Editing Cycling (section)

==Health effects==

Cycling provides a variety of health benefits<ref>[https://www.researchgate.net/publication/341286587_Perspectives_on_exercise_intensity_volume_and_energy_expenditure_in_habitual_cycle_commuting  Schantz P, Salier Eriksson, J, Rosdahl, H. 2020. Perspectives on exercise intensity, volume and energy expenditure in habitual cycle commuting. Front. Sports Act. Living 2:65]</ref><ref>{{Cite journal |last1=Götschi |first1=Thomas |last2=Garrard |first2=Jan |last3=Giles-Corti |first3=Billie |date=2 January 2016 |title=Cycling as a Part of Daily Life: A Review of Health Perspectives |url=https://doi.org/10.1080/01441647.2015.1057877 |journal=Transport Reviews |volume=36 |issue=1 |pages=45–71 |doi=10.1080/01441647.2015.1057877 |hdl=10536/DRO/DU:30078063 |s2cid=152653005 |issn=0144-1647 |hdl-access=free}}</ref> and reduces the risk of cancers, heart disease, and diabetes that are prevalent in sedentary lifestyles.<ref name="WHO" /><ref name="ReferenceA"/> Cycling on [[Stationary bicycle|stationary bikes]] have also been used as part of rehabilitation for lower limb injuries, particularly after hip surgery.<ref name=":1" /> Individuals who cycle regularly have also reported mental health improvements, including less perceived stress and better vitality.<ref name=":2" />

The health benefits of cycling outweigh the risks, when cycling is compared to a sedentary lifestyle. A Dutch study found that cycling can extend lifespans by up to 14 months, but the risks equated to a reduced lifespan of 40 days or less.<ref>{{cite journal |pmc=2920084 |doi=10.1289/ehp.0901747 |pmid=20587380 |year=2010 |last1=De Hartog |first1=J. J. |title=Do the Health Benefits of Cycling Outweigh the Risks? |journal=Environmental Health Perspectives |volume=118 |issue=8 |pages=1109–1116 |last2=Boogaard |first2=H |last3=Nijland |first3=H |last4=Hoek |first4=G}}</ref> Mortality rate reduction was found to be directly correlated to the average time spent cycling, totaling to approximately 6500 deaths prevented by cycling.<ref>{{Cite journal |last1=Fishman |first1=Elliot |last2=Schepers |first2=Paul |last3=Kamphuis |first3=Carlijn Barbara Maria |date=2015 |title=Dutch Cycling: Quantifying the Health and Related Economic Benefits |journal=American Journal of Public Health |volume=105 |issue=8 |pages=e13–e15 |doi=10.2105/ajph.2015.302724 |pmid=26066942 |pmc=4504332 |issn=0090-0036}}</ref> [[Cycling in the Netherlands]] is often safer than in other parts of the world, so the [[risk-benefit ratio]] will be different in other regions.<ref>{{Cite journal |last1=Schepers |first1=Paul |last2=Twisk |first2=Divera |last3=Fishman |first3=Elliot |last4=Fyhri |first4=Aslak |last5=Jensen |first5=Anne |title=The Dutch road to a high level of cycling safety |journal=Safety Science |volume=92 |pages=264–273 |date=February 2017 |language=en |doi=10.1016/j.ssci.2015.06.005 |url=https://eprints.qut.edu.au/120431/1/SchepersetalTheDutchroadtoahighlevelofcyclingsafety.pdf |access-date=4 December 2019 |archive-date=17 December 2019 |archive-url=https://web.archive.org/web/20191217180051/https://eprints.qut.edu.au/120431/1/SchepersetalTheDutchroadtoahighlevelofcyclingsafety.pdf |url-status=dead |hdl=11250/2766251 |s2cid=110938997 |hdl-access=free}}</ref> Overall, benefits of cycling or walking have been shown to exceed risks by ratios of 9:1 to 96:1 when compared with no exercise at all, including a wide variety of physical and mental outcomes.<ref>{{Cite journal |url=https://ubcmedicaljournal.files.wordpress.com/2015/11/ubcmj_3_2_2012_6-11.pdf |title=Bicycling: Health Risk or Benefit? |author1=Kay Teschke |author2=Conor C.O. Reynolds |author3=Francis J. Ries |author4=Brian Gouge |author5=Meghan Winters |journal=University of British Columbia Medical Journal |date=March 2012 |access-date=19 October 2016 |archive-url=https://web.archive.org/web/20161020050801/https://ubcmedicaljournal.files.wordpress.com/2015/11/ubcmj_3_2_2012_6-11.pdf |archive-date=20 October 2016 |url-status=dead}}</ref><ref>{{Cite journal |author1=IoneAvila-Palencia |date=2018 |title=The effects of transport mode use on self-perceived health, mental health, and social contact measures: A cross-sectional and longitudinal study |journal=Environment International |volume=120 |pages=199–206 |doi=10.1016/j.envint.2018.08.002 |pmid=30098553 |bibcode=2018EnInt.120..199A |hdl=1942/28758 |s2cid=51965322 |hdl-access=free}}</ref><ref>{{Cite journal |last1=Leyland |first1=Louise-Ann |last2=Spencer |first2=Ben |last3=Beale |first3=Nick |last4=Jones |first4=Tim |last5=Reekum |first5=Carien M. van |date=20 February 2019 |title=The effect of cycling on cognitive function and well-being in older adults |journal=PLOS ONE |language=en |volume=14 |issue=2 |pages=e0211779 |doi=10.1371/journal.pone.0211779 |issn=1932-6203 |pmc=6388745 |pmid=30785893 |bibcode=2019PLoSO..1411779L |doi-access=free}}</ref>

