E-cycling and health benefits: A systematic literature review with meta-analyses.

The objective of the present study is to review and meta-analyze the effect of E-cycling on health outcomes. We included longitudinal experimental and cohort studies investigating the effect of E-cycling on health outcomes. The studies were identified from the seven electronic databases: Web of Science, Scopus, Medline, Embase, PsycINFO, Cinahl and SportDiscus and risk of bias was assessed with the revised Cochrane Collaboration Risk of Bias Tool (RoB2). We performed meta-analysis with random effects models on outcomes presented in more than one study. Our study includes one randomized controlled trial, five quasi experimental trials and two longitudinal cohort studies. The trials included 214 subjects of whom 77 were included in control groups, and the cohort studies included 10,222 respondents at baseline. Maximal oxygen consumption and maximal power output were assessed in four and tree trials including 78 and 57 subjects, respectively. E-cycling increased maximal oxygen consumption and maximal power output with 0.48 SMD (95%CI 0.16-0.80) and 0.62 SMD (95%CI 0.24-0.99). One trial reported a decrease in 2-h post plasma glucoses from 5.53 ± 1.18 to 5.03 ± 0.91 mmol L-1 and one cohort study reported that obese respondents performed 0.21 times more trips on E-bike than respondents with normal weight. All the included studies had a high risk of bias due to flaws in randomization. However, the outcomes investigated in most studies showed that E-cycling can improve health.

National Trends in Cycling in Light of the Norwegian Bike Traffic Index.

National and international strategies and recommendations are intended to increase physical activity in the general population. Active transportation is included in interdisciplinary strategies to meet these recommendations. Cycling seems to be more health enhancing than walking for transportation since cycling seems to reduce the risk of cardiovascular disease and associated risk factors. Furthermore, the health benefits of cycling are proven to outrun the risk of injuries and mortality. Politicians seem to approve costly infrastructure strategies to increase the amount of cycling in the population to improve public health and shift to more sustainable travel habits. A linear relationship between cycle-friendly infrastructure and the amount of commuter cycling has been demonstrated. However, in Norway and on a global level, there is a lack of robust evaluations of actions and sensitive monitoring systems to observe possible change. Therefore, we aimed to develop the Norwegian bike traffic index and describe the national, regional, and local trends in counted cycle trips. We used a transparent methodology so that the index can be used, developed, and adapted in other countries. We included 89 stationary counters from the whole country. Counters monitored cycling from 2018 onward. The index is organized at local, regional, and national levels. Furthermore, the index is adjusted for population density at the counter level and presented as ratio of counted cycle trips, comparing 2018 to subsequent years. The index is presented as a percentage change with 95% confidence intervals. In Norway, counted cycle trips increased by 11% from 2018 (100, 100-100) to 2020 (111.0, 106.2-115.1), with large geographical differences. In Southern Norway, there was a significant increase of 23%, and in Northern Norway, there was a nonsignificant decrease by 8% from 2018 to 2020. The indices may indicate possible related effects of local to national cycling strategies and how the COVID-19 pandemic has affected Norwegian travel habits in urban areas.

Correlates of Commuter Cycling in Three Norwegian Counties.

Globally, there is an increasing challenge of physical inactivity and associated diseases. Commuter cycling is an everyday physical activity with great potential to increase the health status in a population. We aimed to evaluate the association of self-reported factors and objectively measured environmental factors in residence and along commuter routes and assessed the probability of being a commuter cyclist in Norway. Our study included respondents from a web-based survey in three Norwegian counties and we used a Geographic Information Systems (GIS) to evaluate the natural and built environment. Of the 1196 respondents, 488 were classified as commuter cyclists. Self-reported factors as having access to an e-bike (OR 5.99 [CI: 3.71-9.69]), being physically active (OR 2.56 [CI: 1.42-4.60]) and good self-rated health (OR 1.92 [CI: 1.20-3.07]) increased the probability of being a cyclist, while being overweight or obese (OR 0.71 [CI: 0.54-0.94]) reduced the probability. Environmental factors, such as high population density (OR 1.49 [CI: 1.05-2.12]) increased the probability, while higher slope (trend p = 0.020), total elevation along commuter route (trend p = 0.001), and >5 km between home and work (OR 0.17 [CI: 0.13-0.23]) decreased the probability of being a cyclist. In the present study, both self-reported and environmental factors were associated with being a cyclist. With the exception of being in good health, the characteristics of cyclists in Norway, a country with a low share of cyclists, seem to be similar to countries with a higher share of cyclists. With better knowledge about characteristics of cyclists, we may design better interventions and campaigns to increase the share of commuter cyclists.

