1 Recommendations

The evidence statements underpinning the recommendations are listed in appendix C.

The Programme Development Group (PDG) considers that the recommended approaches are highly cost effective.

For the research recommendations and gaps in research, see section 5 and appendix D respectively.

The evidence reviews, supporting evidence statements and economic modelling report are available at the NICE website.

Background

This guidance considers walking and cycling as forms of transport, for example, to get to work, school or the shops. It also considers them as recreational activities, for example, as a means of exploring parks or the countryside.

Walking and cycling are distinct activities which are likely to appeal to different segments of the population. A range of factors may be important in helping or restricting people from taking part. These will vary according to whether someone is walking or cycling for transport purposes, for recreation or to improve their health. Wherever the term 'walking and cycling' is used in this guidance, these variations should be kept in mind.

In the context of this guidance, walking and cycling includes the use of adapted cycles (such as trikes, tandems and handcycles), wheelchairs and similar mobility aids.

The action needed to increase levels of walking and cycling will vary according to people's local and personal circumstances. For instance, it will differ according to whether someone lives or works in an urban or rural area, the local traffic conditions and their perceptions of safety.

'Local' may refer to an area defined by geography or for administrative purposes. It may comprise an area larger than that covered by a single local authority such as Greater London, Manchester or Merseyside. It may also refer to a housing estate, a small town or a village.

Benefits of walking and cycling

Increasing how much someone walks or cycles may increase their overall level of physical activity, leading to associated health benefits. These include:

  • Reducing the risk of coronary heart disease, stroke, cancer, obesity and type 2 diabetes.

  • Keeping the musculoskeletal system healthy.

  • Promoting mental wellbeing.

An increase in walking or cycling can also help:

  • Reduce car travel, leading to reductions in air pollution, carbon dioxide emissions and congestion.

  • Reduce road danger and noise.

  • Increase the number of people of all ages who are out on the streets, making public spaces seem more welcoming and providing opportunities for social interaction.

  • Provide an opportunity for everyone, including people with an impairment, to participate in and enjoy the outdoor environment.

Encouraging people to walk and cycle

Encouraging and enabling people to walk or cycle requires action on many fronts – and by many different sectors. A range of issues have to be addressed, including environmental, social, financial and personal factors.

In addition to the recommendations made in this (and related) NICE guidance, other measures are needed to tackle the wider influences on walking or cycling. This includes measures to reduce road dangers and to reallocate road space to create a more supportive environment (see the scope for further detail). Action in these areas is particularly important in tackling inequalities in health, including with regard to people with impairments.

Whose health will benefit?

Unless otherwise stated, the recommendations will benefit everyone.

Policy and planning

Recommendation 1 High-level support from the health sector

Who should take action?
  • Directors of public health.

  • Public health portfolio holders in local authorities.

  • Clinical commissioning groups.

What action should they take?
  • Ensure a senior member of the public health team is responsible for promoting walking and cycling. They should support coordinated, cross-sector working, for example, by ensuring programmes offered by different sectors complement rather than duplicate each other (see recommendation 2). The senior member should also ensure NICE's recommendations on physical activity and the environment are implemented.

  • Ensure the joint strategic needs assessment, the joint health and wellbeing strategy and other local needs assessments and strategies take into account opportunities to increase walking and cycling. They should also consider how impediments to walking and cycling can be addressed.

  • Ensure walking and cycling are considered, alongside other interventions, when working to achieve specific health outcomes in relation to the local population (such as a reduction in the risk of cardiovascular disease, cancer, obesity and diabetes, or the promotion of mental wellbeing[1]). These include outcomes identified through the joint strategic needs assessment process.

  • Ensure walking and cycling are included in chronic disease pathways.

  • Ensure all relevant sectors contribute resources and funding to encourage and support people to walk and cycle.

  • Where appropriate, ensure walking and cycling are treated as separate activities which may require different approaches.

  • Ensure walking and cycling projects are rigorously evaluated. This includes evaluating their impact on health inequalities.

For more on the role of the NHS in promoting walking and cycling, see recommendations 9 and 10.

