Impact of Physical Activity on Obesity and Health

Overview:

The Journal of the American Medical Association reports that in 2003-2004, 17.1% of US children and adolescents were overweight, with the rates continuing to increase. These children are at an increased risk for developing health problems such as heart disease, diabetes, cancer, and hypertension. Activity levels for many children have declined because of a built environment that is unsafe for walking and bicycling, the low percentage of children who take physical education in school, and the popularity of sedentary leisure-time activities.

Using Safe Routes to School as way to create environment, policy, and behavioral changes is one way to increase physical activity and promote the health of both children and adults. This section highlights academic literature that speaks to the overall health benefits of physical activity, specifically walking to and from school, as well as the impact that increased physical activity opportunities have on current obesity and health trends in the US. The implications of this research are valuable as they guide policy-makers and practitioners to implement effective strategies for improving physical activity opportunities and overall health.

Research Highlights:

  • Walking and bicycling are far more common in European countries than in the United States, Australia, and Canada, where active transportation is inversely related to obesity (Bassett, et al., 2008).
  • Research demonstrates that children who walk or bicycle to school have higher daily levels of physical activity and better cardiovascular fitness than do children who do not actively commute to school (Davison, et al., 2008).
  • Two small lifestyle changes in diet (to eliminate 100 kcal/day) and physical activity (to walk an additional 2000 steps/day) could be useful for addressing childhood obesity by preventing excess weight gain in families (Hill, et al., 2007)
  • Consistent behavioral changes averaging 110 to 165 kcal/day may be sufficient to counterbalance the energy gap resulting in excessive weight gain (Wang, et al., 2006).
  • In one study, researchers report that 100% of the students that walk both to and from school accumulate an average of 60 or more minutes of MVPA on weekdays (Alexander, et al., 2005)
  • One study suggests that a 5% increase in neighborhood walkability is associated with 32.1% more minutes devoted to physically active travel and about one-quarter point lower BMI (0.228) (Frank, et al., 2006).
  • Also available is our short fact sheet on the research linking Safe Routes to School to increases in physical activity.

See 2011 Archived Articles
See 2010 Archived Articles
See 2009 Archived Articles
See 2008 and Earlier Archived Articles

Academic Research Articles and Findings:

Annual Motor Vehicle Travel Distance and Incident Obesity: A Prospective Cohort Study   

  • Obesity has become a major health and economic problem with increasing prevalence. Unfortunately, no country can act as public health exemplar for reduction of obesity. The fınding of associations between sedentary behaviors and obesity, independent of the level of physical activity, may offer new insights.
  • This study was a prospective evaluation of the relationship between annual distance traveled by motor vehicles and subsequent incidence of overweight or obesity in a Mediterranean cohort.
  • Data from a prospective cohort study (Seguimiento Universidad de Navarra Project, 1999 –2011) with a permanently open recruitment were analyzed. Self-administered questionnaires are mailed every 2 years, collecting information on dietary habits, lifestyle, risk factors, and medical conditions. Annual kilometers traveled by motor vehicles were grouped into three categories (<10,000; >10,000 to <20,000; and >20,000). Multivariate Cox regression analyses were used to assess the risk of overweight or obesity across categories of distance traveled annually.
  • In all, 9160 participants (58% female, average age 37 years) were followed up for a median of 6.4 years. During 39,175 person-years of follow-up, 1044 (15.3%) normal-weight participants at baseline became overweight or obese. Among participants who did not change their category of annual kilometers traveled during follow-up, an increased risk of overweight or obesity in the highest category of annual kilometers traveled was observed, compared with the lowest one (hazard ratio = 1.4, 95% CI=1.1, 1.7).
  • This study suggests a potential pernicious effect of the use of motor vehicles on the risk of overweight or obesity.

Nunez-Cordoba JM, Bes-Rastrallo M, Pollack KM, Segui-Gomez M, Beunza JJ, Syon-Orea C, Martinez-Gonzales MA. (2013).Annual motor vehicle travel distance and incident obesity: a prospective cohort study. American Journal of Preventive Medicine. 44(3), 254-259.

