Population-level Interventions Based on Walking and Cycling as a Means to Increase Physical Activity

4.1 Potential benefits of walking and cycling for health

Increasing activity levels by walking or cycling will bring substantial benefits for overall health and prevent or reduce the risk of chronic diseases. However, despite the fact that the level of physiological intensity associated with cycling is usually higher than that of walking, they are addressed together in most studies as a form of transportation (Bouchard et al., 2012). Therefore, it may not be reasonable to extract the health benefits of cycling. There is strong evidence for health benefits, including (Bouchard et al., 2012; Reinhardt-Rutland, 2011; Oja et al., 2011; Goodman et al., 2014; Gao et al., 2017):

• – Reducing the risk of coronary heart disease, colon and breast cancer, obesity, stroke and type 2 diabetes.

• – Lower risk of early death, high blood pressure, adverse blood lipid profiles, metabolic syndrome.

• – Maintaining a healthy musculoskeletal system.

• – Promoting mental wellbeing.

• – Regular walking has been associated with a lower risk of hip fracture in women.

• – Prevention of falls, reducing depression.

• – Improves general health and leads to fewer days of ill health each year.

• – Decreases the rate of premature mortality.

4.2 An increase in walking or cycling can also help environment

• – Decreases car travel, resulting in prevention of air pollution, carbon dioxide emissions and travel congestion, thereby tackling climate change.

• – Decreases greenhouse gas emissions.

• – Decreases road risk and noise.

• – Helps people to come out from different age groups and interact with each other to build strong relationships and use public spaces.

• – In congested areas, cyclists and pedestrians breathe in less fumes from cars.

• – Often saves time to get around in towns and cities more easily.

• – Fewer cars on the road and more cyclists and pedestrians mean safer roads.

• – Provides an opportunity for everyone to take part in and enjoy the outdoor environment, particularly for people with disabilities (Reinhardt-Rutland, 2011).

4.3 Economics benefits of cycling and walking

• – Reducing the number of trips made by car, thereby reducing congestion and freeing up road space for essential motor vehicle trips.

• – Reducing costs for construction and maintenance of roads.

• – Reducing costs for provision of parking facilities (Bouchard et al., 2012).

4.4 Potential negative aspects of cycling and walking

There are substantial benefits derived from cycling and walking, but they may also have some negative aspects, especially cycling. Walking for exercise carries a particularly low risk of injury, even for the elderly (Bouchard et al., 2012). The most common risks from cycling are injuries and the consequences of exposure to air pollution. A recent study showed that the greatest risk of travelling by bicycle is a higher incidence of fatality than travelling by car, and this increases according to the distance of the trip. In the USA, the reported fatality and injury rates per bike trip were about 2.3, 1.8 times higher respectively than those for car trips. Although cycling has been shown to reduce air pollution, there is evidence that cyclists may face exposure to air pollution if they travel on busy routes due to uptake of fine and ultrafine particulate matter (Teschke et al., 2012). Furthermore, another study showed that the rate of death caused by collisions among cyclists of all ages except 15–30 old is much higher than that of car drivers (de Hartog et al., 2010).

5.1 Facilitators

Although the substantial benefits of walking were mentioned, this was not adequate to motivate people to walk outside of a group. Social interaction and participation in walking groups were an especially important side of walking interventions for older adults, women and families. Family based interventions play a vital role in encouraging the enjoyment of walking in children and families (Johnson et al., 2012). Organized walking routes can also be motivating. The use of self-monitoring and pedometers may be motivating in terms of the element of competition in some individuals or groups (Johnson et al., 2012).

Support from peers and family, or using incentives, could also maintain interest in walking. There is a special requirement to discover ways of merging walking into daily life, especially for younger groups that have family and work commitments. Other barriers involve physical and psychological limitations. Overcoming barriers can include reconsidering time management and engaging the family, in addition to having a positive attitude to the activity (Johnson et al., 2012).

Providing sufficient facilities such as safe storage, showers, and changing services at schools and workplaces could facilitate in the engagement in cycling interventions. This is more important because cycling often involves many journeys for some distance. For young people a fun aspect is needed, as well as a social element and overcoming image concerns (Johnson et al., 2012).

5.2 Barriers

Outside of organised interventions, lack of time and lack of belief in walking as a form of exercise, for younger people and men, often deter walking for travel or for leisure. For larger adults, safety issues, concerns associated with external environment, and post-retirement as part of the social aspect of walking are also essential. These can be achieved by indoor walking as a safe way for walking. People who live in deprived areas are more likely to be de-motivated from walking as a result of neglected local environments. Therefore, individuals perhaps get out of the habit of walking; thus, stimulators are essential to change this situation. However, women in these areas are often compelled to walk with small children for long distances (Johnson et al., 2012).

