ABSTRACT:

Objective:

To evaluate the changes in commuting to work and physical activity (PA) in the population of three municipalities in the São Paulo region in 2000 and 2010.

Methods:

Cross-sectional study with a representative sample of 602 adults (62.3% men) carried out in the municipalities of Santo André, São Bernardo do Campo and São Caetano do Sul in 2000 (n = 304; 66.1% men) and 2010 (n = 298; 58.4% men). Physical activity was assessed by the International Physical Activity Questionnaire and participants were classified into active (≥ 150 min/week) and insufficiently active (< 150 min/week). The commuting to work was classified in active transport (walking and cycling), private (bike, car, vans and buses) and public (buses, vans, train or subway).

Results:

Average (min/week) PA walk (229.4 versus 190.6), moderate (449.1 versus 347.4), vigorous (354.4 versus 317.4) and total (552.3 versus 442.5) shows the participants were greater in 2010 than in 2000. The prevalence assets increased from 62.2 to 78.2%, respectively. A negative relationship was found between active transport and public with socioeconomic status; active transport and education level; public transport and age. Positive relationship was found only among private transport and socioeconomic status. The average of the total PA (min/week) was higher (p = 0.024; 32.2%) in 2010 than in 2000 for active transport.

Conclusions:

Surveillance data in full PA in the three municipalities of São Paulo indicate that the average active commuting to work increased after ten years, while public transport has decreased.

Keywords:
Motor activity; Epidemiology; Health surveys; Risk factors; Developing countries

INTRODUCTION

The maintenance of physical activity (PA) is responsible for an improvement in cardiovascular health, providing protection against the development of comorbidities such as hypertension, diabetes, vascular and cardiac diseases, among others¹1. Reiner M, Niermann C, Jekauc D, Woll A. Long-term health benefits of physical activity--a systematic review of longitudinal studies. BMC Public Health 2013; 13: 813.. Worldwide, its absence is estimated to contribute between 21 and 25% with the global burden of diseases such as breast and colon cancer; in even greater proportions, it contributes to diabetes (27%) and to ischemic heart disease (30%)². In addition, 31% of the world’s adult population is estimated not to have achieved the recommended PA for health³3. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, et al. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012 Jul 21; 380(9838): 247-57..

Considered as little susceptible to interventions from public policies in domestic and work environments⁴4. Brasil. Evaluation of Physical Activity Program Effectivity in Brazil. Brasília: Secretaria de Vigilância Sanitária em Saúde, Departamento de Análise de Situação em Saúde; 2013. and stabilized for over two decades as being performed during periods of free time⁵5. Hallal P, Knuth A, Reis R, Rombaldi A, Iser B, Bernal R. Tendências temporais de atividade física no Brasil. Rev Bras Epidemiol 2011; 14(1): 53-60., strategies that promote the increase of PA time in the transportation domain have been receiving increased attention over the world⁶6. Pucher J, Dill J, Handy S. Infrastructure, programs, and policies to increase bicycling: an international review. Prev Med 2010; 50: S106-25.^,77. Carnall D. Cycling and health promotion: A safer, slower urban road environment is the key. BMJ 2000; 320(7239): 888.. Also, its increase in the transportation domain is noteworthy, contributing to an increase in its total time, collaborating so that adults meet the PA recommendations in terms of public health⁸8. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee I-M, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011; 43(7): 1334-59..

