Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
if only 5%, why continue to "encourage"
- Michael R. King (28 September 2004)
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Walking to Work
- Bhaskar Ghosh (30 September 2004)
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Re: Walking to Work
- Mark Struthers (1 October 2004)
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Vested interests doom puny healthcare interventions
- Douglas J Carnall (2 October 2004)
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Plain English from Australia
- Michael J McGrath (2 October 2004)
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there is an 'infrastructure' definition problem too
- michael m yeates (4 October 2004)
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Unnecessary barriers to walking and cycling
- Peter M B English (4 October 2004)
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Re: Promotion of Health Related Behaviour in General.......
- ian stevens (4 October 2004)
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Walking and cycling: still the best buys for public health.
- Dr. Naseem A. Qureshi, MD, IMAPA, LMIPS (4 October 2004)
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Exercise can be bad for you - coercion worse
- James .n Hardy (5 October 2004)
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Re: Exercise can be bad for you - coercion worse
- Dr.Naseem A. Qureshi, MD (6 October 2004)
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This report is absurd.
- Mark S. Kern (7 October 2004)
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Re: Walking to Work
- Jean D Sinclair (9 October 2004)
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Re: Cycling to Work ~ making it possible.
- Ed Lehmann (12 October 2004)
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A transport planner's perspective
- Patrick C Lingwood (12 October 2004)
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Re: Re: Cycling to Work ~ making it possible.
- Brian T Smith (14 October 2004)
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Re: Exercise Fascism
- Frank J Leavitt (16 October 2004)
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Re: Re: Exercise Fascism
- Adrian S. Blaj (17 October 2004)
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Academic Cycling and Walking matters
- Gedis Grudzinskas, NA (17 October 2004)
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Authors' reply
- David Ogilvie (18 October 2004)
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Re: Re: Exercise Fascism
- Peter Morrell (18 October 2004)
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Re: Re: Exercise Fascism
- Frank J Leavitt (19 October 2004)
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Promoting walking and cycling as an alternative to using cars: systematic review
- Graham P Smith (20 October 2004)
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Does physical exercise reduce car use?
- Frank J Leavitt (9 November 2004)
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Michael R. King, Urban Designer New York, USA 11231
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In the transportation engineering and planning world, much is given to the 3 (or 4 E's: Engineering, Enforcement, Education, and Encouragement. This study cleary shows that the possibilities for the latter two, Education and Encouragement, as it pertains to mode shift, is slim at best. Yet programs are still conceived, touted, funded and implemented. Why? I suspect that politicians and professionals all know that the public wants their cake, and eaten too. These programs merely pay lipservice to that end, all the while more roads are built and cars bought. Competing interests: None declared |
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Bhaskar Ghosh, GP Grimsby
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I would be delighted to dump my car while going to work, provided the NHS/PCT can assure me that I will not have to do 'Home Visit' at all. Primary Care work should be 'practice based' and not 'bed based' as considered by the general population and politicians and a quite a significant number of health care workers, especially those who have come out of the acute care system but have not been able to shrug off their baggage yet. Competing interests: None declared |
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Mark Struthers, GP and prison MO Bedfordshire
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I would suggest that Bhaskar Ghosh should be subject to a ‘targeted behaviour change programme’ instigated by the North East Lincolnshire PCT. If he expects the dead and dying of Grimsby & Cleethorpes to get on their bikes, then he should too - and with all his other baggage. Such individual behaviour change may indeed be the 'best buy' for improving public health up there in Grimsby. On yer bike Dr Ghosh! Competing interests: I still use a car for 'home visits'. I am nevertheless fitter physically (if not mentally) from having been a Grimsby GP in a former life. |
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Douglas J Carnall, General practitioner London, E8 1AJ
