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Systematic Review of Active Commuting to School

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Systematic Review of Active Commuting to School and Children’s Physical Activity and Weight Brief running head: Systematic Review of Active Commuting to School MURRAY C. LEE Habitat Health Impact Consulting Corp. #307, 908-17th Ave SW Calgary, Alberta, Canada T2T 0A3 Tel: (403) 451-0097 Fax: (403) 245-9548 Email: [email protected] Affiliated Population Health Intervention Research Centre University of Calgary Calgary, Canada MARLA R. ORENSTEIN Habitat Health Impact Consulting Corp. #307, 908-17th Ave SW Calgary, Alberta, Canada T2T 0A3 Tel: (403) 451-0097 Fax: (403) 245-9548 Email: [email protected] Affiliated UC Berkeley Traffic Safety Center 2614 Dwight Way #7374 Berkeley, CA 94720 MAXWELL J. RICHARDSON Habitat Health Impact Consulting Corp. #307, 908-17th Ave SW Calgary, Alberta, Canada T2T 0A3 Tel: (403) 451-0097 Fax: (403) 245-9548 Email: [email protected] Additional key words: active commuting, exercise, BMI, obesity, overweight Disclosure statement: the authors have no financial interest in this research.

Page 1 of 26 Journal of Physical Activity and Health © Human Kinetics, Inc.


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ABSTRACT

Background: The recent decline in children’s active commuting (walking or biking) to school

has become an important public health issue. Recent programs have promoted the positive

effects of active commuting on physical activity and overweight. However, the evidence

supporting such interventions among schoolchildren has not been previously evaluated.

Methods: This paper presents the results of a systematic review of the association between

active commuting to school and outcomes of physical activity, weight, and obesity in children.

Results: Thirty-two studies were found that assessed the association between active commuting

to school and physical activity or weight in children. The majority of studies assessing physical

activity outcomes found a positive association between active commuting and overall physical

activity levels. However, almost all studies were cross-sectional in design, and do not indicate

whether active commuting leads to increased physical activity or whether active children are

simply more likely to walk. Only three of eighteen studies examining weight found consistent

results, suggesting that there may be no association between active commuting and reduced

weight or body mass index.

Conclusion: While there are consistent findings from cross-sectional studies associating active

commuting with increased total physical activity, interventional studies are needed to help

determine causation.

Page 2 of 26Journal of Physical Activity and Health © Human Kinetics, Inc.


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INTRODUCTION

The remarkable rise in rates of obesity among children worldwide has attracted an extraordinary

amount of attention. Many observers have noted that accompanying this phenomenon has been

another equally pervasive trend: the decline in the proportion of children walking to school.

Across nations, walking to school has been replaced by motorized transport, particularly in

private vehicles driven by parents.

The loss of such a routine and easy source of physical activity at a time of burgeoning

rates of obesity is unfortunate. It seems self-evident that by coaxing children out of cars and onto

sidewalks we can increase their physical activity and improve their physical health. But while

this linkage seems to make common sense, is it supported by evidence?

This paper presents a systematic review of the literature on active commuting (walking or

bicycling) and the outcomes of physical activity and weight/obesity in school-age children.

The International Decline of Active Commuting to School

Over the last 30 to 40 years, there has been a significant and pervasive shift in the manner in

which children are transported to school. In the United States, walking as a mode share fell from

50% to 12% for all children and from 87% to 31% for those who live within one mile of school.1

Similar declines have been noted elsewhere, including Australia and the UK.2, 3 A corresponding

increase has been seen in the proportion of children traveling by car. Many theories have been

advanced as to the cause of this decline, including perceptions of traffic safety, parental fear of

injury and abduction, and alterations in the urban form that favor building schools in more

sprawling, less walkable neighborhoods.4, 5 The actual cause of the change is unknown and is



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likely complex and multifactorial; its universality suggests a social phenomenon that belies easy

explanation.

The loss of this widely available and easy form of physical activity is a concern to public

health. Many of the chronic diseases burdening society, including diabetes, depression, heart

disease, some cancers, osteoporosis and obesity, are mitigated by physical activity.6 Walking is

seen as an ideal health promotion intervention—it is cheap and easy, with little equipment and no

training required. Utilitarian walking—that is, traveling by foot for activities such as running

errands, visiting friends or traveling to work or school—is particularly desirable, as it may be

associated with higher adherence rates than deliberate exercise or walking for fitness.5 Currently,

there is a public health push to increase utilitarian walking in general and walking and cycling to

school in particular.7 However, while there is some evidence that active commuting improves

health in adults8 there is no such evidence regarding children.9 There is, in fact, very little

literature exploring whether walking to school even increases physical activity.

It is reasonable to suspect that the school commute and physical activity are connected.

Theoretically, walking to school could be expected to increase total activity in a number of ways.

First, the commute itself could be a significant source of activity. Second, an active commute

may enable other activity if opportunities arise for extra activity and spontaneous play during the

walk to school or on the return trip home. Finally, walking or cycling may encourage active

behavior in other areas of the child’s life. However, an active commute is not necessarily

associated with increased physical activity. Consider, for instance, the fact that the majority of

children who actively commute live very close to school: it may be that their commute is neither

long enough nor intense enough for it to make a significant contribution to daily activity.

Currently there is broad support for interventions to increase physical activity by



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encouraging walking to school. Effective interventions require an understanding of whether

walking to school increases physical activity, and if so, how. Moreover, given that the impetus

for these interventions is primarily drawn from the obesity epidemic, it is important to know

whether walking to school is itself associated with weight status.

METHODS

A systematic review was conducted to identify all published literature relating to the association

between active commuting to school and children’s physical activity or weight. The search was

conducted by an epidemiologist with experience in literature searching and data extraction. A

number of different databases were accessed, including PubMed, SportDiscus, and the TRIS

Online National Transportation Library. The search strategy involved combining three sets of

keywords:

a) active commut*, active transport*, walk*, bicycl*, bik*, or cycl* (the asterisk denotes

the use of all possible suffixes or word endings. Commut* therefore represents commute,

commuting, commuter, commuted, etc. Some databases—such as PubMed—allow the use of an

asterisk in this way. For other databases, all suffixes were added to the search);

AND b) activity, physical activity, exercise, weight, overweight, obesity, body mass index,

BMI, or body composition;

AND c) school*, child*, adolescen*, or youth.

The results included all publications that included at least one search term from each of the

three categories. No restrictions were placed on language, location or date. 1,277 articles were

intially identified through SportDiscus; 885 articles through the TRIS database, and 4,885

through PubMed. In addition, the reference lists of relevant articles were hand-searched, and the



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archives of relevant journals (Obesity, the Journal of Physical Activity & Health, and Medicine,

Science, Sport & Exercise) were searched. Google and Google Scholar were both queried to

identify any additional Internet-based sources or other leads. The searches were last repeated on

December 29, 2007.

The titles and abstracts of all identified articles were examined for relevance. To be

included in the review, studies had to be restricted to children (any school age below university);

explicitly examine active commuting to school (as opposed to active transportation to all

locations combined); differentiate between active school commuters and passive commuters; and

present quantitative results on the association between active commuting and some aspect of

physical activity or weight. No studies were identified that were not in English; therefore,

language was not a barrier. A total of 32 relevant studies were identified, 25 of which addressed

active commuting and physical activity, and 18 of which addressed active commuting and weight

(several studies examined both). No review articles or meta-analyses on the topic were found.

Each relevant study was classified by date, location, study type, population age and sex,

and by method used to assess physical activity or weight. The association between active

commuting and physical activity / weight was defined by reported statistical significance,

regardless of whether an association was claimed by the authors.