"Leveraging the Health Benefits of Active Transportation: Creating an Actionable Agenda for Transportation Professionals" (2012)

  • The authors are researchers at the University of North Carolina Highway Safety Research Center, Chapel Hil, North Carolina.  They provide a review of the health benefits of active transportation as a call to transportation planners to include health in the agenda for transportation planning, funding, and engineering considerations. 
  • They list many useful active transportation references (from TRB, Sustainable Communities Partnership, Federal Highway Administration, APHA, and the World Health Organization) and comment on the increasing dialog between the transportation and public health communities, highlighted by the formation of a new Health and Transportation Subcommittee of the TRB which will address active transportation and interface with other key groups such as the American Public Health Association’s Transportation, Health, and Equity Program.
  • The Center for Disease Control and Prevention (CDC) convened an expert panel: Measuring Walking and Cycling for Transportation in Feb 2012.  This meeting included representatives from state, local, and federal transportation agencies, and academia, including experts in public health, planning, environmental science, engineering and transportation.  The report of this meeting will be made availabe to the public.
  • Issues covered in the article overview include: benefits of walking and biking, addressing barriers, environments and facilities, connecting with transit, partnering with other agencies, and collaborative endeavors.

Sandt L, Pullen-Seufert N, Lejeunesse S Gelinne D. (2012). Leveraging the Health Benefits of Active Transportation:  Creating an Actionable Agenda for Transportation Professionals. TR News, May/June(280), 18-25.

“Effects of Locomotor Skill Program on Minority Preschoolers’ Physical Activity Levels” (2012)

  • This pilot study examined the effects of a teacher-taught, locomotor skill (LMS)-based physical activity (PA) program on the LMS and PA levels of minority preschooler-aged children.
  • Eight low-socioeconomic status preschool classrooms were randomized into LMS-PA (LMS-oriented lesson plans) or control group (supervised free playtime). Interventions were delivered for 30 min/day, five days/week for six months. Changes in PA (accelerometer) and LMS variables were assessed with MANCOVA.
  • LMS-PA group exhibited a significant reduction in during-preschool and total daily percent time spent in sedentary activity. LMS-PA group also exhibited significant improvement in leaping skills. No other, significant changes were observed. The implementation of a teacher-taught, LMS-based PA program could potentially improve LMS and reduce sedentary time of minority preschoolers.

Alhassan, S., O. Nwaokelemeh, et al. (2012). "Effects of locomotor skill program on minority preschoolers' physical activity levels." Pediatric Exercise Science 24(3): 435-449.

"Unwalkable Neighborhoods, Poverty, and the Risk of Diabetes Among Recent Immigrants to Canada Compared With Long-Term Residents” (2012)

  • This study was designed to examine whether residents living in neighborhoods that are less conducive to walking or other physical activities are more likely to develop diabetes and, if so, whether recent immigrants are particularly susceptible to such effects.
  • The authors conducted a population-based, retrospective cohort study to assess the impact of neighborhood walkability on diabetes incidence among recent immigrants (n = 214,882) relative to long-term residents (n = 1,024,380). Adults aged 30–64 years who were free of diabetes and living in Toronto, Canada, on March 31, 2005 were identified from administrative health databases and followed until March 31, 2010 for the development of diabetes, using a validated algorithm. Neighborhood characteristics, including walkability and income, were derived from the Canadian Census and other sources.
  • Neighborhood walkability was a strong predictor of diabetes incidence independent of age and area income, particularly among recent. Coexisting poverty accentuated these effects; diabetes incidence varied threefold between recent immigrants living in low-income/low walkability areas (16.2 per 1,000) and those living in high-income/high walkability areas (5.1 per 1,000).
  • Neighborhood walkability was inversely associated with the development of diabetes in our setting, particularly among recent immigrants living in low-income areas.

Booth, G. L., M. I. Creatore, et al. (2012). Unwalkable Neighborhoods, Poverty, and the Risk of Diabetes Among Recent Immigrants to Canada Compared With Long-Term Residents. Diabetes Care.

“Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association” (2012)

  • Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established.
  • In this paper, the authors systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use.
  • Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts.
  • Several specific population interventions were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. School-related interventions included increased availability and types of school playground spaces and equipment, increased number of PE classes, and revised PE curricula to increase time in at least moderate activity.
  • This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

Mozaffarian, D., A. Afshin, et al. (2012). Population Approaches to Improve Diet, Physical Activity, and Smoking Habits A Scientific Statement From the American Heart Association. Circulation 126(12):1514-1563.

“Does The Effect of a School Recess Intervention on Physical Activity Vary by Gender Or Race? Results from the Ready for Recess Pilot Study” (2012)

  • The recess environment in schools has been identified as an integral part of school-based programs to enhance physical activity (PA). The purpose of this study was to report pilot findings on the extent to which the Ready for Recess intervention was associated with a different amount of increase in moderate to vigorous PA (MPVA) during recess and the rest of the school day between girls and boys, and between nonwhites and whites.
  • The Ready for Recess intervention modified the recess environment of schools by providing staff training and recreational equipment. The MPVA levels of 3rd, 4th, and 5th grade students (n = 93) at 2 schools were measured pre- and post-intervention using ActiGraph accelerometers. Multiple regression models with robust variance were utilized to test for the interaction of intervention with gender and race/ethnicity.
  • The intervention was associated with an adjusted increase of 4.7 minutes (P <.001) in moderate/vigorous PA during recess. There was no evidence that this effect varied by gender (P = .944) or race (P = .731). The intervention was also associated with an adjusted increase of 29.6 minutes (P < .001) in moderate/vigorous PA during rest of the school day. While this effect did not vary by gender, there was some evidence (P = .034) that nonwhites benefited more from the intervention than whites.
  • Simple strategies such as staff training and recreational equipment may be an effective way to increase PA in children (despite gender or ethnicity) during recess time as well as during the rest of the school day.

Siahpush, M., J. L. Huberty, et al. (2012). Does the Effect of a School Recess Intervention on Physical Activity Vary by Gender or Race? Results From the Ready for Recess Pilot Study. Journal of Public Health Management and Practice 18(5): 416-422.

“The Healthy Afterschool Activity and Nutrition Documentation Instrument” (2012)

  • Policies call on afterschool programs to improve the physical activity and nutrition habits of youth attending. No tool exists to assess the extent to which the afterschool program environment meets physical activity and nutrition policies.
  • This paper seeks to describe the development of the Healthy Afterschool Activity and Nutrition Documentation (HAAND) instrument, which consists of two subscales: Healthy Afterschool Program Index for Physical Activity (HAPI-PA) and the HAPI-Nutrition (HAPI-N).
  • Thirty-nine afterschool programs took part in the HAAND evaluation during fall/spring 2010-2011. Inter-rater reliability data were collected at 20 afterschool programs during a single site visit via direct observation, personal interview, and written document review. Validity of the HAPI-PA was established by comparing HAPI-PA scores to pedometer steps collected in a subsample of 934 children attending 25 of the afterschool programs. Validity of the HAPI-N scores was compared against the mean number of times/week that fruits and vegetables (FV) and whole grains were served in the program.
  • Data were analyzed in June/July 2011. Inter-rater percent agreement was 85%-100% across all items. Increased pedometer steps were associated with the presence of a written policy related to physical activity, amount/quality of staff training, use of a physical activity curriculum, and offering activities that appeal to both genders. Higher servings of FV and whole grains per week were associated with the presence of a written policy regarding the nutritional quality of snacks.
  • The HAAND instrument is a reliable and valid measurement tool that can be used to assess the physical activity and nutritional environment of afterschool programs.

Ajja, R., Beets, M.W., Huberty, J., Kaczynski, A.T., Ward, D.S. (2012). The Healthy Afterschool Activity and Nutrition Documentation Instrument. American Journal of Preventive Medicine 43(3), 263-271.

