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The Problem
Deaths attributed to 19 leading modifiable risk factors, by country income level, 2004
Globally, obesity responsible for 44% of diabetes 23% of ischemic heart disease 7 - 41% of colon, uterine, postmenopausal breast cancer Physical inactivity responsible for 27% of diabetes, 30% of ischaemic heart disease, 21 - 25% of breast and colon cancers.
Source: WHO
The Problem
Source: US CDC
Estimated economic costs of physical inactivity/obesity in Canada (2001): $5.3 billion (2.6% of all health care costs)/$4.3 billion
The Problem
Percentage at least moderately active in leisure time (Canada, 2001- 2010). Source CCHS
2010
Canadian physical activity guidelines (adults 18-64 yrs): 150 mins. moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 min. or more
Why cycling?
5kcal/minute60 mins/day for weight control Especially good physical activity for overweight as 70% of load is borne by bike Huge upside as rates in Canada and U.S. are very low <2%, while rates as high as 30% are achievable (Denmark, Netherlands) Utilitarian exercise more sustainable and as effective as structured physical activity
Percentage of trips in urban areas made by walking and bicycling in North America and Europe, 1995.
Cycling benefits
European Cyclists Federation, 2007
Adult obesity and active transport in Australia, 13 countries in Europe and North America: 20002006.
Share of workers commuting by bicycle or foot and share of adults with recommended (CDC) levels of physical activity: 50 US states and 47 of the 50 largest US cities, 2007.
11% reduction in cardiovascular disease risk (13% women, 9% men) Prospective cohort studies Hamer and Chida, 2008
13,000 women, 17,000 men in Copenhagen 14.5 year follow-up After adjustment for other risk factors, including leisure time physical activity, those who cycled to work (~3 hrs/week on average) experienced a 39% lower mortality rate
Interventions
71 healthy young/middle-age adults with lowmoderate fitness. Previously commuted by car/bus switched to cycling for 30 minutes one way 10 week follow-up:
improved aerobic fitness (greater improvement compared to walkers) Decreased cardiovascular load in submaximal standard work increase in HDL cholesterol.
6 yr follow-up of 334 ~10 yr old children Those switching to cycling were more fit, had better cholesterol/HDL ratio, better glucose metabolism, and a lower composite CVD risk factor score than those who did not cycle at start or end of study
Andersen et al, 2011
Cancer
Germany: 360 breast cancer cases/886 controls. Increased cycling and decreased breast cancer.
34% risk reduction for women > 3 hours/week moderate intensity cycling
Risks
~ 2% of traffic fatalities are bicyclistsof these: 94% 16 years old
~2/3 (all modes) fatal collisions and 1/3 of injury crashes occur on rural roads
Pedestrian and bicycling fatality rates and nonfatal injury rates in the United States, Germany, and The Netherlands, 2000. Cyclist present much less risk to others than cars Pucher et al, 2003
TRENDS
Helmets
Improve survival for those involved in accidents, but .Helmets do not prevents accidents from occurring Helmet laws discourage cycling so much that the reduced health benefits from less cycling are much greater than safety benefits of helmet laws Helmets as an individual choice
Photo by Kyel, Flickr.com
Risk Perception
RISK = HAZARD + OUTRAGE
Additional risks
Elevated air pollution EXPOSURES of cyclists
Authors Location
Grabow et al, 2012 Lindsay et al, 2010
Change
Risk
Benefit
Physical activity Reduced air pollution
Balance
Combined effect: 1,129 fewer deaths/ 31.9 million population = 35 fewer deaths/million population / year.
Midwest 50% shift of None USA, 11 car round trips evaluated metro areas of 8 km to cycling. New Zealand 5% shift in Traffic Vkmt for trips crashes < 7km, adults. Increased Traffic active crashes transportation : 2X walking & 8X cycling.
Benefit to risk ratio: no risks considered. Combined effect: 117 fewer deaths / 2.7 million population = 43 fewer deaths/million population/year.
Combined effect: 530 fewer premature deaths and 7,332 more disability-adjusted life-years per million population per year.
Netherlands 500,000 Traffic Physical activity adults switch crashes from car to Air pollution bicycle for trips < 7.5 km. Europe Driver who switches to 5 km of cycling for work commute 181,982 public bike share users, compared to car use. Traffic crashes Air pollution Traffic crashes Air pollution Physical activity Reduced air pollution (reduced noise and congestion) Physical activity Reduced air pollution
9:1 96:1
1 De
Lower traffic levels/ lower (perceived) traffic injury risk Parents more likely to let kids bike Seniors may be more comfortable Older communities may be more cycle-friendly Low air pollution Fewer space constraints for new infrastructure Conversion of existing infrastructure (rails to trails) Cycle tourism Climate Distances Infrastructure Wayfinding End-of-trip facilities Integration with transit
Challenges
www.cyclevancouver.ubc.ca
www.walkscore.com/bike
Bike Lane Score
Hill Score
Destinations Score
Thank you!
michael.brauer@ubc.ca