Health and Fitness
Strategies That Improve Public Health Through Physical Activity
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TDM
Encyclopedia
Victoria Transport Policy Institute
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Updated
August 27, 2007
This chapter discusses ways to improve public fitness and health by more active transportation, including walking, cycling, running and skating. Inadequate physical activity is a major contributor to many diseases. Transportation and land use policies that result in even modest increases in aerobic exercise could provide significant health benefits, equal or greater than the benefits of traffic safety programs. Many TDM strategies increase active transportation by improving nonmotorized travel conditions, creating land use patterns that are more suitable for nonmotorized travel, and by encouraging shifts from driving to nonmotorized travel.
Transportation facilities and activities can affect health
in many ways, including crash risk, physical activity, air and noise pollution
impacts, transport related stress, mental health and community cohesion
(Litman, 2005; Frank, Kavage and Litman, 2006). Health objectives (including
new ones, such as encouraging physical activity) are becoming more important in
transport planning (
Physical Activity refers to physical exercise. Inadequate physical activity is a major contributor to cardiovascular disease, diabetes, hypertension, obesity, osteoporosis and some cancers (Killingsworth and Lamming, 2001). Research by Franco, et al (2005) indicates that moderate physical exercise increases average longevity by 1.3 and 3.7 years in typical middle-age Americans. A sedentary lifestyle ranks second only to smoking as a lifestyle risk for disease and premature death, contributing to more than 10% of all deaths in the United States, representing direct economic costs of $150 billion annually (Surgeon General, 1999).
Diseases Associated With Inadequate Physical Activity
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·
Heart disease ·
Hypertension ·
Stroke ·
Diabetes |
·
Obesity ·
Osteoporosis ·
Depression ·
Some types of cancer |
Even modest increases in physical activity tend to reduce mortality rates for both older and younger adults (Sallis, et al., 2004). Health experts recommend at least 30 minutes of moderate exercise a day, at least 5 days a week, in intervals of ten-minutes or more, and additional exercise up to 60 minutes per day of vigorous physical activity appears to provide additional health benefits (Cavill, 2001; www.cdc.gov). ICLEI (2003) provides a method for valuing the health benefits of more active transportation.
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Center
for Disease Control Physical Activity Recommendations (www.cdc.gov/nccdphp/dnpa/physical/recommendations/index.htm)
Adults should: · Engage in
moderate-intensity physical activities for 30-60 minutes on 5 or more days of
the week. (Moderate-intensity means that a person feels some exertion but can
carry on a conversation comfortably during the activity. Examples include
walking briskly, dancing, easy swimming or bicycling on level terrain.) OR · Engage in
vigorous-intensity physical activity 3 or more days per week for 20 or more
minutes per occasion. (Vigorous-intensity physical activity results in a
significant increase in heart and breathing rate. Examples include jogging,
chopping wood, participating in high-impact aerobic dancing, swimming
continuous laps or bicycling uphill.) Adolescents should: · Be physically active daily, or nearly every day, as part of play, games, sports, work, transportation, recreation, physical education, or planned exercise. · Adolescents should engage
in three or more sessions per week of activities that last 20 minutes or more
at a time and that require moderate to vigorous levels of exertion. Elementary school-aged children should: · Accumulate at least 30-60 minutes of age-appropriate and developmentally appropriate physical activity from a variety of activities on all, or most, days of the week. · An accumulation of more
than 60 minutes, and up to several hours per day, of age-appropriate and
developmentally appropriate activity is encouraged. · Some of the child’s
activity each day should be in periods lasting 10 to 15 minutes or more and
include moderate to vigorous activity. This activity will typically be
intermittent in nature, involving alternating moderate to vigorous activity
with brief periods of rest and recovery. · Children should not have
extended periods of inactivity. |
The total health costs of inadequate physical activity are greater than those resulting from traffic crashes, although traffic crashes tend to injure and disable people at a younger age than most sedentary lifestyle illnesses and so crash health costs rank relatively high when measured in terms of Potential Years of Life Lost (PYLL) (“Crash Costs,” Litman, 2005). According to a major study by the Harvard University School of Public Health, cardiovascular diseases are the leading causes of premature death and disability in developed countries, causing ten times as many lost years of productive life as road crashes (Murray, 1996, Table 2). Even modest reductions in these illnesses could provide even greater overall health benefits than large reductions in traffic crashes.
