Artigos

I - BACKGROUND
Globally, in recent years the discussion around urban mobility has gained more and more space, highlighting the importance of alternative transport as a healthier and more sustainable path [1]. Cycling, in particular, in addition to generating health-promoting effects resulting from increased physical activity, long-term adoption has a positive impact on socio-environmental quality, which ranges from reducing emissions of polluting gases that intensify global warming, even economic and social impacts caused by traffic deaths and consequences. Constant use of bicycles can also contribute to relieving healthcare systems and promoting gender equality [2, 3].
Thus, different conditions of urban mobility can interfere in the health disease process of populations where the model adopted can favor well-being or enhance harmful effects on the quality of human life, resulting in health inequities. Studies carried out in the United States of America (USA) and Europe show that countries that adopt cycling as a means of transport tend to reduce problems caused by the use of motorized vehicles and show decreasing rates of obesity [4, 5]. However, it is important to highlight in North America around 1% to 2% of trips are made by bicycle compared to cycling-friendly European cities (15% 40% of trips). Safety concerns due to motor vehicle collisions are primary barriers to active mode expansion [5]. In the United States, the federal government's strategic mobility plan between 2014 and 2018 highlighted that the expansion of sustainable travel in cities was associated with improvements in the quality of life of residentes [6].
Cities such as Sydney, Australia, Copenhagen and Denmark, have made good progress in creating a cycling-friendly environment, resulting in a significant increase in the number of bicycle trips [6]. The Netherlands, in particular, has been innovating by revitalizing space with priority for pedestrians and cyclists and implementing an extensive cycle network with 15,000 km connecting the entire country, where 14 million people circulate, corresponding to a third of the Dutch's daily trips [7].
In regions of peripheral capitalist, such as in Latin America, investigations show that only a fifth of transport time is spent on cycling mobility, which is worrying, considering that between 27% and 47% of the majority of people in this region do not comply with physical activity recommendations for health, as recommended by the World Health Organization (WHO) [8,9].
In the city of Bogotá, Colombia, there is a widely recognized initiative (CicloRutas) with the implementation of the most extensive network of cycle paths in the region where roads connect to public transport and provide access to a wide variety of destinations. A study showed that CicloRutas played an important role with an estimated reduction in CO2 emissions equivalent to 36.6 thousand tons, in addition to facilitating the movement of low-income people in the city [8]. Changes to the built environment have also been made in other countries, on different continents, with the aim of increasing access to active displacement activities and enhancing the reduction of harmful effects on human health [9]. According to Branas et al. [10] multilevel strategy, which combines the individual and the environment, can achieve more sustainable goals because it influences a greater number of people, over a longer period of time, compared to initiatives that focus exclusively on individuals.
The objective of this article is to explore the effects of cycling policies in promoting the health and safety of cyclists, specifically to understand the influences of the built environment on the lifestyle of cyclists.

II - METHODS

Study design
This research was based on the Scoping Review method, an exploratory review, with the aim of mapping the extent of literature on a given topic/area of research that has not yet been comprehensively reviewed or has a complex and heterogeneous nature [11]. The objective is to synthesize evidence that addresses the active modal and its relationship with health promotion and cyclist safety, thus providing significant bases for carrying out valid and replicable studies in different contexts. The structure used was the one proposed by The Joanna Brigs Institute (JBI) for Scoping Reviews [12] guided by the research protocol published in BMJ Open in 2017 [13]. The results are described according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews (PRISMA-ScR) extension.

Intervention

Cyclomobility is part of a broader mobility policy whose interpretation considers the conditions of movement of people and cargo in urban space, including and prioritizing modes of public and non-motorized transport. For this study, we define cyclomobility policy as socio-organizational characteristics that facilitate coordination and cooperation in favor of a sustainable, environmentally responsible and economically accessible urban mobility alternative for different social classes and age groups.

Research Question

The scoping review was guided by the following question: What are the possible effects of policies focusing on cyclomobility on promoting the health and safety of cyclists? Based on the research question, the acronym PICO was constructed: P (Participants): General population; I (Intervention): Cycle mobility policies; C (Comparator): Not applicable; Outcomes: Health Promotion (involves a wide range of social and environmental interventions to enable people to improve their health) and Cyclist safety.