Besides contributing to the increase of the total PA practice⁹9. Teixeira I, Nakamura P, Smirmaul B, Fernandes R, Kokubun E. Fatores associados ao uso de bicicleta como meio de transporte em uma cidade de médio porte. Rev Bras Atividade Física Saúde 2013; 18(6): 698-710., active transportation (by bicycle or on foot) is also associated to other health aspects, such as the prevention and treatment of cardiovascular diseases, some types of cancer, mortality due to all general causes and body weight control¹⁰10. Gordon-Larsen P, Boone-Heinonen J, Sidney S, Sternfeld B, Jacobs DR, Lewis CE. Active commuting and cardiovascular disease risk: the CARDIA study. Arch Intern Med 2009; 169(13): 1216-23.. On the other hand, the increasing use of passive transportation (public: bus, subway, or train; private: car or motorcycle) as the main means of commuting has been causing serious problems in the urban transportation system, such as traffic jams¹¹11. Ogilvie D, Egan M, Hamilton V, Petticrew M. Promoting walking and cycling as an alternative to using cars: systematic review. BMJ 2004; 329 (7469): 763., air and sound polution¹²12. Rojas-Rueda D, de Nazelle A, Tainio M, Nieuwenhuijsen MJ. The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study. BMJ 2011; 343: d4521.. Thus, active commuting has been considered a great alternative to minimize such environmental¹¹11. Ogilvie D, Egan M, Hamilton V, Petticrew M. Promoting walking and cycling as an alternative to using cars: systematic review. BMJ 2004; 329 (7469): 763. and health problems¹²12. Rojas-Rueda D, de Nazelle A, Tainio M, Nieuwenhuijsen MJ. The health risks and benefits of cycling in urban environments compared with car use: health impact assessment study. BMJ 2011; 343: d4521..

Brazil, as well as other emerging economies, has been fast changing in terms of urbanization and transportation over the last few years¹³13. Comarú FA, Westphal M. Housing, urban development and health in Latin America: contrasts, inequalities and challenges. Rev Environ Health 2004; 19(3-4): 329-45.. In this context, one of the most notable changes is the public and private means of transportation. As a result, there was an increase in the incidence of traffic-related deaths, in the prevalence of respiratory diseases and in the levels of stress¹⁴14. Reynolds C, Harris MA, Teschke K, Cripton PA, Winters M. The impact of transportation infrastructure on bicycling injuries and crashes: a review of the literature. Environmental Health 2009; 8(1): 47.^,1515. Dratva J, Phuleria HC, Foraster M, Gaspoz J-M, Keidel D, Künzli N, et al. Transportation noise and blood pressure in a population-based sample of adults. Environ Health Perspect 2012; 120: 50-5.. Another negative effect is the increased physical inactivity due to the lower PA values obtained through transportation¹⁶16. Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: what are the contributors? Annu Rev Public Health 2005; 26: 421-43..

The evidence available in low and medium income countries show that walking and cycling are more prevalent among men and low income groups¹⁷17. Cervero R, Sarmiento OL, Jacoby E, Gomez LF, Neiman A. Influences of built environments on walking and cycling: lessons from Bogotá. Int J Sustainable Transportation 2009; 3(4): 203-26.^,1818. Gomes GA, Reis RS, Parra DC, Ribeiro I, Hino AA, Hallal PC, et al. Walking for leisure among adults from three Brazilian cities and its association with perceived environment attributes and personal factors. Int J Behav Nutr Phys Act 2011; 8(1): 111.. In communities in the United States, walking is more prevalent among women¹⁹19. Martinez SM, Arredondo EM, Roesch S, Patrick K, Ayala GX, Elder JP. Walking for transportation among Latino adults in San Diego County: who meets physical activity guidelines? J Phys Act Health 2011; 8(7): 898-906.. In Brazil, only 17% of people use a bicycle as a means of transportation and only 8% consider it as their main means of transportation in the city²⁰20. Confederação Nacional da Indústria I. Retratos da sociedade brasileira: locomoção urbana. Brasil: Confederação Nacional da Indústria; 2011.. Therefore, a better understanding of the prevalence of adults using different means of transportation and of PA over the years is necessary, once that many initiatives are being developed, such as the city gym and the bike lane²¹21. Malta DC, Morais Neto OL, Silva Junior JB. Apresentação do plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis no Brasil, 2011 a 2022. Epidemiol Serv Saúde 2011; 20(4): 425-38.. This study aimed to verify the changes in commuting to work and PA of the population in three locations in 2000 and 2010.