RESULTS

Active Commuting and Physical Activity in Children

Twenty-five studies were found that presented data on the association between children’s

commute mode and physical activity.3, 10-33 Descriptive characteristics of these studies are

presented in Table 1. The majority of the studies were cross-sectional, with only one using a



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prospective design. The studies were generally well-powered, with relatively large study

populations, and covered a diverse range of ages and geographical locations. The proportion of

active commuters ranged from around 5% to a high of over 90%.

Physical activity was defined and assessed in diverse ways among the studies. While

most studies defined physical activity as time spent in moderate-to-vigorous physical activity

(MVPA), a number of studies did not clearly identify the difference between higher and lower

activity, or used other indices. Twenty-two studies gathered physical activity data via self- or

parental report, and ten studies used an accelerometer or pedometer to objectively assess activity

(several studies employed both methods).

Of these 25 studies, 24 examined the association between active commuting and the

child’s total level of physical activity. That is, the studies looked at whether children who

actively commuted also had higher levels of physical activity from all sources combined—the

school commute itself, active commuting to other destinations, recreational activity, organized

sport, or in-school physical activity. Of these 24 studies, 12 found that children who actively

commute to school had significantly higher total physical activity levels than passive commuters

(or irregular active commuters in some circumstances).10-21 Four additional studies found mixed

results when data were stratified by gender or activity type.22-25 Eight studies found no

significant association.3, 26-32

The magnitude of the difference between active and passive commuters varied greatly

among studies. Seven studies examined the effect size in terms of additional minutes per day of

activity.10, 14, 16, 17, 19, 23, 25 Results ranged from as little as 4.7 additional minutes of MVPA per

day17 to as much as 45 additional minutes of MVPA per day25 with an average of approximately

28 minutes.



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Potential differences by sex were examined in nine studies, but no consistent results

emerged. Three studies found that higher physical activity was associated with active commuting

for both boys and girls14, 16, 33, one study found associations in boys but not girls25, two studies

found associations in girls but not in boys17, 22 and three studies found no association for either

sex.3, 24, 29

Similarly, there were no clear distinctions in results by age. Among adolescents (ages 13

to 18), six 10, 11, 14, 15, 18, 20 of seven10, 11, 14, 15, 18, 20, 22 studies found a positive association between

walking and total physical activity. Among 10 studies in younger children (age 12 or under)3, 16,

17, 19, 23, 25, 26, 29, 32, 34 six found mixed or positive results and four3, 26, 29, 32 found no association.

One study examined two age groups separately, finding an association among younger children

but not among adolescents.12

Although active commuting includes both walking and cycling (as well as less common

travel modes such as skateboard or rollerblades), only one study presented results separately for

walkers and cyclists.22 This study found a significant association with total physical activity

among walkers, but not among cyclists. This finding may be in part due to the use of

accelerometers, which perform poorly at quantifying the activity involved in cycling. The

remainder of the studies either looked at walking alone or at a pool of active commuters that

included both cyclists and walkers. As such there is little data by which to compare the

independent associations of active commute mode and physical activity.

Contribution to Total Physical Activity

Four studies quantified active transport as a percent of total daily physical activity (PA).3, 14, 33, 35

In other words, these studies attempted to assess to what extent the commute itself contributed to

children’s overall activity. The results varied greatly, ranging from 50% to ‘negligible’.



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The highest figure, obtained from a secondary analysis of a nationally representative

dataset in Russia, found that active transportation to school accounted for 40-50% of total daily

physical activity, implying that the walk to school itself may have been the children’s main

source of activity.33 The questionnaire, however, had a limited definition of total physical

activity, including the school commute, physical education classes and out-of-school active

pursuits, but excluding walking to other destinations or other activity. The authors do not provide

any data on the amount of time spent in the school commute or on the amount of total physical

activity reported by the parents; this makes it difficult to judge how representative or

unrepresentative the students might be of other locations.

A questionnaire-based study in Germany reported that active commuting accounted for

28.4% of daily activity.14 In this case, however, the pool of active commuters was restricted to

those who traveled at least 1.5 km to school, thus excluding over 58% of potential participants

and introducing a selection bias that accentuates the contribution of an active commute to total

activity.