Recommendation 2 Ensuring all relevant policies and plans consider walking and cycling

Who should take action?
  • Local authorities, in particular, portfolio holders, lead members and directors responsible for:

    • adult and older people's services

    • children and young people's services

    • community safety

    • countryside management

    • disability

    • education

    • environment

    • health and wellbeing (including mental health)

    • land use, planning and development control

    • parks and leisure

    • planning (including district planning)

    • regeneration and economic development

    • social services

    • transport.

  • National parks authorities.

  • Integrated transport authorities.

  • Local enterprise partnerships.

  • Chief constables, police authorities and elected police commissioners.

  • Agencies with an interest in walking and cycling.

  • Agencies with an interest in health and wellbeing or that work with population groups such as older people or people with disabilities.

What action should they take?
  • Ensure local, high-level strategic policies and plans support and encourage both walking and cycling. This includes a commitment to invest sufficient resources to ensure more walking and cycling – and a recognition that this will benefit individuals and the wider community. Relevant policies and plans include those on:

    • air quality

    • community safety

    • disability

    • education

    • environment (including sustainability and carbon reduction)

    • health and wellbeing

    • housing

    • land use, planning and development control

    • physical activity

    • regeneration and economic development

    • transport.

  • Ensure the walking and cycling aspects of these plans are developed in conjunction with relevant voluntary and community organisations.

  • Ensure strategies to promote walking and cycling address factors which influence activity at various levels – from policy down to the individual. This includes ensuring NICE's recommendations on physical activity and the environment are implemented.

  • Assess the impact of relevant policies and decisions on people's ability to walk and cycle. Where necessary, amend them to ensure support for walking and cycling.

  • Ensure plans relevant to walking and cycling are implemented and evaluated[2].

Local action

Recommendation 3 Developing programmes

Who should take action?
  • Local authority directors and portfolio holders for:

    • countryside management

    • environment (including sustainability)

    • leisure services

    • parks

    • public health

    • regeneration and economic development

    • transport.

  • Police traffic officers and neighbourhood policing teams.

What action should they take?
  • Develop coordinated, cross-sector programmes to promote walking and cycling for recreation as well as for transport purposes, based on a long-term vision of what is achievable and current best practice. Ensure the needs of all sections of the population are addressed. Incorporate public health goals to increase the prevalence of people cycling and walking, as well as the distance covered by those who already walk and cycle regularly.

  • Aim to shift attention away from focusing on individual risk factors and isolated, small-scale interventions and ensure programmes comprise an integrated package of measures, implemented by all relevant sectors and stakeholders. Where appropriate, they should link to existing national and local walking and cycling initiatives, and incorporate actions in specific settings, such as workplace or schools (see recommendations 8 and 9).

  • Ensure walking and cycling programmes form a core part of local transport investment planning, on a continuing basis. In line with the Department for Transport's Manual for streets and the Chartered Institution of Highways and Transportation's Manual for streets 2 – wider application of the principles, pedestrians and cyclists should be considered before other user groups in the design process – this helps ensure that they are not provided for as an afterthought.

  • Draw on data, including the transport and physical activity elements of the joint strategic needs assessment, to ensure programmes are based on an understanding of:

    • the local population and the journeys people take using all modes of transport (the aim is to assess the potential for a 'modal change' towards walking and cycling)

    • the opportunities available to increase people's level of walking and cycling, given the right circumstances

    • the behaviour and preferences of existing walkers and cyclists

    • the needs of people with impairments

    • general factors influencing people's behaviour such as their attitudes, existing habits, what motivates them and their barriers to change, taking into account NICE's recommendations on behaviour change.

  • Ensure programmes address the behavioural and environmental factors that encourage or discourage people from walking and cycling. These include measures to reduce road danger or the perception of danger. (Environmental factors can be tackled by implementing NICE's recommendations on physical activity and the environment.)

  • Ensure local expertise is available so that programmes are based on a realistic understanding of the scale of changes needed to encourage the population to change its behaviour.

  • Ensure programmes take account of recommendations on developing local and regional programmes (recommendations 13–18) in NICE's guidance on preventing cardiovascular disease, in particular those relating to the need for long-term action.

  • Ensure programmes take account of the geography of the surrounding area (for instance, connections with neighbouring local authority areas), as well as local factors such as major road and rail routes, rivers and hills.

  • Ensure programmes include communications strategies to publicise the available facilities (such as walking or cycle routes) and to motivate people to use them. Include information that people with impairments will require, such as where dropped kerbs are located, the location and design of barriers at access points to cycle paths, and where public transport links and disabled toilets can be found.

