Active commuting and cardiovascular risk: A meta-analytic review

Objective. Leisure time physical activity is inversely associated with cardiovascular risk, although evidence for the protective effects of active commuting is more limited. The present review examines evidence from prospective epidemiological studies of commuting activity and cardiovascular risk. Methods. Meta-analytic procedures were performed to examine the association between commuting physical activity and cardiovascular risk. Several cardiovascular endpoints were examined including mortality, incident coronary heart disease, stroke, hypertension and diabetes. Results. We included eight studies in the overall analysis (173,146 participants) that yielded 15 separate risk ratios (RR). The overall meta-analysis demonstrated a robust protective effect of active commuting on cardiovascular outcomes (integrated RR=0.89, 95% confidence interval 0.81-0.98, p=0.016). However, the protective effects of active commuting were more robust among women (0.87, 0.77-0.98, p=0.02) than in men (0.91, 0.80-1.04, p=0.17). Conclusions. Active commuting that incorporates walking and cycling was associated with an overall 11% reduction in cardiovascular risk, which was more robust among women. Future studies should investigate the reasons for possible gender effects and also examine the importance of commuting activity intensity. (C) 2007 Elsevier Inc. All rights reserved.