New World Health Organisation report of walking and cycling: Do we really need any more updates?

This blog was written by Dr Adrian L Davis, Professor of Transport & Health, Transport Research Institute at Edinburgh Napier University.

Since a few early studies, including the UK Whitehall Study (started 1967) which especially focused on cardiorespiratory disease prevalence, and a Birmingham male factory workers study (1986) of commuter cyclists, there began a trickle of evidence suggesting that walking and cycling provide significant health benefits. The headline was reduced all-cause mortality and for cycling higher fitness levels equivalent to being five to ten years younger. Then, from around 2000 there was a sharp increase in peer reviewed research, likely led by sport scientists getting more interested in population health. Then other scientists got interested.

Simple graph representing the increase of published research on walking and cycling, from 2000 to 2020.

So, why this new World Health Organisation (WHO) report? Well, the four main premises are:

  1. These are good times for advancing walking and cycling
  2. Walking and cycling are central to urban mobility – rather than an afterthought
  3. Research provides a strong case to promote walking and cycling
  4. Practice provides a rich portfolio of measures to promote walking and cycling

The target audience is firstly policy makers by providing support to make the case for more walking and cycling. Secondly, it’s for practitioners by providing an overview of effective measures. Thirdly, advocates can draw on this evidence to help develop a narrative of the most compelling arguments in favour of walking and cycling. Fourth, it’s also accessible for general readers as we take you through the breadth of research findings with further readings references.

Why now? There are quite a few good reasons, not least: COVID-19 and the lessons that travel patterns can change quickly and so can some infrastructure; more urgent Climate change challenges; electrification and E-bikes, other technological advances; and the need for equity in transport. Taking e-biking, the battery energy support and the expanded km range etc, has led to a broader demographic market, including those long-ago lapsed cyclists aged 60+. Across Europe we continue to witness substantial sales growth. That’s the up-side. On the downside we also see that e-biking is about twice as risky as cycling (based on Swiss data).

More generally, we must address perceived and actual harms which starts with road danger. Higher safety can be achieved through infrastructure and traffic regulation, a prerequisite for higher walking and cycling levels. In terms of air pollution, the evidence remains that physical activity benefits outweigh harms from pollution exposure although we must deal with this issue. In putting benefits and harms into perspective we highlight the increasing value of the Health Economic Assessment Tool. The HEAT is designed to enable users without expertise in impact assessment to conduct economic assessments of the health impacts of walking or cycling. Case studies are included. We hope they inspire. Just look at Seville (p 67), for example, to see what can be achieved with political will.

We conclude that a rich body of evidence finds that there are substantial benefits accruing from walking and cycling, for individual and population health. Moreover, their role in replacing existing car trips, helping move towards carbon-free mobility, is increasingly recognised. The challenge: current planning practice needs to realign prioritisation of travel modes regarding funds and space away from private cars and recognise active travel as central – not an afterthought – to meeting a broad set of policy goals including health and sustainability. Ending on a personal note, we largely know the infrastructural measures needed, we have to work hard to resolve the human behaviour challenges – embedded as they are in cultural norms – and re-enforced by spatial planning. In Scotland government policy is reflecting better the evidence-base although that does not alone guarantee success. We all need to take meaningful action, as advocates, and in how we choose to move around.

Read the full WHO report here: Walking and cycling: latest evidence to support policy-making and practice (who.int)

Meet Ali, the avatar nurse who wants to help people to manage their atrial fibrillation

By Dr Coral Hanson, Senior Research Fellow, Edinburgh Napier University

Atrial fibrillation is a common abnormal heart rhythm that affects more than 2 million people in the UK. People with atrial fibrillation are more likely to have a stroke and these strokes are more likely to be severely disabling than strokes of other causes. A medication that prevents blood clots from forming (an oral anticoagulant), reduces this risk by two-thirds. However, 75% of people with atrial fibrillation do not take their medication as recommended either because they do not understand or believe in their medications, or forget.

We wanted to develop a digital solution to help people to remember to take their medication. At the start of the project, we talked to people who had atrial fibrillation and asked them what they thought should be included in a mobile app. They told us that they wanted to know more about their medication, get reminders to take it, and be able to record what they had taken. They also wanted easy to understand information about their condition and know when to seek medical help for symptoms.

The team at the Centre for Cardiovascular Health, colleagues at Flinders University in Adelaide in Australia, and a technology company called Monkey Stack developed a mobile health app called My AF Nurse: available at Google Play: My AF Nurse or  Apple: My AF Nurse.

Developing the app

First, we developed a storyboard that contained everything that would be in the app, and a script. We recruited one of our Scottish nurse colleagues to be the ‘voice’ of the app and students from the School of Arts and Creative Industries filmed her reading the script. The avatar’s facial expressions are based on the expressions of our ‘real Ali’.

Monkey Stack used the film and audio recorded by our students to create the finished app.

The My AF Nurse app

Ali, the avatar atrial fibrillation nurse is available 24 hours a day, seven days a week to help people to manage their atrial fibrillation. The app is jam packed full of information. We talked to cardiologists, doctors, other nurses, and patients to make sure we covered all the important stuff. Information is broken down into bite size chunks, so that users can listen in their own time, as many times as they want.  There is a medication tracker to help users to remember to take their medication at the right time, every time.

Testing the My AF Nurse app

Now that we have created the app, we are testing whether we can recruit patients to use it via their GP surgery or cardiology clinic. We are exploring how they use the app and trying to understand the best way to measure whether users take their medication. More information about this study can be found at:  https://doi.org/10.1186/ISRCTN10135302

Find out more about our research linked to Atrial Fibrulation