title: Associations between active travel and weight, blood pressure and diabetes in six middle income countries: a cross-sectional study in older adults.
abstract: BACKGROUND
  There is little published data on the potential health benefits of active travel in low and middle-income countries. This is despite increasing levels of adiposity being linked to increases in physical inactivity and non-communicable diseases. This study will examine: (1) socio-demographic correlates of using active travel (walking or cycling for transport) among older adults in six populous middle-income countries (2) whether use of active travel is associated with adiposity, systolic blood pressure and self-reported diabetes in these countries.
  
  
  METHODS
  Data are from the WHO Study on Global Ageing and Adult Health (SAGE) of China, India, Mexico, Ghana, Russia and South Africa with a total sample size of 40,477. Correlates of active travel (≥150 min/week) were examined using logistic regression. Logistic and linear regression analyses were used to examine health related outcomes according to three groups of active travel use per week.
  
  
  RESULTS
  46.4% of the sample undertook ≥150 min of active travel per week (range South Africa: 21.9% Ghana: 57.8%). In pooled analyses those in wealthier households were less likely to meet this level of active travel (Adjusted Risk Ratio (ARR) 0.77, 95% Confidence Intervals 0.67; 0.88 wealthiest fifth vs. poorest). Older people and women were also less likely to use active travel for ≥150 min per week (ARR 0.71, 0.62; 0.80 those aged 70+ years vs. 18-29 years old, ARR 0.82, 0.74; 0.91 women vs. men). In pooled fully adjusted analyses, high use of active travel was associated with lower risk of overweight (ARR 0.71, 0.59; 0.86), high waist-to-hip ratio (ARR 0.71, 0.61; 0.84) and lower BMI (-0.54 kg/m(2), -0.98;- 0.11). Moderate (31-209 min/week) and high use (≥210 min/week) of active travel was associated with lower waist circumference (-1.52 cm (-2.40; -0.65) and -2.16 cm (3.07; -1.26)), and lower systolic blood pressure (-1.63 mm/Hg (-3.19; -0.06) and -2.33 mm/Hg (-3.98; -0.69)).
  
  
  CONCLUSIONS
  In middle-income countries use of active travel for ≥150 min per week is more common in lower socio-economic groups and appears to confer similar health benefits to those identified in high-income settings. Efforts to increase active travel levels should be integral to strategies to maintain healthy weight and reduce disease burden in these settings.
authors.affiliation: Department of Primary Care & Public Health, Imperial College London, London, UK. a.laverty@imperial.ac.uk.|, Room 322, Reynolds Building, St Dunstan's Road, W6 8RP, London, UK. a.laverty@imperial.ac.uk.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Laverty
authors.affiliation: Department of Primary Care & Public Health, Imperial College London, London, UK. r.palladino@imperial.ac.uk.|Department of Public Health, University Federico II of Naples, Naples, Italy. r.palladino@imperial.ac.uk.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Palladino
authors.affiliation: Department of Primary Care & Public Health, Imperial College London, London, UK. t.lee@imperial.ac.uk.
authors.forename: John Tayu
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Department of Primary Care & Public Health, Imperial College London, London, UK. c.millett@imperial.ac.uk.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D001642:Bicycling / Q000706:statistics & numerical data; D001794:Blood Pressure / Q000502:physiology*; D001835:Body Weight / Q000502:physiology*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009043:Motor Activity / Q000502:physiology*; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D057566:Self Report; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014186:Transportation / Q000379:methods; D014195:Travel / Q000706:statistics & numerical data*; D016138:Walking / Q000706:statistics & numerical data; D055815:Young Adult