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The association of cycling with all-cause, cardiovascular and cancer mortality: findings from the population-based EPIC-Norfolk cohort
  1. Shannon Sahlqvist1,2,3,
  2. Anna Goodman2,4,
  3. Rebecca K Simmons1,
  4. Kay-Tee Khaw5,
  5. Nick Cavill6,7,
  6. Charlie Foster7,
  7. Robert Luben8,
  8. Nicholas J Wareham1,2,
  9. David Ogilvie1,2
  1. 1Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
  2. 2UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
  3. 3Centre for Physical Activity and Nutrition Research (C-PAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
  4. 4Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  5. 5Department of Gerontology in Clinical Medicine, University of Cambridge, Cambridge, UK
  6. 6Cavill Associates, Stockport, UK
  7. 7British Heart Foundation Health Promotion Research Group, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  8. 8Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
  1. Correspondence to Dr Shannon Sahlqvist; shannon.sahlqvist{at}


Objectives To investigate associations between modest levels of total and domain-specific (commuting, other utility, recreational) cycling and mortality from all causes, cardiovascular disease and cancer.

Design Population-based cohort study (European Prospective Investigation into Cancer and Nutrition study-Norfolk).

Setting Participants were recruited from general practices in the east of England and attended health examinations between 1993 and 1997 and again between 1998 and 2000. At the first health assessment, participants reported their average weekly duration of cycling for all purposes using a simple measure of physical activity. At the second health assessment, participants reported a more detailed breakdown of their weekly cycling behaviour using the EPAQ2 physical activity questionnaire.

Participants Adults aged 40–79 years at the first health assessment.

Primary outcome measure All participants were followed for mortality (all-cause, cardiovascular and cancer) until March 2011.

Results There were 22 450 participants with complete data at the first health assessment, of whom 4398 died during follow-up; and 13 346 participants with complete data at the second health assessment, of whom 1670 died during follow-up. Preliminary analyses using exposure data from the first health assessment showed that cycling for at least 60 min/week in total was associated with a 9% reduced risk of all-cause mortality (adjusted HR 0.91, 95% CI 0.84 to 0.99). Using the more precise measures of cycling available from the second health assessment, all types of cycling were associated with greater total moderate-to-vigorous physical activity; however, there was little evidence of an association between overall or domain-specific cycling and mortality.

Conclusions Cycling, in particular for utility purposes, was associated with greater moderate-to-vigorous and total physical activity. While this study provides tentative evidence that modest levels of cycling may reduce the risk of mortality, further research is required to confirm how much cycling is sufficient to induce health benefits.

  • active travel
  • active commuting
  • physical activity

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