Changing policy and practice to increase active travel to school
Submitting InstitutionUniversity of Bristol
Unit of AssessmentSport and Exercise Sciences, Leisure and Tourism
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
In May 2012 the UK Chief Medical Officer (CMO) convened a specialist
group of 20 academics to discuss a solution to the "population-level lack
of physical activity". The group, including Professor Ashley Cooper,
concluded that increasing active travel (walking or cycling) to
destinations such as work or school is the best option for achieving this
aim and encouraged the CMO to embed this is future policy initiatives.
Children are a major focus of such initiatives, since the majority of UK
children are not sufficiently active to meet current health guidelines,
and over the past decade active travel to school has been recognised as a
major opportunity for children to achieve healthy levels of physical
activity. This case study describes a programme of funded [6,7] research
work which has directly informed and underpinned understanding of the
importance of active travel to school by policy makers and public health
practitioners. The research is heavily cited in policy and planning
documents from 2009 to the present date, both in the UK and
internationally, and is used by organisations which implement
interventions to increase active travel in the UK and internationally. Via
these routes this work has benefitted children in many countries through
increased physical activity, higher fitness and improved health.
The research underpinning this case study is a body of published work
[1-5] investigating children's active travel to school led by Ashley
Cooper (Lecturer/Senior Lecturer in Exercise and Health Sciences,
1997-2008, Reader in Exercise and Health Science, 2008-2011, Professor of
Physical Activity and Public Health, 2011 to present) and Angie Page
(Lecturer/Senior Lecturer in Exercise and Health Sciences, 1994-2011,
Reader in Exercise and Health Science, 2011 to present) since 1998. The
work has been conducted both Nationally and Internationally and was
stimulated by a 1998 UK Government White Paper on transport which stated
that "Not walking or cycling to school means that children get much
less exercise......". They identified that there were no data that
supported this assertion, and that whilst intuitively true, alternatively
children could compensate for the "effort" of walking to school by lower
physical activity elsewhere during the day. They used newly developed
instruments (accelerometers) which provide an objective measure of the
level and pattern of children's physical activity to address this issue.
They published the first study worldwide to use innovative time-patterning
of accelerometer data in 2003, showing active travel to school to be an
important contributor to daily physical activity in a sample of Bristol
children . Children who walked to school were significantly more
physically active than those travelling by car, and time-patterning showed
that the differences occurred during morning and afternoon commuting
times, suggesting that it is the journey to/from school that is important.
This paper was the first to use this methodology and is highly cited.
To confirm these observations and to extend the work to include cycling,
Cooper & Page used their involvement as originators in the European
Youth Heart Study (EYHS) to explore the physical activity levels of
children travelling to school by foot, car and bicycle in Odense, Denmark,
working with Prof L.B.Andersen (an acknowledged world leader in the field)
in the University of Southern Denmark. Similar to the UK, they found that
children who walked to school were more active than car travellers, with
cyclists at an intermediate level due to the limited ability of
accelerometers to accurately measure physical activity whilst cycling .
These data have also been highly cited. Cycling is the most common form of
travel to school in Denmark, and to further explore its contribution to
health they compared the fitness levels of children by how they travelled
to school, finding that cyclists were significantly fitter (8%) than both
walkers and car travellers. These were the first data to describe the
physical fitness of children by mode of travel to school and to identify
higher fitness in cyclists . To confirm that the association with
fitness was not self-selection (i.e. fitter children choose to cycle) they
utilised the longitudinal nature of the EYHS data showing that children
who did not cycle to school when 9yrs old, but had changed to cycling by
15yrs old, increased fitness, whilst those who did not cycle were
unchanged . This international work has continued, showing that
children who cycle to school have a better cardiovascular risk factor
profile than non-cyclists. Importantly, those who changed from non-cycling
at 9yrs to cycling by age 15yrs are also healthier, demonstrating the
importance of cycling to school for children's health.
Cooper and Page extended this work within the UK in the PEACH project 
by employing innovative methodology. Combining accelerometer and GPS data
they visualised journeys to and from school in a Geographical Information
System, allowing activity in these journeys to be accurately quantified, a
method called spatial segmentation. They have published unique papers
using this method to describe the contribution of walking to school to
overall moderate to vigorous physical activity (MVPA) and hence to meeting
health guidelines for children . They have extended this method to
study adults , showing that walking to work is an important contributor
to adult physical activity.
In summary, Cooper and Page have conducted an ongoing programme of work
over the past 12 years, supported by five inter-related grants from highly
competitive funding agencies (MRC (National Prevention Research
Initiative), World Cancer Research Fund, NIHR) which has provided original
and unique data describing the role of active commuting in children's
physical activity and health. They were the first to use objective
measures of physical activity to show the importance of active travel to
overall physical activity, a study that has been replicated many times in
different countries and contexts. Their papers are highly cited, were
included in the Centres submission to RAE 2008 [1-3] where the Centre was
ranked third (UoA 46), and have been widely incorporated into policy
documents and guidance.