Eligibility criteria and sources of information

The eligibility criteria adopted in this study include complete indexed papers, qualitative, quantitative or based on mixed methods, involving primary and/or secondary data, intervention studies and reviews in general. Conference abstracts, comments and editorial publications were excluded.
The extraction period for studies published in Portuguese, English and Spanish was from 2011 to 2022. To define the search strategy, papers that addressed direct and indirect effects of the intervention on eligible outcomes (promotion of cyclists' health and safety) were considered. The search was carried out in electronic databases (PubMed, Scopus - which includes EMBASE and MEDLINE and Web of Science), using Boolean operators (AND/OR) and search resources (*), with the strategy used for PubMed being adapted for other databases, depending on the specific requirements of each one. The research was carried out between January and March/2024.

Selection of relevant studies

The search results were exported to the bibliographic reference manager (https://www.rayyan.ai/). In the screening process, duplicates were removed and the titles and abstracts of all papers were read by two researchers to determine their eligibility. In cases of doubt, a second reviewer carried out the arbitration, reading the title and abstract. The studies that remained were read in full and those that met the eligibility criteria were selected for data extraction. Two members of the research team extracted information from the articles by inserting the characteristics and elements of the extensive reading phase. One of the research team members led the extraction of results from each article and the second carried out a quality review of the process. The flowchart showing the entire process of data extraction and selection of eligible articles is described in Figure 1.

Synthesis of results

Considering the characteristics that would best answer the research questions, a standardized Excel spreadsheet was created to extract the data. A descriptive analysis of the general characteristics of the studies and a qualitative analysis of the themes were carried out with the following variables:
(1) General characterization of the studies: title, year of publication, objective of the study, country, method and type of intervention (implemented policy); (2) Results: effects/results of the cycling mobility policy. To synthesize the evidence, the studies were categorized into two main themes: cycling policies and health promotion and cycling policies focusing on cyclist safety.

III - RESULTS

Search and selection of articles
Considering the search and selection stages of studies, 199 papers were initially identified and, after eliminating duplicates and reviewing the eligibility criteria, 85 were included. In the next stage, with extensive reading, 26 papers remained for data extraction and evidence synthesis.


Characteristics of the included studies

Regarding the general characterization of the studies, given that the articles were published in different countries, there was a greater concentration of research in North America, particularly in the USA followed by European countries. Quantitative and qualitative studies were identified, six of which were cross-sectional, two reported program evaluation, two focused on systematic review and the others reported a qualitative method.
Considering urban mobility as a social determinant of health policies related to active travel may operate at various levels of the socio-ecological framework, including societies, cities, routes or individuals and there are several measures that can drive cities to become more sustainable and liveable, creating multiple benefits that contribute to well-being.

The implementation of bicycle sharing systems, the facilitation of bicycle rental, new cycle paths, bicycle stations in areas further away from the city center and integration with public transport were identified in several paper as the most important strategies for defining the form and function of neighborhoods, encouraging more regular use of active mode.

Analysis of the effect of cyclomobility on health promotion

Cycling promotion initiatives mainly involve intervention in the design and urban planning of cities, which includes the execution and improvements of sidewalks, squares, parks and cycle paths, making them more accessible, safe, comfortable and attractive. As individuals opt for active travel, in addition to the positive effect on physical and mental health, benefits will be achieved by reducing noise emissions and air pollutants. In the study by Evenson et al. [14], living closer to infrastructure did not predict changes in physical activity levels in 1 year of follow-up, but generated increases in sports practice in 2 years compared to those who lived further away (15.3 additional minutes/week of walking and cycling per nearest km).

A study by Woodcock et al. [9] observed after the introduction of a bike sharing system in London that physical activity increased by an average of 0.06 reductions in depression (-7 DALYs).

MET (Metabolic Equivalent Task) per week, per person, although this differed between men and women. Among men, almost half of the benefit in terms of DALYs (disability-adjusted years of life lost) came from reductions in ischemic heart disease (-41 DALYs), while among women the greatest benefit came from A limitation of this study was that it modeled the benefits of behavior change in the short and medium term, as reliable data on these long-term effects are limited and omitting them from the model may underestimate the benefits over the long term. of life for those who start cycling at a younger age.

Ricci [15] found gains in terms of health, environment and economy with bike sharing systems in his research, however the author mentioned that the available studies show a variety of evaluated results.
Brown et al. [15] analyzed changes in bicycle use and its impact on caloric expenditure in a neighborhood that received a bike lane, subway and other road improvements. The results indicated more calories burned among cyclists compared to those who never cycled. Furthermore, the introduction of a cycle path with greater investment was associated with a lower BMI (body mass index) among those who took longer journeys on the new cycle paths.
Yu et al [17] revealed that over 10 years, the program to expand bike sharing in low-income neighborhoods in New York was associated with approximately $34 in increased costs and gains of 0.004 QALYs ( quality-adjusted life year).
Estevan, Queralt & Molina-García [19] analyzed teenagers' commute to school, focusing on bike sharing, in Valencia (Spain). Having cycle paths within 250m of the school helped encourage the use of bicycles to and from school – when there are no cycle paths, teenagers are 64% less likely to cycle. In the same vein, Kellstedt et al. [20] evaluated a pilot bike sharing program at a university in Texas (USA). Three months after the introduction of the program, one third of the campus population registered as users and 33.6% of those interviewed reported having used bicycles. Macmillan et al. [21] modeled the impact of a regional implementation of cycle lanes on population health, including variables such as equity by income and ethnicity. The participatory design allowed for better knowledge of the community to conduct a proposal that had a greater chance of achieving changes in the population.
Rissel et al., 2015 Described the users of the new bicycle path, and examines its short-term impacts upon cycling behaviour and perceptions of the local environment in Australia. The authors identified that pre-existing cycling behavior and proximity to the cycle path were associated with the use of the new cycle path. Increasing cycling frequency may require longer waiting times and further maturation of Sydney's cycle path promotional network. Kraus and Koch [22] analyzed bicycle counts in 736 locations in 106 European cities, which built, on average, 11.5 km of temporary cycle paths in response to the pandemic, which generated an increase of between 11 and 48% in cyclist counts.
Stankov et al. [23] in a systematic review highlighted an underrepresentation of certain types of transport policies to encourage cycling, evaluating their results with the following markers: anthropometric measurements and health equity. Considering the countries where they were implemented, mainly those defined by the World Bank as low and medium income (PRMB), the authors identified that cycle paths and bicycle sharing systems are promising initiatives to promote physical activity in the population. In Bogotá, the Ciclovia and Cicloruta programs had the potential to equally promote physical activity and provide alternative mobility in the city's urban environments [8].
Ogilvie et al., 2015 sought to evaluate in the United Kingdom the effects of an iConnect infrastructural intervention (with a focus on improving local routes for pedestrians and cyclists) in the UK. The study provided valuable information about the behavioral effects and mechanisms of change in local transport infrastructure and its importance for health, transport and energy and climate policy.