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Ogilvy et al's paper demonstrates the greatest weaknesses of the "evidence-based" approach rather neatly. They assume that motoring is a disease and that interventions must be found to cure it, without examining the social forces that led to the car use in the first place, or that sustain it now it is here. They review various "interventions" that have tried to part the motor-dependent from their motors in favour of walking and cycling, and find they are weakly, or not at all, effective. This is hardly surprising, given the massive social currents acting in the opposite direction: car advertising, predict and provide road transport policies, retail monoliths with giant car parks and other horrors of surburban planning. Together this alliance of big business, oil suppliers, motor manufacturers and civil engineers have a massive vested interest in the continued growth of motorised transport. Free travel on foot or by bicycle is an insult to those businesses, who will actively discourage it. Those who have bought into this motor dependent lifestyle can be trusted to extend the infliction of motor tyranny on everyone else: motorists object to being taxed, though they are major pollutors, or confined by speed limits, though they killed 3,508 people in Britain last year, as they barge through towns and cities greeting their fellows with a snarl of the engine, a blast of the horn, and the acrid reek of their exhaust. Undermining this metal-carapaced horde is rather difficult, tiresome, and boring, so I am glad I am well paid to do it. Any driver suffering from a condition in which lack of exercise is a factor: hypertension, obesity, stress, depression--most of the general practice caseload in fact, is told to sell their car and get a bike instead. I do have my successes: I am particularly fond of the man in his fifties who came back for a followup appointment saying he wished he lived further from work so he had more time on his bike everyday, and a (no-longer-so-)depressed patient in her thirties who thanked me and said "I wish I'd taken cycling up years ago." But when I look at the vested interests lined up against me--not least George W. Bush's latest oil grab--I realise I am pissing into the wind and wonder why I bother. I find doctors who continue to drive particularly depressing, take for example, the consultant car park at Bart's, or the two jokers above, arguing about a visit. Since when do you need a car to carry a briefcase? Competing interests: I own five bikes and might sell one of them soon. |
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Michael J McGrath, editor–Freesail magazine (windsurfing) Manly Vale, Australia 2093
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As an ardent cyclist I was keenly interested in reading your paper. Unfortunately the language style is so impenetrable that I’m not confident I understand your conclusions. I refer you to <http://www.plainenglishfoundation.com/> for a guide on how to write reports that ordinary people can easily read and clearly understand. Regarding the content, as I understood it: I am obviously disappointed to see that the various “interventions” have such negligible effects on behaviour. I have been cycling for over 40 years, in Britain, all over Europe and, for the past 20 years, in Australia. In Sydney traffic conditions are so dangerous to cyclists that my riding is reduced to a Sunday morning ride with friends and occasional rides with Critical Mass or other organised rides. I am disillusioned that my children cannot enjoy the affordable freedom and pleasure that cycling gave me in my youth. If an infrastructure “intervention” increased my frequency of cycling, or made it feasible to commute to work, I would see that as a great improvement. As I see it most drivers are wedded to the comfort of their cars and the protection they offer from the elements. Compared to public transport cars give people the freedom to go where they wish, when they wish. There is also a social cocooning effect. To give cycling a chance of competing on the comfort and protection front I believe a whole new approach needs to be considered. I’m thinking of covered, off-road cycleways. There needs to be a serious trial where cyclists are protected from rain, strong winds, exhaust fumes and, in places like Australia, the damaging rays of the sun. Of course the cost of this level of “intervention” is unthinkable in the present car-dominated era. In the near future though dwindling petrol stocks will force governments to focus on alternatives. Perhaps this is one worth pursuing. Competing interests: Bicycle Committee, Manly Council, Manly Australia. Community representative. |
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michael m yeates, postgraduate student university of queensland
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The paper by Ogilvie et al provides some interesting results but also illustrates other definitional difficulties. For example, what exactly is an infrastructure intervention and how it might create a significant or insignificant contribution to some walking or cycling trips but not others is clearly a major issue in comparative studies such as this. I am not surprised that the results appear so limited as it is inevitable that significant behaviour changes take time and often, take significant effort. These vital elements do not appear to have been taken into account and this is clearly another essential project. It seems to be of limited value to know that some promotional interventions work while others do not, if the "setting" is not virtually identical, which of course is in general, fairly unlikely. So rather than being disappointed by some of the reported results, perhaps the limited outcomes are more a measure of the extent and commitment of the intervention ie a limited intervention would seem likely to obtain a limited outcome in even the most favourable "setting". In other words, more effort is needed to obtain better results. In practice too, there is a real issue if promotion is successful but the setting is unsatisfactory. If people are motivated to try walking or cycling but then find the environment is not as they expected, these people can quickly change from potential converts to advocates