METHODS

Since 1984, the Research Institute of Universidade de São Caetano do Sul coordinates the ABC Socioeconomic Research for the regional group comprising the municipalities of Santo André (704,942 inhabitants), São Bernardo do Campo (811,489 inhabitants) and São Caetano do Sul (156,362 inhabitants), all located in the state of São Paulo. This research is conducted annually from a sampling survey of households²²22. Romeiro MC. Pesquisa socioeconômica do ABC Sao Paulo, Brazil. 2011; 20(4). [Internet]. Disponível em: http://repositorio.uscs.edu.br/handle/123456789/115 (Acessado em: 20 de abril de 2015).
http://repositorio.uscs.edu.br/handle/12... .

The article includes the results of the cross-sectional research for 2000 and 2010. For each survey, about 602 households were selected using the probabilistic random sampling technique. First, the postal codes (Códigos de Endereçamento Postal - CEP) of the municipalities were organized in ascending order. Next, the households were systemically selected. Finally, in each household selected, one resident older than 18 years of age was chosen using a random approach. All residents aged older than 18 years of age were initially considered eligible. Individuals who were unable to answer to the questionnaire were excluded and, in all surveys, participants were approached in their households. The error estimated in each survey for the results obtained was 3.0% for a 95.5% confidence interval. In case of refusal of participation, the following household was selected for the research. Previously trained professionals performed all data collection. The project was approved by the Ethics Committee of Santa Casa Hospital, in São Paulo, under protocol 2015/06. The participants signed the Informed Consent.

Of all the households analyzed in each period (2000 and 2010), 327 (54.5%) residents responded to the questionnaire on commuting in 2000, 63.9% (209) men and 36.1% (118) women. In 2010, 349 (58.2%) residents took part in the questionnaire on means of commuting, 54.4% (190) men and 55.6% (159) women aged older than 18 years of age.

The instrument used to measure the PA of walking, at moderate and vigorous intensity, was the International Physical Activity Questionnaire (IPAQ), in its short version, duly tested and validated in the adult Brazilian population²³23. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003 Aug; 35(8): 1381-95.. It was applied as an individual interview with an explanation of all questions for better understanding. PA practice was measured based on the answers to the IPAQ questionnaire, which consisted of questions about the frequency and duration of the activities in different domains. For each one of the domains evaluated, scores were determined by multiplying the weekly frequency by the time of duration in days on which the PA was carried out. The questions in the questionnaire were related to walking at moderate and vigorous intensity for at least ten minutes the week prior to its application.

In the present study, participants were classified into active and insufficiently active, based on the recommendation of PA for adults²⁴24. World Health Organization. Global Recommendations on Physical Activity for Health. Genebra: World Health Organization; 2010.. In order to be considered active, they should carry out ≥ 150 min/week of PA; and in order to be considered insufficiently active, < 150 min/week.

As a means of commuting, we considered active (on foot or by bicycle), private (motorcycle, car, van and bus, either carpooling or company car) and public transportation (bus, van, train or subway). The way of commuting to work (self-reported) of the participants of the research was known through their answer to the following question: What is the main means of transportation you use to go to work? This question was made for each of the means of transportation considered in the present study²²22. Romeiro MC. Pesquisa socioeconômica do ABC Sao Paulo, Brazil. 2011; 20(4). [Internet]. Disponível em: http://repositorio.uscs.edu.br/handle/123456789/115 (Acessado em: 20 de abril de 2015).
http://repositorio.uscs.edu.br/handle/12... .

The variables of gender, age range, socioeconomic level (SEL) and education were also considered for the analyses. The age range was categorized into four groups: 18 to 29, 30 to 44, 45 to 60 and > 60 years of age. The Brazilian Socioeconomic Classification questionnaire²⁵25. Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil. Brasil: Associação Brasileira de Empresas de Pesquisa; 2010. 4p. was used to classify the SEL. Brazil’s Economic Classification Criterion takes into account the score system and the education degree of the head of the household. The former identified the possessions and the number of items considered “assets” in the household, those being between zero and four or more. The latter presents the education degree and goes from illiterate (zero points) and complete higher education (eight points). After scoring and identification, the SEL is calculated and classified between “A1” and “E”, according to the cutoff points of Brazil’s Criterion²⁵25. Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil. Brasil: Associação Brasileira de Empresas de Pesquisa; 2010. 4p.. Participants were classified into three groups: A+B (high), C (intermediate) and D+E (low). The degree of education was measured according to: ≤ 8, 9 to 11 and ≥ 12 years of study. All questions were exactly the same within the different years of evaluation.