“Philadelphia School District Reports Progress in Reducing Childhood Obesity Rates” (2012)

  • Epidemic increases in obesity negatively affect the health of US children, individually and at the population level. Although surveillance of childhood obesity at the local level is challenging, height and weight data routinely collected by school districts are valuable and often underused public health resources.
  • The authors analyzed data from the School District of Philadelphia for 4 school years (2006–2007 through 2009–2010) to assess the prevalence of and trends in obesity and severe obesity among public school children.
  • The prevalence of obesity decreased from 21.5% in 2006–2007 to 20.5% in 2009–2010, and the prevalence of severe obesity decreased from 8.5% to 7.9%. Both obesity and severe obesity were more common among students in grades 6 through 8 than among children in lower grades or among high school students. Hispanic boys and African American girls had the highest prevalence of obesity and severe obesity; Asian girls had much lower rates of obesity and severe obesity than any other group. Although obesity and severe obesity declined during the 4-year period in almost all demographic groups, the decreases were generally smaller in the groups with the highest prevalence, including high school students, Hispanic males, and African American females.
  • Although these data suggest that the epidemic of childhood obesity may have begun to recede in Philadelphia, unacceptably high rates of obesity and severe obesity continue to threaten the health and futures of many school children.

Robbins JM, Mallya G, Polansky M, Schwarz DF. (2012). Prevalence, Disparities, and Trends in Obesity and Severe Obesity Among Students in the Philadelphia, Pennsylvania, School District, 2006–2010. Preventing Chronic Disease 9:120118.

“Is There an Association Between Gasoline Prices and Physical Activity? Evidence from American Time Use Data” (2012)

  • A recent paper in the economics literature finds an inverse relationship between gasoline prices and obesity risk—suggesting that increased gasoline prices via higher gasoline taxes may have the effect of reducing obesity prevalence. This study builds upon that paper.
  • This study utilizes cross-sectional time series data from the American Time Use Survey (ATUS) over 2003–2008, utilizes the increases that occurred in gasoline prices in this period due to Hurricane Katrina and to the global spike in gasoline prices as a “natural experiment,” and explores how time spent by Americans on different forms of physical activity is associated with gasoline price levels.
  • Economic theory suggests that higher gasoline prices may alter individual behavior both via a “substitution effect” whereby people seek alternatives to motorized transportation, and an “income effect” whereby the effect of higher gasoline prices on the disposable family budget leads people to make various adjustments to what they spend money on. Thus, ultimately, the relationship between gasoline prices and physical activity must be empirically determined.
  • Results from multivariate regression models with state and time fixed effects indicate that higher gasoline prices are associated with an overall increase of physical activity that is at least moderately energy intensive. The increases are most pronounced in periods where gasoline prices fluctuate more sharply and unexpectedly. These results appear robust to a number of model specifications. One of the major components of this increase appears to be an increase in housework that is at least moderately energy intensive—such as interior and exterior cleaning, garden, and yard work.
  • The results from this study tentatively suggest that there is an income effect of higher gasoline prices, or a possible increase in prices of such services when gasoline prices increase. However, the increases in physical activity associated with increased gasoline prices are weaker among minorities and low socioeconomic status (SES) individuals.
  • Hence, while a policy that increases gasoline prices via raised gasoline taxes may have benefits in terms of increasing overall physical activity levels in the United States, these benefits may not accrue to low SES individuals to the same extent as to their higher SES counterparts. This suggests that if increasing physical activity is the primary goal, then it may be more efficient to use a tax that can exert an income effect on mid-to-high SES households, such as a targeted income tax. On the other hand, if gasoline taxes are imposed to address other negative externalities of gasoline use, then these taxes may have the added benefit of increasing physical activity at least among some segments of U.S. society.

Sen, B. (2012). Is There an Association Between Gasoline Prices and Physical Activity? Evidence from American Time Use Data. Journal of Policy Analysis and Management 31(2): 338-366.

“Walking to School in Japan and Childhood Obesity Prevention: New Lessons from an Old Policy” (2012)

  • The study analyzed the Japan’s walking-to-school practice implemented in 1953 for lessons useful to other cities and countries.
  • The authors reviewed background documents (gray literature, online government information, local policy documents, and regulations) for existing regulations in several urban settings. We also contacted boards of education.
  • Each municipality has a board of education in charge of public schools, which considers the geography, climate, and the transport situation to determine the method of commuting. Because there is high availability of schools in urban areas and most are located within walking range of the children’s homes, walking is the most common method. There are different safety initiatives depending on the district’s characteristics. Parents, school staff, and local volunteers are involved in supervision.
  • The walk-to-school practice has helped combat childhood obesity by providing regular physical activity. Recommendations to cities promoting walking to school are (1) base interventions on the existing network of schools and adapt the provision to other local organizations, (2) establish safety measures, and (3) respond specifically to local characteristics. Besides the well-established safety interventions, the policy's success may also be associated with Japan's low crime rate.

