CHAPTER 1

A Healthier World

I No Longer Trusted My Body

This book isn’t a memoir. But it would never have been written without my own very personal experience of cycling, particularly the effect it had on my health. There’s even a plausible argument that riding a bike saved my life. So before I describe how bikes could transform global health, allow me a brief personal detour.

It’s not wholly unfair to say I was something of a runt as a child, scrawny to a degree that these days would possibly bring a family visit from a social worker. I was also affected by severe asthma, which emerged very early at age two, in the wake of a near-fatal bout of pneumonia.

As a child this never stopped me from playing sports. I was an enthusiastic if very obviously untalented footballer, but my efforts were generally sound-tracked by a slight wheeze and the voices of concerned adults asking if I should perhaps have a short break.

All this was nonetheless manageable until my late teens, when I experienced a spate of sudden and very acute bouts of breathlessness, not uncommon in asthmatics at that age. For me, these culminated in half a dozen or more trips to the emergency unit of my local hospital in suburban Cheshire, in the northwest of England. There I was swiftly injected with Aminofilin, a powerful and near-miraculous drug I only later learned can have occasional serious side effects, including heart complications. Suddenly able to breathe again, I would then spend several days begging doctors to be allowed to go home and be freed from a chest ward packed with coughing retirees smelling of tobacco.

More than once my breathlessness was sufficiently worrying for a doctor to sprint to the drugs cupboard. This is not a reassuring sight. Well more than one thousand people die from asthma every year in Britain.¹ It’s far from inconceivable that I could have been among them.

As often happens with asthma, things improved gradually over time. My three years at college saw just one hospital stay. But by then I had lost confidence in my physicality. I stopped playing sports, rarely even broke into a run, and kept my spindly, ghostly pale legs wrapped in long trousers. I no longer trusted my body.

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Fast-forward a few years to a large, shabby rented house in North London. Twenty-two-year-old me has pushed a chair into the middle of a bedroom and, clad in a T-shirt and a pair of extremely tight leggings, I am standing on it to examine myself full length in a large, wall-mounted mirror.

Before this vignette gets too alarming, let me explain. Three months earlier I’d suddenly given up a dull if secure graduate career to become a bicycle courier, or messenger. This was something of a surprise to friends and family, especially those who knew I’d not ridden a bike, or even done anything noticeably physical, for quite a few years.

It’s hard to explain my motivation. I’m not sure even I knew at the time. An element was possibly to present myself with an inescapable daily physical challenge. “You feel let down by your body?” went the half-heard internal voice. “Now you’re relying on it to pay the rent.”

These days courier fashion is a staple in style magazines—the tattoos, the single rolled-up trouser cuff, the fixed-gear bike. But this was an era when the trade was generally populated by misfits, by greasy-fingered, unsocialized types who got anxious if they had to stay indoors for more than ten minutes.

Even amid this world of slight oddballs, I stood out, mainly because, knowing next to nothing about cycling, I had kitted myself with an absurdly impractical and clunky mountain bike, weighing about as much as a small moped. I rode this around London dressed in a combination of my own clothes and those borrowed from my then-girlfriend, wrapped in ever-thicker layers—I’d compounded my rashness by beginning this new, outdoor career in autumn.

The mechanics of the courier trade are fascinating. It is simultaneously a deeply exploitative industry and one where, at least in that largely pre-e-mail era, the paid-by-the-delivery earnings could be extremely high. Before long these were sufficient to pay off my student debts, a process helped by my being too exhausted to spend money on much else beyond the industrial-sized sacks of pasta on which I subsisted. More relevant is that after a few months pedaling my behemoth of a bike for about sixty miles a day, the effect was starting to show, even on a milquetoast like me.

This brings us back to the North London bedroom. A couple of days beforehand I had begun insulating my legs from the winter chill with a pair of my girlfriend’s thick cotton leggings, over which I wore a pair of denim shorts (I did say the courier trade wasn’t fashionable then). That evening, getting undressed ahead of the obligatory postwork bath, where I would happily steam amid a rising black tidemark of pollution residue, I decided to inspect my new look.

Then came the shock. Not from the leggings. The mirror showed those to be about as curious-looking as I’d expected. What struck me was the encased silhouette of my legs. They had always been traditionally unimpressive. A cruel teenage acquaintance once likened them to lengths of string with knots for the knees. But now they had shape. Form. Muscles. Definite muscles. I was amazed. I spent a good ten minutes on that chair, staring.

