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Active mobility and health:
Insights from the PASTA project
Luc Int Panis, VITO/UHasselt, Belgium
Evi Dons, UHasselt, Belgium
Michelle Laeremans, VITO/UHasselt, Belgium
Thomas Götschi, UZH, Switzerland
on behalf of the PASTA consortium
This project has received funding from the European Union’s Seventh
Framework Programme for research; technological development and
demonstration under grant agreement no 602624-2.
Life platform meeting Barcelona 26-27 September 2017
www.pastaproject.eu
54%
16%
29%
1%
35%
18%
46%
1%
29% 28%
6% 37%
54%
9%
12%
25%
31% 3%
42%
24%
26%
34%
36%
4%
41%
16%
23%
20%
London /
Newham Antwerp
Oerebro
Vienna
Rome Barcelona
Zurich
Walking
Cycling
Public Transport
Private motorised
7 Case-study Cities
www.pastaproject.eu
Cycling Networks are Associated with Cycling Mode Shares
Mueller N. Et al. forthcoming
www.pastaproject.eu
How does Active Travel affect Health?
Individual perspective
How healthy or unhealthy (risky) is AT?
><
Public health perspective
What is it worth to society?
www.pastaproject.eu
www.pastaproject.eu
Review of Reviews: Measures to Promote Active Mobility
Buehler, R, Götschi, T, Winters, M. Moving Toward Active Transportation: How Policies Can Encourage Walking and Bicycling. San Diego, CA: Active
Living Research; 2016. Available at www.activelivingresearch.org
Winters, Meghan, Ralph Buehler, and Thomas Götschi. "Policies to promote active travel: evidence from reviews of the literature." Current environmental
health reports (2017): 1-8.
http://activelivingresearch.org/ActiveTravelreview
PASTA DATA COLLECTION & EXPERIMENTS
• How do policy makers know what works?
• Health recommendations often derived from cross-sectional / observational studies
– Causality issues
– Risk of false/reverse associations
– Observed Effects Biased towards null because of exposure misclassification
– Risk of ineffective policies & wasted tax money
=> Need for
– Longitudinal studies
– Experimental studies
– Accountability studies
(What effect does a change in exposure* have on health?
=> Need for accurate (personal) exposure measurement)
Evidence based health policy
* Physical activity / Air Pollution 7
Study design
www.pastaproject.eu
Recruitment for the online Survey
1000
483
407 351
949 961
488
396 391
210
551
425
736
247
111
203
371
457
722
381 345 366
61 31 31 8 9
12,825 registrations
www.pastaproject.eu
Sample description
54% 46%
12%
15%
14%
17%
16%
14%
12%
Participants by city
Antwerp
Barcelona
London
Oerebro
Rome
Vienna
Zurich
www.pastaproject.eu
Online Survey
www.pastaproject.eu
Longitudinal Online Survey
• Before/after, trend evaluation
• Active travel and physical activity vary in time
• Lots of questions to ask
Baseline
Q
Socio-d.