Mori, N., F. Armada, et al. (2012). Walking to School in Japan and Childhood Obesity Prevention: New Lessons from an Old Policy. American Journal of Public Health: e1-e6.

The Healthy Afterschool Activity and Nutrition Documentation Instrument (2012)

  • Policies call on afterschool programs to improve the physical activity and nutrition habits of youth attending. No tool exists to assess the extent to which the afterschool program environment meets physical activity and nutrition policies.
  • This paper seeks to describe the development of the Healthy Afterschool Activity and Nutrition Documentation (HAAND) instrument, which consists of two subscales: Healthy Afterschool Program Index for Physical Activity (HAPI-PA) and the HAPI-Nutrition (HAPI-N).
  • Thirty-nine afterschool programs took part in the HAAND evaluation during fall/spring 2010-2011. Inter-rater reliability data were collected at 20 afterschool programs during a single site visit via direct observation, personal interview, and written document review. Validity of the HAPI-PA was established by comparing HAPI-PA scores to pedometer steps collected in a subsample of 934 children attending 25 of the afterschool programs. Validity of the HAPI-N scores was compared against the mean number of times/week that fruits and vegetables (FV) and whole grains were served in the program.
  • Data were analyzed in June/July 2011. Inter-rater percent agreement was 85%-100% across all items. Increased pedometer steps were associated with the presence of a written policy related to physical activity, amount/quality of staff training, use of a physical activity curriculum, and offering activities that appeal to both genders. Higher servings of FV and whole grains per week were associated with the presence of a written policy regarding the nutritional quality of snacks.
  • The HAAND instrument is a reliable and valid measurement tool that can be used to assess the physical activity and nutritional environment of afterschool programs.

Ajja, R., Beets, M.W., Huberty, J., Kaczynski, A.T., Ward, D.S. (2012). The Healthy Afterschool Activity and Nutrition Documentation Instrument. American Journal of Preventive Medicine 43(3), 263-271.

Philadelphia School District Reports Progress in Reducing Childhood Obesity Rates (2012)

  • Epidemic increases in obesity negatively affect the health of US children, individually and at the population level. Although surveillance of childhood obesity at the local level is challenging, height and weight data routinely collected by school districts are valuable and often underused public health resources.
  • The authors analyzed data from the School District of Philadelphia for 4 school years (2006–2007 through 2009–2010) to assess the prevalence of and trends in obesity and severe obesity among public school children.
  • The prevalence of obesity decreased from 21.5% in 2006–2007 to 20.5% in 2009–2010, and the prevalence of severe obesity decreased from 8.5% to 7.9%. Both obesity and severe obesity were more common among students in grades 6 through 8 than among children in lower grades or among high school students. Hispanic boys and African American girls had the highest prevalence of obesity and severe obesity; Asian girls had much lower rates of obesity and severe obesity than any other group. Although obesity and severe obesity declined during the 4-year period in almost all demographic groups, the decreases were generally smaller in the groups with the highest prevalence, including high school students, Hispanic males, and African American females.
  • Although these data suggest that the epidemic of childhood obesity may have begun to recede in Philadelphia, unacceptably high rates of obesity and severe obesity continue to threaten the health and futures of many school children.

Robbins JM, Mallya G, Polansky M, Schwarz DF. (2012). Prevalence, Disparities, and Trends in Obesity and Severe Obesity Among Students in the Philadelphia, Pennsylvania, School District, 2006–2010. Preventing Chronic Disease 9:120118.