In retrospect it might sound obvious that being in your early twenties and exercising vigorously for ten hours a day makes you look and feel much better, but it was a transformative moment for my life. In the months to come I’d occasionally bump into university contemporaries as I delivered packages and, once they’d stifled their surprise that someone with a good degree from a decent university was doing such a job, many would remark on how, you know, healthy I looked.

I remained a bike messenger for three years, far longer than strictly necessary. This included a stint in Sydney, Australia, working for a company called Top Gun, who, perhaps believing the name alone wasn’t camp enough, kitted out their riders in skintight, hot pink Lycra jerseys. If you didn’t start off with some measure of body confidence, you soon picked it up. A couple of times I was on the receiving end of wolf whistles, and I still like to think they weren’t ironic.

Amid this period I forgot my lifelong sense of doomed physical fragility. It was always assumed that I was the fittest person in my peer group. Friends in the pub would, after a few drinks, quietly ask to squeeze my thigh muscles. I would race buses from the traffic lights on my bike for fun. I was suddenly invincible.

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Let me add some important context here: you don’t need to ride three hundred miles a week, every week, or even be in your early twenties, to feel the benefits of cycling. As we’ll see, even a relatively sedate daily bike commute can have a near-miraculous health impact at just about any age. And, as mentioned in the introduction, my own cycling is now closer to this more tranquil model. I’m now very much more the everyday rider. It’s been some time since anyone squeezed my thigh in a pub.

Given this, I decided to see whether this more ordinary regime was still keeping me healthy. The best way to find out was to take a VO2 max test, which measures peak oxygen uptake. Expressed in milliliters of oxygen absorbed per kilo of body weight per minute, it’s generally viewed as being as good a way as any to objectively measure someone’s aerobic fitness, and thus their associated cardiovascular health.

And so I ended up in the sports science laboratory of the University of Kent, a large, windowless room filled with stationary exercise bikes, between which flitted white-coated technicians carrying trays of test tubes. I was there to take what’s known as a ramp test, one of the more obviously sadistic procedures scientists are permitted to inflict. This saw me placed on one of the bikes and ordered to turn the pedals at a certain, constant speed while the resistance was incrementally raised, as if climbing an increasingly steep incline. The torment lasted for about twenty minutes until my lungs eventually gave out, and I reached a sweaty, juddering, breathless halt. If that wasn’t enough, this was all done while wearing a clammy, full-face rubber mask, while every five minutes someone pricked my finger to extract blood and test it for levels of exertion-induced lactates.

My personal torturer/tester was James Hopker, an affable senior academic at the university, who works closely with British Cycling. The results would take a week to be processed, he told me, gently peeling the mask from my slumped form. What would happen, I thought gloomily, if the conclusion came back that I have distinctly average fitness for a man of my age? Possibly I’d give up the idea for this book.

It’s Not Cycling That’s Dangerous

Many cyclists will have experienced this conversation at some point. While waiting at a red traffic light, a driver, generally a man, starts chatting through the open car window. “You’re brave,” they will say in a convivial tone. “Wouldn’t catch me cycling. Much too dangerous.”

When this happens to me I usually have time for no more than a weak smile before the lights change. But in a parallel fantasy world I would discover the driver’s home address and burst through their front door that evening. “Dangerous?” I would bellow, as they stumbled up from the sofa, lit by the flickering blue glow of a flat-screen television. “You think riding a bike is dangerous? It’s this TV that’s going to kill you.” This would, of course, be vastly pompous, and risk a well-deserved punch to the nose. But I’d be right. It might sound counterintuitive, but watching television can be far more dangerous than riding around the truck-clogged streets of a major city.

One major study by researchers at the Maryland-based National Cancer Institute followed more than half a million Americans ages fifty to seventy over eight years. The key conclusion? Watching a lot of TV made people significantly more likely to die, even when you accounted for factors like smoking, age, gender, race, and education. In fact, those who watched the most TV—an admittedly Herculean average of seven hours or more per day—were 60 percent more likely to die during the course of the project than those who limited it to an hour or less.²

Here’s Dr. Adrian Davis, a British public health expert who is a world expert on how various forms of activity affect our health: “When people say cycling is dangerous, they’re wrong. Sitting down—which is what most of the population does far too much of—that’s the thing that’s going to kill you.”³

That’s not to claim cycling holds no risks. In many countries it’s more perilous than it should be. For example, in the United States, it’s about five times more dangerous than in the Netherlands, measured by deaths per billion kilometers cycled.⁴ But it’s also very important to not overstate the hazards. In more or less any industrialized country, the health incentives for cycling massively outweigh the perils, and provably so.