There are many ways to be physically active. Some people play sports or exercise regularly in a gym, but these cost money and require special time and effort, so most people will not participate in such activities regularly over their full lifetime (Sevick, et al., 2000). Walking is the most popular form of physical activity, and many experts believe that more Nonmotorized Transportation (Walking and Bicycling, and their variants such as Wheelchairs and Small Wheeled Modes, also called Active Modes and Human Powered Transport) is the most practical and effective way to improve public fitness. One major study concluded, “Regular walking and cycling are the only realistic way that the population as a whole can get the daily half hour of moderate exercise which is the minimum level needed to keep reasonably fit” (Physical Activity Task Force, 1995). Health experts recommend that people walk 10,000 steps or about 5 miles per day for basic physical fitness.
Active transportation is declining in most industrialized countries. Table 1 indicates changes in walking and cycling recorded by the U.S. National Personal Transportation Surveys between 1977 and 1995. Although cycling increased slightly, walking, which is much more common, declined by more than 40%. Similar patterns have occurred in most other countries.
Table 1 Personal Trips By Active Modes (NPTS)
|
|
1977 |
1983 |
1990 |
1995 |
|
Walk |
9.3% |
8.5% |
7.2% |
5.5% |
|
Bicycle |
0.6% |
0.8% |
0.7% |
0.9% |
|
Total |
9.9% |
9.3% |
7.9% |
6.4% |
Inadequate physical activity is often viewed as an individual problem (“fat people are lazy”), but public policies and design factors can also have significant effects on the amount of physical activity that occurs in a community (Sallis, et al., 2004). Current transportation and land use patterns tend to create barriers to walking and cycling (Evaluating Nonmotorized Transportation). Research summarized by Jackson and Kochtitzky (2001) and Killingsworth (2003) indicate that Automobile Dependency and urban sprawl can be considered a health risk, while more balanced transportation systems and TDM programs can contribute to improved public health.
Communities with suitable conditions have much higher levels
of walking and cycling (Land Use Impacts on Transportation).
Some researchers argue that there is little empirical evidence that automobile-dependent land use patterns are unhealthy, pointing out that in the U.S., residents of suburbs tend to be fitter than urban residents (Schwartz, 2002; Utt, 2003), but such aggregate analysis indicates little about potential fitness and health benefits that could occur if urban and suburban residents were more physically active. In an international comparison of travel patterns and health impacts, Pucher and Dijkstra (2003) found that cyclists in the Netherlands and Germany have lower per mile and per trip crash injury rates, and that residents of countries with higher rates of walking and cycling have much lower rates of obesity, diabetes and hypertension than in the U.S. For example, residents of the Netherlands, Denmark and Sweden have obesity rates only a third of those in the U.S., and Germany’s is only half as high; residents of these four European countries live an average of 2.5 to 4.4 years longer while spending half as much on health care as in the U.S.
Research by Sturm (2005) found that, accounting for
demographic factors such as age, race/ethnicity, educational achievement and
income, the frequency of self-reported chronic medical conditions such as
asthma, diabetes, hypertension and cancer increased with sprawl. On average
there are 1,260 reported chronic medical conditions per 1,000 population. A
50-point change from more to less sprawling cities is associated with 96 fewer
conditions. Shifting from a very sprawled region such as
Besser and Dannenberg (2005) used the 2001 National Household Travel Survey to analyze the amount of walking associated with public transit trips, and factors that affect this activity. They found that Americans who use public transit on a particular day spend a median of 19 daily minutes walking to and from transit, and that 29% achieve the recommended 30 minutes of physical activity a day solely by walking to and from transit. In multivariate analysis, rail transit, lower-income, age, minority status, being female, being a nondrivers or zero-vehicle household, and population density were all positively associated with the amount of time spent walking to transit.