“Cycling to School Is Associated With Lower BMI and Lower Odds of Being Overweight or Obese in a Large Population-Based Study of Danish Adolescents” (2012)

  • Previous studies have been inconclusive concerning the effect of active transport on BMI. This study investigates the association between travel mode and BMI in a large community-based sample of Danish adolescents.
  • A cross-sectional survey on health and lifestyle was distributed to all pupils from the 7th to 9th grade (12–16 years of age) in the municipality of Odense, Denmark.
  • Cycling to school was associated with 0.38 lower BMI compared to passive travelers (P = .006) after multivariable adjustment. Cycling to school was associated with 0.55 lower odds of being overweight (P < .001) and 0.30 lower (P < .001) odds of being obese compared to individuals using passive transport. Walking to school was associated with 0.65 lower odds of being overweight (P = .006). Post hoc pairwise comparisons of ethnicity revealed that adolescents of foreign ethnicity were more likely to be walkers or passive commuters (75.14% vs. 29.72%) than cyclists (24.86% vs. 70.28%; P < .001) compared to subjects of Danish ethnicity.
  • Cycling to school was associated with lower BMI and lower odds of being overweight or obese compared to passive travel in Danish adolescents, whereas walking to school was associated with lower odds of being overweight.

Østergaard L, Grøntved A, et al. (2012). “Cycling to School Is Associated With Lower BMI and Lower Odds of Being Overweight or Obese in a Large Population-Based Study of Danish Adolescents.” Journal of Physical Activity & Health 9(5): 617-25.

“Influence of Sports, Physical Education, and Active Commuting to School on Adolescent Weight Status” (2012)

  • This study compares the associations between weight status and different forms of physical activity among adolescents.
  • The authors conducted telephone surveys with 1718 New Hampshire and Vermont high school students and their parents as part of a longitudinal study of adolescent health. They surveyed adolescents about their team sports participation, other extracurricular physical activity, active commuting, physical education, recreational activity for fun, screen time, diet quality, and demographics. Overweight/obesity (BMI for age ≥ 85th percentile) and obesity (BMI for age ≥ 95 percentile) were based on self-reported height and weight.
  • Overall, 29.0% (n = 498) of the sample was overweight/obese and 13.0% (n = 223) were obese. After adjustments, sports team participation was inversely related to overweight/obesity (relative risk [RR] = 0.73 [95% confidence interval (CI): 0.61, 0.87] for >2 sports teams versus 0) and obesity (RR = 0.61 [95% CI: 0.45, 0.81] for >2 sports teams versus 0). Additionally, active commuting to school was inversely related to obesity (RR = 0.67 [95% CI: 0.45, 0.99] for >3.5 days per week versus 0). Attributable risk estimates suggest obesity prevalence would decrease by 26.1% (95% CI: 9.4%, 42.8%) if all adolescents played on 2 sports teams per year and by 22.1% (95% CI: 0.1%, 43.3%) if all adolescents walked/biked to school at least 4 days per week.
  • Team sport participation had the strongest and most consistent inverse association with weight status. Active commuting to school may reduce the risk of obesity, but not necessarily overweight, and should be studied further. Obesity prevention programs should consider strategies to increase team sport participation among all students.

Drake, K. M., M. L. Beach, et al. (2012). “Influence of Sports, Physical Education, and Active Commuting to School on Adolescent Weight Status.” Pediatrics 130(2): e296-e304.

“Commuting Distance, Cardiorespiratory Fitness, and Metabolic Risk” (2012)

  • Limited evidence exists on the metabolic and cardiovascular risk correlates of commuting by vehicle, a habitual form of sedentary behavior.
  • To examine the association between commuting distance, physical activity, cardiorespiratory fitness (CRF), and metabolic risk indicators.
  • This cross-sectional study included 4297 adults who had a comprehensive medical examination between 2000 and 2007 and geocoded home and work addresses in 12 Texas metropolitan counties. Commuting distance was measured along the road network. Outcome variables included weekly MET-minutes of self-reported physical activity, CRF, BMI, waist circumference, triglycerides, plasma glucose, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, and continuously measured metabolic syndrome. Outcomes were also dichotomized using established cut-points. Linear and logistic regression models were adjusted for sociodemographic characteristics, smoking, alcohol intake, family history of diabetes, and history of high cholesterol, as well as BMI and weekly MET-minutes of physical activity and CRF (for BMI and metabolic risk models). Analyses were conducted in 2011.
  • Commuting distance was negatively associated with physical activity and CRF and positively associated with BMI, waist circumference, systolic and diastolic blood pressure, and continuous metabolic score in fully adjusted linear regression models. Logistic regression analyses yielded similar associations; however, of the models with metabolic risk indicators as outcomes, only the associations with elevated blood pressure remained significant after adjustment for physical activity and CRF.
  • Commuting distance was adversely associated with physical activity, CRF, adiposity, and indicators of metabolic risk.

