Bewegungsförderung 2013 = Promotion de l'activité physique 2013

Die Schweiz hat neue Empfehlungen für gesundheitswirksame Bewegung - aber wie bringt man eine Bevölkerung tatsächlich dazu, sich genügend zu bewegen? Einer von sieben erfolgversprechenden Ansätzen liegt in der medizinischen Grundversorgung. La Suisse a émis de nouvelles recommandations préconisant l'exercice physique comme gage de bonne santé. Mais, dans la réalité, comment parvenir à convaincre toute une population de bouger suffisamment? Les soins médicaux primaires constituent l'une des sept approches prometteuses

Health economic assessment tools (HEAT) for walking and for cycling

Physical inactivity is a significant public health problem in most regions of the world, which is unlikely to be solved by classical health promotion approaches alone. The promotion of active transport (cycling and walking) for everyday physical activity is a win-win approach; it not only promotes health but can also lead to positive environmental effects, especially if cycling and walking replace short car trips. Cycling and walking can also be more readily integrated into people’s busy schedules than, for example, leisure-time exercise. These forms of physical activity are also more practicable for groups of the population for which sport is either not feasible because of physical limitations or is not an accessible leisure activity for economic, social or cultural reasons. There is a large potential for active travel in European urban transport, as many trips are short and would be amenable to being undertaken on foot or by bicycle. This, however, requires effective partnerships with the transport and urban planning sectors, whose policies are key driving forces in providing appropriate conditions for such behavioural changes to take place. This has been recognized by a number of international policy frameworks, such as the Action Plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016, adopted by the WHO Regional Committee for Europe (1). The strategy identifies the promotion of active mobility as one of the supporting interventions endorsed by WHO Member States to address this highpriority topic in the European Region, as do other international policy frameworks such as the Toronto Charter for Physical Activity launched in May 2010 as a global call for action (2)

Aktive Mobilität und Gesundheit : Hintergrundbericht für den nationalen Gesundheitsbericht 2015

Zu Fuss gehen und Velofahren tragen viel zu einer gesundheitsfördernden Bewegung bei. Die vielfältigen positiven Gesundheitseffekte regelmässiger Bewegung sind heute umfassend belegt. Ob in der Freizeit oder im Alltag, zu Fuss gehen und Velofahren - so genannte aktive Mobilität - können viel zu einer gesundheitsfördernden Bewegung beitragen. Zahlreiche Faktoren beeinflussen indessen die Neigung, zu Fuss zu gehen oder mit dem Velo zu fahren, darunter Wegeigenschaften, Alter, Fitness, aber auch Verkehrssicherheit und ganz allgemein die Merkmale von Quartieren und Städten. Die veränderbaren strukturellen Faktoren, insbesondere die Verkehrsinfrastruktur und -Sicherheit stehen im Zentrum zeitgemässer Förderung der aktiven Mobilität. Aus Sicht der Gesundheitspolitik ist eine intersektorielle Zusammenarbeit zwischen Gesundheitssektor und Verkehrs- und Städteplanung erstrebenswert. Bei den Überlegungen werden dadurch auch Gesundheitsfolgen fokussiert

The price of precision: trade-offs between usability and validity in the World Health Organization Health Economic Assessment Tool for walking and cycling

Objectives The widely used World Health Organization (WHO) Health Economic Assessment Tool (HEAT) for walking and cycling quantifies health impacts in terms of premature deaths avoided or caused as a result of changes in active transport. This article attempts to assess the effect of incorporating ‘life-years’ as an impact measure to increase the precision of the model and assess the effect on the tool's usability. Study design This article is a methods paper, using simulation to estimate the effect of a methodological change to the HEAT 4.2 physical activity module. Methods We use the widely used WHO HEAT for walking and cycling as a case study. HEAT currently quantifies health impacts in terms of premature deaths avoided or caused as a result of changes in active transport. We assess the effect of incorporating “duration of life gained” as an impact measure to increase the precision of the model without substantially affecting usability or increasing data requirements. Results Compared with the existing tool (HEAT version 4.2), which values premature deaths avoided, estimates derived by valuing life-years gained are more sensitive to the age of the population affected by an intervention, with results for older and younger age groups being markedly different between the two methods. This is likely to improve the precision of the tool, especially where it is applied to interventions that affect age groups differentially. The life-years method requires additional background data (obtained and used in this analysis) and minimal additional user inputs; however, this may also make the tool harder to explain to users. Conclusions Methodological improvements in the precision of widely used tools, such as the HEAT, may also inadvertently reduce their practical usability. It is therefore important to consider the overall impact on the tool's value to stakeholders and explore ways of mitigating potential reductions in usability

Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship

BACKGROUND AND OBJECTIVE: Walking and cycling have shown beneficial effects on population risk of all-cause mortality (ACM). This paper aims to review the evidence and quantify these effects, adjusted for other physical activity (PA). DATA SOURCES: We conducted a systematic review to identify relevant studies. Searches were conducted in November 2013 using the following health databases of publications: Embase (OvidSP); Medline (OvidSP); Web of Knowledge; CINAHL; SCOPUS; SPORTDiscus. We also searched reference lists of relevant texts and reviews. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Eligible studies were prospective cohort design and reporting walking or cycling exposure and mortality as an outcome. Only cohorts of individuals healthy at baseline were considered eligible. STUDY APPRAISAL AND SYNTHESIS METHODS: Extracted data included study population and location, sample size, population characteristics (age and sex), follow-up in years, walking or cycling exposure, mortality outcome, and adjustment for other co-variables. We used random-effects meta-analyses to investigate the beneficial effects of regular walking and cycling. RESULTS: Walking (18 results from 14 studies) and cycling (8 results from 7 studies) were shown to reduce the risk of all-cause mortality, adjusted for other PA. For a standardised dose of 11.25 MET.hours per week (or 675 MET.minutes per week), the reduction in risk for ACM was 11% (95% CI = 4 to 17%) for walking and 10% (95% CI = 6 to 13%) for cycling. The estimates for walking are based on 280,000 participants and 2.6 million person-years and for cycling they are based on 187,000 individuals and 2.1 million person-years. The shape of the dose-response relationship was modelled through meta-analysis of pooled relative risks within three exposure intervals. The dose-response analysis showed that walking or cycling had the greatest effect on risk for ACM in the first (lowest) exposure interval. CONCLUSIONS AND IMPLICATIONS: The analysis shows that walking and cycling have population-level health benefits even after adjustment for other PA. Public health approaches would have the biggest impact if they are able to increase walking and cycling levels in the groups that have the lowest levels of these activities. REVIEW REGISTRATION: The review protocol was registered with PROSPERO (International database of prospectively registered systematic reviews in health and social care) PROSPERO 2013: CRD42013004266

Physical activity through sustainable transport approaches (PASTA): protocol for a multi-centre, longitudinal study

BACKGROUND: Physical inactivity is one of the leading risk factors for non-communicable diseases, yet many are not sufficiently active. The Physical Activity through Sustainable Transport Approaches (PASTA) study aims to better understand active mobility (walking and cycling for transport solely or in combination with public transport) as an innovative approach to integrate physical activity into individuals' everyday lives. The PASTA study will collect data of multiple cities in a longitudinal cohort design to study correlates of active mobility, its effect on overall physical activity, crash risk and exposure to traffic-related air pollution. METHODS/DESIGN: A set of online questionnaires incorporating gold standard approaches from the physical activity and transport fields have been developed, piloted and are now being deployed in a longitudinal study in seven European cities (Antwerp, Barcelona, London, Oerebro, Rome, Vienna, Zurich). In total, 14000 adults are being recruited (2000 in each city). A first questionnaire collects baseline information; follow-up questionnaires sent every 13 days collect prospective data on travel behaviour, levels of physical activity and traffic safety incidents. Self-reported data will be validated with objective data in subsamples using conventional and novel methods. Accelerometers, GPS and tracking apps record routes and activity. Air pollution and physical activity are measured to study their combined effects on health biomarkers. Exposure-adjusted crash risks will be calculated for active modes, and crash location audits are performed to study the role of the built environment. Ethics committees in all seven cities have given independent approval for the study. DISCUSSION: The PASTA study collects a wealth of subjective and objective data on active mobility and physical activity. This will allow the investigation of numerous correlates of active mobility and physical activity using a data set that advances previous efforts in its richness, geographical coverage and comprehensiveness. Results will inform new health impact assessment models and support efforts to promote and facilitate active mobility in cities

Health impact assessment of active transportation: A systematic review

Objective Walking and cycling for transportation (i.e. active transportation, AT), provide substantial health benefits from increased physical activity (PA). However, risks of injury from exposure to motorized traffic and their emissions (i.e. air pollution) exist. The objective was to systematically review studies conducting health impact assessment (HIA) of a mode shift to AT on grounds of associated health benefits and risks. Methods Systematic database searches of MEDLINE, Web of Science and Transportation Research International Documentation were performed by two independent researchers, augmented by bibliographic review, internet searches and expert consultation to identify peer-reviewed studies from inception to December 2014. Results Thirty studies were included, originating predominantly from Europe, but also the United States, Australia and New Zealand. They compromised of mostly HIA approaches of comparative risk assessment and cost–benefit analysis. Estimated health benefit–risk or benefit–cost ratios of a mode shift to AT ranged between − 2 and 360 (median = 9). Effects of increased PA contributed the most to estimated health benefits, which strongly outweighed detrimental effects of traffic incidents and air pollution exposure on health. Conclusion Despite different HIA methodologies being applied with distinctive assumptions on key parameters, AT can provide substantial net health benefits, irrespective of geographical context