The two remaining studies used accelerometers to quantitatively assess physical activity,

and both obtained much lower estimates. A study among five-year-olds in the UK3 found that

the commute represented only 2% of total activity, and a study of nine-year-olds in Denmark

gauged the contribution of the commute as “negligible”.35 However, the trip lengths in both

these studies was short; the average trip took only 6 minutes (0.7 km) in the UK study, and 85%

of students in the Denmark study had a trip of less than 15 minutes.

Active Commuting and Weight Levels in Children

Eighteen studies (Table 2) reported associations between active commuting and weight levels, as



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assessed by body-mass index (BMI), overweight, obesity, or percent body fat.12-14, 17, 20, 22, 23, 25, 26,

29, 36-43 Two of the studies followed subjects prospectively23, 29 and the remainder were cross-

sectional. Fifteen studies used clinically measured weight values, while three studies relied on

self-report and/or proxy-reporting by parents.

Nine of the 18 studies found no significant association between active commuting and

any measure of body composition.12, 14, 17, 19, 22, 25, 26, 40, 44 An additional five found significant

results only for subgroups of the study population or for limited measures.20, 23, 29, 37, 42 Only

three studies13, 36, 39 found a consistent association between active commuting and lower body

weight, and the remaining one study found a significant association between active commuting

and higher BMI.38

The eight studies that found mixed or positive results were heterogenous in terms of age,

gender, geography and weight measurement. Li et al. found that overweight status was

associated with active commuting among children age 7-17 in China; de Bourdeaudhuij et al.

found similar results for children ages 11-19 in Belgium, and Gordon-Larsen et al. for children

in grades 7-12 in the US. However, Tudor-Locke et al. and Rosenberg et al. both found an

association in boys but not in girls; Ortega et al. found no association for BMI but an association

among girls for smaller waist circumference (although not for boys); Evenson et al. found an

association for children in grades 6-8 but not among those in grades 9-12; and Heelan et al.

found an association with BMI among overweight children but not among normal-weight

children. Interestingly, the study by Evenson et al. was the only study to differentiate between

overweight children (BMI ≥85th percentile and < 95th percentile) and obese children (BMI ≥95th

percentile) in the presentation of results. This study found that although overweight children

were significantly less likely to walk to school than normal weight children, there was no



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difference in active commuting between obese children and normal weight children.

DISCUSSION

Our review of the 32 studies that comprise this literature focuses on three fundamental questions:

Is active commuting associated with overall physical activity in children? Is the commute itself a

significant component of total physical activity? And is there an association between active

commuting and BMI, weight or obesity?

Of 24 studies on active commuting and overall physical activity levels in children, 13

found a consistent positive association, and an additional three found positive results in subsets

of the study population. A summary of these overall research findings is given in Table 3. The

strength of the association is mixed, and a summary estimate is not possible due to the

heterogeneity in study design. Nevertheless, in multiple studies in a number of countries, a

significant association between physical activity and walking or cycling to school has been noted

across many age groups of school children.

Regardless of this association, it remains unclear as to whether the commute trip itself is

a significant component of total physical activity. Only two studies have used objective

measurements to quantify the contribution of the trip to and from school.3, 35 Neither study found

the school journey itself to be significant, representing 2% or less of children’s overall activity.

While data from two other studies assessed the contribution of the commute to be much larger,

these two studies relied on self- or parental report, and in one case was restricted by definition to

children with longer trip lengths.14, 33 Given the paucity of this data, it is not yet possible to

determine whether or to what degree the commute itself may be responsible for potentially

higher levels of physical activity in children who walk or cycle.



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With regards to the 18 studies that examined the association between commute mode and

weight levels, only three found a consistent association, while an additional five found results in

subsets of the population or for limited outcome measures. From this information, there does not

appear to sufficient evidence to support an association between active commuting and body-mass

index, overweight or obesity in schoolchildren.