References to the research
Publications in peer reviewed journals
 Cooper AR, Page AS, Foster LJ, Qahwaji D. (2003). Commuting to
school. Are children who walk more physically active? American Journal
of Preventive Medicine; 25: 273-276. doi:
10.1016/S0749-3797(03)00205-8. 181 citations
 Cooper AR, Andersen LB, Wedderkopp N, Page AS, Froberg K. (2005).
Physical activity levels of children who walk, cycle or are driven to
school. American Journal of Preventive Medicine;29: 179-184. doi:
 Cooper AR, Wedderkopp N, Wang H, Andersen LB, Froberg K, Page AS.
(2006). Active travel to school and cardiovascular fitness in Danish
children and adolescents. Medicine and Science in Sport and Exercise;38(10):
1724-1731. doi: 10.1249/01.mss.0000229570.02037.1d. 91 citations
 Cooper AR, Wedderkopp N, Jago R, Kristensen PL, Moller NC, Froberg K,
Page AS, Andersen LB. (2008). Longitudinal association between cycling to
school and adolescent fitness. Preventive Medicine;47(3):324-8.
doi: 10.1016/j.ypmed.2008.06.009. 41 citations
 Cooper AR, Page AS, Wheeler BW, Griew P, Davis L, Hillsdon M, Jago R.
(2010). Mapping the walk to school using accelerometry combined with GPS.
American Journal of Preventive Medicine 38(2):178-183. doi: 10.1016/j.amepre.2009.10.036.
Journal ranking: AJPM 18/151 (Medicine, General and Internal);
MSSE 3/83 (sports Science); Prev Med 20/151 (Medicine, General and
Internal). Citations at November 2013.
 Health Education Authority. "Development of physical activity
measurement in young people". 1.5 years from 03/05/99. £53,698. Page (PI),
 The PEACH project: Personal and Environmental Associations
with Children's Health. Three grants:
National Prevention Research Initiative (administered through the
MRC). "Environmental determinants of physical activity and obesity in
adolescents"£243,850. 3 years from 1/5/06. Cooper (PI), Page, Fox,
Hillsdon (then at Bristol), Jago.
World Cancer Research Fund. "Personal and Environmental
Determinants of Eating Behaviours and Obesity in Adolescents (PEACHEB)".
£143,893. 3 years from 1/11/07. Cooper (PI), Page, Jago, Hillsdon,
World Cancer Research Fund. "PEACH: Personal and Environmental
Determinants of Children's Health" £246,051. 3.5 years from 1/11/10.
Cooper (PI), Page, Jago, Thompson.
 National Institute for Health Research (PHR). "Employer
schemes to encourage walking to work: feasibility study incorporating an
exploratory randomised controlled trial". £286,000. 27 months from
1/10/11. Audrey (PI; UoB), Cooper.
Details of the impact
This body of work has been pivotal in the implementation of local,
national and international active travel policies for children. These
policies have led to increases in active travel among children. As active
travel has been associated with improved health and is a sustainable form
of physical activity these policies will deliver both physical and mental
health benefits for beneficiaries in both the short and longer term. Three
broad pathways demonstrate the impact of the research:
A) UK Public Health Guidance
The research led to Cooper being invited to sit on the Programme
Development Group (PDG) for development of National Institute for Health
and Clinical Excellence (NICE; now National Institute for Health and Care
Excellence) Public Health Guidance for increasing children and young
people's physical activity. The guidance was published in January 2009
[a]. His invitation was a direct result of his leadership in research
demonstrating the potential for active travel to school to increase
children's overall physical activity. The guidance is intended for
implementation by a wide range of deliverers from national and high level
policy and strategy through to local strategic planning, local
organisations (planning, delivery and training) and local practitioners
(delivery) (guidance pg7). The recommendations are aimed at a wide range
of organisations and groups, including children's trusts and services,
community and voluntary groups, early years providers, Government
departments, local authorities, parents, families and carers and schools
and colleges (guidance pg 9) with the beneficiaries being pre-school and
school-age children and young people. Cooper contributed expert opinion on
academic research into active travel to school in the development of these
guidelines. The PDG produced 15 recommendations, of which two were
specifically about active travel (Rec5: Local Transport Plans: "Transport
plans should aim to increase the number of children and young people who
regularly walk, cycle and use other modes of physically active travel";
Rec12: Active and Sustainable School Travel Plans: that school leaders
should "encourage a culture of physically active travel (such as
walking or cycling)". The guidance is ubiquitous in regional and
national strategic plans to improve children's health (Section 4B);
however NICE do not collect evidence of impact.