  • Ensure programmes, including specific elements within them, are evaluated. Assess how much walking and cycling people are doing. Also assess the number of trips undertaken, using different modes of transport, by different groups within the local population. Where appropriate, control groups should be used. (See, for example, the National Obesity Observatory evaluation tool.)

  • Use an appropriate tool to establish the cost effectiveness of initiatives. For instance, use the World Health Organization's Health economic assessment tool (HEAT) for cycling and walking.

  • Consider providing specific support for people at a 'transition point' in their lives, for instance, when they are changing job, house or school. At these times people may be open to trying a new mode of transport or new types of recreation. Note: some people may be considering motorised transport, instead of walking or cycling – and support may be needed to help them maintain their active travel habits.

Recommendation 4 Personalised travel planning

Who should take action?
  • Transport planners.

  • Directors of public health.

What action should they take?

Help those interested in changing their travel behaviour to make small, daily changes by commissioning personalised travel planning programmes. These should be based on current best practice[3]. Staff running these programmes should:

  • Identify those willing to make changes, for example, people at transitional points in their life (such as when moving house, job or school).

  • Provide people with information and help, such as tickets, maps, timetables and, if required, more support to make different travel choices. This includes people with impairments who may rely on wheelchairs or adapted cycles.

  • Consider implementing NICE's recommendations on physical activity and the environment to create a supportive environment to encourage and sustain walking or cycling.

Recommendation 5 Cycling programmes

Who should take action?
  • Adult and child disability services.

  • Clinical commissioning groups.

  • Local authority transport leads, transport planners and other transport department staff.

  • Local education services.

  • Organisations with an interest in cycling.

  • Public health practitioners.

  • Public transport operators.

What action should they take?
  • Address infrastructure and planning issues that may discourage people from wanting to cycle. Take into account NICE's recommendations on physical activity and the environment and on road design. For example, ensure local facilities and services are easily accessible by bicycle and make changes to existing roads, where necessary, to reduce traffic speeds.

  • Implement town-wide programmes to promote cycling for both transport and recreational purposes. These should be linked to existing national and local initiatives. (Note: 'town-wide' in this case could include cities or suburban areas.) Programmes could include:

    • provision of information, including maps and route signing

    • fun rides, recreational and sponsored group rides and school sports promotions

    • use of leisure routes on and off roads

    • use of off-road mountain bikes, BMX courses, circuits and parks

    • car-free events or days, virtual cycle races and links with cycle sports events

    • cycle hire schemes

    • intensive sessions in particular settings or aimed at particular groups, such as: 'Bike to work' weeks and workplace challenges; activities aimed at children and families (such as 'Bike it', 'Bike club' and other school programmes); and activities for people with impairments who may use specially adapted cycles

    • activities and campaigns to emphasise the benefits of cycling (including the health benefits, the reliability and ease of access to local facilities and services).

  • Ensure programmes are based on an accepted theoretical framework for behaviour change and take into account NICE's recommendations on behaviour change. They should also be based on an understanding of the needs of existing and potential cyclists, including those with impairments (see recommendation 3).

  • Ensure cycle parking and residential storage issues are addressed.

  • Ensure travel by cycle and public transport is integrated to support longer journeys. This includes providing secure cycle parking at public transport sites as well as support to transport adapted cycles and tandems for people with disabilities.

  • Ensure training is available for those who are interested in cycling, either as a form of transport or as a recreational activity. An example of a cycle training programme is the Department for Transport's Bikeability.

  • Ensure all training is sensitive to cultural issues, for instance, by providing women-only groups with female trainers, where appropriate. Also ensure it includes an understanding of the needs of people with impairments

  • Consider providing free cycle safety checks (such as Dr Bike sessions) and cycle maintenance training.

  • Use local media to publicise activities and to clarify the links between different elements of the programme (for instance, the programme may include the provision of maps, local cycling classes and local challenges and events). In addition, use local media to raise awareness of any new or improved infrastructure. Also provide success stories from different elements of the programme to create momentum.

Recommendation 6 Walking: community-wide programmes

Who should take action?
  • Adult and child disability services.

  • Clinical commissioning groups.

  • Local transport leads, transport planners and other transport department staff.