===Exercise===
[[File:Cyclist-189.JPG|thumb|left|Heavily equipped London cyclist: specialist cycle clothing, pollution mask, dark glasses and helmet.|alt=A man with sports clothes and a white helmet on a bicycle on a road.]]
The [[physical exercise]] gained from cycling is generally linked with increased health and well-being. According to the [[World Health Organization]] (WHO), physical inactivity is second only to [[tobacco smoking]] as a health risk in developed countries,<ref name="WHO">{{cite web |url=http://www.euro.who.int/document/e75662.pdf |title=A Physically Active Life through Everyday Transport |publisher=World health Organisation |access-date=29 September 2009 |archive-url=https://web.archive.org/web/20090928174944/http://www.euro.who.int/document/e75662.pdf |archive-date=28 September 2009 |url-status=dead}}</ref> and is associated with 20-30% increased risk of various cancers, heart disease, and diabetes<ref>{{Cite web |url=https://www.who.int/westernpacific/health-topics/physical-activity |title=Physical activity |website=www.who.int |language=en |access-date=24 October 2019}}</ref> and tens of billions of dollars of healthcare costs.<ref>{{cite web |url=https://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm |title=Overweight and Obesity: Economic Consequences |publisher=Centers for Disease Control and Prevention (cdc.gov) |access-date=29 September 2009}}</ref> The WHO's 2009 report<ref name="WHO" /> suggests that increasing physical activity is a public health "best buy", and that cycling is a "highly suitable activity" for this purpose. The charity [[Sustrans]] reports that investment in cycling provision can give a 20:1 return from health and other benefits.<ref>{{cite web |url=http://www.sustrans.org.uk/default.asp?sID=1158137684156 |archive-url=https://web.archive.org/web/20070312033043/http://www.sustrans.org.uk/default.asp?sID=1158137684156 |archive-date=12 March 2007 |title=How transport can save the NHS |publisher=sustrans.org.uk}}</ref> It has been estimated that, on average, approximately 20 life-years are gained from the health benefits of road bicycling for every life-year lost through injury.<ref>{{cite book |author3=British Medical Association |first1=Mayhew |last1=Hillman |first2=David |last2=Morgan |title=Cycling: Towards Health and Safety |publisher=[[Oxford University Press]] |isbn=978-0-19-286151-1 |year=1992}}{{page needed|date=March 2015}}</ref>