STATISTICAL ANALYSIS

The descriptive statistic with mean, standard deviation, frequency and percentage was used. The χ² test was used in order to compare categorical variables and the Student’s t-test for independent samples for the comparison of means of the quantitative variables.

In 2000 and 2010, the proportion and their respective 95% confidence interval (95%CI) was estimated for each means of commuting to work (active, private, and public transportation) according to age, SEL, education, gender, and PA. The variation between 2010 and 2000 was assessed by delta percentage (Δ%), the calculations were performed by the Statistical Package for the Social Sciences (SPSS) software, version 20.0, and the significance level adopted was p < 0.05²⁶.

RESULTS

The sample analyzed included 602 participants, 375 (62.3%) males. The descriptive statistic of the results is presented in Table 1, and no significant differences were found between the frequencies of gender and age in the periods evaluated (2000 and 2010). In both cases, most of the sample was male, aged between 10 and 34 years old and of intermediate socioeconomic level. Regarding education, most of the sample had ≤ 8 years of study in 2000 and ≥ 12 in 2010 (Table 1).

The mean PA for walking at moderate and full intensity were statistically higher in 2010. Besides, the prevalence of active individuals showed a significant increase from 62.2% in 2000 to 78.2% in 2010 (Table 1).

In relation to commuting to work, the proportion of individuals using active transportation increased from 17.8 to 24.2% in a 10-year period. On the other hand, the proportion using public transportation to go to work decreased from 35.9 to 23.8% (Table 1).

Figure 1 presents the different means of commuting to work according to age range, SEL and education.

In all age ranges, there was an increased proportion of individuals using active and private transportation, and decreased proportion of those using public transportation between 2000 and 2010. In the range of 18 to 29 years, most individuals used public transportation in 2000 and 2010. However, in other age ranges (30 to 44, 45 to 60 and > 60), the private transportation was the most often one used in both periods. In addition, the results showed a negative relation between age range and commuting to work via public transportation, considering that the older the individual is, the lesser it is used (Figure 1A).

There was a decrease in all SELs for use of public transportation in commuting to work. Among individuals of high SEL, a drop in the proportion of people using active transportation in commuting to work was observed, as well as a rise in the proportion of the ones using private transportation. Among individuals with intermediate SEL, there was an increase in the proportions of people who use active and private transportation when commuting to work. And among individuals of low SEL, an increased proportion of people using active transportation was verified, as well as a decrease in the proportions for private transportation. In high and intermediate SELs, private transportation was the most often one used in 2000 and 2010; among individuals with low SEL, public transportation was the most used one in 2000 and active transportation in 2010. Also, results show a negative relation between SEL and the use of active transportation.

Regarding education, an increase in the proportion of individuals using active transportation when commuting to work was observed among those with < 8 and 9 to 11 years of study, as well as a decrease among the ones with ≥ 12 years between 2000 and 2010. The use of private transportation recorded a decrease among those with < 8 and 9 to 11 years of study; and an increase between those with ≥ 12 years of study. The use of public transportation had an increase among those who had < 8 years of study and an increase among those who had 9 to 11 and ≥ 12 years of study. Moreover, results show a negative relation between education and the use of active transportation, once that the higher the education, the lesser the use (Figure 1B).

Table 2 describes the changes occurred in different means of commuting to work between 2000 and 2010 according to gender and PA level. Data show that, in the period analyzed, the use of active transportation increased proportionally and similarly in both genders (30.8% in males and 29.6% in females). Private transportation had an increase only among males, while the use of public transportation decreased for both genders.

As for PA levels, the proportions of active and insufficiently active individuals who used active and private means for commuting to work increased between 2000 and 2010. On the other hand, the proportion of active and insufficiently active people using public transportation in commuting to work decreased between 2000 and 2010.