for not walking and not cycling. It seems to me that projects such as those investigated should therefore also be subject to what might best be described as a relative "safety+convenience" audit in order that the relative "safety+convenience" for people walking and/or cycling in the different environments can be assessed and compared, a concept about which I have written elsewhere. As the Heart Foundation in South Australia (among others) has shown, the daily dose of healthy exercise is related to the extent to which the local environment is, and is considered to be, "supportive" ie of walking and/or cycling. The concerns and fears attached to children walking or cycling to school illustrate this well. If the environment is not supportive, then even a very small or insignificant increase in people walking or cycling would in fact be "significant". Finally, one of the most interesting "interventions" is achieving even small speed reductions such that people can assert their right to walk or cycle on the road knowing they are safer. Competing interests: None declared |
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Peter M B English, CCDC Surrey HPU, KT19 8BX
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In my part of Surrey, many schools explicitly create barriers to pupils' walking or cycling to school, by enforcing school uniform regulations that require pupils to camouflage themselves in navy blue or black outer clothing, and forbidding hats, scarves and gloves until the head-teacher (usually a hardy soul) considers it to be cold enough. The conspicuity issues add weight to parents' anxieties about their children walking or cyclying to school; and banning warm clothing would certainly put some pupils off in winter. I have pointed out the effect of these regulations to some of my local schools, and been told that it would be "inappropriate" to permit anything else. No further explanation was given. When I approached the LEA "walking to schools" officer, I was told that school governors set uniform policy, and there is no way to direct them to change their minds on this sort of issue. Peter English. Competing interests: None declared |
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ian stevens, Physiotherapist FK
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I am a lifelong cyclist ,a Physiotherapist and I work in Primary Care .....I have to work in a practice 25 miles away(50 miles away is a bit of a distance to travel by bike) meanwhile there are others driving from where I go to work with similar qualifications in the opposite direction to the same employer .......This happens nationwide! I remember the joys of cycling down Glasgow High Street in driving sleet and the cyle lanes throughout Glasgow grinding to a halt or the cycle lanes being occupied by lines of parked cars ......No wonder cycling won't catch on..... My wife as a postgrad student worked as a secretary and was all set to take the managing director accross town via a small walk to the tube station when the plan was vetoed ..It is far more acceptable to be stuck in a grinding jam than mix with the run of the mill public ....... Cars are personal, comfortable, convenient ,status driven and in some people extensions or facets of their personality (why else would people deliberately try and run others off the M8 ?? I have talked to people who have driven to Cornwall and back to Scotland in a day and then go to the Chiropracter to get the back 'fixed'........ However such is the way of modern life I suppose . There are some good chapters on the barriers to exercise in Perspectives on Health and Exercise by McKenna and Riddoch (reviewed in the BMJ last year)....the environment is certainly the biggest barrier. Handing out advice to cycle or walk is never going to work ....surprisingly some people I now work with don't seem to have a problem driving to the gym and walking on a treadmill for while! Ian Stevens Competing interests: None declared |
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Dr. Naseem A. Qureshi, MD, IMAPA, LMIPS, Medical Director [A], Director, CME&R Buraidah Mental Health Hospital, Postcode.2292, Saudi Arabia
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Dear Editor, This systematic review by Ogilvie and colleagues is absolutely biased against walking and cycling, the two well established means of majority of people for enhancing positively several health parameters and by extension promotion of health at global population level. As a consequence, these authors have in fact done a disservice to a larger group of population who uses regularly cycles for multiple purposes, the end result of which is to consume excessive energy. Likewise, regular brisk walking is highly useful and recommended mode of therapy for a variety of medical disorders and it also promotes overall health and well being. It is advisable that despite the discouraging results of this review, people must continue to use cycles and do regular exercises including walking for keeping themselves hale and hearty. Another consequence of this systematic review, which is clearly favouring for using cars is to deliver a good and healthy message to car manufacturers not to worry about any presumptive reduction in car sales. This article may act as a booster for their image. This review is not balanced and has looked at walking and cycling from a distorted point of view. Like cars, walking and cycling have their own advantages and disadvantages but are completely devoid of any air pollution which is alarming affecting the health of all commuters. The last but not the least, the use of cars is like smoking which not only adversely affects the health of the smokers but also nonsmokers. Reference: David Ogilvie, Matt Egan, Val Hamilton, and Mark Petticrew Promoting walking and cycling as an alternative to using cars: systematic review. BMJ 2004; 329: 763-0 Competing interests: None declared |