There are several problems common to these studies that limit the interpretation of these

results. The first of these has to do with the definition of active commuting and the potential for

misclassification bias. Most studies dichotomized respondents into active commuters vs. passive

commuters based on the student’s reported mode of “usual” transportation. However, if a sizable

proportion of the students use a combination of modes to travel to school (e.g., walking on some

days, traveling by car on others), the categorization may not be accurate, and a bias towards the

null would occur. Two studies that have examined this question found quite different results.

Tammelin et al. assessed the test-retest reliability of a questionnaire item on commuting to

school among 15-16 year olds, and found an intraclass correlation coefficient of only 0.57 after

two weeks.45 However, Heelan et al. found a concordance of 97% when elementary school

students were questioned two days apart about their commute mode.23

Another limitation in this literature is the methodology of measuring physical activity.

Only 10 of the 25 studies assessing physical activity levels used accelerometers or pedometers to

objectively quantify the child’s activity. The remainder of the studies relied on self- or parental

report. At a minimum, this is likely to introduce inaccuracy, especially in the estimate of the

contribution of the commute to total daily physical activity. It also raises the potential for bias in

the association between commute mode and physical activity, if active commuters recall or

estimate their activity differently than passive commuters.



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Perhaps most important among limitations is the issue of study design. Almost all of these

studies examined cross-sectional associations between active commuting and physical

activity/weight. As a result, causality cannot be inferred. While it is possible that active

commuting stimulates additional physical activity in children, it is equally plausible that more

highly active children are the ones who choose to walk or cycle. The findings in the literature

lend support to the notion that active commuting could be a potentially important source of

physical activity in school age children. However, to make this claim, the question of causation

is a primary concern.

An active commute could lead to increased activity via any of three mechanisms: through

the school trip itself, through increased opportunities for activity presented on the way to and

from school, or from inducing physical activity at other times during a child’s week. Only on

the first mechanism—the contribution of the commute itself to total physical activity—does the

current literature offer any evidence. As described above, the evidence does not at this time

support the contention that active commute trips comprise a significant component of children’s

total physical activity.

As for the other potential mechanisms by which an active commute may cause increased

physical activity, the literature is mute. Nevertheless, they are important considerations in the

design of walking to school interventions. For instance, a walking school bus, where children are

escorted to school in groups by supervising adults may have no effect if the true association

between active commuting and increased physical activity is a result of spontaneous play that

arises on the walk home. Although the walking school bus may expose more children to an

active commute, in this example the design of the intervention would block the actual causal

pathway that links the walk to school to increased total physical activity.



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Finally, there is the issue of whether active commuting engenders activity elsewhere a

child’s life: will a child who walks or cycles to school become more likely to walk or cycle

elsewhere in his or her life? Or, conversely, does the active commute time come with an

opportunity cost, limiting a child’s access to more organized and active forms of exercise? Only

prospective quantitative analyses, particularly of successful walk-to-school programs, will be

able to answer these questions.

Although interventions to increase the proportion of children walking to school have been

successfully implemented, research investigating their impact on activity levels and health

outcomes is virtually non-existent. Until such interventional data are available it is premature to

suggest that promotion of active commuting will by itself result in an increase in physical

activity or reduction in the rate of childhood obesity.

CONCLUSIONS

Overall, the studies examined in this systematic review suggest an association between

children’s active commuting and higher physical activity levels. However, the research at this

point hinges almost entirely on cross-sectional data, and is not able to address issues of causality.

The association between active commuting and BMI/overweight is far less clear, with most

studies finding no significant association. Future research should focus on measuring the impact

of interventions that succeed in changing commuting behavior and quantifying the contribution

of the commute to children’s daily activity.

Finally, when it comes to the school commute, physical activity and obesity are only two

possible health outcomes. The decline in walking to school and interventions to reverse it must

also be considered in a broader health context; traffic safety, air pollution (and exposure to it),

and psychosocial benefits are other equally relevant potential health impacts. While evidence for



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active commuting as an important intervention point for obesity is weak, cumulative positive

health impacts may be substantial both for children and for their neighborhoods. If interventions

to increase walking to school are effective in promoting walking, the full effect they have on the

health of children should be more fully considered and investigated.

