Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study

I biked to work for 27 years prior to my stroke, 4 miles each way 9 months out of the year.
Still had a stroke, that was not enough to keep my arteries clear. I'm sure that my cardiovascular fitness was what allowed me to survive my stroke.
http://www.bmj.com/content/357/bmj.j1456
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1456 (Published 19 April 2017) Cite this as: BMJ 2017;357:j1456

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1. Carlos A Celis-Morales, research associate1,
2. Donald M Lyall, research associate2,
3. Paul Welsh, senior lecturer1,
4. Jana Anderson, research associate2,
5. Lewis Steell, postgraduate student1,
6. Yibing Guo, postgraduate student1,
7. Reno Maldonado, postgraduate student1,
8. Daniel F Mackay, reader2,
9. Jill P Pell, professor2,
10. Naveed Sattar, professor1,
11. Jason M R Gill, reader1

Author affiliations

1. Correspondence to: J M R Gill jason.gill@glasgow.ac.uk

• Accepted 16 March 2017

Abstract

Objective To investigate the association between active commuting and incident cardiovascular disease (CVD), cancer, and all cause mortality.

Design Prospective population based study.

Setting UK Biobank.

Participants 263 450 participants (106 674 (52%) women; mean age 52.6), recruited from 22 sites across the UK. The exposure variable was the mode of transport used (walking, cycling, mixed mode v non-active (car or public transport)) to commute to and from work on a typical day.

Main outcome measures Incident (fatal and non-fatal) CVD and cancer, and deaths from CVD, cancer, or any causes.

Results 2430 participants died (496 were related to CVD and 1126 to cancer) over a median of 5.0 years (interquartile range 4.3-5.5) follow-up. There were 3748 cancer and 1110 CVD events. In maximally adjusted models, commuting by cycle and by mixed mode including cycling were associated with lower risk of all cause mortality (cycling hazard ratio 0.59, 95% confidence interval 0.42 to 0.83, P=0.002; mixed mode cycling 0.76, 0.58 to 1.00, P<0.05), cancer incidence (cycling 0.55, 0.44 to 0.69, P<0.001; mixed mode cycling 0.64, 0.45 to 0.91, P=0.01), and cancer mortality (cycling 0.60, 0.40 to 0.90, P=0.01; mixed mode cycling 0.68, 0.57 to 0.81, P<0.001). Commuting by cycling and walking were associated with a lower risk of CVD incidence (cycling 0.54, 0.33 to 0.88, P=0.01; walking 0.73, 0.54 to 0.99, P=0.04) and CVD mortality (cycling 0.48, 0.25 to 0.92, P=0.03; walking 0.64, 0.45 to 0.91, P=0.01). No statistically significant associations were observed for walking commuting and all cause mortality or cancer outcomes. Mixed mode commuting including walking was not noticeably associated with any of the measured outcomes.

Conclusions Cycle commuting was associated with a lower risk of CVD, cancer, and all cause mortality. Walking commuting was associated with a lower risk of CVD independent of major measured confounding factors. Initiatives to encourage and support active commuting could reduce risk of death and the burden of important chronic conditions.