For a 2010 study, researchers from Utrecht University’s self-explanatorily named Institute for Risk Assessment Sciences studied dozens of existing papers to calculate what would happen if a hypothetical group of five hundred thousand people switched overnight from cars to bikes: would the health gains from more exercise outweigh the risks from pollution and road crashes?

For the bike-friendly Netherlands the results were, as you’d expect, conclusive: on average the benefits exceeded the perils by a factor of about nine, a figure that increased as people got older. But the effect was dramatically positive more or less anywhere you looked. Even in Britain the life-extending benefits were greater by a factor of seven.⁵

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When you expand this effect to a national level, any dangers from cycling, even amid the somewhat feral traffic environment of a New York City, a London, or a Sydney, become a mere speck on public health risk charts.

Every year about seven hundred Americans die on bikes, a figure that could and should be significantly lower.⁶ But over the same period at least two hundred thousand of their compatriots die from conditions linked to a lack of physical activity, notably cardiovascular problems and cancer.⁷ Even this is likely to be a very conservative estimate. In Britain, public health experts say, the official estimate for this inactivity toll is about eighty-five thousand a year,⁸ against one hundred or so cyclists killed annually.⁹ Depending on who you listen to, sedentary living is either the second or fourth most common risk factor associated with early deaths worldwide. Not far behind it is obesity, which is itself exacerbated by inactivity.

Those who chronicle these perils say that even relatively small amounts of fairly moderate exercise can slash the risks. Cycling, in particular, has been found to have an almost miraculous effect, in part because it is so easy to incorporate into everyday life, but also because it has a tendency to tempt people into slightly more strenuous effort, magnifying the advantage.

Study after study has shown that people who cycle regularly are less prone to obesity, diabetes, strokes, heart disease, and various cancers. Cyclists don’t just get extra life years, they’re more likely to remain mobile and independent into older age. Scientists are also only just beginning to understand the effects of exercise on our brains, and how it appears to ward off dementia.

The most comprehensive study of the health benefits of bike commuting, which we’ll read more about later, found people who commuted by bike had a 40 percent lower chance of dying during the fifteen-year course of the project than those who didn’t. That’s not far short of a miracle. If these benefits could be administered in an injection, it would be considered one of the greatest medical breakthroughs of all time. The scientist who devised it would be a shoo-in for a Nobel Prize. Millions of lives a year would be saved. And yet it’s already here.

The Pandemic of Physical Inactivity

If you ask a public health expert why cycling is so good for people, they usually begin with the inescapable contradiction that even as human lifestyles have changed beyond recognition in just the past few decades, the basic physiology of our bodies remains more or less the same as it was tens of thousands of years ago. “We are designed as hunter-gatherers, and we’ve not outlived our biological destiny,” says Adrian Davis. “We are meant to be physically active, and within modernity we’ve done everything we conceivably can, it seems, to remove physical activity from our lives, down to having electric toothbrushes.”¹⁰

The point is echoed by Francesca Racioppi, a senior policy maker at the World Health Organization (WHO), who has spent twenty years devising programs to make people more active. “We have to bear in mind that the way people live is very different to the way it was not very long ago,” she says. “Once, half of us were peasants and another forty percent worked in factories, and those were physically demanding jobs. Now the vast majority of people have switched to jobs where physical activity is excluded, and we have to live with the unintended side effects.”¹¹

These unintended side effects are vast. In fact, it’s not any sort of exaggeration to say the world faces a health catastrophe from sedentary living.

How precisely big a catastrophe depends on who you ask. The subject is complicated, not least because problems caused by lack of exercise inevitably become entwined with those connected to obesity. However, the WHO puts the annual global toll for inactivity alone at around 3.2 million people.¹² That’s more or less the entire city of Berlin, dying younger than they should, every year. About nine thousand people a day. On a very gloomy WHO league table of what kills most people around the world, inactivity is fourth, beaten only by high blood pressure, tobacco, and excess blood glucose. But some experts think even this is an underestimate.

Ahead of the London 2012 Olympics, revered medical journal The Lancet ran a special issue devoted to what it termed the “pandemic of physical inactivity.” One of the papers, led by I-Min Lee, a Harvard professor of epidemiology—the study of population-wide health trends—went further than the WHO estimates. It calculated that inactivity causes between 6 and 10 percent of cases of heart disease, type 2 diabetes, and breast and colon cancers, killing around 5.3 million people a year, about the same number as tobacco.¹³

That’s not the population of Berlin, it’s the population of Norway.