ACKNOWLEDGMENT

The authors wish to thank the University of California (Berkeley) Traffic Safety Center for

funding this study.



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transportation to school-differences in screen time, socio-economic position and perceived

environmental characteristics in adolescent girls. Ann Hum Biol 2007;34(3):273-82.

45. Tammelin T, Ekelund U, Remes J, Nayha S. Physical activity and sedentary behaviors

among Finnish youth. Med Sci Sports Exerc 2007;39(7):1067-74.


Evidence on Walking to School

21

TABLE 1 Association between Active Commuting to School and Physical Activity in Children

Author, Year.Location

Study Design PhysicalActivityMeasurement

ParticipantAges /Sex

Number ofChildren inStudy (N)

Percent ofChildrenClassifiedas Active

Commuters

ActiveCommute as% of Total

Daily Activity

Association Between Active Commute Status and OverallDaily Activity Levels

Bungum andLounsbery, 2007.USA

Cross-sectional Self-report Mean age 15/Both

2,689 4.7% Not reported Active commuters significantly more likely to meetguidelines for MVPA.

Dollman and Lewis,2007. Australia

Cross-sectional Parental report Ages 9-15 /Both

1,643 31% Not reported No significant association with free-time physicalactivity.Active school commuters significantly more likely touse active transport to other neighborhood destinations.

Ford et al., 2007.UK

Cross-sectional Accelerometer Ages 5-11 /Both

239 48% Not reported No significant association with weekday or weekendactivity, or with out-of-school activity.

Landsberg et al.,2007. Germany

Cross-sectional Self-report Age 14 /Both

626 62.6% 28.4% Overall physical activity significantly higher in activecommuters vs. non-active commuters for boys andgirls, 9.3 vs. 6 hrs/week and 7.9 vs. 3.0 hrs/week,respectively.

Loucaides et al.,2007. Canada

Cross-sectional Self-report Mean age15.6 / Both

1,398 Notreported

Not reported Significantly correlated with MVPA in urban and ruralyouth.

Saksvig et al., 2007.USA

Cross-sectional Self-report andAccelerometer

Age 12 /Girls

1,596 15.7% Not reported Girls walking before and after school experiencedsignificantly more total physical activity and MVPAthan girls who did not; additional 13.7 minutes total PAand 4.7 minutes MVPA per day.

Martin et al., 2007,USA

Cross-sectional Self-report Ages 11-15 /Both

2,256 47.9% Not reported Children who live within a mile of school and whoactively commute were significantly less likely toparticipate in organized physical activity.No association with free time physical activity.

Cooper et al., 2006.Denmark


Ages 10 and15 /Both

919 73.5% “Negligible”.*

Children who walked to school were more physicallyactive than those using passive transport; 737 vs. 624accelerometer counts per minute (cpm). Significant forgirls, but not boys, when stratified by gender.No association in adolescents.No significant association with time spent on MVPAand active commuting.

Rosenberg et al.,2006. USA

Cross-sectional**

Self-report andAccelerometer

Grades 4-5 /Both

1,083 32.5% Not reported No association in girls or boys at baseline. No follow-up data provided.

Spinks et al., 2006.Australia


518 Notreported

Not reported Active commuters were significantly less likely to haveinsufficient levels of physical activity; Odds



22

ratio=0.48.Alexander et al.,2005. Scotland


Ages 13-14 /Both

92 38% Not reported MVPA was significantly higher in walkers vs. non-walkers; 123 vs. 97 minutes per day.

Fulton et al., 2005.USA

Cross-sectional Self-report andParental report

Grades 4-12 /Both

1,395 14% Not reported Active commuters were significantly more likely topartake in moderate physical activity 5+ times perweek compared to passive commuters; Odds ratio=1.8.