Commute route
Health status
GPAQ
Mobility scale
Travel D
Psychology
Top measure FU short Mobility –scale
PA single item
Crash-q
FU short
FU long
GPAQ
Travel-D
Crash-q FU short
Crash Q (only in case of crash
or near-miss)
FU short
Participant
burden
www.pastaproject.eu
10’000+ Participants, 87’000 Questionnaires
www.pastaproject.eu
Concern over health effects of air pollution
27%
7% 13% 8%
11%
29%
7%
25%
30%
13% 14%
21%
32%
19%
26%
23%
48% 65%
49%
11%
51%
36% 29%
29% 16% 15% 21%
7% 5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Antwerp Barcelona London Oerebro Rome Vienna Zurich
Not worried at allNot worriedNeither worried nor not worriedWorriedExtremely worried
NO2
PM2.5
www.pastaproject.eu
Concern over health effects of air pollution
NO2
PM2.5
Antwerp Barcelona
London
Oerebro
Rome
Vienna
Zurich
y 1.4 0.057 x , r2
= 0.752y 1.4 0.057 x , r2
= 0.752y 1.4 0.057 x , r2
= 0.752y 1.4 0.057 x , r2
= 0.752y 1.4 0.057 x , r2
= 0.752y 1.4 0.057 x , r2
= 0.752y 1.4 0.057 x , r2
= 0.752
2.5
3.0
3.5
4.0
20 30 40
NO2
Concern
over
health
effects
of T
RA
P
Being male, having children in the household, being more
physically active, and higher NO2 at the home address higher
concern over health effects of air pollution
AIR POLLUTION: ENVIRONMENTAL PATHWAY
• Current epi studies largely ignore:
– Concentration heterogeneity
– Movement of people
– Indoor/Outdoor
– Inhalation rate
17
=> Small wearable sensors
can potentially solve all of
these problems
PEOPLE DON’T SPENT THEIR DAYS ON THEIR DOORSTEP…
18
NEED FOR PERSONAL EXPOSURE ASSESSMENT
– Need for portable sensors
– Large temporal/spatial differences in concentrations (esp. BC)
– Large differences in inhalation rate
19
0
5000
10000
15000
20000
25000
Bla
ck c
arb
on
(n
g/m
³)
In transport
car driver
In transport
car driver
In transport
bicycle
Social activity
Work
In transport
bicycle
0h 24h
Man
Woman
Outdoor
(Dons et al., ATMOS ENVIRON, 2011)
LOWER CONCENTRATION BUT HIGHER DOSES FOR CYCLISTS
0
100
200
300
400
500
600
Bla
ck
Ca
rbo
n d
os
e (
ng
/min
)
0
5000
10000
15000
20000
25000
Bla
ck
Ca
rbo
n e
xp
os
ure
(n
g/m
³)
Exposure
Dose
Source: PhD by Evi Dons
Dons et al 2011 https://www.researchgate.net/publication/232070900_Personal_exposure_to_Black_Carbon_in_transport_microenvironments
20
www.pastaproject.eu
The Sensewear
The micro-Aeth
| 21 [email protected]
The PASTA experiment
One week
Our experiment:
122 participants
3 repeated measures/participant
In different seasons
3 cities
Integrates multiple biomarkers
www.pastaproject.eu
What physiological signals did we measure?
| 22 [email protected]
Heart rate
variability Blood pressure Exhaled NO Retinal pictures Lung function
(spirometry)
www.pastaproject.eu | 23 [email protected]
BC
(n
g/m
³)
BC
(n
g/m
³)
Physical activity (PA) and black carbon (BC) levels by city.
Points represent average levels per individual.
Black carbon levels by activity types and by city.
PA
(M
ET
min
/we
ek)
www.pastaproject.eu
Key questions in PASTA
Does an increase in walking and cycling translate into more physical activity?
YES: active mobility helps to increase physical activity levels
www.pastaproject.eu
Is self-reported PA reliable?
Vigorous-intensity PA: YES
Moderate-intensity PA: underestimated
Sedentary time: inaccurate
SenseWear vs. GPAQ
www.pastaproject.eu
We did not observe any immediate physiological
reactions to air pollution
| 26 [email protected]
The beneficial effect of physical activity decreases
with increasing black carbon concentrations
www.pastaproject.eu
Long term: physical activity benefit on the respiratory
system decreases with air pollution levels
| 27 [email protected]
Lung function ~ FEV*1
Lung function ~ FEV1
FEV1 = Forced Expiratory Volume
in the 1st second
www.pastaproject.eu
The benefit of additional hour of physical activity per
week on FEV1 tends to zero, in black carbon
concentrations of 1.5 µg/m³.
| 28 [email protected]
www.pastaproject.eu
In case of all-cause mortality, most studies report that
physical activity benefits outweigh the risks.
However, the respiratory system might need some
additional attention.
| 29 [email protected]
www.pastaproject.eu
BMI analysis What happens when you start cycling?
