Active Transportation and Planetary Health

Introduction[edit | edit source]

Physical inactivity is one of the leading causes of disability globally and together with factors such as climate change and environmental degradation, these are fueling worsening health effects. Active transportation can be a planetary health intervention and a meaningful strategy to promote increased physical activity levels. Rehabilitation professionals are well positioned to have meaningful impacts on planetary health through supporting environmental sustainability, reducing environmental impacts of the health care system environmental impacts and to increase resilience of the population to climate changes.[1]

What is Planetary Health?[edit | edit source]

Human health depends on flourishing natural systems on Earth. Any disruption to these systems can negatively affect our health. By protecting these systems, we ensure that humans continue to thrive.[2]

Planetary health focuses on the interaction between human health and the health of our planet. However, we are currently experiencing "unprecedented environmental crises",[3] including climate change, the melting of polar ice caps, ocean pollution and other natural habits pollution.[3] These environmental crises and other challenges, eg social injustice, inequity and population health, all influence each other.[4] In this context, planetary health is seen as a growing and increasingly important part of population health.

"Health and health care can no longer be thought of and practiced in an isolated manner. All healthcare professionals must educate their current and future colleagues with the necessary understanding and skills to develop and implement integrated responses to today's inseparable social, environmental and health crises and achieve sustainable developmental goals."[4]

Physiotherapists are stakeholders in population health and, as will be discussed in this page, can also play a role in planetary health and well-being.[2]


What is Active Transportation?[edit | edit source]

Active transportation is defined as using active methods (i.e. walking, cycling, scooting, or any other physical activity) to get to or from work/school (walking or biking etc, to a public transport stop is also considered active transportation).

Active transportation can have many health benefits as it encourages increased physical activity, but it can also be considered a planetary health intervention.[1]


Interactions in Active Transportation[edit | edit source]

As shown in Figure 1, there are six key interactions between physiotherapists, active transportation, human health and the environment (labelled a-f). These are discussed in more detail below.

Table representing the interaction between the physiotherapist, active transportation, human health and the environment

a) Interaction Between the Physiotherapist and Human Health[edit | edit source]

An individual who has a health problem such as an injury may seek care from a physiotherapist. The physiotherapist can positively impact the patient's health through the treatment offered (i.e. education, manual treatments, prescribing an exercise programme, encouraging physical activity).[2]

b) Interaction Between the Physiotherapist and Active Transportation[edit | edit source]

Active transportation might increase access to physiotherapy services for patients. In addition, physiotherapists can use active transportation to increase a patient's physical activity levels.[2]

c) Interaction Between the Physiotherapist and the Environment[edit | edit source]

This refers more to the built environment than the natural environment. Physiotherapists can advocate for changes in the built environment in order to improve access to physiotherapy services or other facilities that are important to the patient.[2]

d) Interaction Between Active Transportation and Human Health[edit | edit source]

In theory, increasing a patient's physical activity will have a positive impact on their health. However, poor health might be a barrier to engaging in active transportation.[2]

e) Interaction Between Active Transportation and the Environment[edit | edit source]

This refers to both the built and the natural environment. As mentioned above, active transportation can increase physical activity, which has health benefits, but it also has positive environmental effects, such as reducing greenhouse gas emissions through a decrease in private car use.[2][7]

However, a patient's environment needs to be considered, specific features of this environment can either encourage or discourage exercise and active transportation. One recent study found that environmental features such as the proximity of destinations and safety from crime had an association with walking for transport in older adults.[8]

f) Interaction Between Human Health and the Environment[edit | edit source]

There is a clear link between the environment, a loss of biodiversity and human health.[2] The current pandemic highlights this point. As COVID 19 is a zoonotic disease, "it cannot be considered in full without considering human-animal relations and the biodiversity crisis in general".[9]

Similarly, poor human health can have a negative impact on the environment, particularly if illness or injury increases the consumption of medical supplies and/or pharmaceuticals. The COVID-19 pandemic again highlights this point with the increased use of disposable Personal Protective Equipment.[2]

Benefits of Active Transportation[edit | edit source]

  • Active transport to work can[10]:
    • improve physical fitness
    • decrease body weight
    • decrease fat mass
    • decrease body mass index
    • decrease cholesterol levels
  • Cycling is associated with a decrease in all-cause mortality[11] and an increase in general physical activity levels[2]
  • Similarly, walking is associated with a reduced risk of cardiovascular disease[11]
  • Access to blue and green spaces has various health benefits,[12] including reduced mental health issues,[13] improved cardiovascular and respiratory health and it can alter pain levels and may reduce the transition from acute to chronic pain[1][2]
    • Access to green spaces may also have a positive impact on the human microbiome[14]
      • Associations have been reported between the human microbiome and health conditions such as[1]:
        • pain
        • fibromyalgia
        • rheumatic diseases
        • psoriatic diseases
        • multiple sclerosis
        • depression
        • anxiety
        • cancer
  • Active transportation reduces air pollution and air pollution-related deaths[2][15]
  • It also decreases traffic congestion and noise pollution[2]
  • It reduces greenhouse gas emissions

Challenges to Implementing Active Transportation[edit | edit source]

