Associations Between Active School Transport and Physical Activity, Body Composition, and Cardiovascular Fitness: A Systematic Review of 68 Studies

Background: The impact of active school transport (AST) on daily physical activity (PA) levels, body composition and cardiovascular fitness remains unclear. Methods: A systematic review was conducted to examine differences in PA, body composition and cardiovascular fitness between active and passive travelers. The Medline, PubMed, Embase, PsycInfo, and ProQuest databases were searched and 10 key informants were consulted. Quality of evidence was assessed with GRADE and with the Effective Public Health Practice Project tool for quantitative studies. Results: Sixty-eight different studies met the inclusion criteria. The majority of studies found that active school travelers were more active or that AST interventions lead to increases in PA, and the quality of evidence is moderate. There is conflicting, and therefore very low quality evidence, regarding the associations between AST and body composition indicators, and between walking to/from school and cardiovascular fitness; however, all studies with relevant measures found a positive association between cycling to/from school and cardiovascular fitness; this evidence is of moderate quality. Conclusion: These findings suggest that AST should be promoted to increase PA levels in children and adolescents and that cycling to/from school is associated with increased cardiovascular fitness. Intervention studies are needed to increase the quality of evidence.