The Travel Smart TDM program in
The health benefits of Nonmotorized Facilities such as paths and sidewalks extend to all sectors of society including the elderly and the disabled, not just people who run or cycle for exercise. Recreational walking and cycling are among the most common forms of physical exercise. Most cycling and walking takes place on public roads. This suggests that there are justifications to fund Pedestrian and Cycling improvements through both transportation and recreation budgets.
Although traffic safety is widely recognized as an important objective in conventional transportation planning, increased physical activity is not. Most planners consider it desirable to accommodate walking and cycling where there is demand, but not at the expense of motorized modes. Recognizing increased physical activity as a transportation planning goal would give greater emphasis to projects that improve nonmotorized travel conditions, and policies that encourage shifting from automobile travel to walking, cycling and transit, since most transit trips include nonmotorized links.
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World
Health Organization Charter on Transport, Environment and Health www.who.dk/London99/transport02e.htm
Physical
Activity Lack
of physical activity is one of the major risk factors for coronary heart
disease, which is the leading cause of mortality in The health benefits of
regular physical activity can be summarized as: 50%
reduction in the risk of developing coronary heart diseases (i.e. a similar effect
to not smoking). 50%
reduction in the risk of developing adult diabetes. 50%
reduction in the risk of becoming obese. 30%
reduction in the risk of developing hypertension. 10/8 mm Hg decline in blood
pressure in hypertensive subjects (i.e. a similar effect to that obtained
from antihypertensive drugs). Other
effects include reduced osteoporosis, relief of symptoms of depression and
anxiety, and the prevention of falls in the elderly. A
total of 30 minutes’ brisk walking or cycling on most days of the week, even
if carried out in 10–15 minute episodes, is effective in providing these
health benefits. The
average trip by walking in Psychosocial
Effects Certain
patterns of transport have a broad range of effects on mental health,
including risk-taking and aggressive behaviors, depression, and post-traumatic
psychological effects of crashes. High
levels of traffic can cause social isolation and limit interpersonal networks
of support, factors which have been found to be associated with higher
mortality and morbidity in the elderly. Children
who have the opportunity of playing unhindered by street traffic and without
the presence of adults have been found to have twice as many social contacts
with playmates in the immediate neighbourhood as those who could not leave
their residence unaccompanied by adults due to heavy traffic. The
fear of collisions is reported by parents as being the main reason for taking
children to school by car. This hinders the development of children’s
independence and reduces their opportunities for social contact. It also has
an influence on children’s attitudes towards car use and personal mobility in
adulthood. The
lack of physical activity, including walking and cycling, is associated with
mental ill health, including depression. |
In many situations, nonmotorized travel has a higher per
mile crash rate than motorized travel (Traffic Safety).
In the
Changes in individual pedestrian and bicyclist behavior can also reduce current crash risk. A combination of improved cycling skills, increased helmet use, improved night lighting, and reduced drunk cycling and driving could reduce bicyclist fatality rate per mile by half or more. Traffic Calming and appropriate Nonmotorized Planning can reduce risk further.
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Bicycle Fatality Reduction
Strategies Based
on American Society of Civil Engineers’ Human Powered Transport Subcommittee
analysis of bicyclist behavior and additional sources. Risk factors overlap
and are therefore not cumulative. Potential Fatality Reduction 1. Teaching riders to avoid common mistakes. 50% or more. 2. Helmet use. 40%
to 50% 3. Eliminating intoxicated bicyclists. 16% or more 4. Eliminate intoxicated automobile drivers. 16% 5. Enforcing nighttime lighting requirements. 10% or more 6. Teaching motorists to share the road with
bicyclists. 5% or more 7. Infrastructure improvements. Significant |
Based on this analysis, a responsible bicyclist who follows traffic rules is estimated to have a per trip crash fatality rate approximately equal to that of non-interstate automobile occupants, and poses a minimal accident risk to other road users, resulting in a reduction in overall fatalities compared with motor vehicle driving. Walking can have even lower risks. There is no evidence that shifting travel from driving to non-motorized travel is a public health risk, especially if safety education and facility improvements are provided.