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To get the grips with the science behind all this, I asked Dr. Justin Varney, head of adult well-being for Public Health England, what would happen if I were to hypothetically give away my bike and spend most of the next few years sitting on a sofa watching television. My mitochondria, the “engine houses of your individual cells,” as he calls them, would get increasingly sluggish. Before long the cells would not function so well, making me more prone to some cancers, notably bowel cancer.

Then there are the telomeres. These tiny strands of protein in our cells gradually shorten as part of the aging process, but this process seems to be slowed by staying active (and also, Varney added, by meditation—that’s believed to be one reason why you see so many ancient Buddhist monks). Scientists still don’t quite understand how it happens, but the simple answer is that if I stopped exercising I’d age more quickly. Finally, by being active, I get my blood pumping faster, properly oxygenating my organs. Varney eloquently describes it thus: “If you imagine your blood like a flowing stream, the faster it moves the more it moves out all the crud in your system.”¹⁴ The combined effect of my inactivity marathon would eventually place me at far greater risk of everything from high blood pressure to heart disease and cancer.

My hypothetical experiment has, in a way, been replicated on a vast level in the world’s most populous nation. During China’s recent and rapid economic development, millions of its citizens stopped cycling and walking and suddenly began to drive. As late as the mid-1980s, cars were virtually never seen outside a few cities. Now there are more than 150 million of them. And the effect is being felt. Researchers on one city, Shanghai, tracked the lives of seventy-five thousand women from 1997 to 2004, finding that those who still cycled for transport had 35 percent less chance of dying over the study period than even their previously healthy peers who were less active.¹⁵

Even limited exercise can bring significant results. Francesca Racioppi describes a recent WHO project carried out with Oxford University to quantify the overall health benefits of even just the minimum of physical activity. It concluded that just reaching the very modest WHO recommended level—more on that in a second—cuts your overall chance of dying early by 10 percent.

“This isn’t a huge amount of exercise,” she says. “It’s just moderate things like walking or cycling, meeting the basic WHO guidelines. But 10 percent is massive, a very important effect. If this was a pill, people would say it was a miracle.”¹⁶

Cars Make You Fatter

This idea of activity as a wonder drug is one you hear a lot. And yet this miracle pill is, relatively speaking, quick, easy, and pain-free to administer. The official WHO threshold of being physically active for adults is doing 150 minutes of moderate exercise a week, or half an hour a day, five days a week. By “moderate,” they really do mean moderate—it includes things like brisk walking, gardening, or housework. The official WHO table lists around a dozen examples, also including “traditional hunting and gathering” and “thatching a house.”

The WHO’s more technical definition of “moderate” is three to six metabolic equivalents, or METs, which means expending between three and six times as much effort as you would by just sitting down. This isn’t a huge amount. Jogging can easily reach ten or twelve METs of effort. By happy coincidence, a slow trundle on a bike tends to equate to about five or six METs.

Even if you’re not a roof-thatching hunter and gatherer, 150 minutes a week doesn’t sound like a huge amount. And yet vast numbers of people simply don’t do it. Professor David Buchner spent nine years in charge of physical activity for the Centers for Disease Control and Prevention, chairing the group that wrote the US government’s official guidelines on the subject.

“It’s a major public health issue in the United States, as it is globally,” he says. “If you want to have round, ballpark figures, about 50 percent of adults in this country do not meet the guidelines.”¹⁷

The US guidelines match those of the WHO—at least 150 minutes a week of moderate exercise, or twice that for even more benefit. But, as Buchner says, almost anything does some good. “The truth is that if everybody in the country added ten minutes a day, it would have a huge public health effect,” he says. “It’s a very steep dose-response curve at the low range of physical activity. We don’t want the public to misunderstand that if they don’t get up to high levels they won’t get the benefit. They just need to start doing a little bit more, and they’ll start getting more benefit.”

But a lot of people aren’t heeding this advice. The WHO says about a third of all adults worldwide are insufficiently active.¹⁸ Some of the statistics are almost shocking. The national travel survey carried out by Britain’s Department for Transport has found that people make a third fewer trips on foot than they did in 1995. A fifth of all people say they haven’t walked more than twenty minutes even once in the past year.¹⁹

Additionally, as health statisticians wearily note, even in the era of activity trackers on phones and other fitness gadgets, most data is still self-reported, meaning the scale of the problem is almost certainly even greater than this. It is in part why some experts are setting their targets very low. Justin Varney and his team at Public Health England are currently trying to persuade people to do just thirty minutes of moderate exercise a week. That might seem remarkably little—just walking half a mile three times a week would do it—but even this modest effort can bring impressive results.

“If we get everyone to one hundred fifty minutes, fantastic,” he said. “However, I come from a pragmatic school of thought. If we can get the entire population doing at least thirty minutes a week, which is not scary for people, that would have a significant impact on the burden of ill health in this country.”²⁰

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Others set more ambitious goals. Professor Wendy Brown from Queensland University led the team that compiled Australia’s current physical activity guidelines. These advise people to aim for twice the WHO recommendation—three hundred minutes of exercise a week, or an hour a day five times. Brown explains this as a response to the parallel public health scourge of obesity in Australia, a country now ranked as the fourth fattest in the developed world. “One of the things about us is that there’s a perception we’re a nation of active, bronzed Aussies—surfing, being on beaches, and things like that,” Brown says. “In reality we’re actually much more a nation of sports watchers.”

The three-hundred-minute goal was an attempt to “push the range.” She explains: “We advise that if you want to avoid weight gain it has to be an hour a day. We’re the only ones in the world so far, but I reckon it won’t be long before others follow.”²¹

The WHO calculates that more than a third of all adults worldwide are overweight or obese. In a first for human history, significantly more people are now dying from eating too much than too little. The health consequences are almost beyond comprehension. In Britain, the National Health Service (NHS) spends about £16 billion a year treating conditions associated with obesity, especially type 2 diabetes, the form of the disorder often associated with excess weight and inactivity.²² In 2014, the head of England’s health service said obesity could soon bankrupt the NHS, calling it “a slow-motion car crash in terms of avoidable illness and rising healthcare costs.”²³

Obesity is a slightly more tricky area for this book, since it’s arguably caused as much by diet, especially the modern ubiquity of cheap, high-sugar, high-starch convenience foods, as well as other factors. But physical activity does play a key role in maintaining a healthy weight. And there’s another, less-known connection: overweight people who exercise tend to be far more healthy than their slim, inactive peers.

Justin Varney explains: “There’s more and more evidence that if you’re fat and fit you’re healthier than someone who is a healthy weight and sedentary. Your best option is to be a healthy weight and to be physically active. But if you’re an unhealthy weight, being active will significantly reduce the risk of things like diabetes and coronary heart disease, and reduces your mortality.”²⁴

There is increasing evidence that being inactive is, in fact, more deadly than being overweight. One huge recent study, led by Cambridge University, traced more than three hundred thousand European men and women over twelve years, seeing what impact both of these had on their health. It extrapolated the findings to estimate that of 9.2 million deaths in Europe in a given year, about 337,000 could be attributed to obesity. The number blamed on physical inactivity? A total of 676,000.²⁵

At the same time, cycling is a great way to ensure people don’t become overweight in the first place. One landmark study saw academics follow the health of five thousand people in eight provinces around China from 1989 to 1997, a period when many households bought their first-ever car. Even after adjusting for diet and other factors, men who acquired a motor vehicle for the first time gained on average nearly four pounds of weight more than those who didn’t.²⁶

It seems that cars make you fatter.

The Benefits of Accidental Exercise

Now that we’ve outlined this huge, worldwide problem, the obvious question occurs: why is cycling the solution? In part it’s down to a phenomenon known as “incidental activity.” Guaranteed to make a public health expert prick up their ears, this is based around the idea that people are far more likely to be physical if the exercise is integrated into their everyday lives rather than being an artificial extra.

“When we say, ‘Go to a gym,’ that’s discretionary time,” explains Anne Lusk, a public health expert at Harvard University who specializes in ways to get people cycling. “You have to eke that time out of your week, which includes not being with your spouse, not being with your children, tending to your house or job. Yes, it’s good to go to the gym. But, boy, is that hard time to carve out of your already packed day.”²⁷

This is where the bike comes in. Riding a bike as a means of transport has the wonderful capability to create physical activity while also, given sufficiently safe and connected cycle lanes, being fun and saving you time. This is the key, the experts say. Ashley Cooper, professor of physical activity and public health at the University of Bristol in the UK, a man who has spent more than twenty years warning governments about the perils of sedentary living, describes active travel as “probably one of the best bets for improving population-level physical activity.”

Cooper describes being summoned a couple of years ago to see the UK’s chief medical officer, the government’s most senior health adviser: “He asked what the answer was to physical inactivity. I told him it’s about creating an environment in which active travel is easily doable. It has to become a habit rather than a chore. There are numerous trials where people are told to go out and walk, and they’re not sustainable. People don’t go out and do it if there’s no purpose to it. But if it’s everyday transport there’s evidence that when people stop for a period, for example because of winter, or an illness, they’re likely to return to it.”²⁸

By “active travel,” Cooper and others do of course mean walking as well as cycling. Regular walking can also greatly assist your health, even if the benefits, as we’ll see below, might be less dramatic. But cycling has another big advantage—you can travel farther. Even riding pretty slowly, most people can cycle a three-mile commute in about twenty minutes. On foot it could take an hour. That means a lot of workplaces are easily reachable by bike.

The UK government has particularly detailed data on work travel patterns drawn from the once-a-decade national census. The latest figures, from 2011, found that even as average commutes are gradually increasing, half of all working people still travel less than three miles to work. More than two-thirds of people live less than six miles from their work.²⁹

Of course, many people commute longer distances, especially outside Europe. Also, not everyone will want to cycle three or six miles each way to their job, even if they are in a country with safe and connected bike lanes. But the potential is still huge, especially with the rapid growth in the use of electrically assisted bikes, or e-bikes. Even if just one in ten car commuters got on two wheels, that’s a lot of people getting their daily dose of activity. The picture is similar in many other countries. And with more than half the globe’s population now living in urban areas, the overall scope is unimaginably vast.

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There is another key reason why cycling is such a good fit for the inactivity crisis: an increasing bulk of evidence shows that riding a bike brings notably greater health benefits than even the WHO-approved regime of walking, gardening, and roof thatching. Push yourself that little bit harder, and a little longer, and the dividends multiply. Riding a bike, especially to and from a job, or a school or college, generally involves the exertion of setting off from traffic lights, or riding up a hill, and can often last more than half an hour a day.

Scientists are not prone to hyperbole, but Dr. Adrian Davis calls the benefits of bike commuting “amazing.” He says: “It’s really because of the vigorous element you often get in cycling, which you don’t get in other activities—it raises the heart rate over a certain threshold, strengthening the heart’s function. If you’re going at a moderate pace, you’re doing your moderate physical activity, which is fine, but it’s the vigorous which will provide you with much greater protection by time.”³⁰

One common problem with walking is that it needs to be fairly brisk to count even as moderate exercise, a point many people miss. Anne Lusk points to studies showing US dog owners actually tend to weigh more than the national average. “People have been saying for a long time, ‘Gee, I’m going for a walk to the dog park, that’s good,’” she says. “Your dog is exercising in the dog park. You’re not. You’re walking slowly, or standing and talking to friends. You’re at one MET.” In contrast, she explains, it’s much harder to not exert yourself on a bike. “I always joke that you can’t bike slowly, as if you did you’d fall over,” she says. “When we have a bad day we can all walk slowly.”³¹

Along with lower weight, cycling brings astonishing improvements to cardiovascular health. One of the more straightforward if gloomy studies involved a doctor at Northern General Hospital in the north of England examining the autopsy reports of thirty-two regular cyclists who had died in various ways and comparing their hearts with those of noncyclists of the same gender and similar age. Those who’d ridden bikes, he found, had a very significantly lower incidence of blocked arteries or other coronary obstructions.³²

The most famous and exhaustive research of its kind is the one mentioned at the start of the chapter. Perhaps inevitably it took place in Copenhagen.

Led by Lars Bo Andersen, an epidemiologist at the University of Southern Denmark, it charted the lives of more than thirty thousand Danes of all ages over an average of fifteen years, during which almost six thousand of them died. Even factoring in things like noncommuting exercise levels, it found those who biked to work were 40 percent less likely to die during the study. Forty percent. If you tried to skew the odds so much your way in a casino, they’d throw you out for cheating.³³

The Barnet Graph of Doom

Callous as it might sound, while the idea of physically inactive people dying young is a worry to government ministers, it’s the thought of the inactive ones who stay alive for decades that really keeps them awake at night. This is the notion of morbidity, simply meaning the quality of health experienced by people, especially as they age. It’s a question ultimately of money, especially the costs connected to people who become debilitated by illnesses from sedentary lifestyles but, in part due to medical advances, are still able to live long lives.

Most industrialized countries are facing a looming health-related catastrophe when it comes to public finances. Their populations are aging, with all the medical complications this incurs. At the same time, more and more people are acquiring expensive-to-treat conditions like type 2 diabetes at an ever-younger age. Britain’s Royal College of Physicians summed it up bluntly: “Current costs of providing healthcare cover for a physically inactive ageing population are not sustainable.”³⁴

It’s not just about direct medical costs. There is also the problem of paying for more and more care for people increasingly unable to look after themselves as they age. The crisis this has brought is summarized in something known, in all seriousness, as the Barnet Graph of Doom. While in fact the most prosaic of things—a dull-looking chart taken from a local government PowerPoint presentation—a glance at it is enough to prompt an involuntary shudder in most senior government officials.

Drawn up a few years ago for a speech by the chief executive of Barnet, a council on the northern edge of London, it portrays two elements: rising bars showing the projected cost of the authority’s future statutory social care obligations into the coming years, and a gently declining line for the predicted budget over the same period. At some point in around 2022, the two meet. If this were to happen, there would be no money left for anything else. No libraries. No swimming pools. No parks. Not even refuse collection.

The Graph of Doom can be dismissed as one of those oversimplified models that happen when you extrapolate current trends without factoring in possible changes. But it’s still a fantastic exemplar of the scale of official worries about poor health later in life. About two-thirds of the forecast costs on Barnet’s graph come from adult care, much of which is taken up with older people unable to look after themselves.

The key point is this: the less active someone is when they’re younger, the more likely it is they will eventually need expensive assistance, such as visiting nurses or a place in a residential home.

This is a connection Justin Varney regularly makes to prod people into taking up exercise: “I tell them, ‘Being active throughout your life is about being able to get to the loo on time in your old age.’ It does resonate. They can get their heads around that. It’s about dignity as much as anything else.”

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Given all this, are countries where a lot of people cycle invariably healthier? The short answer seems to be a qualified yes. A 2008 study in the Journal of Physical Activity and Health compared rates of active travel in two dozen nations—comparing the prevalence of cycling, walking, and public transport to obesity levels. The headline results were striking. The nations with the most active transport—the Netherlands, Switzerland, and Latvia—had the lowest obesity rates. Meanwhile the United States had the least amount of active travel (12 percent) and the most obesity (34.3 percent at the time selected).³⁵ It is, inevitably, more nuanced than this. The study used figures collected variously between 1994 and 2006, and some of the data was self-reported and thus potentially of mixed quality. Also, physical activity is just one part of the public health picture. Denmark, for example, has higher than average smoking and alcohol consumption rates.

That said, more cycling can bring a series of almost accidental benefits for countries. Research in Denmark has found that when people start riding a bike, they also often then begin eating a better diet and cutting back on alcohol and tobacco. “Taking up the bicycle as a mode of transportation for work seems to have an effect on your wider lifestyle,” says Bente Klarlund Pedersen, one of Denmark’s best-known public health experts.³⁶

From another major cycling nation, the Netherlands, comes a more curious example still. “In grocery shops here we don’t have a lot of the gallon packages for soft drinks and juice,” says Saskia Kluit, head of the Fietsersbond, the Dutch cyclists’ association. “The reason is that a lot of people cycle and they can’t be transported as well on a bicycle. It’s not anybody consciously thinking, ‘We should only sell one-liter packages.’ It’s just a positive interaction.”³⁷

The next frontier of physical activity science appears to be the brain. The ability of exercise to alleviate depression, stress, and anxiety is already much documented. Less well known is its apparent boost to overall cognitive function.

“In some sense this is not even understood by science yet,” says David Buchner. “The most recent consensus reports have a lot of interesting evidence on the effect of physical activity on the brain. They haven’t quite sorted it out yet, but I would expect over the next ten years it will be. It’ll have implications both for diseases of the brain, like Alzheimer’s, and academic performance in children.”³⁸

You Should Be Reading This Book Standing Up

As a warning for any fit and healthy cyclist currently reading this book from the comfort of an armchair or sofa and feeling even slightly smug—there is another area in which science is making new strides over sedentary living. Studies show that even regular, vigorous exercise doesn’t completely insulate you from the perils of sitting down for long periods.

This is, Ashley Cooper explains, partly due to the fact humans have particularly big muscles in their legs. If you fail to use these for an hour or so at a time, then the cells can undergo a process known as “downregulation,” meaning they produce less of certain proteins. This, in turn, is associated with poorer cardiovascular health and worse handling of glucose, increasing the risk of diabetes.

“There’s quite good evidence in adults that, regardless of activity level—unless you’re a completely mad athlete—then high and prolonged levels of being sedentary is associated with worse health outcomes,” Cooper says. In simple terms, he explains, it means that even if you’re a regular cyclist and you sit down at home to watch a couple of hours of TV in the evening, he’d recommend you get up every twenty minutes or so, to make a cup of tea or just stretch your legs.³⁹

While this remains a relatively new development, it’s notable and sobering that almost every time I’ve phoned a public health expert for this book they were talking from a standing desk.

Theresa Marteau, a Cambridge University professor who studies the interaction between public health and the environment, not only has a standing desk in her office, she has another one for meetings. Research into their benefits remains at an early stage, she says: “What we’re particularly interested in is what happens during a twenty-four-hour period. If there’s any kind of compensatory behavior, for example people then go home and lie down a lot, that’s not so great. But I like to think that in twenty years’ time we will find it unbelievable that people spent hours sitting down.”⁴⁰

And if by some chance you ever make a speech to a room of public health experts and, when it ends, they all stand up to clap, bear in mind it might not necessarily be that you’re such an amazing orator. They could be thinking of their health.

“It’s called active applause,” says Ashley Cooper. “Very popular in the physical activity world. They tend to be complete believers. If you were to go to one of our conferences you’d find about half the audiences would be listening to the presentations standing up. It’s a very hot topic.”

So should we be worried that the people who know the most about the perils of inactivity are themselves a bit nervy if they sit down for more than about half an hour?

Yes, we probably should.

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It barely needs to be pointed out that combating physical inactivity involves more than just people buying a bike. For the world to reverse this pandemic it will require a host of changes to people’s lives, and to the way homes and communities are designed around them. Such open social engineering tends to prove controversial, but it’s been done before. In the 1970s, Finland had the world’s highest rate of heart disease, partly due to inactivity, but also smoking and poor diet. Now, after decades of huge, community-based programs to promote change, rates are 75 percent lower.⁴¹

It’s hard to overstate the potential impact if governments undertook similarly ambitious attempts to create mass cycling. Cars are among the main factors associated with inactivity. Even if the globe’s tech companies, as expected, usher in an imminent new era of efficient electric vehicles that drive themselves and never crash, you’re still left with the problem of a sedentary, ailing population.

So why aren’t government ministers across the world crowbarring open the doors to municipal sheds so they can commandeer bulldozers and start carving bike lanes into every available mile of road space? Why are cities not already populated by fleets of healthy, two-wheeled citizens, cheerily pedaling their way to, and past, their 150 minutes per week?

This is, for the most part, a question connected to political inertia, powerful vested interests, a lack of real ambition and leadership from governments, and a set of curious but persistent and damaging myths about cycling and cyclists. These are issues to be addressed later in the book, but it’s worth noting that public health experts believe change is coming, even if it might still take time.

“The amount of attention and funding that’s paid to tobacco control is much larger in the United States than is paid to physical inactivity,” notes David Buchner. “One of the issues with physical activity is it has to have this coordinated response across sectors. It’s not public health that builds the roads or the parks, or puts physical education in the schools. It takes this larger consensus to get things to happen in multiple areas of our lives.”⁴²

Francesca Racioppi agrees. “It’s a relatively long path we need to take,” she says. “So many interests need to be convinced that investing in cycling is good for them. Consider that we’ve known about tobacco as a risk factor for fifty years. It took about forty years until governments started to introduce things like smoking bans in public places. It all takes time.”⁴³

According to Justin Varney, the moment might finally have arrived: “In western countries there is a kind of sense that the time has come for physical activity as a preventative factor we can do something about. It’s fun, it’s free or pretty cheap, it’s easy, anyone can do it. It’s starting to happen.”⁴⁴

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And what of my personal experiment? The Kent University lab results arrived in my e-mail a week later, as promised, in the form of a very professional-looking three-page report. It even had a chart. Luckily for this book, the headline finding was that my VO2 max is fifty-three. This isn’t anywhere near professional level—some top cyclists can reach the high seventies—but it is, Hopker explains, “considerably above” the normal range. The average for a man in my early middle age is nearer thirty-five.

Delighted, I spent several days browsing specialist exercise websites featuring VO2 max comparison tables. Some of these, pleasingly, suggested my aerobic capacity is that of a fit man in his early twenties. My favorite table is that which places me in a category labeled “superior.”

It’s possibly overdramatizing the narrative to say cycling saved my life. But it’s no exaggeration at all to say cycling transformed it. Much as the sudden seriousness of my teenage asthma was simply terrifying, the arguably bigger obstacle was the retrospective sense that I was physically incapable, substandard, helpless. Being active changed this, permanently, and in a remarkably short time.