Active Transport & Health: Evidence from Academia

6 min. read
Professor Xavier Bigard is the Medical Director for the Union Cycliste Internationale (UCI). Bigard is an internationally renowned professor of sports medicine. He has written several books and contributed to eminent scientific publications, and until 2017 was President of the French Society of Sports and Exercise Medicine (SFMES).

Physical inactivity causes 6% of deaths per year making it the 4th leading cause for mortality, resulting in an estimated 1.5%-3% of total healthcare cost in developed countries (Oldridge, 2008). Increasing physical activity may be most successful when incorporated in daily life habits. Switching from private vehicle use to active transportation (mainly biking) could be a sustainable strategy for promoting physical activity and improving mental health (Avila-Palencia et al., 2017). It will also result in other benefits with regards to air quality, traffic noise, urban temperature exposure and improved social interaction (Brand et al., 2013).

Young People:

A physically active life and avoiding long episodes of sedentary behaviour help prevent health complaints and improve wellbeing among adolescents (Ng at al., 2020). A study involving over 171,000 teenagers from 37 countries revealed that young people who lead physically active experience psychosomatic symptoms less frequently (Marques et al., 2019). In particular, the protective functions of physical activity are well established in the context of mental health. Physical activity goes far beyond sports, and includes active transportation walking and biking. Moderate to intense physical activity is important, including daily activities such as active transport to school (ATS).

A lot of studies have shown that ATS plays a significant role in improving adolescent health in many countries. Existing studies have focused mainly on walking and cycling as two forms of active transport. Cycling to school enables young people to meet the WHO recommendations for daily physical activity to a greater extent, reduces the risk of obesity and improves overall body fitness. ATS also strengthens positive effects on mental health and mental wellbeing (Biddle et al., 2019). Moreover, both cycling and walking to school can help to build a self-esteem based on greater independence.

The relationship between non-specific somatic complaints among adolescents (mean age 13.4 years) and ATS, including cycling, was recently examined for nine European countries of various geographical backgrounds (Kleszczewska et al., 2020). Young people who cycle to school are less likely to report health complaints, especially psychological symptoms. Cycling showed a protective effect against psychosomatic complaints in countries of higher economic status in which young people can use bicycle paths, enhancing the sense of security.

Young people who actively commute to school especially using a bicycle as a means of transport are less likely to report health complaints and psychological symptoms. The ATS interventions make it easier and safer for children to walk and bike to school by targeting the physical or social safety of common routes to school or by promoting safe travel behaviors. In order to improve the safety, convenience, and attractiveness of active travel to school, several countries responded in recent years by funding infrastructure and noninfrastructure programs. The economic evidence for the cost and benefit of these programs has been recently examined (Jacob et al., 2021). This study reviewed the evidence for the cost and the economic benefits from ATS interventions. The cost to implement ATS interventions and expected societal benefits varied. Studies that included benefits of reduced injuries and a range of additional environmental and health impacts related to increased bicycling (and walking) and bicycling showed a large benefitcost ratios which evidence that the economic benefits of ATS interventions exceed the cost to implement ATS interventions (Jacob et al., 2021).


In adults, the importance of physical activity for the prevention and control of non-communicable disease is now well-recognised, with active commuting promoted as a means of decreasing sedentary behaviour. Evidence shows that regular physical activity is associated with less sick-leave days from work and a higher productivity by employees at work. Whether active commuting has positive effects on health-related quality of life has been recently examined in a randomized prospective fashion (Neumeier et al., 2020). The results obtained after an intervention period of 12 months substantiate that active commuting and especially cycling to work is able to improve the quality of life of working adults. Moreover, another study showed that cycling to work was associated with reduced sickness absence during one year of follow-up (Mytton et al., 2016). 

Physical activity, including cycling, in natural environments can reduce stress, improve mood and mental restoration when compared to the equivalent activity in urban environments (Gidlow et al., 2016).  In addition, natural environments that are positively evaluated by people might strengthen the health benefits of physical activity. There is evidence of a relationship between natural environments and active commuting, and between natural environment and mental health (Ziljema et al., 2018). Daily natural environment commuting is related to better mental health. The effects of these green exercises have been related to improved cognition, greater restoration and decreased depression, when compared to exercise in urban or indoor settings. These findings suggest that cities should invest in commuting routes with nature for cycling (and walking).

In order to evaluate the association between different transport modes use and several health markers in adults, a study was performed in seven European cities (Antwerp, Barcelona, London, Örebro, Rome, Vienna, and Zurich) (Avila-Palencia et al., 2018). Bicycle use was associated with good self-perceived health, lower perceived stress, better mental health, and higher vitality in the single and multiple transport mode models. Bicycle use was also associated with fewer feelings of loneliness in the multiple mode models. These results suggest that the use of bicycle as a transport mode could help to improve social cohesion in a community, and reduce feelings of loneliness of its population.

Depression is a common and debilitating mental health condition for which physical activity is an important and effective adjunctive therapy (Cleare et al., 2015). The associations between changes in the mode of travel to work and the severity of depressive symptoms were investigated in a cohort of adult commuters with and without symptoms at baseline (Knott et al., 2018). Following adjustment for socio-demographic, lifestyle and health-related factors, findings were consistent with the hypothesis that a transition from travel exclusively by car to more active forms of commuting may contribute to an attenuation of both the development and the progression of depressive symptoms.

Taken together, these results complement the well-known positive effects of cycling on cardiovascular risk factors and reduction of chronic diseases, and are consistent with cycling to work being important for both mental and physical wellbeing. 