Analysis of the effect of cyclomobility on cyclists’ safety

Cycling, as a form of active transport, has well-established health benefits. However, the safety of cyclists in traffic remains a major concern. In the studies analyzed, the authors highlight that collecting quality data on injuries caused by cycling accidents is a challenge, mainly due to the underreporting of non-fatal cycling accidents, as well as the difficulty of appropriate methodologies. Panter et al. [24] analyzed improvements in pedestrian routes and cycle paths and according to the authors, participants who lived nearby and used these routes reported an increase in the perception of provision and safety.
The objective of the study by Pedroso et al. [25] was to evaluate changes in bicycle use and cyclist safety in Boston, Massachusetts, with the expansion of cycling infrastructure between 2007 and 2014.
Called “Boston Bikes”, the program involved the expansion of cycling infrastructure, improvements in bicycle signage, parking and cyclist awareness, as well as introducing a bicycle sharing program. The results show that an integrated approach to improving cycling infrastructure was associated with a significant increase in daily cycling trips and an improvement in overall cyclist safety (reduction over time in the proportion of accidents resulting in injuries). The authors reported a 140% increase in the percentage of bicycle users between 2007 and 2014, but the injury rate did not increase significantly during this period, demonstrating that investments in cycling infrastructure can contribute to increasing bicycle use. and, at the same time, increase security.
Fishman and Schepers [26] showed that bike sharing programs are associated with lower injury risks, which, according to the authors, can be explained by greater attention and care on the part of drivers when sharing Fishman and Schepers [26] showed that bike sharing programs are associated with lower injury risks, which, according to the authors, can be explained by greater attention and care on the part of drivers when sharing systems are introduced and by a possible perception that cyclists are less experienced in using these systems. The objective of the study by Hamra, Schinasi and Quistberg [27] was to quantify the impact of a municipal bicycle sharing program on motor vehicle collision rates involving bicycles.
The authors performed an interrupted time series analysis using Pennsylvania Department of Transportation crash records for Philadelphia (Philadelphia County) from 2010 to 2018. Although there was an increase in the number of cyclists, the total number of cyclist injuries decreased more quickly after the start of bike sharing, which could possibly be attributed to changes in infrastructure to add more cyclists and changes in bicycle driver behavior. cars and buses. These findings indicate that cycle paths can be an important infrastructure intervention to reduce the number of injuries to cyclists.
The study by Pulugurtha and Thakur [28] aimed to evaluate the effectiveness of cycle paths in reducing accidents involving cyclists on urban roads. Carried out in the city of Charlotte, North Carolina/USA, the authors found that cyclists run three to four times more risks on stretches without a bike lane than on stretches with a bike lane on the street, however, collisions per year are not significantly higher in stretches without bike lanes, which, in line with other results of this study, indicates that the effect of bike lanes depends on cyclists' exposure to traffic. Another result was that the increase in the width of cycle lanes and the rightmost lane was associated with a decrease in the number of bicycle collisions. Smith et al. [29] showed a positive effect of improvements to the environment such as the provision of parks and playgrounds and the quality and installation of active transport infrastructure, from safety to cycling and walking.
Wall et al. [30] noted that painted and physically protected bike lanes reduced the occurrence and severity of injuries among urban cyclists. This prospective study recruited injured cyclists who were treated at an urban trauma center in New York City, comprising a sample of 839 patients.
Although physically protected bike lanes are associated with a decrease in the absolute number of injuries, when injuries do occur, they are of greater severity. According to the authors, a possible explanation is that in New York sharrows are intended for low-speed traffic, where the bicycle must have its own space, but, in general, this space is not respected and the speed of traffic is higher and in many situations higher than established.
Goerke et al. [31] demonstrated a reduction in cyclist injuries and deaths after implementing improvements in cycling infrastructure, even with significant increases in the number of cyclists. Research carried out in the city of Minneapolis, USA, demonstrated a 49% increase in estimated daily cyclist traffic from 2007 to 2016 and a significant reduction in injuries. According to the authors, cyclists tend to suffer less serious injuries when there are more people cycling and miles of protected bike space.

Table 1 presents the selected studies and a summary of the main characteristics and findings extracted from the articles to summarize the evidence.