For schoolchildren and their parents, walking or cycling to school could be positive, which means that this is perceived to have health and social benefits. At the same time, this could be negative due to the possibility of an collision on a busy road, as well as dangers from older children and strangers. The distance required to travel, as well as the absence of convenience when children need to attend school at the same time, can also hinder active travel. Fear of stolen bicycles, and having to carry heavy bags are also barriers. School based strategies could fix barriers by encouraging and developing awareness as well as supporting active travel (Johnson et al., 2012).

Shared trails for walking and cycling are valuable for urging individuals to walk and cycle in a traffic free area. However, the concerns of walkers should be taken into account where cyclists in these environments cycle for sport. Moreover, there are perceived risks of crime and attack when trails are quiet and some may feel threatened.

There have also been reported health benefits of cycling to work for both individuals and the environment in terms of reduced traffic problems. Despite this, many people who have cycles do not use them due to lack of confidence, especially with barriers such as hilly terrain and/or absence of suitable cycle lanes. This is also due partly to the negative views of cyclists, that they are competing for space against vehicles and are often marginalised. Cyclists also want to store their bicycles securely and have a place to take showers and change clothes at work. Women and ethnic groups are less likely to be cycling commuters, although this is beginning in order to be more common among some female groups (Johnson et al., 2012).

The majority of studies were conducted within the UK. Walking and cycling facilities differ according to geographical locations and may be restricted by terrain. Furthermore, deprived areas may be less likely to negotiate and on foot or by cycle. The target population is also important to consider in interventions. Results indicate that barriers to walking and cycling vary across age, gender and ethnicity (Johnson et al., 2012).

6.1 Public health policy in the UK and obesity prevention

In England, the trend of overweight or obesity has increased over the past decades, with 63% of adults and 30% of children aged between 2 and 15 obese or overweight. Although there are few signs of decline, the UK ranks as one of the most obese areas in Europe. The consequence of this issue is associated with serious diseases and threats to health and wellbeing. People who are obese have a greater risk of type 2 diabetes, heart disease and certain cancers, as well as difficulties with finding a job, self-esteem and mental health. Additionally, tackling obesity costs the NHS more than £5bn each year and has a negative influence on economic development (Lives, 2011). Therefore, this calls for action on obesity in the UK. The National Institute for Health and Clinical Excellence (NICE) has published the first national guidance on obesity in adults and children, in order to reduce the prevalence of obesity and related diseases, increase the interventions to prevent overweight and obesity, and improve primary care to adults and children with obesity. As NICE mentioned, it is unlikely that preventing and managing overweight and obesity can be addressed via only primary care. Even though there is no simple action to tackle it, sharing similar approaches could be the most effective strategies for preventing obesity (NICE, 2006). To tackle weight gain properly, a life course approach should be adopted – from pre-conception through pregnancy, infancy, early years, childhood, adolescence and teenage years, and through to adulthood and preparing for older age. Indeed, there are opportunities and challenges at every stage of life that need appropriate action to avoid leading to excess weight and to ensuring that health inequalities are addressed. The government has set out two national ambitions to achieve in Healthy Lives, Healthy People: A call to action on obesity in England in 2011: based on The Foresight report, published in 2007, The essential steps need to be undertaken by the Government and partners and may result in reducing the levels of obesity and overweight in children and adults by 2020 (Lives, 2011). The management of overweight and obesity should be a priority for all, due to the substantial benefits of maintaining a healthy weight.

Managers and health professionals in all primary care settings should ensure that preventing and managing obesity is a priority, at both strategic and delivery levels. Dedicated resources should be allocated for action (NICE, 2006).

6.2 Local authorities and partners

Local authorities and local partners should work together in preparing voluntary organisations to ensure security and safety for those who work in and plan physical activity, addressing concerns about safety, crime and inclusion, by (NICE, 2006).

• – providing facilities such as cycling and walking routes, cycle parking, safe play areas and area maps;

• – Making streets safer and cleaner via traffic calming, pedestrian crossings, lighting, walking schemes and cycle routes; and

• – Ensuring buildings and spaces are designed to encourage people to be more physically active.

6.3 Early years settings

Nurseries and childcare facilities should:

• – reduce sedentary activities and provide regular opportunities for enjoyable active play and physical activity sessions; and

• – provide guidance on food procurement and healthy catering (NICE, 2006).

6.4 School

The head of school and governors, in collaboration with parents and pupils, should be aware of the school environment, and to what extent school policies assist children and young people to be a healthy weight, eat a healthy diet and be physically active, in accordance with existing guidance. This includes policies for building recreational spaces, catering, school travel plans and provision for cycling, as well as policies relating to the National Healthy Schools Programme and extended schools (NICE, 2006). Obesity policy is ‘weighed down’ by its complexity and the existence of many theories about the causes and drivers, which are grounded in a number of disciplines including physiology, economics, psychology and sociology. Each of these theories presents different options for action by policy makers and leads to confusion, caution and, possibly, inaction. (see Table 3) Adapted from (Musingarimi, 2009).