Free Bus Travel and Physical Activity,Gait Speed,and Adiposity in the English Longitudinal Study of Ageing

Objectives. We investigated associations between having a bus pass, enabling free local bus travel across the United Kingdom for state pension–aged people, and physical activity, gait speed, and adiposity.Methods. We used data on 4650 bus pass–eligible people (aged ≥ 62 years) at wave 6 (2012–2013) of the English Longitudinal Study of Ageing in regression analyses.Results. Bus pass holders were more likely to be female (odds ratio OR] = 1.67; 95% confidence interval CI] = 1.38, 2.02; P < .001), retired (OR = 2.65; 95% CI = 2.10, 3.35; P < .001), without access to a car (OR = 2.78; 95% CI = 1.83, 4.21; P < .001), to use public transportation (OR = 10.26; 95% CI = 8.33, 12.64; P < .001), and to be physically active (OR = 1.43; 95% CI = 1.12, 1.84; P = .004). Female pass holders had faster gait speed (b = 0.06 meters per second; 95% CI = 0.02, 0.09; P = .001), a body mass index 1 kilogram per meter squared lower (b = –1.20; 95% CI = –1.93, –0.46; P = .001), and waist circumference 3 centimeters smaller (b = –3.32; 95% CI = –5.02, –1.62; P < .001) than women without a pass.Conclusions. Free bus travel for older people helps make transportation universally accessible, including for those at risk for social isolation. Those with a bus pass are more physically active. Among women in particular, the bus pass is associated with healthier aging.Maintaining physical activity is key to good physical functioning in older age,1 aging healthily,2 and reducing obesity risk,3 but only 49% of men and 36% of women aged 65 years and older in England met physical activity guidelines in 2012.4 Active modes of transportation, including public transportation, can contribute substantially to total physical activity.5 Among working-age adults, commuting by public transportation increases physical activity levels6 and can improve health,7–9 but evidence about older people is sparse.The UK older people’s bus pass (“bus pass” herein) enables people of the state retirement age for women (previously 60 years) and older to travel free of charge on local buses, anywhere in the country.10 To our knowledge, this nationwide policy of free bus transportation for older people, irrespective of financial circumstances, is unique. The bus pass was introduced in Scotland in 2002, England and Wales in 2006, and Northern Ireland in 2008, with concessionary policies operating previously. There remain various additional local benefits; for instance, older people living in London are eligible for a Freedom Pass, which provides free travel on all public transportation.Of the forms of public transportation available in the United Kingdom, buses serve the widest range of communities; even the majority of very rural areas have some bus services. Buses operate over relatively short distances, transporting people between residential areas and urban centers, shopping areas, and hospitals. The bus pass is a widely recognized state benefit for older people often discussed in the media. Advice on obtaining a pass is offered by many organizations including older people’s charities and local authorities. The application form is short and simple, and can either be completed online or acquired locally—for example, from a Post Office or government offices.The aim of the bus pass is to “tackle social exclusion” among older people.11 Evidence suggests that it has been successful, providing opportunities for social interaction, giving a feeling of visibility and belonging, improving quality of life, reducing feelings of social exclusion, and improving access to services.12–14 The bus pass has been estimated to cost the UK government approximately £1 billion a year15 and the recent climate of austerity has led to suggestions that eligibility for the bus pass should be means tested, whereby only older people with income and wealth below a certain level would be eligible. However, many of the benefits derive, at least in part, from the universality of free bus travel for older people and the lack of stigma therefore associated with the pass.12,13In addition to the benefits to older people’s social inclusion, there may be unanticipated benefits of the bus pass—for instance, to physical health. We have previously shown that the bus pass is linked to increased walking frequency16 and reduced obesity17; however, it has not been possible to investigate these relationships directly or in detail. We hypothesized that older people who hold bus passes will be more physically active and will have better physical functioning and lower adiposity. We contend that, if these hypothesized relationships are observed, this would indicate that the bus pass helps enable healthier aging, which leads to health care expenditure savings that may mitigate the cost of providing the bus pass to older people.We used data from the English Longitudinal Study of Ageing (ELSA) to determine (1) among those eligible, who takes up the bus pass; (2) what factors are associated with frequency of bus use among those who have a bus pass; (3) whether having a bus pass is associated with how often people use any public transportation; and (4) whether having a bus pass is associated with physical activity levels, gait speed, and adiposity.