Protective Effect on Mortality of Active Commuting to Work: A Systematic Review and Meta-analysis
Résumé
Background: Sedentary behaviour is a major risk of mortality. However, data are contradictory
regarding the effects of active commuting on mortality.
Objectives: To perform a systematic review and meta-analysis on the effects of active
commuting on mortality.
Method: The PubMed, Cochrane Library, Embase, and Science Direct databases were searched
for studies reporting mortality data and active commuting (walking or cycling) to or from work.
We computed meta-analysis stratified on type of mortality, type of commuting, and level of
commuting, each with two models (based on fully adjusted estimates of risks, and on crude or
less adjusted estimates).
Results: 17 studies representing 829 098 workers were included. Using the fully adjusted
estimates of risks, active commuting decreased all-cause mortality by 9% (95% confidence
intervals 3 to 9%), and cardiovascular mortality by 15% (3 to 27%) (p<0.001). For stratification
by type of commuting, walking decreased significantly all-cause mortality by 13% (1 to 25%),
and cycling decreased significantly both all-cause mortality by 21% (11 to 31%) and
cardiovascular mortality by 33% (10 to 55%) (p<0.001). For stratification by level of active
commuting, only high level decreased all-cause mortality by 11% (3 to 19%) and both
intermediate and high level decreased cardiovascular mortality. Low level did not decrease any
type of mortality. Cancer mortality did not decrease with walking nor cycling, and the level of
active commuting had no effect. Low level walking did not decrease any type of mortality,
intermediate level of walking decreased only all-cause mortality by 15% (2 to 28%), and high
level of walking decreased both all-cause and cardiovascular mortality by 19% (8 to 30%) and
by 31% (9 to 52%), respectively. Both low, intermediate and high intensities of cycling
decreased all-cause mortality. Meta-analysis based on crude or less fully adjusted estimates
retrieved similar results, with also significant reductions of cancer mortality with cycling (23%,
5 to 42%), high level of active commuting (14%, 4 to 24%), and high level of active commuting
by walking (16%, 0 to 32%).
Conclusion: Active commuting decreases mainly all-cause and cardiovascular mortality, with
a dose-response relationship, especially for walking. Preventive strategies should focus on the
benefits of active commuting.
Domaines
Médecine humaine et pathologieOrigine | Fichiers produits par l'(les) auteur(s) |
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