Bicycles are often used by people seeking to improve their fitness and cardiovascular health. Recent studies on the use of cycling for commutes have shown that it reduces the risk of cardiovascular outcomes by 11%, with slightly more risk reduction in women than in men.<ref>{{Cite journal |last1=Oja |first1=P. |last2=Titze |first2=S. |last3=Bauman |first3=A. |last4=Geus |first4=B. de |last5=Krenn |first5=P. |last6=Reger-Nash |first6=B. |last7=Kohlberger |first7=T. |date=2011 |title=Health benefits of cycling: a systematic review |journal=Scandinavian Journal of Medicine & Science in Sports |language=en |volume=21 |issue=4 |pages=496–509 |doi=10.1111/j.1600-0838.2011.01299.x |pmid=21496106 |s2cid=19543146 |issn=1600-0838 |doi-access=free}}</ref><ref name=":0">{{Cite journal |last=Shephard |first=Roy J |s2cid=12923997 |date=2008 |title=Is Active Commuting the Answer to Population Health? |journal=Sports Medicine |volume=38 |issue=9 |pages=751–758 |doi=10.2165/00007256-200838090-00004 |pmid=18712942 |issn=0112-1642}}</ref> In addition, cycling is especially helpful for those with [[arthritis]] of the lower limbs who are unable to pursue sports that cause impact to the knees and other joints. Since cycling can be used for the practical purpose of transportation, there can be less need for self-discipline to exercise.

Cycling while seated is a relatively non-[[weight bearing]] exercise that, like [[Human swimming#Recreation|swimming]], does little to promote bone density.<ref>{{cite journal |doi=10.1007/s00198-003-1418-z |pmid=12856112 |title=Low bone mineral density in highly trained male master cyclists |journal=Osteoporosis International |volume=14 |issue=8 |pages=644–9 |year=2003 |last1=Palmer |first1=Jacob E. |last2=Levy |first2=Susan S. |last3=Nichols |first3=Jeanne F. |s2cid=20599717}}</ref> Cycling up and out of the saddle, on the other hand, does a better job by transferring more of the rider's body weight to the legs. However, excessive [[Standing cycling|cycling while standing]] can cause knee damage<ref>{{cite web |url=http://www.sheldonbrown.com/pain.html#knees |title=Bicycling and Pain |access-date=7 February 2011 |archive-url=https://web.archive.org/web/20101223184126/http://sheldonbrown.com/pain.html#knees |archive-date=23 December 2010 |url-status=dead}}</ref> It used to be thought that cycling while standing was less energy efficient, but recent research has proven this not to be true. Other than air resistance, there is no wasted energy from cycling while standing, if it is done correctly.<ref>{{cite news |url=http://www.pezcyclingnews.com/?pg=fullstory&id=4512 |title=Sit or Stand: Tradeoffs in Efficiency? |publisher=PEZ Cycling News |date=21 November 2006 |access-date=28 November 2006}}</ref>
[[File:A_CycleBar_indoor_cycling_center_in_Chattanooga,_Tennessee.jpg|thumb|A CycleBar indoor cycling center in [[Chattanooga, Tennessee]]]]
Cycling on a [[stationary cycle]] is frequently advocated as a suitable exercise for rehabilitation, particularly for lower limb injury, owing to the low impact which it has on the joints. In particular, cycling is commonly used within knee rehabilitation programs, to strengthen the quadriceps muscles with minimal stress on the knee ligaments.<ref>{{Cite journal |last1=McLeod |first1=William D. |last2=Blackburn |first2=T.A. |s2cid=23888818 |date=1980 |title=Biomechanics of knee rehabilitation with cycling |journal=The American Journal of Sports Medicine |language=en-US |volume=8 |issue=3 |pages=175–180 |doi=10.1177/036354658000800306 |pmid=7377449 |issn=0363-5465}}</ref> Further stress of the knee can be relieved by changing seat heights and pedal position to improve the rehabilitation. Cycling is also used for rehabilitation after hip surgery to manage soft-tissue healing, control swelling and pain, and allow a larger range of motion to the nearby muscles earlier during recovery.<ref name=":1">{{Cite journal |last1=Stalzer |first1=Steve |last2=Wahoff |first2=Michael |last3=Scanlan |first3=Molly |last4=Draovitch |first4=Pete |date=2005 |title=Rehabilitation After Hip Arthroscopy |journal=Operative Techniques in Orthopaedics |volume=15 |issue=3 |pages=280–289 |doi=10.1053/j.oto.2005.06.007 |issn=1048-6666}}</ref> As a result, many institutions have established a rehabilitation protocol that involves stationary cycling as part of the recovery process. One such protocol offered by Mayo Clinic recommends 2–4 weeks of cycling on an upright stationary bike following [[hip arthroscopy]], starting from 5 minutes per session and slowly increasing to 30 minutes per session.<ref>{{Cite journal |last1=Spencer-Gardner |first1=Luke |last2=Eischen |first2=Joseph J. |last3=Levy |first3=Bruce A. |last4=Sierra |first4=Rafael J. |last5=Engasser |first5=William M. |last6=Krych |first6=Aaron J. |s2cid=44008338 |date=2013 |title=A comprehensive five-phase rehabilitation programme after hip arthroscopy for femoroacetabular impingement |journal=Knee Surgery, Sports Traumatology, Arthroscopy |volume=22 |issue=4 |pages=848–859 |doi=10.1007/s00167-013-2664-z |pmid=24077689 |issn=0942-2056}}</ref> The goal of these sessions are to reduce joint [[inflammation]] and maintain the widest range of motion possible with limited pain. 
[[File:Bike at Prins hendrikkade Amsterdam centraal.JPG|thumb|Bike at [[Prins Hendrikkade]], Amsterdam]]