  • Local authority leisure services.

  • Organisations with an interest in walking.

  • Public health practitioners.

What action should they take?
  • Address infrastructure issues that may discourage people from walking, for example, motor traffic volume and speed, lack of convenient road crossings, poorly maintained footways or lack of dropped kerbs, where needed. Take into account NICE's recommendations on physical activity and the environment and on road design.

  • Develop walking programmes for adults who are not active enough, based on an accepted theoretical framework for behaviour change and taking into account NICE's recommendations on behaviour change. Ensure groups that are likely to be the least active are encouraged to participate, by addressing issues that may act as a barrier.

  • Ensure walking programmes for all adults link to existing national and local walking initiatives.

  • Ensure all programmes address safety, cultural and disability issues.

  • Ensure all programmes offer a variety of routes, paces and distances at different times of the day (including evenings and on different days of the week or at the weekend). Local people with different preferences, time constraints and physical abilities should all be able to participate. Programmes could include:

    • community-wide events, such as mass participation walking groups, community challenges and 'walkathons'

    • walks led by suitably trained walk leaders (paid or voluntary) and aimed at people who are currently inactive.

  • Ensure walking routes are integrated with accessible public transport links to support longer journeys. Signage should give details of the distance and/or walking time, in both directions, between public transport facilities and key destinations.

  • Provide information tailored for individuals who want to go walking without joining a group or club. Offer continued support in line with recommendation 7.

  • Develop and implement a publicity strategy to let the local community know about the walking routes and events and how accessible they are.

  • Provide support to help people who have started walking as a leisure activity to also consider walking as a means of transport.

This recommendation (together with recommendation 7), updates and replaces recommendation 6 in Four commonly used methods to increase physical activity (NICE public health guidance 2).

Recommendation 7 Walking: individual support, including the use of pedometers

Who should take action?
  • Adult and child disability services.

  • Clinical commissioning groups.

  • Directors of public health and public health specialists with responsibility for physical activity.

  • Local authority leisure services.

  • Organisations with an interest in walking.

What action should they take?
  • Ensure individual support is available for anyone who is walking on their own, walking informally with others in a group, or participating in local walking programmes. This includes helping to assess their activity levels and to set goals which build on this. The aim should be to increase the distance walked gradually, rather than providing them with a set target to aim for.

  • Ensure additional, one-to-one support is offered at regular intervals to help people develop a long-term walking habit. This could be provided face-to-face, via the telephone or by using print-based materials, email, the Internet or text messaging. The support could include:

    • individual, targeted information

    • goal-setting (which may or may not include the use of pedometers), monitoring and feedback.

  • Provide general information including:

    • maps, signs and other details about walking routes

    • how to visit places of interest on foot (such as shops, educational or recreational facilities)

    • details on surface quality and accessibility.

  • Only use pedometers as part of a package which includes support to set realistic goals (whereby the number of steps taken is gradually increased), monitoring and feedback.

This recommendation (together with recommendation 6), updates and replaces recommendation 6 in Four commonly used methods to increase physical activity (NICE public health guidance 2).

Schools, workplaces and the NHS

Recommendation 8 Schools

Whose health will benefit?
  • Pupils, siblings, their parents and carers.

  • School staff.

  • Visitors to schools.

Who should take action?
  • Head teachers and school governors.

  • Local authority PHSE coordinators, school travel advisers and transport planners.

  • Police traffic officers and neighbourhood policing teams.

  • Road danger reduction and/or road safety officers.

What action should they take?
  • Foster a culture that supports physically active travel for journeys to school (for all staff, parents and students) and during the school day. For example, promote the health benefits of cycling[4] and walking and provide sufficient, secure cycle parking. Also ensure it is easy to get into the school grounds by foot or by bike. In addition, schools should provide suitable cycle and road safety training for all pupils[5].

  • Develop and implement school travel plans that encourage children to walk or cycle all or part of the way to school[4], including children with limited mobility. Integrate these plans with those produced by other local schools and other travel plans available for the local community[6]. Involve pupils in the development and implementation of plans.

  • Map safe routes to school and to local play and leisure facilities, taking into account the views of pupils, parents and carers. Also consult with the local community[4], including people with expertise in accessibility issues (such as those with mobility difficulties or community groups that work with them).

