Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship

Paul Kelly, Sonja Kahlmeier, Thomas Götschi, Nicola Orsini, Justin Richards, Nia Roberts, Peter Scarborough, Charlie Foster, Paul Kelly, Sonja Kahlmeier, Thomas Götschi, Nicola Orsini, Justin Richards, Nia Roberts, Peter Scarborough, Charlie Foster

Abstract

Background and objective: Walking and cycling have shown beneficial effects on population risk of all-cause mortality (ACM). This paper aims to review the evidence and quantify these effects, adjusted for other physical activity (PA).

Data sources: We conducted a systematic review to identify relevant studies. Searches were conducted in November 2013 using the following health databases of publications: Embase (OvidSP); Medline (OvidSP); Web of Knowledge; CINAHL; SCOPUS; SPORTDiscus. We also searched reference lists of relevant texts and reviews.

Study eligibility criteria and participants: Eligible studies were prospective cohort design and reporting walking or cycling exposure and mortality as an outcome. Only cohorts of individuals healthy at baseline were considered eligible.

Study appraisal and synthesis methods: Extracted data included study population and location, sample size, population characteristics (age and sex), follow-up in years, walking or cycling exposure, mortality outcome, and adjustment for other co-variables. We used random-effects meta-analyses to investigate the beneficial effects of regular walking and cycling.

Results: Walking (18 results from 14 studies) and cycling (8 results from 7 studies) were shown to reduce the risk of all-cause mortality, adjusted for other PA. For a standardised dose of 11.25 MET.hours per week (or 675 MET.minutes per week), the reduction in risk for ACM was 11% (95% CI = 4 to 17%) for walking and 10% (95% CI = 6 to 13%) for cycling. The estimates for walking are based on 280,000 participants and 2.6 million person-years and for cycling they are based on 187,000 individuals and 2.1 million person-years. The shape of the dose-response relationship was modelled through meta-analysis of pooled relative risks within three exposure intervals. The dose-response analysis showed that walking or cycling had the greatest effect on risk for ACM in the first (lowest) exposure interval.

Conclusions and implications: The analysis shows that walking and cycling have population-level health benefits even after adjustment for other PA. Public health approaches would have the biggest impact if they are able to increase walking and cycling levels in the groups that have the lowest levels of these activities.

Review registration: The review protocol was registered with PROSPERO (International database of prospectively registered systematic reviews in health and social care) PROSPERO 2013: CRD42013004266.

Figures

Figure 1
Figure 1
Flow chart for study selection.
Figure 2
Figure 2
Risk reduction for all cause mortality for an additional 11.25 MET. hours per week of walking (studies displayed by quality score).
Figure 3
Figure 3
Risk reduction for all cause mortality for an additional 11.25 MET. hours per week of cycling (studies displayed by quality score).
Figure 4
Figure 4
Dose-response relationship for walking across the range of reported exposures.
Figure 5
Figure 5
Dose-response relationship for cycling across the range of reported exposures.