Hoehner, C. M., C. E. Barlow, et al. (2012). "Commuting Distance, Cardiorespiratory Fitness, and Metabolic Risk." American journal of preventive medicine 42(6): 571-578.

“Taking Up Cycling After Residential Relocation: Built Environment Factors” (2012)

  • To successfully stimulate cycling, it is necessary to understand the factors that facilitate or inhibit cycling. Little is known about how changes in the neighborhood environment are related to changes in cycling behavior.
  • This study aimed to identify environmental determinants of the uptake of cycling after relocation.
  • The RESIDential Environment Project (RESIDE) is a longitudinal natural experiment of people moving into new housing developments in Perth (Western Australia). Self-reported usual transport and recreational cycling behavior, as well as self-reported and objective built environmental factors were measured before and after residential relocation. Participants who did not usually cycle at baseline in 2003–2004 were included in the study. Logistic regression models were used to relate changes in built environmental determinants to the probability of taking up cycling after relocation (2005–2006). Analyses were carried out in 2010–2011.
  • At baseline, 90% (n=1289) of the participants did not cycle for transport and 86% (n=1232) did not cycle for recreation. After relocation, 5% of the noncyclists took up transport-related cycling, and 7% took up recreational cycling. After full adjustment, the uptake of transport-related cycling was determined by an increase in objective residential density (OR=1.54, 95% CI=1.04, 2.26) and self-reported better access to parks (OR=2.60, 95% CI=1.58, 4.27) and other recreation destinations (OR=1.57, 95% CI=1.12, 2.22). Commencing recreational cycling mostly was determined by an increase in objective street connectivity (OR=1.20, 95% CI=1.06, 1.35).
  • Changes in the built environment may support the uptake of cycling among formerly noncycling adults.

Beenackers, M. A., S. Foster, et al. (2012). "Taking Up Cycling After Residential Relocation: Built Environment Factors." American journal of preventive medicine 42(6): 610-615.

“Is Active Travel to Non-School Destinations Associated with Physical Activity in Primary Schoolchildren?” (2012)

  • This study examines associations between mode of travel to non-school destinations and physical activity in schoolchildren.
  • The authors analyzed data from SPEEDY, an observational study of 9–10 year old British children. In summer 2007, children reported their usual mode of travel to four destinations (to visit family, friends, the park or the shops) and wore accelerometers for at least three days. Time spent in moderate to vigorous physical activity (MVPA) was computed for the following time segments: daily, after school, weekend and out-of-school. Associations between mode of travel and physical activity were assessed using adjusted two-level multiple regression models stratified by sex.
  • N=1859 pupils provided valid data. Boys who used active modes of travel spent significantly more time in MVPA in all time segments than boys who used passive modes. The median daily time spent in MVPA was 87 minutes for active travellers and 76 minutes for passive travellers. In girls, median time spent in MVPA after school was significantly higher in the active (34 minutes) than the passive travellers (29 minutes).
  • Active travel to non-school destinations is associated with higher overall physical activity levels in 9–10 year old schoolchildren. Active travel was associated with higher overall activity levels in males and greater after-school activity levels in females.
  • Promoting non-school active travel may help to achieve higher activity levels.

Smith, L., S. Sahlqvist, et al. (2012). "Is active travel to non-school destinations associated with physical activity in primary school children?" Preventive Medicine. Available online January 18, 2012.

