We have clear epidemiological evidence of the strong protective effect that regular exercise has on decreasing the incidence of cardiovascular disease, diabetes and some cancers. Although it is challenging to get individual patients to exercise more, increasing the general population’s activity level would have significant impact from a public health standpoint. Active travel (walking or cycling) is another way to incorporate physical activity into daily life. Many studies have shown the relationship of active commuting and a decrease in cardiovascular disease while more recent studies have evaluated the association of commuting and the decrease in the risk of developing Type II diabetes.
One of the first studies looking at diabetes was a large population based study by Rasmussen et al which examined the associations between recreational and commuter cycling and the risk of type 2 diabetes (T2D) in Danish adults, while taking into account personal and lifestyle habits. They followed over 50,000 adults between 50-65 years old who were initially free of T2D, for the next five years. Over that time, 7000 people in the study developed T2D. The study found that both commuters and recreational cyclists were associated with a lower risk of developing T2D. Interestingly, a late-in-life initiation of cycling also lowered the risk of T2D. These findings are important as the percentage of patients with diabetes continues to increase and health care looks at ways to both treat and prevent this disease.
A commentary by Panter and Ogilvie also noted the importance of the finding that those who took up cycling after the study began benefited and had a lower risk of developing T2D. They suggest that it is not too late to gain the benefits of taking up cycling, even in this age group. However, they also point out that while cycling is clearly successful in Denmark and the Netherlands, Panter and Ogilvie reference a similar study by Sahlqvist et al on adults in England which reported a much smaller quantity of cycling in adults. They ask the question of how other countries might increase the amount of cycling to attain health benefits as seen in the Dutch study.
As we have mentioned here before, the physical environment is an essential part of the planning to promote increasing active travel, both walking and cycling. Is the environment safe, available, and convenient for walking and cycling? Those factors directly correlate to the amount of recreational and/or commuting, both walking and cycling. Panter and Ogilvie champion the idea of how improving the accessibility and safety of our walking and cycling environments will improve public health. This is described as an “upstream” or primordial intervention which will lead to disease prevention.
As promoters of the benefits of physical activity and cycling, we should educate our patients, family and friends on the health benefits of exercise. In addition, we should educate our local officials on the benefits of a safe and convenient environment for walking and cycling for our community. Safe walking and cycling access should be a priority of local and national governments. This will benefit us all.
Rasmussen MG, Grøntved A, Blond K, Overvad K, Tjønneland A, Jensen MK, et al. (2016) Associations between Recreational and Commuter Cycling, Changes in Cycling, and Type 2 Diabetes Risk: A Cohort Study of Danish Men and Women. PLoS Med 13(7): e1002076. https://doi.org/10.1371/journal.pmed.1002076
Panter J, Ogilvie D (2016) Cycling and Diabetes Prevention: Practice-Based Evidence for Public Health Action. PLoS Med 13(7): e1002077. https://doi.org/10.13