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James .n Hardy, Gp Principal Bethnal Green Health Centre, 60 Florida Street, London E2 6LL
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Editor, Every time I get on my bike I develop a painful effusion in my knee. If I swim, the same thing happens. Walking isn't much better, so I limit myself to 80 trips up and down my corridor each working day. I experience daily pressure from exercise fascists that leaves me feeling disgraced and doubly disabled. I find their smug self satisfaction nauseating and wish they'd go away. David Ogilvie, Matt Egan, Val Hamilton, and Mark Petticrew Promoting walking and cycling as an alternative to using cars: systematic review BMJ 2004; 329: 763-0 Competing interests: 1994 Nissan Micra owner |
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Dr.Naseem A. Qureshi, MD, Director, CME&R POBox.2292, Buraidah Mental Health Hospital, KSA
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Dear Hardy, It is hard to believe that exercise is bad. However, any form of exercise must be tailored according to both the age and disease. Hope you understand this clear message and modify your exercise habit in order not to develop any adverse effect of it. Competing interests: None declared |
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Mark S. Kern, I bicycle a lot. 80302
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It appears the author mentions a few short-term instances, perhaps suggesting 6 months at its greatest extent. I've seen free bikes given away; they may be used once or twice . . . not much more. The author names Phoenix and Eugene . . . as healthy places? In Eugene it rains over 46 inches a year. Allergies are rampant in Eugene. Phoenix, the Valley of the Sun, has valley fever, allergies deluxe (from all the irrigation), etc. Summer days, from spring to fall, exceed 105 F, usually. This is not a healthy place. I saw a record temperature in Phoenix. They had 3 weeks in April with high temperatures exceeding 100 F. There are a few ways to look at activities that are healthy. One way is to see what those who've survived a very long time, did, that apparently helped them survive. That they had a quality of life goes without saying. There is no longevity without a quality of life. If one looks online for the oldest person in the world, who died in 1997 at 122 years of age, it states in her brief biography, that she bicycled until she was 100. No study can beat her example. I'm 58. When I was 22, my blood pressure was 198/88. My mom died from heart failure, when I was 15. I have a mitral valve prolapse, which appeared about 10 years ago. My sister at age 60 completed a triathlon. I bicycle 40-45 miles a day, usually . . . and I travel pretty fast, too. Heart doctors have no use in me, as I take care of my health. Bicycling is my ticket. That author appears out of whack. Competing interests: None declared |
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Jean D Sinclair, RGN - travel clinic & disability benefits tribunal member Cambridge / Coventry
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I know of at least one GP who successfully carries out home visits by bike in Cambridge, a city which has some excellent engineering solutions (eg foot / bike bridges over river & main roads, bike parking racks, including at Addenbrookes hospital & some chemists, but not the clinics / surgeries I use) to encourage cycling, but also enforces by BANNING bikes from the market square & adjacent roads in the middle of the day! Competing interests: None declared |
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Ed Lehmann, Chemical Engineer Culham, Oxon..
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Some contributors in this thread suggest that a GP's baggage makes cycling to a home visit impossible. As a point of information, I doubt many GP's would wish to carry all that can be got in to a pair of "Carradice Bike Bureau" panniers. Just one takes my laptop, power supply, text books, work papers, cyclist's lunch and minor bits. You do need to be careful with it, though. While it's a safe, upright lift off a bike rack, hoicking a loaded one out of the car ricked my back! Carradice can also produce panniers for a burns/first aid kit one side, oxygen/resuci kit the other, with more London paramedic kit going in two front panniers. So no more excuses, fellas! Luggage is not the problem. And you know how to get legs, lungs, heart and mind sorted I'm sure! Competing interests: CTC "Right to Ride" voluntary representative, Vale & S. Oxon.. |
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Patrick C Lingwood, Cycling Development Co-ordinator South EAST Oxford OX1 2JQ
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We should thank Ogilvie et al for their work and research - they highlight the crucial issue of the need to promote cycling and walking as a way of promoting individual health. But I am concerned that their main conclusion, viz: "interventions that engage people in a participative process and address factors of personal relevance may be more effective than those that simply aim to raise awareness or impose changes in the physical and economic environments". may be taken a little too seriously by at least those in the area of health promotion. I think there is a mismatch of philosophy and technique. I am always amazed how medical studies can produce meaningful results from small sample sizes. Transport planning and travel behaviour do not allow such easy interventions or conclusions. We are dealing with a very