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For some, bicycling is a potential ‘solution’ to physical inactivity. Active commuting and recreational cycling can theoretically meet a population's need for health-enhancing physical activity.1 The seductive appeal of cycling relates to its low cost and potentially high population reach. Cycling can be accessed by all ages and social groups, and infrastructure support for cycling is now being built into the new urban development frameworks that include ‘active living’.2
This editorial summarises the health benefits and risks of cycling, and describes current controversies and evidence challenges for cycling policy and promotion. The bicycle is a means for individual health-promoting behaviour, is a clinical tool for rehabilitation and a societal tool for contributing to a healthier environment. Here we do not distinguish between the health effects of outdoor and indoor (stationary) cycling, as both can result in similar energy expenditures, but we do classify cycling by purpose into active transport (commuting and utility cycling) and recreational cycling. Physiologically, cycling has advantages over walking: typical commuting cycling intensity is higher (6–8 metabolic equivalents (MET) compared with walking (2.5–3.5 MET). This is important because higher intensity activity yields greater health benefits.3
Evidence is accumulating: benefits outweigh risks
Until recently there has been promising yet limited evidence on cycling-specific health benefits.4 5 A new systematic review6 identified 16 studies focusing on cycling-specific health outcomes. The studies identified a consistent positive relationship between cycling and cardiorespiratory fitness and functional benefits in boys and girls. Furthermore, they demonstrated improvements in cardiorespiratory fitness and disease risk factor …