As a response to the increased global sedentary lifestyles and consequent overweight and [[obesity]], one response that has been adopted by many organizations concerned with health and environment is the promotion of [[Active travel]], which seeks to promote walking and cycling as safe and attractive alternatives to motorized transport. Given that many journeys are for relatively short distances, there is considerable scope to replace car use with walking or cycling, though in many settings this may require some infrastructure modification, particularly to attract the less experienced and confident.

An Italian study assessed the impact of cycling for commute on major non-communicable diseases and public healthcare costs. Using a health economic assessment model, the study found a lower incidence of type 2 diabetes, acute myocardial infarction, and stroke in individuals that cycled compared to those that did not actively commute. This model estimated that public healthcare costs would reduce by 5% over a 10-year period.<ref>{{Cite journal |last1=Taddei |first1=Cristina |last2=Gnesotto |first2=Roberto |last3=Forni |first3=Silvia |last4=Bonaccorsi |first4=Guglielmo |last5=Vannucci |first5=Andrea |last6=Garofalo |first6=Giorgio |date=30 April 2015 |title=Cycling Promotion and Non-Communicable Disease Prevention: Health Impact Assessment and Economic Evaluation of Cycling to Work or School in Florence |journal=PLOS ONE |language=en |volume=10 |issue=4 |pages=e0125491 |doi=10.1371/journal.pone.0125491 |issn=1932-6203 |pmc=4415918 |pmid=25928421 |bibcode=2015PLoSO..1025491T |doi-access=free}}</ref>

Illinois designated cycling as its [[List of Illinois state symbols|official state exercise]] in 2007.<ref>{{citation |title=Cats and dogs, bikes and milkweed: Illinois adds more state symbols beginning in the new year |last=Herrmann |first=Brett |date=28 December 2017 |work=News Tribune |url=http://www.newstrib.com/free/illinois-adds-more-state-symbols-beginning-in-the-new-year/article_462130f2-ebe1-11e7-8d9b-a7468edb679d.html |access-date=22 May 2019}}{{Dead link|date=September 2019 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>

