Intended for healthcare professionals

CCBYNC Open access

Rapid response to:


The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study

BMJ 2011; 343 doi: (Published 04 August 2011) Cite this as: BMJ 2011;343:d4521

Rapid Response:

Cycling in Urban environment: More needs to be done

Cycling is probably the future of urban transport with inherent
advantage of being ecofriendly and healthy transport medium. Rojas-Rueda D
et al observed that public bicycle sharing initiatives are good for
health(1). Authors studied three primary outcome measures viz. all cause
mortality for the physical activity, air pollution and road traffic
accident mortality for their study. These three outcome measures are
inadequate to study the true benefits and risks of cycling. Non fatal
cycle accidents and other bicycle use related ailments are equally
important parameters for unbiased assessment of benefits of cycling. In
United States the average annual cost of nonfatal bicycle injuries in
children and youth aged 0 to 19 was $4.7 billion for the year 2008(2).
Bikers often suffer musculoskeletal injuries, more commonly due to wear
and tear and bad posture. An old fashioned bicycle that allows one to sit
upright in a balanced position is often very difficult to find now a days.
Modern racing type bicycles encourage a forward bent, flexed position to
maximize speed. Such posture places excessive stress on the low back,
neck, shoulders, elbows and the wrists. Prolonged extension posture of
head fatigues the muscles of the neck. Neck pain, back pain, knee pain,
handlebar neuropathies, plantar fasciitis, Achilles tendonitis etc are
also not uncommon among the cyclists(3). There is increased risk of
Erectile Dysfunction associated with cycling which is further increased by
poor design of the seat(4). Thus further in depth studies are required to
assess the health consequences of switching to the cycling. Policy
decisions of such large extent effecting millions of people should be
based on hard facts not just popular perception. Further, policymakers
need to take proper steps to minimize cycling related injuries like using
appropriate type and design of the bicycles and educating people about the
healthy way of biking.


1. Rojas-Rueda D, de Nazelle A, Tainio M, Nieuwenhuijsen MJ. The
health risks and benefits of cycling in urban environments compared with
car use: health impact assessment study. BMJ. 2011;343:d4521.

2. Sheppard, M. A., & Taylor, D. Medical, work loss, and quality
of life costs for fatal and hospital-admitted bicycle injuries to children
0-19 in 2004 dollars [unpublished data]. Calverton, MD: Pacific Institute
for Research and Evaluation.

3. Thompson MJ, Rivara FP. Bicycle-related injuries. Am Fam
Physician. 2001 May 15;63(10):2007-2014.

4. Sommer F, Goldstein I, Korda JB. Bicycle riding and erectile
dysfunction: a review. J Sex Med. 2010 Jul;7(7):2346-2358.

Competing interests: No competing interests

06 August 2011
Naveen Dutt
Senior Resident
Kirti Chaudhry
Govt. Medical College & Hospital, Chandigarh, India