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Circulation. Author manuscript; available in PMC 2013 February 7.
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Published in final edited form as:
Circulation. 2012 February 7; 125(5): 729–737. doi:10.1161/CIRCULATIONAHA.110.969022.
The Role of Built Environments in Physical Activity, Obesity, and
CVD
James F. Sallis, Ph.D.,
Department of Psychology, San Diego State University
Myron F. Floyd, Ph.D.,
Department of Parks, Recreation and Tourism Management, North Carolina State University
Daniel A. Rodríguez, Ph.D., and
Department of City and Regional Planning, University of North Carolina, Chapel Hill
Brian E. Saelens, Ph.D.
Seattle Children’s Research Institute, University of Washington
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Abstract
In industrialized nations like the United States and Sweden, the vast majority of adults do not meet
the physical activity guidelines of 150 minutes per week.1 Inactive lifestyles put most adults at
risk of cardiovascular diseases (CVD), diabetes, obesity, some cancers, osteoporosis, and
psychological disorders.2 Physical activity can be effective at all phases of chronic disease
management, from primordial prevention (prevention of risk factors) through treatment and
rehabilitation.2 There is particular interest in the potential for physical activity to prevent chronic
diseases, thereby improving quality of life and reducing health care costs.3 In the past decade,
limitations of prevention approaches that target mainly individuals with educational and
motivational programs have been recognized, triggering a trend to consider influences on behavior
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For correspondence: James F. Sallis, Ph.D., Department of Psychology, San Diego State University, 3900 Fifth Avenue, Suite 310,
San Diego, CA 92109, sallis@mail.sdsu.edu.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our
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Disclosures
James F. Sallis:
Research Grant: Active Living Research, RWJF, Amount: >= $10,000
TEAN, NIH, Amount: >= $10,000
IPEN, NIH, Amount: >= $10,000
Senior Neighborhood Quality of Life Study-2, NIH, Amount: >= $10,000
Honoraria: non-profits only; no company, Amount: < $10,000
Myron F. Floyd:
Research Grant: US Department of Agriculture, Amount: >= $10,000
Active Living Research, a program of the Robert Wood Johnson Foundation, Amount: >=$10,000
Other Research Support: North Carolina State Natural Resources Foundation, Inc., Amount: < $10,000
Consultant/Advisory Board: Amount: < $10,000
Member, National Policy and Legal Analysis Network to Prevent Childhood Obesity,
Daniel A. Rodríguez:
Research Grant: National Institutes of Health, Amount: >= $10,000
National Institutes of Health, Amount: >= $10,000
Active Living Research, a program of the Robert Wood Johnson Foundation, Amount: >=$10,000
Consultant/Advisory Board: Healthy Plan Making Research Study, led by the American Planning Association and funded by the
CDC, Amount: < $10,000
Brian E. Saelens:
Research Grant: National Institutes of Health, Amount: >= $10,000
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that are outside the person, such as the built environment.4,5 The purposes of the present paper are
to describe multilevel ecological models of behavior as they apply to physical activity, describe
key concepts, summarize evidence on the relation of built environment attributes to physical
activity and obesity, and provide recommendations for built environment changes that could
increase physical activity. The intent of this non-systematic review is to present conclusions from
previous reviews then illustrate results by highlighting selected studies.
Keywords
exercise; ecological model; recreation; transportation
An Ecological Model of Physical Activity
Ecological models specify multiple levels of influence on behavior, from individual and
social factors, to institutional, community, built environment, and policy factors. A key
principle is that interventions should be most effective when they change the person, the
social environment, as well as built environments and policies.6 Motivating a person to
change in an environment that poses many barriers is not expected to be very effective, nor
is providing a supportive environment in the absence of educational interventions to
promote use of those environments.
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Built environments are the totality of places built or designed by humans, including
buildings, grounds around buildings, layout of communities, transportation infrastructure,
and parks and trails.7 Policies can be laws and regulations at any level of government,
corporate practices, and rules at institutions like schools. Changing built environments and
policies is expected to have long-term impact on most or all of the people in those places.
Characteristics of built environments, from neighborhoods to cities, have been related to
rates of chronic disease and mental health8–10 and risk factors such as obesity11,12 and
hypertension.11 Physical activity is believed to be a critical mechanism by which built
environments can affect chronic disease.8,9
Societal changes over decades have dramatically reduced the need for physical activity in
daily life while creating ubiquitous barriers to physical activity. Mechanization and
computerization have reduced physical activity at work, labor saving devices have reduced
activity required for household chores, and investments and policies that favored travel by
automobiles have reduced walking and bicycling for transportation. Although these societal
changes have had some desirable effects, they have also led to a decrease in daily physical
activity.