=== Mental health ===
The effects of cycling on overall mental health have often been studied. A European study surveying participants from seven cities about self-perceived health based on primary modes of transportation reported favorable results in the bicycle use population.<ref name=":2">{{Cite journal |last1=Avila-Palencia |first1=Ione |last2=Int Panis |first2=Luc |last3=Dons |first3=Evi |last4=Gaupp-Berghausen |first4=Mailin |last5=Raser |first5=Elisabeth |last6=Götschi |first6=Thomas |last7=Gerike |first7=Regine |last8=Brand |first8=Christian |last9=de Nazelle |first9=Audrey|last10=Orjuela|first10=Juan Pablo |last11=Anaya-Boig |first11=Esther |date=1 November 2018 |title=The effects of transport mode use on self-perceived health, mental health, and social contact measures: A cross-sectional and longitudinal study |journal=Environment International |volume=120 |pages=199–206 |doi=10.1016/j.envint.2018.08.002 |pmid=30098553 |bibcode=2018EnInt.120..199A |issn=0160-4120 |hdl=10044/1/62973 |s2cid=51965322 |hdl-access=free}}</ref> The bicycle use group reported predominantly good self-perceived health, less perceived stress, better mental health, better vitality, and less loneliness. The study attributed these results to possible economic benefits and senses of both independence and identity as a member of a cyclist community. An English study recruiting non-cyclist older adults aged 50 to 83 to participate as either conventional pedal bike cyclists, electrically assisted e-bike cyclists, or a non-cyclist control group in outdoor trails measured cognitive function through executive function, spatial reasoning, and memory tests and well-being through questionnaires.<ref>{{Cite journal |last1=Leyland |first1=Louise-Ann |last2=Spencer |first2=Ben |last3=Beale |first3=Nick |last4=Jones |first4=Tim |last5=van Reekum |first5=Carien M. |date=2019 |title=The effect of cycling on cognitive function and well-being in older adults |journal=PLOS ONE |volume=14 |issue=2 |pages=e0211779 |doi=10.1371/journal.pone.0211779 |issn=1932-6203 |pmc=6388745 |pmid=30785893 |bibcode=2019PLoSO..1411779L |doi-access=free}}</ref> The study did not find significant differences in spatial reasoning or memory tests. It did, however, find that both cyclists groups had improved executive function and well-being, both with greater improvement in the e-bike group. This suggested that non-physical factors of cycling such as independence, engagement with the outdoor environment, and mobility play a greater role in improving mental health.

A 15-month randomized controlled trial in the U.S. examined the impact of self-paced cycling on cognitive function in institutionalized older adults without cognitive impairment.<ref>{{Cite journal |last1=Varela |first1=Silvia |last2=Cancela |first2=José M. |last3=Seijo-Martinez |first3=Manuel |last4=Ayán |first4=Carlos |date=1 October 2018 |title=Self-Paced Cycling Improves Cognition on Institutionalized Older Adults Without Known Cognitive Impairment: A 15-Month Randomized Controlled Trial |journal=Journal of Aging and Physical Activity |volume=26 |issue=4 |pages=614–623 |doi=10.1123/japa.2017-0135 |pmid=29431549 |s2cid=46880181 |issn=1063-8652|hdl=11093/6143 |hdl-access=free }}</ref> Researchers used three cognitive assessments: Mini-Mental State Examination (MMSE), Fuld object memory evaluation, and symbol digit modality test. The study found that long-term cycling for at least 15 minutes per day in older adults without cognitive impairment had a protective effect on cognition and attention.

Cycling has also been shown to be effective adjunct therapy in certain mental health conditions.<ref>{{Cite journal |last1=Karssemeijer |first1=E. G. A. |last2=Bossers |first2=W. J. R. |last3=Aaronson |first3=J. A. |last4=Kessels |first4=R. P. C. |last5=Olde Rikkert |first5=M. G. M. |date=21 March 2017 |title=The effect of an interactive cycling training on cognitive functioning in older adults with mild dementia: study protocol for a randomized controlled trial |journal=BMC Geriatrics |volume=17 |issue=1 |pages=73 |doi=10.1186/s12877-017-0464-x |issn=1471-2318 |pmc=5361710 |pmid=28327083 |doi-access=free}}</ref><ref>{{Cite journal |last1=Ryu |first1=Jehkwang |last2=Jung |first2=Jae Hoon |last3=Kim |first3=Jiheon |last4=Kim |first4=Chan-Hyung |last5=Lee |first5=Hwa-Bock |last6=Kim |first6=Do-Hoon |last7=Lee |first7=Sang-Kyu |last8=Shin |first8=Ji-Hyeon |last9=Roh |first9=Daeyoung |date=21 October 2019 |title=Outdoor cycling improves clinical symptoms, cognition and objectively measured physical activity in patients with schizophrenia: A randomized controlled trial |journal=Journal of Psychiatric Research |volume=120 |pages=144–153 |doi=10.1016/j.jpsychires.2019.10.015 |issn=1879-1379 |pmid=31678749 |doi-access=free}}</ref>