IV - DISCUSSION

Since the start of the coronavirus pandemic, cycling has become an even more popular travel option and cycle paths are increasingly common in major cities around the world. The evidence extracted from the studies shows that convergent actions are being developed in several countries towards safe and active mobility given its numerous health benefits, in addition to economic and environmental gains. This topic has increasingly aroused the interest of researchers, planners and society, but a limitation has been the lack of data to monitor and evaluate transport policies, especially in low- and middle-income countries.
The measures aim, in general, to promote the use of bicycles among the population in favor of a less congested environment. In the field of health promotion, several studies highlight the importance of programmatic interventions that aim to encourage healthy living, especially in the urban context, such as adequate infrastructure for active travel and the expansion of community spaces to reduce physical inactivity. Cycle paths and bike-sharing programs have the potential to reduce the prevalence of physical inactivity and should be seen as investments in creating healthy, safe, equitable and sustainable spaces. When included in daily activities, walking and cycling are more likely to be maintained than gym-based exercises, which are essential for an active lifestyle.
Urban mobility policies become opportunities for residents of different age groups to practice physical activities, democratizing sport. Other authors reinforced that bicycle sharing can encourage new cyclists creating a virtuous cycle: the more people cycle, the safer cycling becomes [17].
Countries that established certain combinations to expand active mode exerted a quantifiable influence on motivational factors and allowed for better accessibility between neighborhoods, more walking and cycling trips, more safety and fewer greenhouse gas emissions [34, 35]. Some studies have shown that cycle paths closer to homes (within 500 m), as well as access to train or metro stations, are factors that can increase the use of bicycles for transport [24, 36, 37].
In general, the articles indicate that interventions that reinforce cyclability can represent a positive achievement, including peripheral areas that generally have less opportunity to access health-promoting activities. People who used the cycle paths cycled more, thus obtaining a health benefit. These finding signals that an increase in the general prevalence of cycling in the community tends to increase the general level of physical activity in the population. The way in which incentive strategies are implemented can vary in search of benefits for health, sociability and the climate [36, 37]. School streets are increasingly becoming a valuable tool for improving the environment for children, their caregivers and residents. From this perspective, security must be a fundamental concern and must be included in policies.
Some studies show that the reduction in injuries and deaths among cyclists after the implementation of cycling infrastructure occurs even with a significant increase in the number of cyclists. In general, the most common thing is for cyclists to suffer accidents alone, with young cyclists often being responsible for accidents. Additionally, cyclists tend to suffer fewer serious injuries when there are more people cycling and miles of protected bicycle space [31, 28].
According to the World Health Organization, 41,000 cyclists die in traffic related incidents around the world every year, about 3% of global traffic deaths. In this context, to help reduce risks to cyclists, any new infrastructure must be developed carefully and to the highest standards.
Even spaces have been reallocated for people to cycle and walk more easily, efficiently and safely, which signals that it is necessary to reflect more on the concept of cycle paths as a safe space for cyclists. Cycle paths need to be structured in such a way that vehicles do not enter the lanes, in addition, more advertising campaigns are needed to increase the awareness of car, bus and train drivers about taking care of pedestrians and cyclists. Reducing speed limits on city streets can be an important strategy by changing the design of spaces and reducing speeds, which could help prevent or reduce injuries. And in certain high-speed street contexts, greater investment between cyclists and traffic is needed to prioritize cyclist safety. The best way to make cycling safe is to have more cyclists teaching drivers to pay more attention to cyclists, rather than ignoring the possibility of a cyclist in their path.
The development of cities' strategic plans needs to involve more traffic engineering in dialogue with areas such as health, urban architecture, education and the environment. The intersections project in the Netherlands aims to promote visibility and safety for everyone involved, an experience that can be expanded to other countries. Another example from Paris, France, streets have been redesigned to include cycling infrastructure with plans for more than 650 kilometers (403 miles) of new cycle paths.
The use of helmets, although highlighted in some articles, needs to be further explored in research as a strategic objective in accident risk management. It is important to highlight the growth of workers using bicycles and the lack of evidence surrounding this topic. As delivery people have many demands that need to be delivered in a short period of time, they are more vulnerable to accidents involving third parties. Additional studies with this target audience need to be expanded with the aim of reducing the number and severity of accidents.

V - CONCLUSION

The evidence summarized in this study indicates that creating spaces that encourage active and non-directed travel, which often go hand in hand, benefits public health and the environment. Programs focused exclusively on behavior change have proven largely ineffective, but investments in infrastructure planning, traffic calming, and access to bike paths near destinations can successfully encourage active cycling and reduce cyclist injuries.
The need for investment in monitoring policies focusing on cycling was noted, as well as more rigorous adjustments for confounding factors and better use of outcome measures. An important point is to further explore population data in samples and the measurement of individual exposures to interventions, however these studies require interdisciplinary partnerships that include, for example, epidemiologists, researchers in social and urban planning and transport researchers.
Policymakers could use this knowledge to create spaces that encourage active, non-directed travel, which often go hand in hand, benefiting public health and the environment.

Data availability statement


The sources of the data used in the research are indicated in the body of the article.























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