References

    1. Bull FC, Gauvin L, Bauman A, Shilton T, Kohl HW, 3rd, Salmon A. The Toronto charter for physical activity: a global call for action. J Phys Act Health. 2010;7:421–422.
    1. Samitz G, Egger M, Zwahlen M. Domains of physical activity and all-cause mortality: systematic review and dose–response meta-analysis of cohort studies. Int J Epidemiol. 2011;40:1382–1400. doi: 10.1093/ije/dyr112.
    1. Woodcock J, Franco OH, Orsini N, Roberts I. Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. Int J Epidemiol. 2011;40:121–138. doi: 10.1093/ije/dyq104.
    1. Oja P, Titze S, Bauman A, de Geus B, Krenn P, Reger-Nash B, Kohlberger T. Health benefits of cycling: a systematic review. Scand J Med Sci Sports. 2011;21:496–509. doi: 10.1111/j.1600-0838.2011.01299.x.
    1. Hamer M, Chida Y. Walking and primary prevention: a meta-analysis of prospective cohort studies. Br J Sports Med. 2008;42:238–243. doi: 10.1136/bjsm.2007.039974.
    1. Sattelmair J, Pertman J, Ding EL, Kohl HW, 3rd, Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation. 2011;124:789–795. doi: 10.1161/CIRCULATIONAHA.110.010710.
    1. Ogilvie D, Foster CE, Rothnie H, Cavill N, Hamilton V, Fitzsimons CF, Mutrie N. Interventions to promote walking: systematic review. BMJ. 2007;334:1204. doi: 10.1136/.
    1. Saunders LE, Green JM, Petticrew MP, Steinbach R, Roberts H. What are the health benefits of active travel? A systematic review of trials and cohort studies. PLoS One. 2013;8:e69912. doi: 10.1371/journal.pone.0069912.
    1. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analyses. Ottawa, ON: Ottawa Hospital Research Institute; 2012.
    1. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Jr, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS. Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011;2011(43):1575–1581. doi: 10.1249/MSS.0b013e31821ece12.
    1. World Health Organisation . Global Recommendations on Physical Activity for Health. Geneva: World Health Organisation; 2010.
    1. Deeks JJ, Higgins JPT, Altman DG: Analysing Data and Undertaking Meta-Analyses. In Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons, Ltd; 2008:243–296. .
    1. Committee PAGA. Physical activity guidelines advisory committee report, 2008. Washington, DC: US Department of Health and Human Services. 2008;2008:143–145.
    1. Hamling J, Lee P, Weitkunat R, Ambuhl M. Facilitating meta-analyses by deriving relative effect and precision estimates for alternative comparisons from a set of estimates presented by exposure level or disease category. Stat Med. 2008;27:954–970. doi: 10.1002/sim.3013.
    1. Bijnen FC, Feskens EJ, Caspersen CJ, Nagelkerke N, Mosterd WL, Kromhout D. Baseline and previous physical activity in relation to mortality in elderly men: the Zutphen Elderly Study. Am J Epidemiol. 1999;150:1289–1296. doi: 10.1093/oxfordjournals.aje.a009960.
    1. Johnsen NF, Ekblond A, Thomsen BL, Overvad K, Tjonneland A. Leisure time physical activity and mortality. Epidemiology. 2013;24:717–725. doi: 10.1097/EDE.0b013e31829e3dda.
    1. Sabia S, Dugravot A, Kivimaki M, Brunner E, Shipley MJ, Singh-Manoux A. Effect of intensity and type of physical activity on mortality: results from the Whitehall II cohort study. Am J Public Health. 2012;102:698–704. doi: 10.2105/AJPH.2011.300257.
    1. Stamatakis E, Hamer M, Lawlor DA. Physical activity, mortality, and cardiovascular disease: is domestic physical activity beneficial? The Scottish Health Survey-1998, and 2003. Am J Epidemiol. 2009;169:1191–1200. doi: 10.1093/aje/kwp042.
    1. Schnohr P, Scharling H, Jensen JS. Intensity versus duration of walking, impact on mortality: the Copenhagen City Heart Study. Eur J Cardiovasc Prev Rehabil. 2007;14:72–78. doi: 10.1097/HJR.0b013e3280144470.
    1. Bath PA, Morgan K. Customary physical activity and physical health outcomes in later life. Age Ageing. 1998;27(Suppl 3):29–34. doi: 10.1093/ageing/27.suppl_3.29.
    1. Wannamethee SG, Shaper AG, Walker M. Changes in physical activity, mortality, and incidence of coronary heart disease in older men. Lancet. 1998;351:1603–1608. doi: 10.1016/S0140-6736(97)12355-8.
    1. Smith TC, Wingard DL, Smith B, Kritz-Silverstein D, Barrett-Connor E. Walking decreased risk of cardiovascular disease mortality in older adults with diabetes. J Clin Epidemiol. 2007;60:309–317. doi: 10.1016/j.jclinepi.2006.06.013.
    1. Lee IM, Paffenbarger RS., Jr Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol. 2000;151:293–299. doi: 10.1093/oxfordjournals.aje.a010205.
    1. Hakim AA, Petrovitch H, Burchfiel CM, Ross GW, Rodriguez BL, White LR, Yano K, Curb JD, Abbott RD. Effects of walking on mortality among nonsmoking retired men. N Engl J Med. 1998;338:94–99. doi: 10.1056/NEJM199801083380204.