Figure 2 compares the changes in overall PA (min/week) according to the year evaluated (2000 and 2010) and the means of transportation used in commuting to work. The mean overall PA of the ones using active transportation has significantly increased (p = 0.024; 32.2%) in the period analyzed. No significant differences were found between years 2000 and 2010 in private transportation. In public transportation, on the other hand, there was a significant decrease in the mean PA in min/week (-2.9%).

In 2000, the highest PA mean in min/week was among the ones who used public transportation when commuting to work. In 2010, it was among the ones who used active transportation.

DISCUSSION

This study aimed to describe the main means of commuting to work and the PA among adults of three municipalities in the São Paulo region in 2000 and 2010. The use of active transportation has increased for both genders in the period analyzed, being higher among women. The use of private transportation had a growth among men and dropped among women. Public transportation has suffered a decrease for both genders, being lower among men. Between 2000 and 2010, the proportion of active and insufficiently active individuals increased among those who commuted using active and private transportation, but decreased among those who used public transportation. The mean overall PA in min/week had a significant increase among those commuting with active transportation, and a significant decrease among the ones commuting with public transportation. In addition, the results show a negative relation between education, SEL and the use of active transportation, considering that the higher the education or SEL, the lesser the use of active transportation.

Active transportation is understood as commuting from one point to another by walking, running, cycling, skating, skateboarding, and using non-motorized wheelchairs. It offers a number of benefits, such as promoting health through regular PA practice, improving social interactions, reducing traffic jams, contributing to the reduction of the greenhouse and gas emission effects and saving money with fuel and parking²⁷27. Public Health Agency of Canada. What is Active Transportation? Canada: Federal Government; 2014. p. 1.^,2828. Giles-Corti B, Foster S, Shilton T, Falconer R. The co-benefits for health of investing in active transportation. N S W Public Health Bull 2010 May-Jun; 21(5-6): 122-7..

A cross-sectional study which evaluated the type of transportation with adults in Sweden in years 2008 and 2009 shows that 63% of adults preferred using private transportation, while only 8.3% preferred using active transportation. However, despite using private transportation most of the time, the subjects reported performing PA during their free time²⁹29. Thern E, Forss KS, Jogreus CE, Stjernberg L. Factors associated with active commuting among parents-to-be in Karlskrona, Sweden. Scand J Public Health 2015 Feb; 43(1): 59-65.. These data are different from the ones in the present study, in which 24.2% of the sample used an active means transportation, and 52.0% used private ones. The difference may be explained by many factors, such as culture, availability of built environments and, mainly, the distance to be covered.

A study carried out in Atlanta showed that 89.2% of the subjects interviewed used active transportation in the region, but only 2.6% of this sample met the recommendations of PA for walking, since most of them would choose this kind of transportation due to living close to their destination and using private transportation when commuting to farther locations³⁰30. Lachapelle U, Frank LD. Transit and health: mode of transport, employer-sponsored public transit pass programs, and physical activity. J Public Health Policy 2009; 30 (Suppl 1): S73-94.. These data are different from the ones in the present study, in which 22% met the recommended PA goals when using active transportation, proving that environmental and social factors may influence it and therefore should be taken into account in such researches.

As for the total PA in min/week, the results of the present study are similar to the ones found in others, showing that adults who use active transportation when commuting to work have higher total PA values (min/week) when compared to those who choose public transportation³¹31. Fishman E, Bocker L, Helbich M. Adult active transport in the Netherlands: an analysis of its contribution to physical activity requirements. PLoS One 2015; 10(4): e0121871.^,3232. Larouche R, Saunders TJ, Faulkner G, Colley R, Tremblay M. Associations between active school transport and physical activity, body composition, and cardiovascular fitness: a systematic review of 68 studies. J Phys Act Health 2014 Jan; 11(1): 206-27.^,3333. Wanner M, Gotschi T, Martin-Diener E, Kahlmeier S, Martin BW. Active transport, physical activity, and body weight in adults: a systematic review. Am J Prev Med 2012 May; 42(5): 493-502..