B) International and National Policy impact
The research of Cooper and Page, and resulting NICE public health
guidance, has been cited in many regional, national and international
policy documents. For example, in County Durham the guidance is cited in
the interim cycling strategy 2009-2012 [b] which led to the FEAT 1st
(Families Enjoying Active Travel) pilot project. This measured the effects
of encouraging more physically active travel by supporting daily journeys
to school on foot and by bike and was a collaboration between North
Tyneside Council and the transport charity Sustrans (with whom Cooper
& Page work (Section 4C)). The project resulted in an increase in
active travel to school and an almost doubling of children's physical
activity [c], and is now being rolled out across schools in Tyne and Wear.
Nationally, they are cited in the policy documents of organisations
promoting active travel (e.g. the Cycle Touring Club ("Cycle-friendly
schools and colleges" briefing 7c (July 2012)) and Sustrans [d], and
more broadly health (British Medical Association; "Healthy
Transport=Healthy Lives" (July 2012)). Internationally, they
are cited in policy documents from several countries including Australia,
USA, New Zealand, Denmark and Ireland. For example, In the USA four of
their studies are cited in "Active School Travel: A Resource Binder for
Redwood City Community Members to Implement Walk and Bike to School
Programs" [e]. This document describes how to implement active
travel to school interventions and provides many examples of success, such
as in Marin County where there has been a 64% increase in the number of
students walking to school and a 114% increase in the number of children
bicycling to school (page 29). They also provide three of twenty
references in a policy document from the US National Center for Safe
Routes to School [f] which informed the White House "Task Force on
Childhood Obesity: Report to the President" [g] where their work is
cited twice (of four references) supporting the role of active travel for
obesity prevention. This action plan provides 70 specific recommendations
of which five relate to active travel (5.8 to 5.12) including that "Active
transport should be encouraged between homes, schools, and community
destinations.......". These recommendations were enacted rapidly by
US Federal agencies, with the Department for Transportation initiating
National Bike to School day in 2012, which in 2013 had 1705 schools
participate across all states of the USA.
C) Working with national and international health promotion groups to
deliver direct benefits to beneficiaries
Cooper & Page work directly with national and international
organisations to achieve increases in active travel among children. In
the UK they work closely with Sustrans in supporting active travel
to school programmes such as Safe Routes to Schools and Bike It by
providing both the evidence base from their research and expert guidance
that they provide directly to the organisation. The Sustrans programmes
are highly effective at increasing active travel. For example, in 2011,
work with 340,000 pupils in 1,400 schools resulted in an 80% increase in
the number of children regularly cycling to school. Philip Insall
(Sustrans Director, Health) has written "their research provides
important support for us and helps steer and ensure the success of our
work" [h]. In Denmark their work is represented on the
National Board of Health by Prof. Andersen and integrated into
recommendations ("Physical activity in prevention and treatment of
common diseases"), targeted for GPs and other health professionals.
Their research informs the work of TrygFonden, a not-for-profit Foundation
supporting action-orientated, knowledge-based projects that contribute to
increased safety, and where active transport in children is a primary
focus. For example, in 2010 The All Kids Bikes campaign engaged 143,000
children across Denmark in cycling to school on as many days as possible,
and a recent intervention in almost 2000 children in 24 schools in Odense
increased the proportion of children cycling to school every day by 8.9%
(report in review by Danish Cycling Federation/TrygFonden).
In summary, their work provides the evidence base to support an extensive
range of interventions to increase active travel to school, is cited
widely in policy and planning documents, and is used by agencies
implementing these policies. It should be noted that the policy documents
for these interventions are not extensive reviews of the literature —
rather they include a few examples of authoritative research which has
driven the field. The implementation of school active travel interventions
will increase the physical activity of children with consequent health
benefits and are also likely to have environmental and economic benefit to
society, through reducing car use and lowering carbon emissions.
Sources to corroborate the impact
[a] National Institute for Health and Clinical Excellence (2009). NICE
public health guidance 17. Promoting physical activity, active play and
sport for pre-school and school-age children and young people in family,
pre-school, school and community settings. ISBN 1-84629-872-5
(Cooper listed as member of Programme Development Group on page 54 of
[b] County Durham Interim Cycling Strategy (2009-11).
[c] Sustrans: FEAT 1st — a summary report (2011).
[d] Sustrans: Young People: Related academic evidence (2011).
[e] Active Travel Toolkit — Redwood City: "Active School Travel: A
Resource Binder for Redwood City Community Members to Implement Walk and
Bike to School Programs" (2009).
[f] Safe Routes to School and Health (2010).
[g] White House Task Force on Childhood Obesity: Report to the President:
"Solving the problem of childhood obesity within a generation" 2010.
Reference 321, Page 80.
[h] Letter from P. Insall, Director, Health, Sustrans.