Cycling is associated with a lower incidence of cardiovascular diseases and death: Part 1 - systematic review of cohort studies with meta-analysis.

OBJECTIVES: Physical inactivity is a risk factor for cardiovascular disease (CVD). Cycling as a physical activity holds great potential to prevent CVD. We aimed to determine whether cycling reduces the risk of CVD and CVD risk factors and to investigate potential dose-response relationships. DESIGN: Systematic review and meta-analysis of quantitative studies. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We searched four databases (Web of Science, MEDLINE, SPORTDiscus and Scopus). All quantitative studies, published until August 2017, were included when a general population was investigated, cycling was assessed either in total or as a transportation mode, and CVD incidence, mortality or risk factors were reported. Studies were excluded when they reported continuous outcomes or when cycling and walking were combined in them. We pooled adjusted relative risks (RR) and OR. Heterogeneity was investigated using I. RESULTS: The search yielded 5174 studies; 21 studies which included 1,069,034 individuals. We found a significantly lower association in combined CVD incidence, mortality and physiological risk factors with total effect estimate 0.78 (95% CI (CI): 0.74-0.82; P<0.001; I2=58%). Separate analyses for CVD incidence, mortality and risk factors showed estimates of RR 0.84 (CI, 0.80 to 0.88; P<0.001; I2=29%), RR 0.83 (CI, 0.76 to 0.90; P<0.001; I2=0%), and OR 0.75 (CI, 0.69 to 0.82; P<0.001; I2=66%), respectively. We found no dose-response relationship or sex-specific difference. CONCLUSIONS: Any form of cycling seems to be associated with lower CVD risk, and thus, we recommend cycling as a health-enhancing physical activity. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42016052421.

Cycling and cardiovascular disease risk factors including body composition, blood lipids and cardiorespiratory fitness analysed as continuous variables: Part 2-systematic review with meta-analysis.

OBJECTIVES: We aimed to examine the relationship between cycling (particularly commuter cycling) and risk factors associated with cardiovascular diseases (CVDs) including body composition, blood lipids and cardiorespiratory fitness. This study differed from our recent (Part 1) systematic review in that risk factors for CVD were analysed as continuous variables rather than being present or absent. DESIGN: Systematic review and meta-analysis. ELIGIBILITY CRITERIA: We searched four databases (Web of Science, MEDLINE, SPORTDiscus and Scopus). All quantitative studies, published until August 2017, were included when a general population was investigated, cycling was assessed either in total or as a transportation mode, and CVD risk factors were reported. METHODS: We analysed body composition, physical activity (PA), cardiorespiratory fitness (CRF), blood lipids and blood pressure (BP). Skinfold, waist circumference and body mass index were analysed and prioritised in that order when more than one measure were available. PA included measures of counts per minutes, moderate-to-vigorous PA or minutes per week. CRF included results of maximal tests with or without expired air or submaximal test. For blood lipids and BP, separate analyses were run for low-density and high-density lipoprotein, triglycerides, total cholesterol, systolic BP and diastolic BP. Studies were excluded when reporting dichotomous outcomes or when cycling and walking were combined. Heterogeneity was investigated using I2. RESULTS: Fifteen studies were included; the majority reported commuter cycling. In total, we included 5775 cyclists and 39 273 non-cyclists. Cyclists had more favourable risk factor levels in body composition -0.08 (95% CI -0.13 to -0.04), PA 0.13 (95% CI 0.06 to 0.20), CRF 0.28 (95% CI 0.22 to 0.35) and blood lipids compared with non-cyclists. There was no sex difference in risk reduction. CONCLUSION/IMPLICATION: Cycling mitigated the risk factor profile for CVD. A strength of this systematic review is that all the risk factors were analysed as continuous variables. These data provide evidence for practitioners, stakeholders, policy-makers and city planners to accommodate and promote cycling. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016052421.