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Physical activity can be classified into four domains of life that describe how people spend
their time: leisure/recreation/exercise, occupation (school for youth), transportation, and
household.13 The four domains are relevant to and driven by different built environment
features and policies. Figure 1 is a simple ecological model of physical activity that
identifies institutional and community built environment settings and features, as well as
policies, that are relevant to each physical activity domain.
A commonality across all of the environmental settings identified in Figure 1 (i.e., recreation
facilities, community design, transportation facilities, workplaces, schools, homes) is that
none is controlled by health professionals. Yet these places can affect health. Thus, for both
research and practical applications, it is necessary for health professionals to develop
partnerships with professionals from diverse and often unfamiliar disciplines and sectors of
society.14
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The need for a multi-level, multi-sector approach to physical activity promotion, obesity and
CVD prevention has been recognized by numerous health organizations.4,15–18 These
recommendations justify a vigorous research program to identify modifiable environmental
attributes and policies that have the strongest or most widespread effects/associations to
guide intervention efforts. The Active Living Research program of The Robert Wood
Johnson Foundation has been funding such studies since 2003,19 and the US National
Institutes of Health includes environment and policy research in the Strategic Plan for NIH
Obesity Research.20 Environmental research on physical activity has grown rapidly since
2000, has been reviewed numerous times,21–24 and is informing policy debates at all levels
of government.
Because investigators do not have control over the policy or environment "intervention", it is
rarely possible to randomly assign people or places to experimental conditions. Thus, most
of the studies are observational, though quasi-experimental studies have become more
common. In the present non-systematic review, overviews of the literature are provided and
illustrative results are described as related to active transportation and active recreation,
because these physical activity domains appear most amenable to environment and policy
intervention. Because there is limited evidence about how built environments are related to
occupational and household physical activity, these domains were not addressed.
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Built Environments and Active Recreation
Healthy People 202025 and the Institute of Medicine16 identified public parks and recreation
facilities as providing settings for diverse recreation activities for children, families, and
organizations such as schools and faith-based institutions. Provision of parks and recreation
is a function of government in all developed countries. In the United States, parks are
administered by municipal, county, state, and federal levels of government as well as special
park districts.26 There are more than 9,000 local park and recreation departments with
108,000 public park facilities and 65,000 indoor recreation facilities in the US.27 Because
parks and recreation facilities are generally accessible to populations at highest risk of
inactivity and are available at low user costs, they are well positioned to play a role in
disease prevention. Their provision, design, and quality can be influenced through public
policy.26,28
Recreation environments and active recreation
Availability of and proximity to recreation facilities have been associated consistently with
greater physical activity among adults,29–32 adolescents,33–35 and children,33,34,36,37 with
some exceptions.38
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A national study of US adults found perceived access to parks and trails was positively
associated with physical activity.29 Respondents perceiving access to these resources were
nearly two times more likely to meet physical activity guidelines than those who did not
perceive these resources were available. A 3-city study found that objectively-measured
density of parks and recreation facilities was associated with physical activity among
adults.30 An observational study39 in Tampa and Chicago assessed energy expenditure
associated with different activity zones in 28 neighborhood parks. Courts (basketball and
racquet sports), playgrounds, and soccer fields generally were associated with greater energy
expenditure than baseball/softball fields, picnic areas, and open spaces (Figure 2).
Trails and greenways can be used for active recreation and active commuting. People who
used trails on a weekly basis were twice as likely to meet physical activity
recommendations.40 A study in Dallas, Chicago, and Los Angeles demonstrated that greater
trail usage was associated with trail characteristics such as mixed views (a combination of
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urban and natural scenery), lighting, good trail conditions, cafes, and restrooms.41 Lower
usage was associated with litter, noise, and high density of vegetation on the trails.
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Similar results were found in studies of adolescents and children. A national study of 17,000
adolescents found that odds of participating in frequent physical activity were greater when
there were more recreation facilities nearby (Figure 3).34 A large study36 of Atlanta, GA
youth found that the presence of recreation space within 1km of home was related to walk
trips among all age groups (ages 5 to 20) and was the strongest predictor of walking among
youth in the 15 to 20 age group. Cohen et al.33 found that parks with playgrounds, basketball
courts, walking paths, tracks, swimming areas, and multiple purpose rooms were associated
with greater non-school physical activity among adolescent girls. Thus, presence of parks
and trails, as well as the design of these facilities have been related to physical activity.