dynamic environment - a combination of such factors as the road environment, financial costs, personal circumstances, national and local policy, travel assumptions etc etc. Within this environment it is very difficult to prove that any single intervention will have a significant effect. There is however a weight of evidence which shows what the barriers to cycling are and the kinds of interventions that will make cycling more attractive. The single most prominent is the perception of safety, for which the speed, volume and behaviour of car and other motorised vehicle drivers is the determining factor. The conclusion of this is that there is no use by itself promoting cycling unless cyclists can make their journeys in a cycle friendly road environment. As the authors point out, the difference in cycling levels between nations and towns is of the magnitude of 50 from perhaps 50% of trips in Groningen to around 1% in several UK cities. It is difficult to explain these differences by any one factor - I have tried out correlation tests on data from around 100 European towns, UK census data and all industrialised countries. The really significant correlation (around 0.95) is the historical level of cycling - ie a country or town with high or low levels of cycling will continue to have high or low levels of cycling or put another way, behavioural change is slow. Throughout Europe in most northern countries, cycling is already relatively high and on the increase. UK along with Spain and Portugal is at the bottom of the pile and decreasing. One fact highlights the discrepancy - in Netherlands, 50% of all children's journeys are by cycle and increasing, in UK it is 1% and decreasing. Through our ERCDT (English Regions Cycling Development Team) reports (on the National Cycling Strategy website www.nationalcyclingstrategy.org.uk with an 2004 update shortly to be posted) we have highlighted a range of factors and changes necessary by local authorities to increase cycling. The most important issue currently is for the those involved in health promotion to work with local authorities in preparing their second round of local transport plans (2006-2011) to ensure that the promotion of walking and cycling (by the whole range of interventions) is central to future policy. Competing interests: English Regions Cycling Development Team (ERCDT) |
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Brian T Smith, GP Principal(part time) Park Parade Surgery, Whitley Bay, NE26 1DU
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I am part-time GP in a sub-urban practice on the North East coast and I cycle to work twice a week (round trip 17 miles). I also do home visits on my bike (usually 3-5 miles but has been upto 18 miles), as do both of my partners (though one only does so on sunny summer days!). All the equipment needed can easily be carried in a ruc-sac/single pannier and patients are generally positive about a GP turning up in a day-glo jacket. The only days that I don't cycle to work are those when it is actually raining when I look out of my bedroom window in the morning, if I am unwell, or if my partners are on holiday and I can sense a 13 visit day! Due to the rush-hour congestion, my journey time is comparable to that in my car, and I feel this is very important point. There are few structural cycle "iterventions" on my route to work, but most of those that there are I ignore. This is because they slow my journey down (eg. to get around a roundabout on the cycle path can involve giving-way to the car traffic 4 times), are littered with glass, have a terrible road surface, or just take me on a large detour. If cycling was going to make my journey take twice as long I wouldn't do it. As well as being 'safe', cycle paths have to make journey times shorter. To do this they have to go where people want to go, give priority to cyclists over cars, not be covered in broken glass and not be used as a local residents' parking lane. Competing interests: The bike I use for work was bought out of Prescribing Incentive Savings as a health promotion activity. |
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Frank J Leavitt, Chairman, Centre for Asian and International Bioethics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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I would like to agree with Dr Hardy about coercion. I am an exercise freak, but who can favour any fascism, including exercise fascism? If someone doesn't want to exercise, that is his or her business. And don't plenty of fat, soft lazy people live to healthy old age? Let's all accept each other's ways of life and stay friends. But Dr Hardy's criticism leads to an important question for the ethics of public health. Can exercise-promoting public health interventions be designed to be non-coercive? This is complex because your coercion (restricting your motorcar or cigarette use for example) can be my protection from your polluted air, deadly vehicle, etc.) Again, where is the line between education and coercion? If we don't provide schoolbus service to children who live within a certain radius, are we educating or coercing? Also, encouraging bicycling is not necessarily totally benign. Michael Vandeman has written about ecological damage done by mountain bikers (http://home.pacbell.net/mjvande/scb7.htm Accessed 16th October 2004) So it seems that any intervention aimed at encouraging one way of life risks coercing those who prefer other ways. As I started to write this response I wanted to join Dr Hardy's opposition to exercise fascism. But the more one looks at the complications the more it seems that some exercise fascism may be unavoidable if we want to improve public health. Competing interests: None declared |