Key gaps addressed:
• Cross-sectional analysis vs. longitudinal analysis
• Taking into account important covariates like leisure-time PA
• Many participants using many different modes
• Multicentre study
Baseline questionnaire (t0)
- height
- weight
- transport mode
- etc.
Final questionnaire (t1)
- height
- weight
- transport mode
- etc.
N=8,579 N=3,292
<< 476 days >>
www.pastaproject.eu
BMI analysis
Results from the cross-sectional analysis
-0,015
-0,01
-0,005
0
0,005
0,01
0,015
0,02
0,025
0,03
0,035
Bik
e
Walk
Pu
bli
c t
ran
sp
ort
Mo
torc
ycle
E-b
ike
Ca
r
BM
I diffe
rence (
kg/m
²) per
additio
nal
day p
er
month
-0,5
-0,45
-0,4
-0,35
-0,3
-0,25
-0,2
-0,15
-0,1
-0,05
0
No
n-c
yc
list
Occ
asio
na
l cy
clis
t
Fre
qu
en
t cyc
list
BM
I diffe
rence (
kg/m
²)
www.pastaproject.eu
BMI analysis
• Translate BMI in kilograms.
• Reverse causality.
www.pastaproject.eu
Antwerp Cycling Highway
Cost-benefit ratios indicate that the benefits of the 25 km cycling
highway Antwerp-Mechelen (Belgium) are 2 to 14 times higher
than the initial investment.
Impact factor euro
Physical activity (reduced mortality) 1.2 × 107
Physical activity (reduced morbidity) 2.3 × 106
Reduced air pollution society (mortality) 7.4 × 104
Air pollution active mobility -8.9 × 105
Crash risk -1.4 × 106
Total +1.2 × 107
Infrastructure construction costs -6.0 × 106
Benefit:cost ratio 2.0
34 https://www.researchgate.net/publication/281612872_Health_impact_model_for_modal_shift_from_car_use_to_cycling_or_walking_in_Flanders_Application_to_two_bicycle
_highways
www.pastaproject.eu
Take-home message
Keep on promoting active mobility &
use the PASTA study to
highlight the need for better (urban) air quality
| 35 [email protected]
HEAT FOR WALKING & CYCLING: CONCLUSIE
HEAT 36
http://www.euro.who.int/HEAT
http://www.heatwalkingcycling.org
www.pastaproject.eu
Thanks to all PASTA Collaborators
B. Alasya, E. Anaya, I. AvilaPalencia,
D. Banister, I. Bartana, F. Benvenuti, F. Boschetti, C. Brand, M. Brannion-
Calles, J. Buekers, L. Carniel, G. Carrasco Turigas, A. Castro, M.
Cianfano, A. Clark, T. Cole-Hunter, V. Copley, P. De Boever, A. de Nazelle,
C. Dimajo, E. Dons, M. Duran, U. Eriksson, H. Franzen, M. Gaupp-
Berghausen, R.Gerike, R.Girmenia, T.Götschi, F.Hartmann, F.
Iacorossi, L. Int Panis, S. Kahlmeier, H. Khreis, M. Laeremans, T.
Martinez, M. Meschik, P. Michelle, P. Muehlmann, N. Mueller, M.
Nieuwenhuijsen, A. Nilsson, F. Nussio, J.P. Orjuela Mendoza, S.
Pisanti, J. Porcel, F. Racioppi, E. Raser, S. Riegler, H. Robrecht, D.
Rojas Rueda, C. Rothballer, J. Sanchez, A. Schaller, R. Schuthof, C.
Schweizer, A. Sillero, L. Smidfeltrosqvist, G. Spezzano, A. Standaert,
E. Stigell, M. Surace, T. Uhlmann, K. Vancluysen, S. Wegener, H.
Wennberg, G. Willis, J. Witzell, and V. Zeuschner.
Advisory Board: K. Dziekan, A. Ahrens, M. Jerrett, A. Davis
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