Gordon-Larsen etal., 2005. USA

Cross-sectional Self-report Grades 7-12 /Both

10,771 26.7% Not reported Active commuters were significantly more likely tomeet physical activity recommendations. (37.0% ofparticipants meeting PA recommendations used activetransport vs. 25.6% of participants not meeting PArecommendations).

Heelan et al., 2005.USA

Cross-sectional**

Self-report Ages 9-11 /Both

320 33.3% Not reported Moderate activity was significantly higher in walkersvs. non-walkers; 56 vs. 45 minutes per day. Noassociation with total physical activity or sedentarybehavior.

Santos et al., 2005.Portugal.


450 23.1 Not reported No association.

Schofield et al.,2005. Australia

Cross-sectional Self-report Grades 8 and11 /Both

1,033 10.4% Not reported Active commuters were significantly more likely to bemoderately active than passive commuters, OR=5.76.

Sirard et al., 2005.USA


Age 10 /Both

219 5% Not reported MVPA was significantly higher in regular activecommuters vs. irregular and non-active commuters; anadditional 24 minutes of activity per day.

Kremers et al.,2004. Netherlands


3,859 36.8% Not reported No association.

Metcalf et al., 2004.UK

Cross-sectional Accelerometer Age 5 /Both

275 67% 2% No association.

Ziviani et al., 2004.Australia

Cross-sectional Parental report Grades 1-7 /Both

164 Notreported

Not reported No association.

Cooper et al., 2003.UK

Cross-sectional Accelerometer Age 10 /Both

114 65% Not reported In boys, MVPA significantly higher in walkers vs. non-walkers; 200 vs. 155 minutes per day.No association observed among girls.

Michaud-Thomsonet al., 2003.Australia

Cross-sectional Self-report andPedometer.

Grades 4-7 /Both

491 11.5% Not reported Step counts significantly higher in walkers vs. non-walkers for both girls and boys; approx. 30-35 minutesof additional physical activity per day.

Tudor-Locke et al.,2003. Philippines


Ages 14-16 /Both

1,518 41.7% Not reported Boys and girls who walked to school had significantlyhigher Caltrac-derived energy expenditures than thosethat used motorized transport; 375 kcal vs. 331 kcaland 289 vs. 255, respectively.

Sjolie and Thuen,2002. Norway


88 Notreported

Not reported No association.



23

Tudor-Locke et al.,2002. Russia

Cross-sectional Parental report Ages 7-13 /Both

1,094 91.6% 40-50% *** Not reported.

MVPA - Moderate-to-vigorous physical activity* Reported in Cooper AR et al. Physical activity levels of children who walk, cycle, or are driven to school. Am J Prev Med. 2005;2:179-184.** Although the overall study design was prospective, data on total physical activity was treated cross-sectionally.*** Reported in Tudor-Locke et al. Active Commuting to School: An Overlooked Source of Children’s Physical Activity? Sports Med. 2001;3:309-313.



24

TABLE 2 Association Between Active Commuting to School and BMI / Overweight in Children

Author, Year.Location

StudyDesign

WeightMeasurement

ParticipantAges /Sex

Numberof

Childrenin Study

(N)

Percent ofChildren

Classifiedas Active

Commuters

Association Between Active Commute Status and BMIand/or Overweight

Ford et al., 2007.UK

Cross-sectional

Clinicallymeasured

Ages 5-11 /Both

239 48% No association with percent body fat or fat mass in boys orin girls, or by age group.

Landsberg et al.,2007. Germany

Cross-sectional

Clinicallymeasured

Age 14 /Both

626 62.6% No association in boys or girls.

Li et al., 2007.China

Cross-sectional

Clinicallymeasured

Age 7-17 /Both

6,826 Notreported.

Overweight children had significantly lower participationrates for active transport to school compared to normalweight children; 85% vs. 92%. Time spent in activetransport, however, was not significantly different.Children who walked for transport to/from school had asignificantly reduced risk for overweight compared tochildren who use the bus; Prevalence of 5.5 vs. 15.0, OR0.6.