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Adrian S. Blaj, Psychiatrist Chase Farm Hospital, London, EN2 8JL
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Madam: I note that Frank J Leavitt uses his favourite expression 'exercise fascism' four times in three paragraphs (and title). I am really at a loss trying to understand this new concept; would Mr Leavitt be kind enough to let us know whether exercise communism/socialism would be more suitable for us? Competing interests: None declared |
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Gedis Grudzinskas, Medical Director The London Bridge Fertility,Gynaecology and Genetics Centre,One St Thomas St,London Bridge, SE1 9RY, NA
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Dear Sir, May I bring your attention to a recent publication "The Drive to Work in O & G",(2000)Barts and The London Chronicle,2,28-29, which revealed additional benefits for senior academics who walk or cycle to work. Our survey of the professoriate at that time, 53 of the 57 professors responding to the questionnaire, showed a clear correlation between locomotion and publication rates seen. The youngest professor at that time had never driven to work and went on to receive a Ł20,000,000.00 MRC sponsored grant. Perhaps all academics will soon have their method of locomotion to work assessed. Yours sincerely Gedis Grudzinskas Competing interests: None declared |
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David Ogilvie, MRC fellow MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow G12 8RZ
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We agree with Carnall, McGrath and Stevens that many of the interventions about which we found evidence were unlikely to have large effects in the face of strong economic and personal interests to the contrary, and with Yeates that many of these interventions had rather limited ambitions or evaluation timescales. We also agree with Lingwood that the complexity of transport-related behaviour and interventions makes it difficult to establish causal relationships between interventions and outcomes. However, these do not constitute arguments against the approach we have taken. The evidence about barriers to cycling, to which Lingwood refers, is undoubtedly relevant and contributes another piece in the jigsaw of evidence. But we cannot simply assume that measures which appear to address these factors will necessarily lead to the desired results [1] — a point well illustrated by Smith. The UK Department for Transport has recently admitted that the National Cycling Strategy (NCS), to which Lingwood also refers, has had no effect on the overall level of cycling in England despite its good intentions. [2] One reason identified by the NCS board is a lack of political will to address the deeper causes and competing interests to which Carnall and King refer. [3] The NCS board also notes that transport policy can often appear to be pursuing conflicting goals — a point well illustrated by Sinclair. We hinted in our discussion that more ambitious measures might be more effective, and our findings are consistent with (if not proof for) a view that much more radical changes in society would be required to achieve significant population health gain through a modal shift towards walking and cycling. Carnall complains that we have treated driving as a disease and ignored the social forces which underlie it, but this is not the case. We set out with an entirely open mind as to what types of “intervention” might be relevant, and searched for evidence accordingly (readers can verify this by examining our search strategy on bmj.com). We hoped to find evidence about the effects of policies on, for example, car advertising and suburban planning and would certainly have included such evidence if we had found it. The “weakness” he mentions is not a weakness of the “evidence-based” approach, but a lack of relevant primary research on the factors he identifies. Qureshi makes the remarkable assertion that our review is biased in favour of using cars and underplays the potential health benefits of walking and cycling. Qureshi has chosen to attack a straw man. As we indicated (albeit briefly) in our introduction, the belief that promoting a modal shift would be desirable on public health grounds was the starting point for our review. It was not a review of epidemiological evidence about the health benefits of walking and cycling; it was a review of effectiveness to find out what actually works in achieving these potential benefits in populations. We found relatively little evidence with which to answer this particular question at present, but this is completely different from saying that walking and cycling are not beneficial to health or that promoting a modal shift is not a desirable goal of public policy. Kern is another correspondent who fails to distinguish between evidence that cycling is good for people and evidence of what works in promoting a modal shift. He also misquotes us: we did not say that Phoenix or Eugene are healthy places, we merely identified them as places where relevant research has been carried out. These and other readers may have been unduly influenced by the editors’ summary in “This week in the BMJ”, which contains an error of fact (“Reviewing 22 studies analysing the effect of targeted behaviour change programmes”) and opens with the statement that “Encouraging people to use alternative and healthier modes of transport may not be enough to improve the health of the population”. Readers will struggle to find such a statement anywhere in our paper. The authors did not see the piece in “This week in the BMJ” before publication and do not endorse it now. References 1. Macintyre S, Petticrew M. Good intentions and received wisdom are not enough. J Epidemiol Community Health 2000; 54: 802-3. 2. Department for Transport. Walking and cycling: an action plan. London: Department for Transport, 2004: 7. http://www.dft.gov.uk/stellent/groups/dft_control/documents/contentservertemplate/dft_index.hcst?n=12069&l=2 3. Bike for the future: the NCS board for England's strategic action plan - "more people cycling, more safely, more often". London: National Cycling Strategy Board, 2004: 5-6. http://www.nationalcyclingstrategy.org.uk/fileuploads/ncsb/NCSB098.pdf Competing interests: None declared |