There appears to be significant latent demand for
nonmotorized travel. That is, people would walk and bicycle more frequently if
they had suitable facilities and resources. A
Table 2 Active
Transportation Survey Findings (Environics,
1998)
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|
Cycle |
Walk |
|
Currently use this mode for leisure and recreation. |
48% |
85% |
|
Currently use this mode for
transportation. |
24% |
58% |
|
Would like to use this mode
more frequently. |
66% |
80% |
|
Would cycle to work if
there “were a dedicated bike lane which would take me to my workplace in less
than 30 minutes at a comfortable pace.” |
70% |
|
|
Support for additional
government spending on bicycling facilities. |
82% |
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Appropriate facilities and roadway improvements for walking and cycling (sidewalks, crosswalks, multi-use paths, bike lanes, traffic calming) can increase nonmotorized travel. One study found a significant increase in walking activity and willingness to allow children to exercise outdoors after a Traffic Calming program was implemented in an urban neighborhood (Morrison, Hilary Thomson and Mark Petticrew, 2004). Residents of communities that have suitable walking and cycling conditions use nonmotorized modes more for both recreation and transportation than communities that do not (Land Use Impacts on Transportation). One study found that each mile of bikeway per 100,000 residents increases bicycle commuting 0.075 percent, all else being equal (Nelson and Allen, 1997). This indicates that such facilities provide consumer benefits.
Nonmotorized Transportation Planning, Pedestrian Improvements and Bicycle Improvements help create facilities and travel conditions that are more suitable for active transportation. Public trail development can be particularly important for encouraging nonmotorized transportation and recreation (Rail-to-Trails Conservancy).
Nonmotorized Transportation Encouragement programs include a variety of activities to support and encourage use of active transportation, and increase the number of people using these modes. These can be supported by TDM Marketing programs.
Traffic Calming includes a variety of roadway design features that reduce vehicle traffic speeds and volumes. This tends to create roadway conditions that are safer and more comfortable for walking and cycling.
Comprehensive Car-free Planning and Vehicle Restrictions can improve nonmotorized accessibility and encourage active transportation. Campus Transportation Management can be a way to create and improve Car-Free areas in campus areas.
Land use management strategies such as New Urbanism and Smart Growth are the basis for creating more Accessibility communities with attractive, walkable neighborhoods. These land use patterns can increase walking and cycling (Land Use Impacts on Transportation).
Street Reclaiming is a process for increasing the social, cultural, recreational and economic activity in neighborhood streets. It involves reducing vehicle traffic volumes and speeds, and creating more attractive street environments, to encourage interaction and increase residents’ involvement in their community.
Universal Design refers to pedestrian facility designs that accommodate the widest range of potential users, including people with disabilities and other special needs. Universal Design supports accessibility, and encourages active transportation, particularly by people with physical disabilities who often have difficulty obtaining exercise. Improved accessibility can provide significant health and emotional benefits to people with physical disabilities (Jackson and Kochtitzky, 2001).
School Transport Management encourages parents, students and staff to reduce automobile trips and use alternative modes for travel to and from schools. This improves walking and cycling conditions and encourages active transportation.
Efforts to Address Security Concerns faced by pedestrians and cyclists can help increase active transportation.
Transit and nonmotorized transportation are complementary transportation modes: most transit trips involve walking or cycling links, and pedestrians and cyclists often rely on public transit to travel longer distances. Travel surveys indicate that the average walking distance involved in a transit trip is five to ten times longer than the average walking distance of an automobile trip. Transit Oriented Development can be a catalyst for more pedestrian-oriented land use patterns.
Some new buildings are specifically designed to encourage walking, specifically use of stairs rather than elevators (Naik, 2005).
