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Physical Activity: Built Environment Approaches Combining Transportation System Interventions with Land Use and Environmental Design

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What the CPSTF Found

About The Systematic Review

This CPSTF considered evidence from a Community Guide systematic review of 90 studies (search period through June 2014). The CPSTF issued their finding based on evidence from 16 longitudinal studies. They also considered additional evidence from 74 cross-sectional studies.

This review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to physical activity and the built environment. This review replaces the 2004 CPSTF findings for Physical Activity: Community-Scale Urban Design and Land Use Policies pdf icon [PDF - 895 kB], Physical Activity: Street-Scale Urban Design Land Use Policies pdf icon [PDF - 870 kB], and Physical Activity: Transportation and Travel Policies and Practices pdf icon [PDF - 688 kB].

Context

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Summary of Results

More details about study results are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 849 kB].

The systematic review included 90 studies—16 longitudinal studies and 74 cross-sectional studies. Studies were grouped into categories based on the type of built environment comparison:

  • Construction projects—Studies evaluated the impact of two or more changes to physical characteristics of the built environment on existing residents or people moving into a new environment.
  • Pre-defined neighborhood types—Studies compared residents from selected neighborhoods that had distinct built environment characteristics (typically based on neighborhood layout or design).
  • Existing built environments—Studies used summary scores from standardized assessments to compare communities with different built environment characteristics.
  • Policies restricting sprawl—Studies compared communities based on built environment characteristics associated with sprawl development or proximity to sprawl-affected areas.

Within each category, reported outcomes were grouped into one of six physical activity outcomes:

  • Transportation-related walking or biking
  • Recreation-related walking or biking
  • Total walking
  • Total physical activity
  • Moderate to vigorous physical activity (MVPA)
  • Meeting recommended levels of MVPA

Longitudinal Evidence (16 studies)

Construction Projects

The evidence included 11 studies.

  • One long-term, large-scale study—the community-level natural experiment, Residential Environments Project (RESIDE)—compared changes in physical activity among new residents based on built environment characteristics of their different neighborhoods.
    • Researchers found a dose-response relationship between physical activity and the degree of implementation of activity-friendly improvements.
  • Ten studies used before-after designs to evaluate neighborhood or community-level projects that were smaller in scale.
    • Transportation-related walking and biking
      • Significantly increased (2 studies)
      • Increased (3 studies)
      • Showed mixed results (1 study)
      • Decreased (1 study)
    • Recreation-related walking and biking
      • Significantly increased (1 study)
      • Increased (1 study)
    • Significantly more people achieved recommended levels of MVPA (1 study)
    • MVPA increased (1 study)
    • Total walking increased significantly (1 study)
    • Total physical activity increased significantly (1 study)
    • Effects on mode of transportation were mixed (1 study)
Existing Built Environments

Four studies used composite index scores to evaluate the effects of adding or enhancing built environment features to increase physical activity.

  • Transportation-related walking and biking
    • Significantly increased (2 studies)
    • Increased (1 study)
  • Recreation-related walking and biking
    • Increased (1 study)
    • Had no effect (1 study)
    • Showed mixed results (1 study)
  • MVPA increased (1 study) and showed mixed results (1 study)
Policies Restricting Sprawl

The evidence included one study.

  • Transportation-and recreation-related walking and biking increased significantly following implementation of state-and metropolitan-level policies that restricted or regulated sprawl.

Cross-sectional Evidence (74 studies)

Neighborhood Type

The evidence included seven studies that compared residents from two types of existing built environment neighborhoods:

  • More activity-supportive neighborhoods (e.g., new urbanist, neo-traditional, or traditional neighborhood development)
  • Less activity-supportive neighborhoods (e.g., neighborhoods with dead-end cul-de-sacs, looping streets, contemporary suburbanism)
  • More activity-supportive neighborhoods reported higher levels of physical activity for the following:
    • Transportation-related walking and biking physical activity (4 studies; 1 study showed mixed results)
    • Recreation-related walking and biking (4 studies)
    • Total walking (1 study)
    • Total physical activity (1 study)
  • Two studies measured the proportion of residents who achieved recommended levels of MVPA and found no difference (1 study) or mixed results (1 study).
Existing Built Environments

The evidence included 62 studies that used summary scores to evaluate the effects of built environment features on physical activity.