A survey carried out by the National Traffic Department (Departamento Nacional de Trânsito - DENATRAN) showed an improvement in car fleet between 2000 and 2010, going from approximately 29 million to 64 million³⁴34. Brasil. Departamento Nacional de Trânsito. Frota de veículos. Brasil: Departamento Nacional de Trânsito; 2011. 100p.. These data may be related to the results in the present study, in which a decrease in the use of public transportation and an increase in private transportation was observed.

Throughout the period analyzed in this study, the ABC region went through some changes and the implementation of public policies for the promotion of PA practice. However, the increased commuting by active transportation is hard to be explained, since the present study did not analyze all the necessary variables. In the municipality of Santo André, for example, the city hall implemented bicycle lane projects and created the program Santo André em Movimento (“Santo André on the Move”), with the objective of offering educational guidance on the conscious use of bicycles, skateboards and skates as both means of commuting and leisure³⁵35. André PMS. 'Caminhando para a Saúde' fecha 2013 com 1.517 inscritos. São Paulo; 2014. [Internet]. Disponível em: http://www2.santoandre.sp.gov.br/index.php/component/k2/item/7918-caminhando-para-a-saude-fecha-2013-com-1-517-inscritos (Acessado em: 30 de agosto de 2015).
http://www2.santoandre.sp.gov.br/index.p... . In São Caetano do Sul and Santo André, there were some changes in built environments, such as widening of sidewalks and the construction of bike lanes³⁶36. São Caetano do Sul. São Caetano do Sul - Cidades Ativas. 1: Construção e implementação de ruas de lazer, ciclofaixas e ciclovias]. São Caetano do Sul; 2013. [Internet]. Disponível em: http://www.saocaetanodosul.sp.gov.br/ (Acessado em: 16 de julho de 2015).
http://www.saocaetanodosul.sp.gov.br/... ^,3737. São Bernardo do Campo. Ciclovias e Ciclofaixas. São Bernardo do Campo: Prefeitura; 2013. [Internet]. Disponível em: http://www.saobernardo.sp.gov.br/home (Acessado em: 16 de julho de 2015).
http://www.saobernardo.sp.gov.br/home... . In addition, it is noteworthy that all three municipalities are part of the Regional Health Directorate 1 (Diretoria Regional de Saúde 1) - São Paulo (DRS 1) and are partners of the Programa Agita São Paulo (“Bustling São Paulo Program”), of the State Health Bureau of the state of São Paulo, which is committed to fighting a sedentary lifestyle and increasing PA levels in the population aged 14 years old or older, including students, elderly and workers³⁸38. Paulo PAS. Promoção de Atividade Física no Estado de São Paulo. São Paulo: Victor Matsudo; 1996. [Internet]. Disponível em: http://www.portalagita.org.br/pt/agita-sp/o-agita-sp/o-que-fazemos.html (Acessado em: 16 de julho de 2015).
http://www.portalagita.org.br/pt/agita-s... .

Despite being a representative study of household interviews, some limitations must be considered, such as the use of IPAQ’s short version and of self-report, which may overestimate PA levels; the assessment of just two periods in a 10-year gap, which may prevent the interpretation of the Evolution and the tendency of the results; and the lack of standardization in data collection regarding active transportation, which may hinder the comparison and discussion of the results.

CONCLUSION

After analyzing the results, it may be concluded there was a change in the way of commuting to work in the municipalities studied between 2000 and 2010. The use of active transportation increased for both genders; the use of private transportation expressed an increase among men and a decrease among women; and public use suffered a drop, considering both genders. The total mean PA in min/week had an increase among individuals commuting with active transportation and a decrease among those commuting with public transportation. In addition to that, results showed the higher the education or SEL, the lesser the use of active transportation. These data evidence a positive result in relation to the increased active transportation use and PA level. Thus, the continuous encouragement and the improvement of the knowledge on the positive effects of PA among the population are essential and must be extended, including public policies for health promotion and the construction of favorable environments for the maintenance of healthy life habits.

References

Publication Dates

History