest proportion of all trips taken during the week in Ireland (National Transport Authority
2017). In the present study almost 16% of study participants aged 15 years and older used active commuting. Although this represents an increase from 13% in 2016 (Central Statistics Office
2016) and is similar to that reported in the UK (Laverty et al.
2013; Flint et al.
2014) it is lower than in other European countries, for example in Sweden 38% report actively commuting (Eriksson et al.
2020). These differences may represent different ethnicities, cultural habits and infrastructure availability to the populations in question. Car use is more dominant in Ireland, England and the USA while government policies in other countries such as the Netherlands are more car restrictive in favour of active transport promotion (Pucher and Buehler
2010).
What this study adds
To our knowledge this is the first study in Ireland to investigate associations between active commuting and BMI and SRH. Additionally, our study which uses data from a nationally representative study of the Irish population, contributes to the evidence base regarding active commuting associations with SRH as a single item measure. Interviewers were professionally trained for face-to-face interviews reducing the risk of information bias and error. Objectively measured height and weight data was used for BMI measurement which is more reliable than self-reported data (Maukonen et al.
2018). Information on many potential confounders was collected.
In Ireland only 33% of adults and 12% of adolescents meet the WHO weekly physical activity recommendations (European Commission WHO
2018). Therefore, active travel use is an important lifestyle factor which has the potential to improve health by incorporating physical activity into daily commuting, re-enforcing the benefits of making small behavioural changes. This study, which demonstrated an inverse association between active commuting, particularly among cyclists and those actively commuting ≥3 km, represents a significant contribution to the evidence base regarding active commuting associations with obesity. The findings support the need for further incentives to actively travel. Further research should consider additional confounding factors in this association, in particular environmental factors such as traffic congestion, green space surroundings and public transport availability.
Limitations of this study
However, there are some limitations that should be noted. The cross-sectional study design, which precludes drawing conclusions regarding the temporal direction of relationships, limits inference with respect to causality. Reverse causality is possible; that is that participants who were obese may have been less likely to actively commute. Additionally, self-reported data for active commute use was collected during a face-to-face interview which may be subject to social desirability bias (Adams et al.
2005). Self-selection bias is possible in this study. Healthier people are more inclined to actively commute and have healthier lifestyle habits. Additional data on physical activity levels of participants would help to delineate if the inverse association between active commuting and BMI is related specifically to active travel and not to overall fitness in daily life. This was an Anonymised Microdata File version of the original 2017 Healthy Ireland dataset. Data analysis was limited as a result by the categorised nature of all data which may affect accuracy of results.