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New Buildings Help People Fight Flab Gautam Naik, The Wall Street Journal, November 16, 2005 In July 2007, when students of A key reason for the new design: keeping faculty and students fit. “Clients are making a conscious decision to promote physical activity” in the workplace, says Philip Dordai, an architect at Hillier Architecture of Princeton, N.J., which is designing the new VCU business-school building and has also been involved in other, similar projects. Buildings have long been designed so people can get from one place to another with minimum physical effort. Now, in a bid to fight a rising tide of obesity, companies, universities and other institutions are embracing the opposite idea: buildings that force employees to move around a lot more. At the California Department of Transportation's new district
headquarters in Health-related design has growing appeal for some of the biggest
users of real estate -- companies that rent office space. When architects
were designing a lab for Swiss pharmaceutical giant Novartis AG in To see if he could persuade people to use stairs instead of
elevators, Luuk Engbers, a human-movement scientist at the VU University
Medical Center in Employees at a similar building nearby were studied as a control group. The result: People in the first building took the stairs twice as much, and covered more floors with each use, than those in the control building. Even small steps can yield a worthwhile benefit. James Sallis, a
professor of psychology at Walking up the stairs to their office may be all the exercise
many employees ever get. Leisure-time physical activity in the Barbara Hansen, a 51-year-old technical writer working at Sprint
Nextel's Ms. Hansen attributes her weight reduction to healthier eating, regular visits to a fitness center and plenty of walking -- thanks to the design of Sprint's large campus. Employees are encouraged to bike or jog during their lunch hour; the stairwells are brightly lit and hung with paintings; the elevators are a little slower than usual. Ms. Hansen says she now climbs the stairs everyday to her office, five floors up. |
Converting vehicle traffic lanes to cycling lanes and wider sidewalks can improve nonmotorized travel conditions and shift travel from motorized to nonmotorized modes.
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Neural
Aging Walks Tall: Aerobic Activity Fuels Elderly Brains, Minds Science News Online (www.sciencenews.org/20040221/fob1.asp),
21 Feb. 2004, by Bruce Bower. Seniors
interested in pumping up their brains and maintaining an attentive edge might
consider taking this inexpensive prescription: Go for a walk every 2 or 3
days. Don’t sweat it, but make an effort. Limit each walk to between 10 and
45 minutes. That’s
the conclusion, at any rate, of two new studies that demonstrate for the
first time in people that physical fitness, whether achieved on one’s own or
through a brief aerobic-training course, induces brain changes associated
with improved performance on an attention-taxing task. “Even
moderate cardiovascular activity of the sort that is within reach of most
healthy older adults results in improved neural functioning and may help to
extend or enhance independent living,” says neuroscientist Arthur F. Kramer
of the University of Illinois at Urbana-Champaign. Kramer directed the new
studies with his colleague Stanley J. Colcombe. Prior
research showed that mice score higher on tests of learning, memory, and
attention after regularly exercising on a running wheel for several weeks. In
the animals, this training boosts the brain’s blood supply, increases
connections between neurons, and promotes the development of new brain cells.
Moderate
exercise works similarly in people, Kramer and Colcombe’s team reports in an
upcoming Proceedings of the National Academy of Sciences. The
scientists first assessed physical fitness in 41 older adults, ages 58 to 77,
after each walked 1 mile. Participants then performed an attention task in
which they viewed arrays of five left-or-right-pointing arrows and used
computer keys to indicate whether the central arrow pointed left or right. During
testing, a functional magnetic resonance imaging (fMRI) scanner measured the
rate of blood flow in specific regions of each volunteer’s brain. Adults
identified as particularly fit made judgments about the arrows faster and
with equal accuracy compared with their less-fit peers. Moreover, the fMRI
data show that highly fit seniors exhibited intense blood flow in
frontal-brain areas implicated in allocating attention and minimal neural
activity in a frontal region that usually perks up in situations of
indecision. In
a second study, 15 elderly volunteers accomplished attention tasks markedly
faster after completing a 6-month aerobic-training course than they had
before the course started. Participants gradually built up to walking for 45
minutes at a moderate pace three times each week. By the end of the study,
these volunteers’ brain activity resembled that of highly fit seniors in the
first study. In
contrast, 14 seniors who completed a 6-month course of stretching and toning
exercises, but not aerobic exercise, showed little improvement on the
attention task. Their brain activity was similar to that of less-fit seniors
in the first study. Colcombe
and Kramer’s studies are “an impressive achievement,” remarks psychologist
Timothy Salthouse of the |
Below is a list of specific planning practices that help create healthier communities:
·
Strategic planning. Is there a comprehensive community vision which
individual land use and transportation decisions should support?
