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Personal Health Jane Brody on health and aging.

Cycling as recreation, sport and transport has exploded in recent years, with continued growth likely as more locales install bike lanes and bike-share programs. But as you might expect, with that growth has come an increase in bike-related injuries.

Although there is some truth to the adage of “safety in numbers” — that is, risk should decline as more people ride and drivers become used to sharing the road with cyclists — there is also a rather steep learning curve for bikers and drivers. Alas, the United States is still in kindergarten in this regard.

The latest study, published as a research letter Sept. 1 in JAMA, documents a rise in cycling-related injuries and hospitalizations among adults from 1998 to 2013. Adjusted for age, reported injuries rose 28 percent, and resulting hospitalizations increased 120 percent. There was also an increase, to 56 percent from 40 percent, of accidents that occurred on streets.

Injuries involving the arms and legs declined over the years of the study. But there was a rise in more severe injuries: a 60 percent increase, to 16 percent from 10 percent, in head injuries, and a 20 percent increase in injuries to the torso.

That’s the bad news. The good news, as Dr. Benjamin N. Breyer, the lead author of the study, put it: “The benefits of cycling to the cardiovascular system and to one’s overall sense of well-being way override the risks. Cycling is a fantastic way to get around a city. And it’s great for increasing muscle strength and balance.”

But, he quickly added in an interview, “People need to learn how to ride safely.” And, as an avid cyclist, I will add, streets and roadways need to be made safer for riding — and more drivers have to learn to pay attention to the cyclists who share their road and treat them with respect, not as targets.

I have done cycling trips in Vietnam, Spain, South Africa, Germany, Croatia, Poland and New Zealand, and in all those countries, I felt a lot safer than I do riding in my Brooklyn neighborhood. Drivers approaching from behind did not honk and scare me half to death. They slowed until they could pass me safely, and those planning to turn waited until I had cleared the intersection.

Most amazing perhaps was the Croatian bus coming down a steep hill on a narrow road that stopped and waited for me to pass as I struggled up. All I could think was, “That would never happen in the United States.” But it should!

Dr. Breyer, a urologic surgeon at the University of California, San Francisco, said one of the most striking findings of the study was the “shift in the age of riders being injured; cycling has become a lot more popular among people over 45,” he said, and older riders now account for a disproportionate number and severity of injuries.

He said that older riders may have more accidents because of diminished strength and balance, and their resulting injuries were likely to be more serious. Even when an older rider is in great shape, Dr. Breyer said, “when a 65-year-old falls off a bike, he’s likely to sustain a more serious injury than a 25-year-old.”

According to the National Household Travel Survey, Americans older than 25 accounted for most of the increase in cycling from 1995 to 2009.

Dr. Breyer’s interest in cycling accidents was stimulated in part by the large number of genital and urinary tract injuries he has treated among cyclists, often sustained from landing on handlebars or the crossbar in a fall. Indeed, in another report earlier this year, he and some colleagues found that bicycles were involved in about one-third of genitourinary injuries in children and adults, far more than in any other sport.

Other researchers, like John Pucher and Lewis Dijkstra, have lamented “the appallingly unsafe, unpleasant and inconvenient conditions faced by pedestrians and bicyclists in most American cities.”

“Per kilometer and per trip cycled, American bicyclists are twice as likely to get killed as German cyclists and over three times as likely as Dutch cyclists,” they wrote in 2003 in The American Journal of Public Health.

From 1975 to 2001, during a boom in cycling in Europe, they reported, cyclist fatalities declined by 64 percent in Germany and by 57 percent in the Netherlands, while a 27 percent drop in American cycling fatalities was almost entirely the result of a sharp decline in cycling by children.

Much can be done to enhance the safety and pleasurability of cycling in the United States. Cyclists, for one, should always wear a helmet that fits snugly and covers the upper forehead. They can enhance their visibility by wearing bright colors in the daytime and reflective clothing at night and by installing bike lights front and back and perhaps also a flashing light on their helmets.

Whenever possible, make eye contact with drivers and pedestrians. A mirror on the helmet or handlebar can alert cyclists to vehicles approaching from behind. And a bell that can be activated by one finger while the rest of the hand remains on the handlebar can alert pedestrians who fail to see a bike coming. Cyclists should always ride in the direction of vehicular traffic and obey traffic signals, including those installed on segregated bike paths.

As a city cyclist, I don’t rely on drivers and passengers to see me coming. I’ve learned to give parked vehicles a wide berth and scan for cars about to pull out or doors being opened. Although I use clip pedals on country roads and bike trips, I never use them when riding in the city, where one’s feet should be free to leave the bike in an instant when necessary.

Of course, traffic-calming measures that reduce vehicular speeds, especially in residential areas, would go a long way toward minimizing the risk to cyclists. And more bike lanes, especially ones protected from traffic, are needed everywhere. When painted a different color from the roadway, they increase visibility and may help keep vehicles from double-parking in them, forcing cyclists into traffic lanes.

Peter Lyndon Jacobsen, a public health consultant in Sacramento who found that walking and cycling were safest when there were more walkers and cyclists on the streets, suggested that motorists adjusted their behaviorwhen there were more people to watch out for. While that bodes well for the future, it’s still up to cyclists to remain ever vigilant. That means riding without earbuds that reduce the sound of an approaching vehicle and not texting or talking on cellphones unless you’re stopped.

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