LAUSR

Physical inactivity is associated with a higher incidence and greater severity of a large number of chronic diseases. Active transportation, defined as physical activity to go to work, can be on foot or by bicycle. Intriguingly, there is a favorable dose-response relationship between physical activity with cardiovascular fitness and mortality among individuals who choose active transport, as well as a reduced risk of cardiovascular disease and all-cause mortality. In this issue of the Journal, a thorough ecological study utlized data from 325 local authorities in England, including 43,077,039 employed individuals collected from the UK Census 2011, and 117,521 individuals with myocardial infarction (MI), originating from the Myocardial Ischaemia National Audit. The authors investigated the association of active transport to work and incidence of MI, adjusting for local levels of deprivation, obesity, smoking, diabetes, and physical activity. In 2011, the prevalence of active transportation to work for people in employment in England aged 25–74 years was 11.4% (4,531,182 active transporters; 8.6% walking and 2.8% cycling). Active transport in 2011 was associated with a lower incidence of MI in 2012 amongst men cycling and women walking to work. However, the prevalence of active transport for men and women was not significantly associated with the combined incidence of MI between 2011–2013 after adjusting for physical activity, smoking and diabetes. In England, the prevalence of active transportation was associated with a reduced incidence of MI for women walking and men cycling to work in corresponding local geographic areas). Recent findings suggest that lifelong exercise training may preserve left ventricular systolic function and attenuate the deleterious effects of pathological left ventricular remodeling after myocardial infarction, as well as improve peak oxygen uptake in patients with arterial disease coronary artery. Notably, the effect size is rather modest. More detailed information on exercise duration and intensity, medication use, presence of metabolic syndrome, lipid level, depression and stress would provide a stronger evidence base for the possible implication of active transport programs as a public health intervention. Stronger recommendations for further research, practice and policy actions could be proposed if these results were externally replicated, possibly with more comprehensive adjustment. In conclusion, the article by Munyombwe and colleagues enlightens us as to the important findings on active transportation and incidence of MI for men and women. Public health interventions to encourage active transportation to reduce the global burden of chronic diseases are needed. Further research is needed to determine the economic implications of implementing such programs.