  • Activity-friendly built environment features were associated with levels of physical activity.
    • Transportation-related walking and biking
      • Studies reported higher levels (18 studies), no difference (5 studies), or lower levels (1 study). Three studies reported mixed results.
    • Recreation-related walking and biking
      • Studies reported higher levels (10 studies) or no difference (4 studies). Two studies reported mixed results.
    • Total walking
      • Studies reported higher levels (12 studies), no difference (4 studies), or lower levels (2 studies).
    • Total physical activity
      • Studies reported higher levels (4 studies), no difference (6 studies), or lower levels (4 studies).
    • Moderate to vigorous physical activity (MVPA)
      • Studies reported higher levels (12 studies), no difference (4 studies), or lower levels (2 studies). One study reported mixed results.
    • Recommended levels of MVPA
      • Studies reported higher proportions of residents achieved recommended levels (3 studies) or found no difference (2 studies).
Sprawl

The evidence included five studies that used three different sprawl indices to assess the relationships between sprawl and physical activity.

  • Lower levels of sprawl (i.e., more compact areas) were associated with higher levels of physical activity for the following:
    • Transportation-related walking and biking (2 studies)
    • Recreation-related walking and biking (1 study)
    • Total physical activity (1 study)
    • Total walking (1 study)
  • There was no relationship between sprawl and total physical activity or other MVPA (1 study).

Summary of Economic Evidence

An economic review of this intervention was not conducted.

Applicability

Based on results, the CPSTF finding should be applicable to the following:

  • Adults and youth
  • Women and men
  • Urban and mixed environments (i.e., urban, suburban, rural)
  • Macro-level interventions (elements of overall community design related to walkability)
  • Micro level interventions (e.g., bike racks, street-crossing amenities)

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • What are the long-term effects of built environment intervention approaches? Do they help develop regular physical activity habits that stay with residents from childhood to adulthood?
  • What are the challenges associated with updating and refining summary assessment tools (e.g., walkability indices)? What are the best measures for both objective and perceived environmental characteristics?
  • What is needed to conduct more longitudinal studies (e.g., length of study, cost, study protocol, researcher and stakeholder buy-in)?
  • What specific combinations of built environment intervention approaches have greater, or more robust effects on physical activity?
  • What types of studies effectively capture the magnitude of change in physical activity by time, amount, intensity, or proportion of the population influenced?
  • What types of analyses are best to quantify the magnitude of individual change and the overall impact on an exposed population?
  • How effective are studies implemented in communities that vary by population, race/ethnicity, or socioeconomic status?
  • How is physical activity influenced by setting (i.e., urban, suburban, rural settings)?

Study Characteristics

  • Longitudinal study designs included other designs with concurrent comparison (2 studies), and before-after without a comparison group (14 studies). Remaining studies used a cross-sectional design (74 studies).
  • Studies were conducted in the United States (52 studies), Canada (7 studies), Belgium (7 studies), Australia (5 studies), New Zealand (4 studies), the United Kingdom (4 studies), Sweden (3 studies), the Netherlands (2 studies), Czech Republic (1 study), Denmark (1 study), France (1 study), and Germany (1 study). Two studies were conducted in multiple countries.
  • Studies were conducted in urban (25 studies), suburban (5 studies), and mixed (60 studies) areas.
  • Study populations mainly included adults (ages 18-64 years old; 31 studies), youth (ages 17 and younger; 18 studies), and older adults (aged 65 and older; 6 studies). Eleven studies measured effects on the general population or more than one age group, and the remaining 24 studies did not report age.
  • Across all studies, approximately 54% of participants were female. Eight studies only assessed changes in physical activity among women.
  • Some studies reported on level of educational attainment (19 studies), or income status (14 studies) with limited information provided for race/ethnicity (2 studies).
  • Included studies evaluated macro-level interventions (50 studies), micro-level (12 studies) interventions, or both (28 studies).

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