    1. LaCroix AZ, Leveille SG, Hecht JA, Grothaus LC, Wagner EH. Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults? J Am Geriatr Soc. 1996;44:113–120.
    1. Wang N, Zhang X, Xiang YB, Li H, Yang G, Gao J, Zheng W, Shu XO. Associations of Tai Chi, walking, and jogging with mortality in Chinese men. Am J Epidemiol. 2013;178:791–796. doi: 10.1093/aje/kwt050.
    1. Matthews CE, Jurj AL, Shu XO, Li HL, Yang G, Li Q, Gao YT, Zheng W. Influence of exercise, walking, cycling, and overall nonexercise physical activity on mortality in Chinese women. Am J Epidemiol. 2007;165:1343–1350. doi: 10.1093/aje/kwm088.
    1. Nagai M, Kuriyama S, Kakizaki M, Ohmori-Matsuda K, Sone T, Hozawa A, Kawado M, Hashimoto S, Tsuji I. Impact of walking on life expectancy and lifetime medical expenditure: the Ohsaki Cohort Study. BMJ Open. 2011;1:e000240. doi: 10.1136/bmjopen-2011-000240.
    1. Sahlqvist S, Goodman A, Simmons RK, Khaw KT, Cavill N, Foster C, Luben R, Wareham NJ, Ogilvie D. The association of cycling with all-cause, cardiovascular and cancer mortality: findings from the population-based EPIC-Norfolk cohort. BMJ Open. 2013;3:e003797. doi: 10.1136/bmjopen-2013-003797.
    1. Andersen LB, Cooper AR. Commuter Cycling and Health. In: Gronau W, Reiter K, Pressl R, editors. Transport and Health Issues 2011: Studies on Mobility and Transport Research. Volume 3. Mannheim, Tyskland: Verlag MetaGISInfosysteme; 2011. pp. 9–19.
    1. Schnohr P, Marott JL, Jensen JS, Jensen GB. Intensity versus duration of cycling, impact on all-cause and coronary heart disease mortality: the Copenhagen City Heart Study. Eur J Prev Cardiol. 2012;19:73–80. doi: 10.1177/1741826710393196.
    1. Besson H, Ekelund U, Brage S, Luben R, Bingham S, Khaw KT, Wareham NJ. Relationship between subdomains of total physical activity and mortality. Med Sci Sports Exerc. 2008;40:1909–1915. doi: 10.1249/MSS.0b013e318180bcad.
    1. Andersen LB, Schnohr P, Schroll M, Hein HO. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med. 2000;160:1621–1628. doi: 10.1001/archinte.160.11.1621.
    1. Sterne JAC, Egger M, Moher D: Addressing Reporting Biases. In Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons, Ltd; 2008:297–333.
    1. Kelly P, Doherty A, Mizdrak A, Marshall S, Kerr J, Legge A, Godbole S, Badland H, Oliver M, Foster C. High group level validity but high random error of a self-report travel diary, as assessed by wearable cameras. J Transport Health. 2014;1:190–201. doi: 10.1016/j.jth.2014.04.003.
    1. Inoue M, Iso H, Yamamoto S, Kurahashi N, Iwasaki M, Sasazuki S, Tsugane S. Daily total physical activity level and premature death in men and women: results from a large-scale population-based cohort study in Japan (JPHC study) Ann Epidemiol. 2008;18:522–530. doi: 10.1016/j.annepidem.2008.03.008.
    1. Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose–response data. Stata J. 2006;6:40–57.
    1. Chau JY, Grunseit AC, Chey T, Stamatakis E, Brown WJ, Matthews CE, Bauman AE, van der Ploeg HP. Daily sitting time and All-cause mortality: a meta-analysis. PLoS One. 2013;8:e80000. doi: 10.1371/journal.pone.0080000.
    1. Rutter H, Cavill N, Racioppi F, Dinsdale H, Oja P, Kahlmeier S. Economic impact of reduced mortality due to increased cycling. Am J Prev Med. 2013;44:89–92. doi: 10.1016/j.amepre.2012.09.053.
    1. Morris JN, Hardman AE. Walking to health. Sports Med. 1997;23:306–332. doi: 10.2165/00007256-199723050-00004.
    1. de Nazelle A, Nieuwenhuijsen MJ, Anto JM, Brauer M, Briggs D, Braun-Fahrlander C, Cavill N, Cooper AR, Desqueyroux H, Fruin S, Hoek G, Panis LI, Janssen N, Jerrett M, Joffe M, Andersen ZJ, van Kempen E, Kingham S, Kubesch N, Leyden KM, Marshall JD, Matamala J, Mellios G, Mendez M, Nassif H, Ogilvie D, Peiró R, Pérez K, Rabl A, Ragettli M, et al. Improving health through policies that promote active travel: a review of evidence to support integrated health impact assessment. Environ Int. 2011;37:766–777. doi: 10.1016/j.envint.2011.02.003.
    1. Woodcock J, Givoni M, Morgan AS. Health impact modelling of active travel visions for england and wales using anIntegrated Transport and Health Impact Modelling Tool (ITHIM) PLoS One. 2013;8:e51462. doi: 10.1371/journal.pone.0051462.
    1. Kahlmeier S, Racioppi F, Cavill N, Rutter H, Oja P. “Health in all policies” in practice: guidance and tools to quantifying the health effects of cycling and walking. J Phys Act Health. 2010;7(Suppl 1):S120–S125.
    1. Scarborough P, Nnoaham KE, Clarke D, Capewell S, Rayner M. Modelling the impact of a healthy diet on cardiovascular disease and cancer mortality. J Epidemiol Commun Health. 2012;66:420–426. doi: 10.1136/jech.2010.114520.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj