In this month's edition of the Medical Journal of Australia...


http://www.mja.com.au/public/issues/190_07_060409/bau10159_fm.html

Editorials

Cycling and health: an opportunity for positive change?
Adrian E Bauman and Chris Rissel
MJA 2009; 190 (7): 347-348

Cycling is an affordable, convenient and achievable form of physical tion in
Australia, is increasingly being used as a means of transport. As a form of
regular physical activity, it confers substantial health benefits that are
accessible to people of all ages.1 The epidemiological evidence is growing
that cycling has health-enhancing effects, independent of other leisure-time
physical activity. In a large Danish cohort followed up for 15 years, a 39%
reduction in all-cause mortality was observed in those who cycled to work,
and this was independent of participation in sport and other physical
activity.2 Other large population studies have shown the effects of
commuting by bicycle on reducing mortality and cardiovascular risk among
Finnish women,3 and similar risk reductions for Chinese adults in Shanghai.4
Ecological observations have noted lower rates of obesity in regions with
high rates of cycling.5

The article by Sikic and colleagues in this issue of the Journal describes
cycling-related injuries in Victoria, and shows a 5-year increase in
emergency department presentations, hospital admissions and major trauma
among cyclists.6 This increase is of concern, and the authors reasonably
call for preventive approaches. For many years, cycling advocates have
called for a greater investment in cycling infrastructure, and studies
overseas have demonstrated the potential for this investment to reduce
injury outcomes. For example, cycling injuries are between eight and 30
times more common in the United States compared with the Netherlands or
Germany.7 Similarly, rates of cycling-related deaths are much lower in
Western Europe and declined by 60% between 1975 and 2000, compared with a
much smaller decline in the US.5,8

Importantly, as Sikic et al acknowledge, their analyses do not adjust for
the population denominator.6 More people are cycling now than 5 years ago ‹
there are about a million new bicycles sold in Australia each year, and more
people are cycling to work, with the greatest increases occurring in
Victoria where the study by Sikic et al was conducted.1 Although there is a
positive correlation between numbers of cyclists and injuries, the
association is not simply linear. Known as the ³safety in numbers²
phenomenon, when more people cycle, collectively it becomes safer, and the
injury rate per kilometre cycled decreases.9

Sikic et al suggest that people who ride bicycles should be registered,6 but
requiring registration for all cyclists would not provide an accurate
measure of cycling ³exposure², such as time spent cycling and distance
travelled. It would cost more to administer than it would recoup, and it
would likely act as a significant deterrent to casual or occasional cycling.
In particular, cyclist registration would make it more difficult to
encourage populations to shift to trial spontaneous recreational cycling.
Research to calculate cycling times and distances as a population
denominator for risk assessment should be a priority.

In the Victorian data reported,6 most cycling injuries occurred on streets
or highways where bicycles share the road with cars. Even though the
absolute risk is still low, these injuries are mostly preventable. Making
cycling safer requires better infrastructure and facilities for cycling,
especially the provision of separated bicycle paths and cycle lanes.1,7 At
the same time, driver attitudes and behaviour must be addressed. Strategies
include enforcing lower driving speeds, traffic calming, parking
restrictions, and community support for a safer road environment. Further,
integrating cycling into public transport schedules and systems, including
simple measures such as bicycle parking at train stations, would make
cycling easier and give cyclists more options for safe commuting. In London,
after the introduction of a ³congestion tax² restricting car use into the
city centre, combined with new bicycle lanes, cycling education and better
public transport, many more cycling trips were made, and yet the overall
number of cyclists injured actually declined between 2001 and 2004.10

It is generally understood what needs to be done to increase cycling
participation levels. Better urban design, such as higher density
development, mixing residential and commercial land use, and shorter trip
distances, will facilitate more cycling.1 Other strategies to encourage
cycling include behaviour change programs such as TravelSmart, Ride to Work,
and Ride to School initiatives, public bicycle events to encourage
infrequent and novice riders to cycle in a supportive social environment,
and bicycle education programs for both children and adults.1

A dominant car culture and concerns about safety are the main reasons people
give for not cycling in Australia.11 Mass media marketing campaigns are
needed to help legitimise the value of cycling as transport, and advise
drivers about relevant cycling road rules.

Despite the perceived risks of cycling, the absolute magnitude of the risk
is low, and the benefit-to-risk ratio is overwhelmingly positive; for
chronic disease prevention, obesity reduction and mental health, the
benefits are substantial.12 Cycling provides an affordable, convenient and
achievable form of physical activity for all Australians, including children
and youth, through to older adults with chronic conditions. As a physical
activity, it also meets transport and traffic management needs, and is
eco-friendly.

Much more needs to be done in Australia to provide an environment that
encourages people to cycle safely. This means giving greater funding and
community priority to allocating road space for cycling. It also means
physicians recommending that suitable patients consider cycling, and
supporting efforts to improve the urban environment for cycling.12
Author detailsAdrian E Bauman, PhD, FAFPHM, Professor of Public HealthChris
Rissel, PhD, Associate Professor of Public Health

School of Public Health, University of Sydney, Sydney, NSW.

Correspondence: adrianbAThealth.usyd.edu.au
References

1. Bauman A, Rissel C, Garrard J, et al. Cycling. Getting Australia
moving. Barriers, facilitators and interventions to get more Australians
physically active through cycling. Melbourne. Cycling Promotion Fund, 2008.
http://www.cyclingpromotion.com.au/images/stories/downloads/CPFHlthRpr08V3pr
f1.pdf (accessed Aug 2008).
2. 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. <PubMed>
3. Hu G, Jousilahti P, Borodulin K, et al. Occupational, commuting and
leisure-time physical activity in relation to coronary heart disease among
middle-aged Finnish men and women. Atherosclerosis 2007; 194: 490-497.
<PubMed>
4. Matthews CE, Jurj AL, Shu XO, et al. Influence of exercise, walking,
cycling, and overall nonexercise physical activity on mortality in Chinese
women. Am J Epidemiol 2007; 165: 1343-1350. <PubMed>
5. Bassett DR Jr, Pucher J, Buehler R, et al. Walking, cycling, and
obesity rates in Europe, North America, and Australia. J Phys Act Health
2008; 5: 795-814. <PubMed>
6. Sikic M, Mikocka-Walus AA, Gabbe BJ, et al. Bicycling injuries and
mortality in Victoria, 2001­2006. Med J Aust 2009; 190: 354-348. <eMJA full
text>
7. Pucher J, Buehler R. Making cycling irresistible: lessons from The
Netherlands, Denmark and Germany. Transport Reviews 2008; 28 (4): 495­528.
8. Wardlaw MJ. Three lessons for a better cycling future. BMJ 2000; 321:
1582-1585. <PubMed>
9. Jacobsen PL. Safety in numbers: more walkers and bicyclists, safer
walking and bicycling. Inj Prev 2003; 9: 205-209. <PubMed>
10. Central London congestion charging. Impacts monitoring, 5th annual
report, July 2007. Transport for London, 2007.
http://www.tfl.gov.uk/assets/downloads/fifth-annual-impacts-monitoring-repor
t-2007-07-07.pdf (accessed Feb 2009).
11. Daley M, Rissel C, Lloyd B. All dressed up and nowhere to go? A
qualitative research study of the barriers and enablers to cycling in inner
Sydney. Road and Transport Research 2007; 16 (4): 42-52.
12. Hillman M. Cycling and the promotion of health. Policy Studies 1993;
14: 49-58.

(Received 17 Feb 2009, accepted 17 Feb 2009)

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