Elderly people

Ageing is not necessarily accompanied by decline in cognitive function and recent intervention studies have demonstrated that cognitive function and brain integrity can be maintained, or even improved, through increasing the frequency and duration of moderate to vigorous exercise. Moreover, exercise can reduce the occurrence of age-associated neurodegenerative disorders such as Alzheimer’s disease and vascular dementia. Aerobic exercise on a bicycle may improve cognitive function through increased cerebral vascular blood flow. On the other hand, the psychological wellbeing and quality of life increased through exercise may aid cognitive function in older adults (Allerhand et al., 2014).

Exercising outside in the environment, for example cycling, could further augment the well-known effects of exercise for cognitive function and wellbeing. In addition to the global effects of aerobic exercise on executive function (one of the cognitive components), cycling requires navigation in the environment enabling functional and morphological adaptive changes of the hippocampus. A recent study showed an improvement in wellbeing and different executive functions representative of cognition, in older adults included in a outdoor cycling program (Leyland et al., 2020). These results suggest that there may be an impact of exercising outdoor on executive function and mental health. Moreover, it was shown a similar effect on executive functions for a e-bike group compared to a pedal group.



Allerhand M, Gale CR, Deary IJ. The dynamic relationship between cognitive function and positive wellbeing in older people: A prospective study using the English longitudinal study of aging. Psychol Aging. 2014; 29: 306–318

Avila-Palencia, I., de Nazelle, A., Cole-Hunter, T., Donaire-Gonzalez, D., Jerrett, M., Rodriguez, D.A., Nieuwenhuijsen, M.J., 2017. The relationship between bicycle commuting and perceived stress: a cross-sectional study. BMJ Open 7, e013542.

Avila-Palencia I, Int Panis L, Dons E, Gaupp-Berghausen M, Raser E, Götschi T, Gerike R, Brand C, de Nazelle A, Orjuela JP, Anaya-Boig E, Stigell E, Kahlmeier S, Iacorossi F, Nieuwenhuijsen MJ. The effects of transport mode use on self-perceived health, mental health, and social contact measures: A cross-sectional and longitudinal study. Environ Int. 2018;120:199-206.

Biddle, S.J.; Ciaccioni, S.; Thomas, G.; Vergeer, I. Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality. Psychol. Sport Exerc. 2019, 42, 146–155. 

Brand, C., Goodman, A., Rutter, H., Song, Y., Ogilvie, D. Associations of individual, household and environmental characteristics with carbon dioxide emissions from motorised passenger travel. Appl. Energy 2013 ; 104, 158169.

Cleare, A., Pariante, C.M., Young, A.H., Anderson, I.M., Christmas, D., Cowen, P.J., et al. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2008 British Association for Psychopharmacology guidelines. J. Psychopharmacol. Oxf. Engl. 2015;29 (5), 459525.

Gidlow, C.J., Jones, M.V., Hurst, G., Masterson, D., Clark-Carter, D., Tarvainen, M.P., Smith, G., Nieuwenhuijsen, M. Where to put your best foot forward: psychophysiological responses to walking in natural and urban environments. J. Environ. Psychol. 2016, 45, 2229.

Jacob V, Chattopadhyay SK, Reynolds JA, Hopkins DP, Morgan JA, Brown DR, Kochtitzky CS, Cuellar AE, Kumanyika SK. Community preventive services task force. Economics of interventions to increase active travel to school: A community guide systematic review. Am J Prev Med. 2021;60(1):e27-e40.

Kleszczewska D, Mazur J, Bucksch J, Dzielska A, Brindley C, Michalska A. Active Transport to School May Reduce Psychosomatic Symptoms in School-Aged Children: Data from Nine Countries. Int. J. Environ. Res. Public Health 2020, 17, 8709.

Knott CS, Panter J, Foley L, Ogilvie D. Changes in the mode of travel to work and the severity of depressive symptoms: a longitudinal analysis of UK Biobank. Prev Med. 2018;112:61-69.

 Leyland LA, Spencer B, Beale N, Jones T, van Reekum CM. The effect of cycling on cognitive function and well-being in older adults. PLoS One. 2019;14(2):e0211779. 

Marques, A.; Demetriou, Y.; Tesler, R.; Gouveia, É.R.; Peralta, M.; Matos, M.G. Healthy Lifestyle in Children and Adolescents and Its Association with Subjective Health Complaints: Findings from 37 Countries and Regions from the HBSC Study. Int. J. Environ. Res. Public Health 2019, 16, 3292.

Mytton OT, Panter J, Ogilvie D. Longitudinal associations of active commuting with wellbeing and sickness absence. Prev Med. 2016;84:19-26.

Neumeier LM, Loidl M, Reich B, Fernandez La Puente de Battre MD, Kissel CK, Templin C, Schmied C, Niebauer J, Niederseer D. Effects of active commuting on health-related quality of life and sickness-related absence. Scand J Med Sci Sports. 2020 Aug;30 Suppl 1:31-40.

Ng, K.W.; Sudeck, G.; Marques, A.; Borraccino, A.; Boberova, Z.; Vasickova, J.; Tesler, R.; Kokko, S.; Samdal, O. Associations Between Physical Activity and Perceived School Performance of Young Adolescents in Health Behavior in School-Aged Children Countries. J. Phys. Act. Health 2020, 17, 698–708.

Oldridge NB. Economic burden of physical inactivity: healthcare costs associated with cardiovascular disease. Eur J Cardiovasc Prev Rehabil. 2008;15(2):130-139.

Zijlema WL, Avila-Palencia I, Triguero-Mas M, Gidlow C, Maas J, Kruize H, Andrusaityte S, Grazuleviciene R, Nieuwenhuijsen MJ. Active commuting through natural environments is associated with better mental health: Results from the PHENOTYPE project. Environ Int. 2018;121(Pt 1):721-727.