  • Poor infrastructure
    • Some individuals may also oppose proposed infrastructure changes associated with active transportation such as cycle ways or increasing the footpath width
  • Adverse weather
  • Safety concerns[2]
  • Child active transportation is an important consideration - this can affect the child's direct health but also promote healthy behaviours for adulthood.[1] Barriers to active transportation for children and parents include[1]:
    • distance
    • safety concerns such as:
      • dangerous driving
      • traffic volume and speed
      • bullying and assault
    • convenience
    • time constraints
    • scheduling of extra-mural activities
    • interest of the child in walking, cycling
    • psychological reasons
    • physical reasons such as:
      • fatigue
      • heavy bag to carry
    • lack of social support

Interventions, Considerations and Recommendations[edit | edit source]

The following tables discuss considerations and recommendations when active transportation is proposed as an intervention.[2]

Table 1. Considerations when using active transportation[2]
Interventions Considerations
Encourage active transportation to increase physical activity levels Are patients open to learning about required physical activity levels?
Is active transportation cost-effective for the patient?
Are patients aware of local transportation links and bicycle routes?
Does the patient have safety concerns preventing active transport as an option as a result of their age, ability, gender, or surrounding infrastructure?
Promote positive lifestyle changes through active transportation Could adopting active transportation increase the patient’s social interactions?
Could an individual's sleep improve as a result of increased activity levels?
Table 2. Recommendations for implementing active transportation interventions[2]
Encourage active transport as a form of physical activity to improve individual and population health while yielding, additional health-related environmental benefits
Educate physiotherapists and patients alike about the link between active transport, environment, personal and public health
Advocate for safe and better infrastructure for active transport
Advocate for more green spaces and fewer motorised streets without furthering socioeconomic divides
Advocate for active transportation routes in close proximity to biodiverse green and blue spaces
Advocate making e-bikes and bike-share facilities more accessible to those who are unable to afford them but need them the most
Advocate for better integration of active transportation with sustainable public transport in a way that ensures physical and financial accessibility

Conclusion[edit | edit source]

By recommending active transportation as a way to increase physical activity in our clients, we can contribute to the health of the planet. As rehabilitation professionals we need to be aware of the context-specific challenges and we need to help find solutions to these challenges with the relevant stakeholders. Through recommending active transport and helping address associated barriers and challenges, rehabilitation professionals can have an impact on the reduction of the global burden of disease and improve human health as well as the health of the environment.[1]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Toner A, Lewis JS, Stanhope J, Maric F. Prescribing active transport as a planetary health intervention–benefits, challenges and recommendations. Physical Therapy Reviews. 2021 Jan 19:1-9.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 Toner A. Active Transportation and Planetary Health Course. Plus , 2021.
  3. 3.0 3.1 Maric F, Nicholls D. A call for a new environmental physiotherapy-An editorial. Physiotherapy Theory and Practice. An International Journal of Physical Therapy. 2019;35(10):905-7.
  4. 4.0 4.1 Maric F, Chance-Larsen K, Chevan J, Jameson S, Nicholls D, Opsommer E, Perveen W, Richter R, Stanhope J, Stone O, Strimpakos N. A progress report on planetary health, environmental and sustainability education in physiotherapy–Editorial. European Journal of Physiotherapy. 2021;23(4):201-2.
  5. Planetary Health Alliance. Planetary Health: The Future is Now. Available from: [last accessed 26/09/2021]
  6. McGill Transportation. Active transport Environment. Available from: [last accessed 26/09/2021]
  7. Mizdrak A, Blakely T, Cleghorn CL, Cobiac LJ. Potential of active transport to improve health, reduce healthcare costs, and reduce greenhouse gas emissions: A modelling study. PloS one. 2019 Jul 17;14(7):e0219316.
  8. Oyeyemi AL, Kolo SM, Oyeyemi AY, Omotara BA. Neighborhood environmental factors are related to health-enhancing physical activity and walking among community dwelling older adults in Nigeria. Physiotherapy theory and practice. 2019 Mar 4;35(3):288-97.
  9. Maric F, Nicholls DA. Paradigm shifts are hard to come by: Looking ahead of COVID-19 with the social and environmental determinants of health and the UN SDGs. European Journal of Physiotherapy. 2020 Nov 1;22(6):379-81.
  10. Schäfer C, Mayr B, Fernandez La Puente de Battre MD, Reich B, Schmied C, Loidl M, Niederseer D, Niebauer J. Health effects of active commuting to work: The available evidence before GISMO. Scandinavian journal of medicine & science in sports. 2020 Aug;30:8-14.
  11. 11.0 11.1 Celis-Morales CA, Lyall DM, Welsh P, Anderson J, Steell L, Guo Y, et al. Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study. BMJ. 2017;357:j1456.
  12. Jimenez MP, DeVille NV, Elliott EG, Schiff JE, Wilt GE, Hart JE, et al. Associations between nature exposure and health: a review of the evidence. Int J Environ Res Public Health. 2021;18(9):4790.
  13. Pearson AL, Shortridge A, Delamater PL, Horton TH, Dahlin K, Rzotkiewicz A, Marchiori MJ. Effects of freshwater blue spaces may be beneficial for mental health: A first, ecological study in the North American Great Lakes region. PLoS One. 2019;14(8):e0221977.
  14. Flies EJ, Skelly C, Singh Negi S, Prabhakaran P, Liu Q, Liu K, et al. Biodiverse green spaces: a prescription for global urban health. Front Ecol Environ. 2017;15( 9):510-16.
  15. Johansson C, Lövenheim B, Schantz P, Wahlgren L, Almström P, Markstedt A, et al. Impacts on air pollution and health by changing commuting from car to bicycle. Science of The Total Environment. 2017;584–585:55-63.