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vitality, and less loneliness. The study attributed these results to possible economic benefits and senses of both independence and identity as a member of a cyclist community. An English study recruiting non-cyclist older adults aged 50 to 83 to participate as either conventional pedal bike cyclists, electrically assisted e-bike cyclists, or a non-cyclist control group in outdoor trails measured cognitive function through executive function, spatial reasoning, and memory tests and well-being through questionnaires.[61] The study did not find significant differences in spatial reasoning or memory tests. It did however find that both cyclists groups had improved executive function and well-being, both with greater improvement in the e-bike group. This suggested that non-physical factors of cycling such as independence, engagement with the outdoor environment, and mobility play a greater role in improving mental health. A 15-month randomized controlled trial in the U.S. examined the impact of self-paced cycling on cognitive function in institutionalized older adults without cognitive impairment.[62] Researchers used three cognitive assessments: Mini-Mental State Examination (MMSE), Fuld object memory evaluation, and symbol digit modality test. The study found that long-term cycling for at least 15 minutes per day in older adults without cognitive impairment had a protective effect on cognition and attention. Cycling has also been shown to be effective adjunct therapy in certain mental health conditions.[63][64]

Bicycle safety Further information: Bicycle safety A statue, covered with flowers. Virgin Mary venerated as the holy protector of bicyclists on the roads of the mountainous Basque Country Cycling suffers from a perception that it is unsafe.[65][66] This perception is not always backed by hard numbers, because of under reporting of accidents and lack of bicycle use data (amount of cycling, kilometers cycled) which make it hard to assess the risk and monitor changes in risks.[67] In the UK, fatality rates per mile or kilometre are slightly less than those for walking.[68] In the US, bicycling fatality rates are less than 2/3 of those walking the same distance.[69][70] However, in the UK for example the fatality and serious injury rates per hour of travel are just over double for cycling than those for walking.[68] Thus if a person is, for example, about to undertake a ten kilometre journey to a given destination it may on average be safer to undertake this journey by bicycle than on foot. However, if a person is intending, for example, to undertake an hour's exercise it may be more dangerous to take that exercise by cycling rather than by walking. Despite the risk factors associated with bicycling, cyclists have a lower overall mortality rate when compared to other groups. A Danish study in 2000 found that even after adjustment for other risk factors, including leisure time physical activity, those who did not cycle to work experienced a 39% higher mortality rate than those who did.[71] Injuries (to cyclists, from cycling) can be divided into two types: Physical trauma (extrinsic) Overuse (intrinsic). Physical trauma Acute physical trauma includes injuries to the head and extremities resulting from falls and collisions. Most cycle deaths result from a collision with a car or heavy goods vehicle, both motorist and cyclist having been found responsible for collisions.[72][73][74] A third of collisions between motorists and cyclists are caused by car dooring.[75] However, around 16% of serious cyclist injuries reported to police in the UK in 2014 did not involve any other person or vehicle.[76] Although a majority of bicycle collisions occur during the day,[76] bicycle lighting is recommended for safety when bicycling at night to increase visibility.[77] Bicyclist pedals uphill at the Taroko Gorge in Taiwan Bicycles in Helsinki (Finland) Overuse injuries Of a study of 518 cyclists, a large majority reported at least one overuse injury, with over one third requiring medical treatment. The most common injury sites were the neck (48.8%) and the knees (41.7%), as well as the groin/buttocks (36.1%), hands (31.1%), and back (30.3%). Women were more likely to suffer from neck and shoulder pain than men.[78] Many cyclists suffer from overuse injuries to the knees, affecting cyclists at all levels. These are caused by many factors:[79] Incorrect bicycle fit or adjustment, particularly the saddle. Incorrect adjustment of clipless pedals. Too many hills, or too many miles, too early in the training season. Poor training preparation for long touring rides. Selecting too high a gear. A lower gear for uphill climb protects the knees, even though muscles may be well able to handle a higher gear. Overuse injuries, including chronic nerve damage at weight bearing locations, can occur as a result of repeatedly riding a bicycle for extended periods of time. Damage to the ulnar nerve in the palm, carpal tunnel in the wrist, the genitourinary tract[80] or bicycle seat neuropathy[81] may result from overuse. Recumbent bicycles are designed on different ergonomic principles and eliminate pressure from the saddle and handlebars, due to the relaxed riding position. Note that overuse is a relative term, and capacity varies greatly between individuals. Someone starting out in cycling must be careful to increase length and frequency of cycling sessions slowly, starting for example at an hour or two per day, or a hundred miles or kilometers per week. Bilateral muscular pain is a normal by-product of the training process, whereas unilateral pain may reveal "exercise-induced arterial endofibrosis".[82] Joint pain and numbness are also early signs of overuse injury. A Spanish study of top triathletes found those who cover more than 186 miles (300 km) a week on their bikes have less than 4% normal looking sperm, where normal adult males would be expected to have from 15% to 20%.[83][84] Saddle related Much work has been done to investigate optimal bicycle saddle shape, size and position, and negative effects of extended use of less than optimal seats or configurations. Excessive saddle height can cause posterior knee pain, while setting the saddle too low can cause pain in the anterior of the knee. An incorrectly fitted saddle may eventually lead to muscle imbalance. A 25 to 35 degree knee angle is recommended to avoid an overuse injury.[85] Cycling has been linked to sexual impotence due to pressure on the perineum from the seat, but fitting a proper sized seat prevents this effect.[83][86][87][88] In extreme cases, pudendal nerve entrapment can be a source of intractable perineal pain.[89] Some cyclists with induced pudendal nerve pressure neuropathy gained relief from improvements in saddle position and riding techniques.[90] The National Institute for Occupational Safety and Health (NIOSH) has investigated the potential health effects of prolonged bicycling in police bicycle patrol units, including the possibility that some bicycle saddles exert excessive pressure on the urogenital area of cyclists, restricting blood flow to the genitals.[91] Their study found that using bicycle seats without protruding noses reduced pressure on the groin by at least 65% and significantly reduced the number of cases of urogenital paresthesia. A follow-up found that 90% of bicycle officers who tried the no-nose seat were using it six months later. NIOSH recommends that riders use a no-nose bicycle seat for workplace bicycling.[88][92] Despite rumors to the contrary, there is no scientific evidence linking cycling with testicular cancer.[93] Exposure to air pollution One concern is that riding in traffic may expose the cyclist to higher levels of air pollution, especially if he or she travels on or along busy roads. Some authors have claimed this to be untrue, showing that the pollutant and irritant count within cars is consistently higher,[94] presumably because of limited circulation of air within the car and due to the air intake being directly in the stream of other traffic. Other authors have found small or inconsistent differences in concentrations but claim that exposure of cyclists is higher due to increased minute ventilation[95] and is associated with minor biological changes.[96] A 2010 study estimated that the gained life expectancy from the health benefits of cycling (approximately 3-14 months gained) greatly exceeded the lost life expectancy from air pollution (approximately 0.8-40 days lost).[53] However, a systematic review comparing the effects of air pollution exposure on the health of cyclists was conducted, but the authors concluded that the differing methodologies and measuring parameters of each study made it difficult to compare results and suggested a more holistic approach was needed to accomplish this.[97] The significance of the associated health effect, if any, is unclear but probably much smaller than the health impacts associated with accidents and the health benefits derived from additional physical activity

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