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Physical Activity: Interventions to Increase Active Travel to School

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 52 studies (search period through March 2018) that evaluated the impact of active travel to school interventions on students’ commuting patterns. The Community Guide review combined studies from a published systematic review (Chillón et al. 2011; 11 studies; search period through January 2010) with studies identified in an updated search that used the same terms (41 studies; search period January 2010 to March 2018).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity or preventing pedestrian injuries.

Context

Physical activity among children is a public health priority (USDHHS, 2008a). The U.S. Department of Health and Human Services recommends that young people ages 6–17 years participate in at least 60 minutes of physical activity daily (USDHHS, 2008b, 2018b).

Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces symptoms of anxiety and depression, and may improve cardiovascular health (USDHHS, 2008a, 2018a). Walking or bicycling to and from school provides children and adolescents with an opportunity to be physical active.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

Active Travel to School

Of the 52 studies included in the systematic review, 40 assessed intervention effects on active travel.

  • The proportion of students who walked or bicycled to school increased by a median of 5.9 percentage points (26 studies).
    • The remaining studies used different measures to evaluate active travel, and most reported favorable, though not statistically significant, outcomes (14 studies).
  • A subset of 12 studies evaluated the effectiveness of U.S. Safe Routes to School programs.
    • The proportion of students engaged in active travel to school increased by a median of 6.5 percentage points (9 studies).
    • The remaining studies used different measures of change, and most reported favorable, though not statistically significant, outcomes (3 studies).
  • Study results were mixed with regard to the amount of moderate to vigorous physical activity children engaged in during active travel (10 studies).
  • There was not enough evidence to show that school travel led to increases in students’ overall daily physical activity.

Pedestrian and Bicycling Injuries

Of the 52 studies included in the systematic review, 7 assessed intervention effects on pedestrian and bicycling injuries.

  • Five state or city Safe Routes to School programs implemented street-level engineering improvements.
    • New York City – over a 10-year period, injuries in census tracts funded for Safe Routes to School programs decreased by 44%.
    • Texas (state-wide) – pedestrian and bicyclist injury rates among school-age children decreased by 14% during the program study period.
    • Multi-state study (18 states) – programs reduced pedestrian and bicyclist injury rates in school-age children by 23%.
    • California (state-wide) – collisions in Safe Routes to School project areas were reduced by 53%.
    • California (state-wide) – collisions were reduced by 13% in Safe Routes to School project areas and 15% in non-project areas.
  • Two of the seven included studies examined the impact of specific activities:
    • School crossing guard expansion in Toronto (no effect on injuries)
    • A bicycle safety course in Demark (mixed results)

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

Evidence shows economic benefits exceed the cost for active travel to school interventions. The economic review included 10 studies (search period January 1990–July 2018) that targeted elementary and middle schools. Monetary values are expressed in 2017 U.S dollars.

Intervention cost for the three Safe Routes to School programs ranged from $87,150 to $171,863 per school. Intervention cost for active travel to school programs outside the United States ranged from $3,531 per school in Australia to $636,622 per project in the United Kingdom.

The benefit to cost ratios over a 2-year time horizon for the Safe Routes to School programs were 1.46:1.0 and 1.74:1.0 (2 studies). The median benefit to cost ratio for the programs outside the United States was 5.2:1.0 over a median 10-year time horizon (5 studies).

Applicability

Based on results from the review, findings should be applicable to most urban and suburban school districts in the United States.

Overall, studies found active travel interventions to be effective regardless of the component or combinations of components selected and implemented (e.g., encouragement, education).

However, the subset of study interventions that included an engineering component found a larger change in the proportion of students using active travel (5.9 percentage point increase) compared to interventions without an engineering component (4.8 percentage point increase) across similar baselines.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • What is the relationship between changes in active travel to school and overall measures of total daily physical activity and moderate to vigorous physical activity?
  • How effective are interventions in different U.S. populations and settings such as low income or rural communities?
  • How does intervention effectiveness vary by student demographic characteristics?
  • What is the relationship between local built environment improvements and pedestrian and cycling injury rates?
  • How does the distance students travel between their homes and schools impact intervention effectiveness? Additionally, what is the impact when school buses are offered versus not offered?
  • What are drivers of economic benefits when mode of travel to school shifts from private automobile use to walking or bicycling?
  • What is the percent change in students who choose the active travel mode following U.S. Safe Routes to School implementations?
  • What is the appropriate time horizon for an evaluation of economic benefits?

Study Characteristics

  • Included studies were conducted in the United States (24 studies) and other high-income countries.
  • Most of the studies evaluated programs in public elementary or middle schools. Subset analyses showed greater effects at elementary schools than middle schools or high schools.
  • Across all studies, the mean student age was 9.8 years and 52.8% of participants were girls.
  • Most studies were conducted in urban or mixed urban-suburban communities; none were done in rural communities.
  • Study participants ranged from more than 1000 (22 studies), to between 101-1000 (16 studies), and 100 or less (10 studies).
  • Study duration ranged from longer than one year (22 studies), to 4-12 months (12 studies), or 3 months or less (14 studies).

Publications

Jacob V, Chattopadhyay SK, Reynolds JA, et al. Economics of Interventions to Increase Active Travel to School: A Community Guide Systematic Review. American Journal of Preventive Medicine. 2021;60(1):e27−40.
Petersen R, Pedroso MS. Economic Benefits of Promoting Safe Walking and Biking to School: Creating Momentum for Community Improvements. American Journal of Preventive Medicine. 2021;60(1):e41−3.

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