Mota et al., 2007.Portugal

Cross-sectional

Clinicallymeasured

Grades 7-12 /Girls

705 52.6% No association.

Ortega et al., 2007.Spain

Cross-sectional

Clinicallymeasured

Ages 13-18 /Both

2,859 10% No association in boys. Active commuting associated withsmaller waist circumference but not with BMI in girls.

Saksvig et al., 2007.USA

Cross-sectional

Clinicallymeasured

Age 12 /Girls

1,596 15.7% No association.

Cooper et al., 2006.Denmark

Cross-sectional

Clinicallymeasured

Aged 9 and15 /Both

919 73.5% No association.

Mota et al., 2006.Portugal

Cross-sectional

Clinicallymeasured

Grades 7-12 /Both

550 Notreported.

No association.

Rosenberg et al.,2006. USA

Prospectivecohort

Clinicallymeasured

Grades 4-5 /Both

1,083 32.5% Boys who actively commute had significantly lower BMIvalues at baseline; 17.25 vs. 18.0.No association in girls at baseline.No association between change in BMI values and activecommuting over 2-year period.Active commuting not associated with overweight status.

Fulton et al., 2005.USA

Cross-sectional

Proxy andSelf-report

Grades 4-12 /Both

1,395 14% No association.

Gordon-Larsen et Cross- Clinically Grades 7-12 / 10,771 26.7% Active commuters significantly less likely to be overweight



25

al., 2005. USA sectional measured Both (29.7 of normal-weight participants used active transport vs.22.6% of overweight participants).

Heelan et al., 2005.USA

Prospectivecohort

Clinicallymeasured

Age 9-11 /Both

320 33.3% Significant positive correlation between BMI and activecommuting in overweight children; partial r=0.10.No association in normal weight children.

Klein-Platat et al.,2005. France

Cross-sectional

Clinicallymeasured

Age 12 /Both

2,714 38.6% Children actively commuting to/from school hadsignificantly higher BMI values compared to those who didnot. Length of commute (≤20 min vs. >20 min) appeared tohave no effect.Active commuters had BMI of 19.1-19.2 (boys) and 19.2-19.4 (girls) vs. passive commuters 18.6 (boys) and 18.8(girls).

Sirard et al., 2005.USA

Cross-sectional

Clinicallymeasured

Age 10 /Both

219 5% No association between BMI or overweight status andcommuting mode.

De Bourdeaudhuij etal., 2005. Belgium

Cross-sectional

Self-report Ages 11-19 /Both

6,078 Notreported.

Normal-weight children spent significantly more time inactive commuting than overweight / obese children (0.47 vs.0.35 hours per week).

Cooper et al., 2003.UK

Cross-sectional

Clinicallymeasured

Age 10 /Both

114 65% No association.

Evenson et al., 2003.USA

Cross-sectional

Self-report Grades 6-8and Grades 9-12 /Both

4,448 7.1%-10.5%

Children in grades 6-8 within 85th to 95th percentile for BMIless likely to report walking to school compared to thosebelow 85th percentile; no association found in this age abovethe 95th percentile.No association for students grade 9-12.

Tudor-Locke et al.,2003. Philippines

Cross-sectional

Clinicallymeasured

Ages 14-16 /Both

1,518 41.7% Boys using only motorized transport had significantlyhigher BMI values than boys who only walked; 18.9 vs.18.2.No association in girls.

BMI – Body Mass Index



26

TABLE 3 Summary of Literature on Active Commuting to School, Physical Activity and Weight

Number of studies reporting a statistically significant association

Active commuting and higherphysical activity

Active commuting and lower weight /obesity

Positive 12 3Inverse 0 1

No Association 8 9Mixed 4 5

Not reported 1 -Total 25 18


Documents

Systematic Review of Active Commuting to School and ...€¦ · Systematic Review of Active Commuting to School 4 likely complex and multifactorial; its universality suggests a social