CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Université Clermont Auvergne, Witty Fit, 63000, Clermont-Ferrand, France.
Faculty of Health, School of Exercise Science, Melbourne, Australia2 General Medicine, AMUAC, Australian Catholic University, 63000, Clermont-Ferrand, France.
Sports Med. 2020 Dec;50(12):2237-2250. doi: 10.1007/s40279-020-01354-0.
Sedentary behaviour is a major risk of mortality. However, data are contradictory regarding the effects of active commuting on mortality.
To perform a systematic review and meta-analysis on the effects of active commuting on mortality.
The PubMed, Cochrane Library, Embase, and Science Direct databases were searched for studies reporting mortality data and active commuting (walking or cycling) to or from work. We computed meta-analysis stratified on type of mortality, type of commuting, and level of commuting, each with two models (based on fully adjusted estimates of risks, and on crude or less adjusted estimates).
17 studies representing 829,098 workers were included. Using the fully adjusted estimates of risks, active commuting decreased all-cause mortality by 9% (95% confidence intervals 3-15%), and cardiovascular mortality by 15% (3-27%) (p < 0.001). For stratification by type of commuting, walking decreased significantly all-cause mortality by 13% (1-25%), and cycling decreased significantly both all-cause mortality by 21% (11-31%) and cardiovascular mortality by 33% (10-55%) (p < 0.001). For stratification by level of active commuting, only high level decreased all-cause mortality by 11% (3-19%) and both intermediate and high level decreased cardiovascular mortality. Low level did not decrease any type of mortality. Cancer mortality did not decrease with walking or cycling, and the level of active commuting had no effect. Low level walking did not decrease any type of mortality, intermediate level of walking decreased only all-cause mortality by 15% (2-28%), and high level of walking decreased both all-cause and cardiovascular mortality by 19% (8-30%) and by 31% (9-52%), respectively. Both low, intermediate and high intensities of cycling decreased all-cause mortality. Meta-analysis based on crude or less fully adjusted estimates retrieved similar results, with also significant reductions of cancer mortality with cycling (23%, 5-42%), high level of active commuting (14%, 4-24%), and high level of active commuting by walking (16%, 0-32%).
Active commuting decreases mainly all-cause and cardiovascular mortality, with a dose-response relationship, especially for walking. Preventive strategies should focus on the benefits of active commuting.
久坐行为是导致死亡的主要风险因素之一。然而，关于积极通勤对死亡率的影响，数据存在矛盾。
对积极通勤对死亡率影响进行系统综述和荟萃分析。
检索PubMed、Cochrane Library、Embase 和 Science Direct 数据库，以获取报告死亡率数据和往返工作的积极通勤（步行或骑自行车）的研究。我们根据死亡率类型、通勤类型和通勤水平进行了荟萃分析，每种类型都有两个模型（基于风险的完全调整估计值，以及基于原始或调整较少的估计值）。
纳入了 17 项代表 829098 名工人的研究。使用完全调整后的风险估计值，积极通勤使全因死亡率降低了 9%（95%置信区间为 3-15%），心血管死亡率降低了 15%（3-27%）（p<0.001）。按通勤类型分层，步行使全因死亡率显著降低了 13%（1-25%），而骑车使全因死亡率显著降低了 21%（11-31%）和心血管死亡率显著降低了 33%（10-55%）（p<0.001）。按积极通勤水平分层，仅高水平使全因死亡率降低了 11%（3-19%），中、高水平使心血管死亡率降低。低水平没有降低任何类型的死亡率。步行或骑车对癌症死亡率没有降低作用，积极通勤水平也没有影响。低水平步行没有降低任何类型的死亡率，中水平步行仅使全因死亡率降低了 15%（2-28%），高水平步行使全因和心血管死亡率分别降低了 19%（8-30%）和 31%（9-52%）。低、中、高强度的骑车都降低了全因死亡率。基于原始或不完全调整的估计值进行的荟萃分析得出了类似的结果，骑自行车（23%，5-42%）、高水平的积极通勤（14%，4-24%）和高水平的步行积极通勤（16%，0-32%）都显著降低了癌症死亡率。
积极通勤主要降低全因和心血管死亡率，且呈剂量反应关系，步行的效果尤其明显。预防策略应注重积极通勤的益处。
