Investigating the relationship between active commuting and cardiovascular disease in the UK: Longitudinal and spatial analysis of four large datasets

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It is well known that keeping active reduces our risk of cardiovascular disease (CVD), obesity, high blood pressure and other health problems. However over the past few decades British lifestyles have become increasingly sedentary, with two thirds of us taking insufficient exercise. Globally, physical inactivity has become the fourth leading risk factor for premature death. Active commuting (walking or cycling to work) has been recommended by experts as a practical way of building more exercise into the daily routine. However, more research is needed. The precise ways in which active commuting affects cardiovascular health are not understood, and many important questions remain unanswered. I hope to embark on a three-year Medical Research Council funded programme at the London School of Hygiene and Tropical Medicine, to find out whether active commuting is good for our health. The research will focus not just on walking and cycling trips, but on public transport too. Commuting by train, tube or bus usually involves a walk to the station, and standing when the service is busy also requires some physical exertion. Users of these active and public transport modes will be compared with people who commute by private transport (e.g. car, taxi or motorbike), which is usually more sedentary. The core objective of the project will be to investigate whether active commuters have better cardiovascular health than non-active commuters. This includes the biological antecedents of cardiovascular disease (such as obesity and high blood pressure) as well as more concrete outcomes such as heart disease diagnoses and CVD-related deaths. Factors such as disability, job type, and geographical location will be taken into account to ensure that any health differences observed cannot be explained away by these other elements. Furthermore, the statistical techniques and data sources used will allow the researcher to find out whether active commuting actually causes differences in health between active and non-active commuters. This type of research is made possible by the UK's rich longitudinal data resources, three of which will be used in this project: the Office for National Statistics Longitudinal Study, the UK Household Longitudinal Study, and UK Biobank (middle-aged individuals only). These are large studies which follow tens or hundreds of thousands of individuals over time, inviting the same people to provide information on a number of occasions through their lives. In addition, data from a smaller, more focussed longitudinal study of young people and their families will also be used. The ORiEL (Olympic Regeneration in East London) study follows around 3000 teenagers, inviting them to provide survey data and have their height and weight measured on three occasions during their adolescence. All of the teenagers live and study in East London and characteristics of the urban environment through which they commute to school have been measured and classified. Using the ORiEL data, the research project will investigate whether properties of the areas travelled through affect whether the young people walk to school, cycle, take the bus or get a lift. In summary, this project will answer a number of key questions about the health effects of active commuting. It will show whether active commuting is important for young people or middle-aged people, so that public health messages can be targeted at the most crucial age-group. It will show whether environmental factors such as pavements, crime and dedicated cycle routes actually increase the use of active travel modes. It will provide a long-range perspective by describing trends in active commuting over the past 4 decades and show whether long-term active travel can reduce CVD mortality risk. It will also show which particular points on the CVD 'causal pathway' are most influenced by active commuting: Weight? Fitness? Blood pressure? Or heart disease itself?