Active Commuting Cuts Diabetes Risk

August 07, 2013

A new study illustrates that people who travel to work using public transport or who walk or cycle are at lower risk of developing diabetes than those who use private transport.

Walking or cycling to a place of employment also reduced the risk for hypertension, report Anthony A Laverty, from Imperial College London, United Kingdom, and colleagues in the September 2013 issue of the American Journal of Preventive Medicine.

This research is some of the first to examine the impact of so-called "active travel" on diabetes and hypertension, senior author Christopher Millett, PhD, from Imperial College London, explained to Medscape Medical News. "There have been a lot of studies looking at active travel and the protective effect on obesity," he noted, adding that he and his colleagues also found a similar protective effect against obesity in their study.

This is also some of the first work to show the protective effect of public-transport use, he added, explaining that such commuting usually means that people walk during certain sections of their journey. One US study, for example, showed that those using public transport walked an average of 19 minutes as part of their journey.

Dr. Millett said his results mean that physicians "should encourage people to build physical activity into their everyday life, by adapting their commute to make it more physically active" — for example, by walking or cycling to work if possible or at the very least by using public transport. "It doesn't mean that people necessarily have to spend many sessions in the gym," he noted.

Also, there is a message here for public planners, he said. London came out top of the table for "active travel" in this UK study, but the other regions performed poorly. "We need to persuade governments to invest in active-travel infrastructure," he stressed.

Walking and Cycling to Work Drops Diabetes by 40% to 50%

The current results come from a nationally representative survey of UK residents, called Understanding Society, from 2009 to 2011, analyzed in 2012. Associations between sociodemographic factors and mode of transport to work were assessed with regression models, as was mode of travel and overweight/obesity and having hypertension or diabetes.

Cross-sectional data from 20,458 individuals who participated in wave 1 of the study, aged 16 years or older, were included. Those aged 65 or older were excluded, as were those not working and those working from home. Information on commuting came from two questions: How do you usually get to your place of work? And about how far do you live from your place of work?

Body mass index (BMI) was based on self-reported height and weight, and diabetes and hypertension were also self-reported, based on responses to the question, Has your doctor ever told you that you have diabetes/hypertension?

A total of 69% of participants traveled to work using private transport, with public transport, walking, and cycling used by 16%, 12%, and 3% respectively.

The researchers found that those who walked to work had a 40% lower risk for diabetes and a 17% lower risk for hypertension than those who used private transport. And even just using public transport lowered the risk for diabetes by 18%.

Reductions in overweight or obesity were along similar lines, with a 15% reduction among those using public transport compared with private, a 20% reduction for those who walked to work, and a 37% lower risk for those who cycled.

Adjusted Odds Ratioa for Mode of Travel to Work and Overweight, Obesity, Diabetes, and/or Hypertension

Mode of travel to work Overweight or obeseb Obese Diabetes Hypertension
Private transport Ref Ref Ref Ref
Public transport 0.85 0.89 0.82 1.13
Walking 0.80 0.80 0.60 0.83
Cycling 0.63 0.69 0.50 0.76

a. Adjusted for age, gender, ethnic group, education level, social class, and place of residence.

b. Overweight defined as BMI of 25–29 and obesity as BMI of >30

Large Regional Differences

The researchers also note that there were large differences in active travel across sociodemographic groups. Interestingly, participants from lower socioeconomic groups, for example nonwhite ethnic groups and those with fewer educational qualifications, were more likely to walk to work.

This "marked sociodemographic patterning of active-travel use…may contribute to a lessening of known health inequalities," the authors point out.

And there were large regional differences in active travel across the different regions in the United Kingdom, "perhaps one of the most striking findings in this study….with all regions lagging behind London," they observe.

This included a 10-fold geographic difference in public-transport use between London and most other parts of the United Kingdom, with Northern Ireland performing particularly badly, Dr. Millett noted.

"These findings add to existing evidence that increasing active travel should be prioritized within national and local prevention strategies for obesity, diabetes, and cardiovascular disease," they conclude.

The authors have reported no relevant financial relationships.

AM J Prev Med .2013;45:282-288. Full text

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