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Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study

BMJ 2017; 357 doi: (Published 19 April 2017) Cite this as: BMJ 2017;357:j1456
  1. Carlos A Celis-Morales, research associate1,
  2. Donald M Lyall, research associate2,
  3. Paul Welsh, senior lecturer1,
  4. Jana Anderson, research associate2,
  5. Lewis Steell, postgraduate student1,
  6. Yibing Guo, postgraduate student1,
  7. Reno Maldonado, postgraduate student1,
  8. Daniel F Mackay, reader2,
  9. Jill P Pell, professor2,
  10. Naveed Sattar, professor1,
  11. Jason M R Gill, reader1
  1. 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
  2. 2Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  1. Correspondence to: J M R Gill jason.gill{at}
  • Accepted 16 March 2017


Objective To investigate the association between active commuting and incident cardiovascular disease (CVD), cancer, and all cause mortality.

Design Prospective population based study.

Setting UK Biobank.

Participants 263 450 participants (106 674 (52%) women; mean age 52.6), recruited from 22 sites across the UK. The exposure variable was the mode of transport used (walking, cycling, mixed mode v non-active (car or public transport)) to commute to and from work on a typical day.

Main outcome measures Incident (fatal and non-fatal) CVD and cancer, and deaths from CVD, cancer, or any causes.

Results 2430 participants died (496 were related to CVD and 1126 to cancer) over a median of 5.0 years (interquartile range 4.3-5.5) follow-up. There were 3748 cancer and 1110 CVD events. In maximally adjusted models, commuting by cycle and by mixed mode including cycling were associated with lower risk of all cause mortality (cycling hazard ratio 0.59, 95% confidence interval 0.42 to 0.83, P=0.002; mixed mode cycling 0.76, 0.58 to 1.00, P<0.05), cancer incidence (cycling 0.55, 0.44 to 0.69, P<0.001; mixed mode cycling 0.64, 0.45 to 0.91, P=0.01), and cancer mortality (cycling 0.60, 0.40 to 0.90, P=0.01; mixed mode cycling 0.68, 0.57 to 0.81, P<0.001). Commuting by cycling and walking were associated with a lower risk of CVD incidence (cycling 0.54, 0.33 to 0.88, P=0.01; walking 0.73, 0.54 to 0.99, P=0.04) and CVD mortality (cycling 0.48, 0.25 to 0.92, P=0.03; walking 0.64, 0.45 to 0.91, P=0.01). No statistically significant associations were observed for walking commuting and all cause mortality or cancer outcomes. Mixed mode commuting including walking was not noticeably associated with any of the measured outcomes.

Conclusions Cycle commuting was associated with a lower risk of CVD, cancer, and all cause mortality. Walking commuting was associated with a lower risk of CVD independent of major measured confounding factors. Initiatives to encourage and support active commuting could reduce risk of death and the burden of important chronic conditions.


  • This research was conducted using the UK Biobank resource. We thank the participants of the UK Biobank.

  • Contributors: CACM, JPP, NS, and JMRG contributed to the conception and design of the study, advised on all statistical aspects, and interpreted the data. CACM performed the statistical analysis, assisted by LS, YG, and RM. CACM, JPP, NS, and JMRG drafted the manuscript. CACM, DML, PW, JA, LS, YG, RM, DFM, JPP, NS, and JMRG reviewed the manuscript and approved the final version to be published. CACM, JPP, NS, and JMRG had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. JPP, NS, and JMRG contributed equally to this work and are joint senior authors. CACM, JPP, NS, and JMRG are the guarantors.

  • Funding: The UK Biobank was supported by the Wellcome Trust, Medical Research Council, Department of Health, Scottish government, and Northwest Regional Development Agency. It has also had funding from the Welsh Assembly government and British Heart Foundation. The research was designed, conducted, analysed, and interpreted by the authors entirely independently of the funding sources.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: UK Biobank received ethical approval from the North West Multi-centre Research Ethics Committee (REC reference: 11/NW/03820). All participants gave written informed consent before enrolment in the study, which was conducted in accord with the principles of the Declaration of Helsinki.

  • Data sharing: Researchers can apply to use the UK Biobank resource and access the data used. No additional data are available.

  • Transparency: The manuscript’s guarantors (CACM, JPP, NS, and JMRG) affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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