Public employees in South-Western Norway using an e-bike or a regular bike for commuting - A cross-sectional comparison on sociodemographic factors, commuting frequency and commuting distance.

Large-scale analyses on the travel behavior of e-bikes are scarce, and current knowledge regarding who the e-bike owners are is inconsistent. Also, commuters represent a relevant user group with an unexploited potential. Therefore, the purpose of the present study was to examine (i) associations between type of bike (e-bike vs. regular bike) with place of residence (county), sociodemographic variables (age, sex, educational level, income and ethnicity) and habitual physical activity level, and (ii) if public employees possessing an e-bike cycle more often and longer distances to work. A cross-sectional survey was conducted in 2017 among 1977 (5.2% of eligible subjects) public employees in Southern and Western Norway. Binary and multinomial logistic regression analyses were conducted. Respondents possessing an e-bike were less likely to perform high levels of leisure time physical activity (OR 0.56 (CI 0.39-0.82)), compared to those possessing a regular bike only. For those residing in Agder, the likelihood of possessing an e-bike (vs. regular bike) was almost 4 times higher (OR 3.98 (CI 2.53-6.26)), compared with participants residing in Sogn og Fjordane. Compared with those possessing a regular bike only, e-bike users cycled more frequently to work, both occasionally (OR 3.71 (CI 2.44-5.65)) and most of the time (OR 4.28 (CI 2.79-6.55)), and they had higher odds of cycling medium distances to the workplace (OR 1.74 (CI 1.04-2.90)). In conclusion, e-bike access could result in increased commuter cycling, both in terms of cycling frequency and cycling distance, which in turn could contribute to enhanced physical activity levels.

Nordic walking and specific strength training for neck- and shoulder pain in office workers: a pilot-study.

BACKGROUND: More than half of all adults have experienced neck pain during the last six months. Studies have demonstrated reduced pain in the neck-and shoulder region after specific strength training of the affected muscles, but specific endurance training of neck and shoulder muscles has not been properly examined. AIM: To examine the impact of Nordic walking (NW) compared to specific strength training (ST) and a non-training control group (Con) on self-reported neck-and shoulder pain among office workers. DESIGN: Randomized intervention trial with a stratified control group. SETTINGS: University research laboratory. POPULATION: Thirty-four female office workers with neck- and shoulder pain. METHODS: The participants were allocated to NW, ST or Con. Pain intensity (0-100 mm Visual Analog Scale), isometric abduction strength and a Six-Minute Walk Test (6MWT) were assessed pre, post and 10 weeks postintervention. Both training groups attended the training programs twice per week for ten weeks (30 minutes per session). RESULTS: Both training groups demonstrated a similar (P=0.421-0.802), but significant reduction in pain intensity (P=0.014-0.018). Between post-test and the 10 weeks postintervention test, similar pain intensity was observed in the NW (P=0.932) while the ST demonstrated an increase (P=0.136). Throughout the testing period, no difference in pain was observed for the Con (P=0.724-1.000) or between the Con and the training groups (P=0.421-0.802). No changes in strength and 6MWT were observed between or within the groups (P=0.184-0.870). CONCLUSIONS: Both NW and ST reduced pain for office workers with low neck-and shoulder pain and appear to be useful exercise modalities for this group. CLINICAL REHABILITATION IMPACT: Both interventions reduced pain, but larger randomized studies should verify these findings.