Utility cycling as a public health strategy to integrate physical activity into everyday life: a systematic enquiry A thesis submitted for the Degree of Doctor of Public Health (DrPH) by Glenn Stewart Department of Clinical Sciences, College of Health and Life Sciences Brunel University 2016 Table of Contents Table of Contents .................................................................................................... 2 List of tables: ........................................................................................................... 8 List of figures: ........................................................................................................ 10 List of Graphs ........................................................................................................ 11 APPENDICES ....................................................................................................... 12 List of Abbreviations ................................................................................................. 13 Acknowledgements .................................................................................................. 16 List of publications .................................................................................................... 17 ABSRACT ................................................................................................................ 18 Ethics ....................................................................................................................... 19 CHAPTER 1: Introduction ....................................................................................... 20 CHAPTER 2: Impact of physical activity upon health, the need to increase its prevalence and possible way forward ...................................................................... 24 Introduction ........................................................................................................... 24 Context ................................................................................................................. 24 Economic costs of physical inactivity .................................................................... 26 Prevalence of physical (in)activity ......................................................................... 27 Physical activity guidelines.................................................................................... 27 Reasons for lack of physical activity ..................................................................... 29 Approaches to increasing population levels of physical activity ............................ 30 Physical activity through non-sporting cycling ....................................................... 32 UK transport policy ................................................................................................ 33 Potential benefits of cycling beyond physical activity ............................................ 33 Potential benefits of cycling to the wider society ................................................... 34 Why cycling and not walking? ............................................................................... 35 Why commuter cycling? ........................................................................................ 36 Why adults and not children? ................................................................................ 37 Conclusion ............................................................................................................ 38 Recommendations ................................................................................................ 39 Thesis implications ................................................................................................ 39 CHAPTER 3: What interventions increase commuter cycling? A systematic literature review ........................................................................................................ 41 2 Methods ................................................................................................................ 42 Search strategy ..................................................................................................... 42 Table 1: Database search ..................................................................................... 43 Table 2: Eligibility criteria for literature search ....................................................... 46 Identification .......................................................................................................... 48 Data analysis ........................................................................................................ 48 Included ................................................................................................................ 48 Eligibility ................................................................................................................ 48 Screening .............................................................................................................. 48 Results .................................................................................................................. 49 Study characteristics ................................................................................................ 49 Table 3: Characteristics of, and results from, included studies ............................ 49 Control variables ................................................................................................ 52 Table 4: Studies included, covariates cited and how specified: ............................ 52 Individual or group interventions ........................................................................... 54 Randomised control trials .................................................................................. 54 Pre-post intervention studies ............................................................................. 55 Environmental interventions .................................................................................. 56 Discussion............................................................................................................. 59 Conclusion ............................................................................................................ 63 Recommendations ................................................................................................ 63 Chapter 4: Evaluation of Public Health interventions: a conceptual mapping ......... 65 Section 1 ............................................................................................................... 66 Description of the Cycling Cities and Towns ...................................................... 66 Hierarchy of evidence ........................................................................................ 66 Evaluation of natural experiments ......................................................................... 69 The Use of Natural Experiments in Public Health ................................................. 70 The use of natural experiment methodology to evaluate the CCTs ...................... 70 Table 5: MRC guidance on natural experiments and evaluation of CCTs against criteria ................................................................................................................... 71 Section 2: Data ..................................................................................................... 73 Search Strategy .................................................................................................... 74 Search terms (applicable to search of the UK data service) .............................. 74 Selection criteria ................................................................................................ 74 3 Results .................................................................................................................. 75 Table 6: Datasets found through UK Data-archive, inclusion or exclusion and reasoning .............................................................................................................. 76 Implications for empirical analysis ......................................................................... 80 Conclusion ............................................................................................................ 81 Recommendations ................................................................................................ 82 Conceptual mapping of this thesis ........................................................................ 82 Chapters 1 - 3 ....................................................................................................... 83 Public health issue ................................................................................................ 83 Potential practical solution .................................................................................... 83 So what? ............................................................................................................... 83 Chapters 7-9 ......................................................................................................... 83 Potential conceptual solution ................................................................................ 83 Chapters 5 - 6 ....................................................................................................... 83 CHAPTER 5: Effect of CCTs on utility cycling and physical activity ........................ 83 Introduction .............................................................................................................