“The effect of a school-based active commuting intervention on children's commuting physical activity and daily physical activity” (2012)

  • This study investigates the effect of a school-based intervention called Travelling Green (TG) on children's walking to and from school and total daily physical activity.
  • A quasi-experiment with 166 Scottish children (8–9 years) was conducted in 2009. One group (n = 79) received TG and another group (n = 87) acted as a comparison. The intervention lasted 6 weeks and consisted of educational lessons and goal-setting tasks. Steps and MVPA (daily, a.m. commute, p.m. commute, and total commute) were measured for 5 days pre- and post-intervention using accelerometers.
  • Mean steps (daily, a.m., p.m., and total commute) decreased from pre- to post-intervention in both groups (TG by 901, 49, 222, and 271 steps/day and comparison by 2528, 205, 120, and 325 steps/day, respectively). No significant group by time interactions were found for a.m., p.m., and total commuting steps. A medium (partial eta squared = 0.09) and significant (p < 0.05) group by time interaction was found for total daily steps. MVPA results were similar to step results.
  • TG has a little effect on walking to and from school. However, for total daily steps and daily MVPA, TG results in a smaller seasonal decrease than for children who do not receive the intervention.
  • The effect of a walk to school intervention was investigated among 8–9 year olds.
  • Educational lessons and goal setting tasks did not increase walking to school.
  • Walk to school interventions should be targeted to the parents of younger children.
  • Older children may have greater autonomy to change their school travel behaviors.

McMinn, D., D. A. Rowe, et al. "The effect of a school-based active commuting intervention on children's commuting physical activity and daily physical activity." Preventive Medicine.

“Moderate to Vigorous Physical Activity and Sedentary Time and Cardiometabolic Risk Factors in Children and Adolescents” (2012)

  • Sparse data exist on the combined associations between physical activity and sedentary time with cardiometabolic risk factors in healthy children.
  • This study examined the independent and combined associations between objectively measured time in moderate- to vigorous-intensity physical activity (MVPA) and sedentary time with cardiometabolic risk factors.
  • The study pooled data from 14 studies between 1998 and 2009 comprising 20 871 children (aged 4-18 years) from the International Children's Accelerometry Database. Time spent in MVPA and sedentary time were measured using accelerometry after reanalyzing raw data. The independent associations between time in MVPA and sedentary time, with outcomes, were examined using meta-analysis. Participants were stratified by tertiles of MVPA and sedentary time.
  • The main outcome measures for this study were: waist circumference, systolic blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and insulin.
  • Times (mean [SD] min/d) accumulated by children in MVPA and being sedentary were 30 and 354, respectively. Time in MVPA was significantly associated with all cardiometabolic outcomes independent of sex, age, monitor wear time, time spent sedentary, and waist circumference (when not the outcome).
  • Sedentary time was not associated with any outcome independent of time in MVPA. In the combined analyses, higher levels of MVPA were associated with better cardiometabolic risk factors across tertiles of sedentary time. The differences in outcomes between higher and lower MVPA were greater with lower sedentary time. Mean differences in waist circumference between the bottom and top tertiles of MVPA were 5.6 cm (95% CI, 4.8-6.4 cm) for high sedentary time and 3.6 cm (95% CI, 2.8-4.3 cm) for low sedentary time. Mean differences in systolic blood pressure for high and low sedentary time were 0.7 mm Hg (95% CI, −0.07 to 1.6) and 2.5 mm Hg (95% CI, 1.7-3.3), and for high-density lipoprotein cholesterol, differences were −2.6 mg/dL (95% CI, −1.4 to −3.9) and −4.5 mg/dL (95% CI, −3.3 to −5.6), respectively. Geometric mean differences for insulin and triglycerides showed similar variation. Those in the top tertile of MVPA accumulated more than 35 minutes per day in this intensity level compared with fewer than 18 minutes per day for those in the bottom tertile. In prospective analyses (N = 6413 at 2.1 years’ follow-up), MVPA and sedentary time were not associated with waist circumference at follow-up, but a higher waist circumference at baseline was associated with higher amounts of sedentary time at follow-up.
  • Higher MVPA time by children and adolescents was associated with better cardiometabolic risk factors regardless of the amount of sedentary time.

Ekelund, U., J. Luan, et al. (2012). "Moderate to Vigorous Physical Activity and Sedentary Time and Cardiometabolic Risk Factors in Children and Adolescents." JAMA: The Journal of the American Medical Association 307(7): 704-712.

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