  • Develop programmes to ensure the local environment around schools and the nearby catchment area provide opportunities for all children to cycle or walk. This should include addressing motor vehicle speed, parking and dangerous driving practices.

  • Introduce regular 'walking buses' and other activities, such as 'Walk once a week' projects, which support and encourage walking and cycling to school[4].

  • Set performance targets for school travel plans which are audited annually and which form part of delivery plans. Remedial action should be taken when agreed targets are not reached[5].

  • Ensure all children can take part in 'Bikeability' training (see the Department for Transport website for details). Ensure cycle training is age-appropriate and timed to allow cycling to school to become a habit. In addition, ensure it is appropriate for those with limited mobility who may need additional support.

  • Schools should develop parents' and carers' awareness of the wider benefits of walking and cycling and other physically active modes of travel. For example, they should explain how it can improve children and young people's movement skills, social wellbeing, self-confidence and independence. They should also explain how it can help children to explore and become more familiar (and at ease) with their local environment while, at the same time, being physically active[4].

  • Head teachers should identify a walking or cycling champion (or champions) with sufficient senior support to coordinate activities. The champion/s should liaise with the local authority and other potential partners to address any environmental or organisational barriers to walking and cycling to school.

Recommendation 9 Workplaces

Whose health will benefit?

Staff and others who use workplaces.

Who should take action?
  • Employers, including the NHS and local authorities.

  • Directors and senior staff including managers, health and safety staff, estates managers and human resources professionals.

  • Active travel champions.

What action should they take?
  • Develop strategies in consultation with staff (and other relevant stakeholders, for example, students in universities and colleges) to promote walking and cycling in and around the workplace[7]. Ensure activities are developed in line with wider local activities (see recommendations 2, 3 and 4) and are linked to existing national and local initiatives.

  • Liaise with local authority transport departments, neighbouring businesses and other partners to improve walking and cycling access to workplace sites. (Also see NICE's recommendations on physical activity and the environment and promoting physical activity in the workplace.)

  • Identify an 'active travel champion' (or champions) within the workplace, at a sufficiently senior level. They should coordinate activities such as led and informal walking groups, workplace 'challenges' and promotional competitions (for example, using pedometers), bicycle user groups and walking interest groups. The active travel champion/s should also develop (or promote) schemes that give staff access to a pool of bicycles for short-distance business travel, or access to discounted cycle purchases (such as cycle to work schemes).

  • Ensure workplace walking and cycling programmes are developed using an evidence-based theoretical model of behaviour change (see NICE guidance on behaviour change).

  • Provide information tailored for the specific workplace on walking and cycling routes and circuits. This should include details on the distances involved, maps, routes and safety information.

See NICE guidance on promoting physical activity in the workplace for further recommendations.

Recommendation 10 NHS

Who should take action?
  • Clinical commissioning groups.

  • National commissioning board.

  • Primary and secondary healthcare professionals.

What action should they take?
  • Incorporate information on walking and cycling into all physical activity advice given by health professionals. (See also NICE's recommendations on four commonly used methods to increase physical activity.)

  • Ensure walking and cycling are among the options provided by the Let's get moving physical activity care pathway.

  • Ensure people who express an interest in walking or cycling as a way of being more physically active are given information about appropriate national and local initiatives. Also provide individual support and follow-up (see recommendation 7).

  • Direct people with limited mobility to specialist centres where adapted equipment, assessment and training are available for walking and cycling.

  • Ensure walking and cycling programmes link to existing national and local initiatives.

For more on the role of the NHS in promoting walking and cycling, see also recommendations 1 and 9.



[1] Descriptions of the links between physical activity and health outcomes can be found in the Chief Medical Officers' report on physical activity Start active, stay active.

[2] Further advice on evaluation can be found in the National Obesity Observatory guide to evaluation.

[4] Adapted from recommendation 12 in Promoting physical activity for children and young people (NICE public health guidance 17).

[5] This is part of recommendation 12 in Promoting physical activity for children and young people (NICE public health guidance 17).

[6] Adapted from recommendations 5 and 12 in Promoting physical activity for children and young people (NICE public health guidance 17).

[7] This is adapted from recommendation 1 in Promoting physical activity in the workplace (NICE public health guidance 13).

  • National Institute for Health and Care Excellence (NICE)