The association between commuter cycling and sickness absence Ingrid J.M. Hendriksen a,b, ⁎, Monique Simons a,b,c , Francisca Galindo Garre a , Vincent H. Hildebrandt a,b a TNO Quality of Life, Leiden, The Netherlands b Body@Work, Research Center Physical Activity, Work and Health, TNO-VUmc, VU University Medical Center, Amsterdam, The Netherlands c Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands abstract article info Available online 24 May 2010 Keywords: Active transport Cycling Physical activity Absenteeism Dose–response relationship Objective. To study the association between commuter cycling and all-cause sickness absence, and the possible dose–response relationship between absenteeism and the distance, frequency and speed of commuter cycling. Method. Cross-sectional data about cycling in 1236 Dutch employees were collected using a self-report questionnaire. Company absenteeism records were checked over a one-year period (May 2007–April 2008). Propensity scores were used to make groups comparable and to adjust for confounders. Zero-inflated Poisson models were used to assess differences in absenteeism between cyclists and non-cyclists. Results. The mean total duration of absenteeism over the study year was more than 1 day shorter in cyclists than in non-cyclists. This can be explained by the higher proportion of people with no absenteeism in the cycling group. A dose–response relationship was observed between the speed and distance of cycling and absenteeism. Compared to people who cycle a short distance (≤5 km) three times a week, people who cycle more often and longer distances are absent for fewer days on average. Conclusion. Cycling to work is associated with less sickness absence. The more often people cycle to work and the longer the distance travelled, the less they report sick. © 2010 Elsevier Inc. All rights reserved. Introduction Despite warnings about the potentially negative health consequences of a sedentary lifestyle, a large proportion of employed adults are not physically active enough. Promoting physical activity (PA) that fits in well with normal daily routines is a promising way of reaching large numbers of less active people. Cycling to work is very good exercise that is relatively easy to incorporate in normal daily routines (Vuori et al., 1994; Hendriksen et al., 2000). It is also an excellent option for more frequent physical activity in a large group of employees (Oja et al., 1998). Earlier studies have shown that commuter cycling substantially reduces the risk of premature mortality (Anderson et al., 2000; Matthews et al., 2007) and cardiovascular risk (Hamer and Chida, 2008), improves health (Oja et al., 1991; de Geus et al., 2008) and physical performance (Hendriksen et al., 2000; de Geus et al., 2009), and can have a positive effect on preventing overweight (Wagner et al., 2001; Hu et al., 2002; Lindström, 2008; Wen and Rissel, 2008). It is less clear whether these health benefits of commuter cycling also lead to a measurable reduction in absenteeism. There is evidence documenting the positive effect of regular PA on sickness absence. A Dutch prospective study showed that employees who participated in sporting activities were off sick 20 days less over a 4-year period compared with non-sporting colleagues (van den Heuvel et al., 2005). Furthermore, in a study of three large databases, vigorous-intensity PA at least three times a week had a positive effect on sick leave (Proper et al., 2006), while PA at a less vigorous level did not seem to have this effect. However, very little research has been published that focuses specifically on active commuting and absenteeism. A recent review therefore focused on how available evidence from workplace PA promotion might be applied to walking and cycling to work (Davis and Jones, 2007). The most significant finding was that an increase in PA of more than 1 h per week, which can easily be achieved by walking or cycling to work, is expected to lead to a measurable reduction in the level of absenteeism. If it can be demonstrated that cycling to work can reduce absenteeism costs, there could be a major impact on the number of companies encouraging commuter cycling. Employers will probably be more willing to promote cycling to work if there is a demonstrable return on investment. The aim of this study was to assess the association between commuter cycling and all-cause sickness ab- sence, and to explore the influence of distance, frequency and speed of commuter cycling on this relationship. Methods Participants and study design A cross-sectional study was performed at companies where a substantial proportion of employees cycled to work regularly. Participation was restricted to organisations with white-collar workers, a minimum of 1000 employees, and an Preventive Medicine 51 (2010) 132–135 ⁎ Corresponding author. TNO Quality of Life, P.O. Box 2215, 2301 CE Leiden, Netherlands. Fax: +31 71 5181916. E-mail address: ingrid.hendriksen@tno.nl (I.J.M. Hendriksen). 0091-7435/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2010.05.007 Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed