Bicycle Trains, Cycling, and Physical Activity: A Pilot Cluster RCT


      Increasing children’s cycling to school and physical activity are national health goals. The objective was to conduct an RCT of a bicycle train program to assess impact on students’ school travel mode and moderate-to-vigorous physical activity (MVPA).

      Study design

      Pilot cluster RCT with randomization at the school level and N=54 participants.


      Fourth–fifth graders from four public schools serving low-income families in Seattle, WA in 2014 with analyses in 2015–2016. All participants were provided and fitted with bicycles, safety equipment (helmets, locks, and lights), and a 2- to 3-hour bicycle safety course.


      The intervention was a bicycle train offered daily (i.e., students volunteered to cycle with study staff to and from school).

      Main outcome measures

      Time 1 assessments occurred prior to randomization. Time 2 assessments occurred after 3–5 weeks of the intervention (i.e., during Weeks 4–6 of the intervention period). The primary outcome was the percentage of daily commutes to school by cycling measured by validated survey. MVPA, measured by accelerometry and GPS units and processed by machine learning algorithms, was a secondary outcome.


      For two separate adjusted repeated measures linear mixed effects models in which students (N=54) were nested within schools (N=4), intervention participants had: (1) an absolute increase in mean percentage of daily commutes by cycling of 44.9%, (95% CI=26.8, 63.0) and (2) an increase in mean MVPA of 21.6 minutes/day, (95% CI=8.7, 34.6) from Time 1 to Time 2 compared with controls.


      A pilot bicycle train intervention increased cycling to school and daily MVPA in the short term among diverse, inner-city elementary school students. The bicycle train intervention appears promising and warrants further experimental trials among large, diverse samples with longer follow-up.

      Trial registration

      This study is registered at NCT02006186.
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        • McDonald N.C.
        • Brown A.L.
        • Marchetti L.M.
        • Pedroso M.S.
        U.S. school travel, 2009: an assessment of trends.
        Am J Prev Med. 2011; 41: 146-151
        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 311: 806-814
        • Troiano R.P.
        • Berrigan D.
        • Dodd K.W.
        • Masse L.C.
        • Tilert T.
        • McDowell M.
        Physical activity in the United States measured by accelerometer.
        Med Sci Sports Exerc. 2008; 40: 181-188
        • Skinner A.C.
        • Perrin E.M.
        • Skelton J.A.
        Prevalence of obesity and severe obesity in U.S. children, 1999-2014.
        Obesity. 2016; 24: 1116-1123
        • Mendoza J.A.
        • Liu Y.
        Active commuting to elementary school and adiposity: an observational study.
        Child Obes. 2014; 10: 34-41
        • Mendoza J.A.
        • Watson K.
        • Baranowski T.
        • Nicklas T.A.
        • Uscanga D.K.
        • Hanfling M.J.
        The walking school bus and children’s physical activity: a pilot cluster randomized controlled trial.
        Pediatrics. 2011; 128: e537-e544
        • Mendoza J.A.
        • Watson K.
        • Nguyen N.
        • Cerin E.
        • Baranowski T.
        • Nicklas T.A.
        Active commuting to school and association with physical activity and adiposity among U.S. youth.
        J Phys Act Health. 2011; 8: 488-495
        • Davison K.K.
        • Werder J.L.
        • Lawson C.T.
        Children’s active commuting to school: current knowledge and future directions.
        Prev Chronic Dis. 2008; 5: A100
        • Lubans D.
        • Boreham C.
        • Kelly P.
        • Foster C.
        The relationship between active travel to school and health-related fitness in children and adolescents: a systematic review.
        Int J Behav Nutr Phys Act. 2011; 8: 5
        • Lee M.C.
        • Orenstein M.R.
        • Richardson M.J.
        Systematic review of active commuting to school and childrens physical activity and weight.
        J Phys Act Health. 2008; 5: 930-949
        • Chillon P.
        • Evenson K.
        • Vaughn A.
        • Ward D.
        A systematic review of interventions for promoting active transportation to school.
        Int J Behav Nutr Phys Act. 2011; 8: 10
        • Heelan K.A.
        • Abbey B.
        • Donnelly J.
        • Mayo M.
        • Welk G.J.
        Evaluation of a walking school bus for promoting physical activity in youth.
        J Phys Act Health. 2009; 6: 560-567
        • Machado-Rodrigues A.M.
        • Santana A.
        • Gama A.
        • et al.
        Active commuting and its associations with blood pressure and adiposity markers in children.
        Prev Med. 2014; 69: 132-134
        • Mendoza J.
        • Levinger D.
        • Johnston B.
        Pilot evaluation of a walking school bus program in a low-income, urban community.
        BMC Public Health. 2009; 9: 122
        • Mendoza J.
        • Watson K.
        • Baranowski T.
        • Nicklas T.
        • Uscanga D.
        • Hanfling M.
        Validity of instruments to assess students’ travel and pedestrian safety.
        BMC Public Health. 2010; 10: 257
      1. Office of Disease Prevention and Health Promotion. Healthy People 2020. U.S. DHHS. Washington, DC: U.S. DHHS; 2010.

        • Ainsworth B.E.
        • Haskell W.L.
        • Herrmann S.D.
        • et al.
        2011 Compendium of Physical Activities: a second update of codes and MET values.
        Med Sci Sports Exerc. 2011; 43: 1575-1581
        • Ridley K.
        • Ainsworth B.
        • Olds T.
        Development of a Compendium of Energy Expenditures for Youth.
        Int J Behav Nutr Phys Act. 2008; 5: 45
        • Chillón P.
        • Ortega F.B.
        • Ruiz J.R.
        • et al.
        Bicycling to school is associated with improvements in physical fitness over a 6-year follow-up period in Swedish children.
        Prev Med. 2012; 55: 108-112
        • Cohen D.
        • Ogunleye A.A.
        • Taylor M.
        • Voss C.
        • Micklewright D.
        • Sandercock G.R.
        Association between habitual school travel and muscular fitness in youth.
        Prev Med. 2014; 67: 216-220
        • Ostergaard L.
        • Grontved A.
        • Borrestad L.A.
        • Froberg K.
        • Gravesen M.
        • Andersen L.B.
        Cycling to school is associated with lower BMI and lower odds of being overweight or obese in a large population-based study of Danish adolescents.
        J Phys Act Health. 2012; 9: 617-625
        • Andersen L.B.
        • Wedderkopp N.
        • Kristensen P.
        • Moller N.C.
        • Froberg K.
        • Cooper A.R.
        Cycling to school and cardiovascular risk factors: a longitudinal study.
        J Phys Act Health. 2011; 8: 1025-1033
        • Larouche R.
        • Saunders T.J.
        • Faulkner G.
        • Colley R.
        • Tremblay M.
        Associations between active school transport and physical activity, body composition, and cardiovascular fitness: a systematic review of 68 studies.
        J Phys Act Health. 2014; 11: 206-227
      2. Brown A, Marchetti L, Pullen N, Scully M, Zegeer C Safe Routes to School Guide. Chapel Hill, NC: National Center for Safe Routes to School; 2007, updated 2015. Accessed May 18, 2017.

      3. National Center for Safe Routes to School. The walking school bus: combining safety, fun and the walk to school. Published August 17, 2006.Accessed May 18, 2017.

        • Smith L.
        • Norgate S.H.
        • Cherrett T.
        • Davies N.
        • Winstanley C.
        • Harding M.
        Walking school buses as a form of active transportation for children - a review of the evidence.
        J Sch Health. 2015; 85: 197-210
        • Pucher J.
        • Buehler R.
        Analysis of Bicycling Trends and Policies in Large North American Cities: Lessons for New York.
        University Transportation Research Center Region II, New York, NY2011
        • Pucher J.
        • Buehler R.
        • Seinen M.
        Bicycling renaissance in North America? An update and re-appraisal of cycling trends and policies.
        Transp Res Part A Policy Pract. 2011; 45: 451-475
        • Kumanyika S.K.
        • Obarzanek E.
        • Stettler N.
        • et al.
        Population-based prevention of obesity: the need for comprehensive promotion of healthful eating, physical activity, and energy balance: a scientific statement From American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (Formerly the Expert Panel on Population and Prevention Science).
        Circulation. 2008; 118: 428-464
        • Davis M.M.
        • Gance-Cleveland B.
        • Hassink S.
        • Johnson R.
        • Paradis G.
        • Resnicow K.
        Recommendations for prevention of childhood obesity.
        Pediatrics. 2007; 120: S229-S253
      4. U.S. Department of Education. Improving basic programs operated by local educational agencies (Title I, Part A). Published 2015. Accessed February 25, 2016.

        • D’Haese S.
        • De Meester F.
        • De Bourdeaudhuij I.
        • Deforche B.
        • Cardon G.
        Criterion distances and environmental correlates of active commuting to school in children.
        Int J Behav Nutr Phys Act. 2011; 8: 88
      5. National Center for Safe Routes to School. Bicycle Trains. The walking school bus: combining safety, fun and the walk to school. Published August 17, 2006. Accessed November 8, 2006.

        • Troped P.J.
        • Oliveira M.S.
        • Matthews C.E.
        • Cromley E.K.
        • Melly S.J.
        • Craig B.A.
        Prediction of activity mode with global positioning system and accelerometer data.
        Med Sci Sports Exerc. 2008; 40: 972-978
        • Kerr J.
        • Duncan S.
        • Schipperijn J.
        Using global positioning systems in health research: a practical approach to data collection and processing.
        Am J Prev Med. 2011; 41: 532-540
        • Klinker C.D.
        • Schipperijn J.
        • Christian H.
        • Kerr J.
        • Ersboll A.K.
        • Troelsen J.
        Using accelerometers and global positioning system devices to assess gender and age differences in children’s school, transport, leisure and home based physical activity.
        Int J Behav Nutr Phys Act. 2014; 11: 8
        • Trost S.G.
        • Loprinzi P.D.
        • Moore R.
        • Pfeiffer K.A.
        Comparison of accelerometer cut-points for predicting activity intensity in youth.
        Med Sci Sports Exerc. 2011; 43: 1360-1368
        • Evenson K.R.
        • Catellier D.J.
        • Gill K.
        • Ondrak K.S.
        • McMurray R.G.
        Calibration of two objective measures of physical activity for children.
        J Sports Sci. 2008; 26: 1557-1565
        • Jakicic J.M.
        • Winters C.
        • Lagally K.
        • Ho J.
        • Robertson R.J.
        • Wing R.R.
        The accuracy of the TriTrac-R3D accelerometer to estimate energy expenditure.
        Med Sci Sports Exerc. 1999; 31: 747-754
        • Treuth M.S.
        • Schmitz K.
        • Catellier D.J.
        • et al.
        Defining accelerometer thresholds for activity intensities in adolescent girls.
        Med Sci Sports Exerc. 2004; 36: 1259-1266
        • Carlson J.A.
        • Jankowska M.M.
        • Meseck K.
        • et al.
        Validity of PALMS GPS scoring of active and passive travel compared with SenseCam.
        Med Sci Sports Exerc. 2015; 47: 662-667
        • Carlson J.A.
        • Schipperijn J.
        • Kerr J.
        • et al.
        Locations of physical activity as assessed by GPS in young adolescents.
        Pediatrics. 2016; 137: 1-10
        • Jerrett M.
        • Almanza E.
        • Davies M.
        • et al.
        Smart growth community design and physical activity in children.
        Am J Prev Med. 2013; 45: 386-392
        • Ellis K.
        • Kerr J.
        • Godbole S.
        • Staudenmayer J.
        • Lanckriet G.
        Hip and wrist accelerometer algorithms for free-living behavior classification.
        Med Sci Sports Exerc. 2016; 48: 933-940
        • Kerr J.
        • Patterson R.E.
        • Ellis K.
        • et al.
        Objective assessment of physical activity: classifiers for public health.
        Med Sci Sports Exerc. 2016; 48: 951-957
        • Lyden K.
        • Keadle S.K.
        • Staudenmayer J.
        • Freedson P.
        • Alhassan S.
        Energy cost of common activities in children and adolescents.
        J Phys Act Health. 2013; 10: 62-69
        • Silva V.
        • Grande A.J.
        • Rech C.R.
        • Peccin M.S.
        Geoprocessing via Google Maps for assessing obesogenic built environments related to physical activity and chronic noncommunicable diseases: validity and reliability.
        J Healthc Eng. 2015; 6: 41-54
        • Schantz P.
        • Stigell E.
        A criterion method for measuring route distance in physically active commuting.
        Med Sci Sports Exerc. 2009; 41: 472-478
        • Coulton C.J.
        • Korbin J.E.
        • Su M.
        Measuring neighborhood context for young children in an urban area.
        Am J Community Psychol. 1996; 24: 5-32
        • Kuczmarski R.J.
        • Ogden C.L.
        • Guo S.S.
        • et al.
        2000 CDC Growth Charts for the United States: methods and development.
        Vital Health Stat 11. 2002; : 1-190
        • Davison K.K.
        • Lawson C.T.
        Do attributes in the physical environment influence children’s physical activity? A review of the literature.
        Int J Behav Nutr Phys Act. 2006; 3: 19
        • Ding D.
        • Sallis J.F.
        • Kerr J.
        • Lee S.
        • Rosenberg D.E.
        Neighborhood environment and physical activity among youth: a review.
        Am J Prev Med. 2011; 41: 442-455
        • Saelens B.E.
        • Handy S.L.
        Built environment correlates of walking: a review.
        Med Sci Sports Exerc. 2008; 40: S550-S566
        • Winters M.
        • Teschke K.
        • Brauer M.
        • Fuller D.
        Bike Score(R): Associations between urban bikeability and cycling behavior in 24 cities.
        Int J Behav Nutr Phys Act. 2016; 13: 18
        • Faul F.
        • Erdfelder E.
        • Lang A.-G.
        • Buchner A.
        G*power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Gueorguieva R.
        • Krystal J.H.
        Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the archives of general psychiatry.
        Arch Gen Psychiatry. 2004; 61: 310-317
        • Cnaan A.
        • Laird N.M.
        • Slasor P.
        Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data.
        Stat Med. 1997; 16: 2349-2380<2349::AID-SIM667>3.0.CO;2-E
        • Jacqmin-Gadda H.
        • Sibillot S.
        • Proust C.
        • Molina J.-M.
        • Thiébaut R.
        Robustness of the linear mixed model to misspecified error distribution.
        Comput Stat Data Anal. 2007; 51: 5142-5154
        • de Boer M.R.
        • Waterlander W.E.
        • Kuijper L.D.
        • Steenhuis I.H.
        • Twisk J.W.
        Testing for baseline differences in randomized controlled trials: an unhealthy research behavior that is hard to eradicate.
        Int J Behav Nutr Phys Act. 2015; 12: 1-8
        • Schulz K.F.
        • Altman D.G.
        • Moher D.
        • CONSORT Group
        CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomized Trials.
        Ann Intern Med. 2010; 152: 726-732
        • Ostergaard L.
        • Borrestad L.A.
        • Tarp J.
        • Andersen L.B.
        Bicycling to school improves the cardiometabolic risk factor profile: a randomised controlled trial.
        BMJ Open. 2012; 2: e001307
        • Ducheyne F.
        • De Bourdeaudhuij I.
        • Lenoir M.
        • Cardon G.
        Effects of a cycle training course on children’s cycling skills and levels of cycling to school.
        Accid Anal Prev. 2014; 67: 49-60
        • Metcalf B.
        • Henley W.
        • Wilkin T.
        Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54).
        BMJ. 2012; : 345
        • Kriemler S.
        • Meyer U.
        • Martin E.
        • van Sluijs E.M.F.
        • Andersen L.B.
        • Martin B.W.
        Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update.
        Br J Sports Med. 2011; 45: 923-930
        • Sims J.
        • Scarborough P.
        • Foster C.
        The effectiveness of interventions on sustained childhood physical activity: a systematic review and meta-analysis of controlled studies.
        PLoS One. 2015; 10: e0132935
        • Nader P.R.
        • Bradley R.H.
        • Houts R.M.
        • McRitchie S.L.
        • O’Brien M.
        Moderate-to-vigorous physical activity from ages 9 to 15 years.
        JAMA. 2008; 300: 295-305
        • Flay B.R.
        Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs.
        Prev Med. 1986; 15: 451-474
        • Courneya K.
        Efficacy, effectiveness, and behavior change trials in exercise research.
        Int J Behav Nutr Phys Act. 2010; 7: 81