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Peter Morrell, Hon Research Associate, History of Medicine Staffordshire University, UK
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When Dr Leavitt says, "the more one looks at the complications the more it seems that some exercise fascism may be unavoidable if we want to improve public health," then there indeed lies the rub. He raises a very valid point. On the one side, some people will contend that ALL medical interventions are fascist or dictatorial; on the other side, some people will say this is merely 'friendly advice' that the patient is free to take or leave. Deciding which is which might prove to be a difficult matter. Competing interests: None declared |
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Frank J Leavitt, Chairman, Centre for Asian and International Bioethics, Faculty of Health Sciences Ben Gurion University of the Negev, Beer Sheva, ISRAEL
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With all due respect to Dr Blaj, these "Rapid Responses" are an ongoing discussion. Individual contributions cannot be understood unless one reads the previous ones. "Exercise fascism" (or "exercise fascists") is not my term at all but Dr Hardy's. (above) I was simply responding to his provocative comment. Competing interests: None declared |
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Graham P Smith, urban designer OX1 4LF
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I guess we will all see the BMJ study through our own eyes! There has been much discussion in the cycling policy discussion group. The study rightly says that not much will change, but when the system is designed to prevent any modal shift towards cycling, walking or public transport, what surprise is that? It is quite clear to me that the physical environment we now live in, has been made into a barrier, and every day practice reinforces the barrier affect. The effect of forty + years of segregating residential development by design (Radburn Layouts and DB32, (Guidance for Residential Development)); the mindless use of Design Manual for Roads and Bridges (DMRB) (because national policy regarding integrating mixed-use streets was that they would disappear - therefore guidance for them was irrelevant) and the bizarre approach of Planning in general that only segregated development was acceptable, have, together made walking, cycling and public transport all but impossible. That is particularly so for most new development since the 40s. The segregation by physical layout is now deeply embedded and if you propose even a foot route through a cul-de-sac development you will discover the depth of negative feeling. With buyers, developers, DC Officers, Highways and the dreaded Highways Safety Audit all (mostly) working against integration and mix, the job of promoting the benign modes is at least, vexed. It is continually surprising to me that those interested in public health and increasing obesity; those interested in 'Bobbies on the beat'; those interested in the efficiency of the emergency services; those interested in making bus journeys more desirable; those who moan about the food deserts created by ever larger superstores; and those who bemoan the loss of the local high street (to name but a few) have not raised more of a cry about the mind numbing consequences of DoT, DoE, DETR, ODPM, DfT policies regarding urban layout. Everything is focused on maximizing capacity and in increasing speed for motorized private travel. Oxford is a surprising disbeneficiary of this thinking at a local level! Competing interests: None declared |
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Frank J Leavitt, Chairman, Centre for Asian and International Bioethics Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. 84105
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Sorry to write so many responses here. But an important aspect of this discussion has not yet been touched. I participate in stenuous physical exercise, with training sessions at least four evenings every week. I also bicycle quite a bit for physical fitness. I live too far from work for bicycle commuting, however. So I keep my bicycle at work and use it primarily for fitness, and for transportation in the region of the university. The vast majority of my kilometrage is by car. Also, needing some substantial equipment for training sessions I use the car to take my equipment to and from the training hall, even though it is within very short walking distance from my office. One of my trainers lives far from the training hall and drives at least an hour and a half each way, twice a week, to come and teach us. I also use the car quite often to get to training sessions in far away cities. Although I am not a competitive cyclist or serious bicycle tourist, I often see bicycles carried on racks on cars on their way to or from meets or touring take-off points. Maybe some inverse correlation obtains between physical exercise and car use. But factors of the sort which I have mentioned would seem to make it very hard to establish such a correlation. Competing interests: None declared |
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