·
Self-contained community. Are common services such
as shops, medical services, transit service, schools and recreation facilities
located within convenient walking distance of houses and each other? Is there a
good jobs/housing ratio within a 2-mile radius?
·
Walkability. Do streets have sidewalks? Are sidewalks well
designed, maintained and connected, and suitable for people using wheelchairs
and pushing strollers and carts? Are streets easy to cross, even by people with
disabilities?
·
Cycling. Are there adequate bike paths, lanes and routes? Are there
cycling skills training and law enforcement programs? Are there bike racks and
changing facilities at worksites?
·
School access. Are most children able to walk or bicycle to
school? Are walking and cycling condition around the school adequate. Are there
programs to improve walking and cycling, and encourage use of alternative modes
for travel to school?
·
Mixed income communities. Are there a mix of
housing types and prices, allowing lower income and disabled people to live in
the community? Are there programs to insure affordable housing is located in
accessible, multi-modal areas where residents can easily walk to public
services such as stores, medical clinics and transit stops?
· Sense of place. Does the community have a
strong sense of identity and pride? Does the neighborhood have a name?
·
Transit service quality. Does the neighborhood have high quality public
transit, with more than 20 buses or trains a day (less than half-hour headways)
and little crowding during peak periods?
·
Parking management. Are parking requirements flexible, so developers
and building managers can reduce their parking supply in exchange for implementing
a parking management program?
·
Roadway and walkway connectivity. Are streets and paths
well-connected, with short blocks and minimal cul-de-sacs. Are streets as
narrow as possible, particularly in residential areas and commercial centers.
Are traffic management and traffic calming to control vehicle impacts.
·
Complete streets. Are streets designed to accommodate walking,
cycling and public transit, and comfortable and convenient for activities such
as strolling, playing, shopping, sightseeing, eating and special events?
·
Site design and building orientation. Are buildings to be
oriented toward city streets, rather than set back behind large parking lots?
·
Transportation demand management. Are TDM strategies and
programs implemented to the degree that they are cost effective? Do employers
have incentives to implement commute trip reduction programs? Is there a local
transportation management association?
·
Greenspace. Are there efforts to preserve greenspace,
particularly wild areas such as streams, shorelines and forests?
To help
consumers, real estate professionals and planning practitioners apply these
concepts the Healthy Location Index below indicates the degree to which
a particular site or neighborhood reflects healthy community planning principles.
Table 3 Healthy Community Index Calculations
|
Feature |
How to Calculate |
Points |
|
Sidewalks on block |
No (0 points) Yes (10 points) |
|
|
Portion of local streets with sidewalks. |
Range from 0 points for no street within ½ kilometer have sidewalks up to 10 points for all streets have sidewalks. |
|
|
Portion of local streets and paths that accommodate wheelchairs. |
Range from 0 points for no street within ½ kilometer with sidewalks that accommodate wheelchairs, up to 10 points for all streets with sidewalks that accommodate wheelchairs. |
|
|
School walkability |
10 minus number of minutes required for a child to walk safety to school. 0 if walking to school is not feasible for a typical child. |
|
|
Cycling conditions |
Portion of streets within 1 kilometer that safely accommodate bicycles, rated from 0 to 10. |
|
|
Neighborhood service destinations |
One point for each of the following located within ½ kilometer convenient walking distance, up to 10 maximum: grocery store, restaurant, video rental shop, public park, recreation center, library. |
|
|
Public transit service quantity |
Number of peak period buses per hour within ½ kilometer, up to 10 maximum. |
|
|
Public transit service quality |
Portion of peak-period transit vehicles that are clean and comfortable from 0 (all vehicles are dirty or crowded) up to 10 (all vehicles are clean and have seats available). |
|
|
Local traffic speeds |
Portion of vehicle traffic within 1-kilometer that have speeds under 40 kilometers per hour, from 10 (100%) to 0 (virtually none). |
|
|
Air Pollution |
10 minus one for each exceedance of air quality standards. |
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