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Background  Trend analyses of active commuting and potential variations in trends and association with cardiovascular disease (CVD) risk within subgroups are unknown.    Objectives  To (a) describe trends in active commuting between 1998 and 2015 and (b) to study the association between different amounts of active commuting and the incidence risk of CVD in a large sample of Swedish workers, and analyses of potential variations across subgroups of socio‐demographics, physical activity, and BMI.    Methods  A total of 318 309 participants (47% women, 18‐74 years) who participated in a nationwide occupational health service screening between 1998 and 2015 were included. Commuting habits were self‐reported, and data on first‐time CVD events were derived from national registers.    Results  Self‐reported passive commuters decreased between 1998 and 2015 (64% to 56%), transferring to an increase in mainly moderate/high‐dose active commuters (12% to 19%). Changes were seen in all subgroups. The characteristics and lifestyle habits of the typical passive and active commuter changed little over the study period. Low‐ and moderate/high‐dose active commuters had significantly decreased risks for a first time CVD during follow‐up. This was accentuated in men, middle‐aged, and in participants with light physical work situations, irregular exercise habits, being overweight/obese, and with low fitness.    Conclusion  Increases in active commuting were observed between 1998 and 2015, however still leaving a majority who do not actively commute. As active commuting, regardless dose, is associated with a lower CVD risk, encouraging more people to actively commute may provide an easily accessible and time‐efficient possibility to increase physical activity and health in the general population.

Active commuting in Swedish workers between 1998 and 2015—Trends, characteristics, and cardiovascular disease risk