Recreation environments and obesity
There is limited research on the link between access to recreation environments and weightrelated outcomes. Findings generally do not support associations between recreation
environments and obesity for either adults or youth.12 This is not surprising because
recreation environments are just one component of the built environment. One notable
exception was a US national study of adolescents that found odds of being obese were lower
among youth in neighborhoods with more recreation facilities (Figure 3).34
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Interventions and active recreation
A few studies evaluated impacts of environmental interventions in park and recreation
settings using quasi-experimental designs. For instance, a study conducted in ethnically
diverse communities in San Francisco compared visitation and physical activity in two
renovated parks to a control park.42 Renovations included turf replacement, new fencing and
lighting, and additional programming. Both “intervention" parks experienced a significant
increase in youth and adult visitors. Another study investigated whether expansion of a skate
park and improvements to a community center for older adults (e.g., building renovations
and adding exercise equipment) were related to facility use and physical activity, with
comparisons to two control parks.43 Renovation of the skate park was associated with a sixfold increase in use and more physical activity. Use levels of the renovated senior center
actually declined compared to baseline and was not significantly different than control
parks. The researchers suggested the decline might be explained by park users not being
aware of the renovations. This highlights the importance of coupling informational and
environmental interventions, consistent with ecological models.44
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Built Environments and Active Transportation
Active transportation has declined in recent decades. Between 1977 and 1995, the number of
all walking trips decreased by 32 percent for adults, with similar reductions for youth.45
Adults walk for only 21.2 percent of trips that are one mile or less, and children walk for
only 35.9 percent of trips to school of that distance.45 Reversing the recent decline in rates
of walking and biking for transportation, especially for short trips, presents a major
opportunity for improving health for all ages. Evidence is accumulating about how the built
environment can support active transportation, and this evidence can inform policy changes.
Built environment, active transportation, and physical activity
Key characteristics of built environments and community design are land use (residential,
commercial, institutional, or park and open space), intensity (population density), location
relative to other community destinations, the interconnections available to reach those
destinations, and aesthetic qualities. Having a variety of destinations close by has been
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positively associated with walking and bicycling for transportation.22,23,46–48 Destinations
refer to land uses that are frequently accessed in daily life for shopping, education, work,
and recreation. Proximity to parks and commercial areas is associated with higher active
transportation.24,49
Population density refers to the number of individuals or households living in a particular
area and is consistently associated with higher active transportation.23,46 In areas of high
density, destinations can be closer together because the number of people needed to support
shops, services, and schools is found in a smaller area.
Ttransportation facilities that connect residential areas and destinations also are related to
active transportation. When neighborhoods have sidewalks, streets are well-lit, and
pedestrians are shielded from traffic, residents are often found to walk more and have higher
physical activity, though results are not highly consistent.46,47,50,51 Having bicycle paths or
trails that separate bicycles from traffic is sometimes associated with increased bicycle
use.48,52
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Public bus and rail stops nearby have been positively associated with active
transportation.51,53,54 People who use public transportation tended to be more active and
less likely to be overweight and obese than adults who did not use public transportation.55
Nationwide, 29 percent of those who used transit were physically active for 30 minutes or
more each day, solely by walking to and from public transit.54
Many of the environmental factors associated with active transportation among youth are
similar to findings with adults. Two reviews56,57 found consistent evidence that proximity to
destinations and the presence of paths for walking and bicycling are important for active
transportation among youth.58 Living in neighborhoods with high density and a variety of
non-residential land uses such as parks, play areas, and recreational facilities is associated
with higher rates of active transportation in children58 and overall physical activity.57 One
difference from the evidence on adults is that for children, the importance of commercial
uses close to home is more equivocal.58
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A commonality across adults and children is the concern regarding safety from traffic as a
barrier to physical activity. Parental concern about personal and traffic safety has been
associated with whether children are allowed to walk or bicycle in their community or to and
from school.56,59 Focusing on behavior-specific correlates, such as with active transport to
school, promises to clarify associations and provide more concrete guidance regarding
environmental interventions.57,60 Higher rates of walking to school have been consistently
associated with closer proximity to school, greater population density, and supportive
pedestrian infrastructure and safety conditions on the route.57,59,60 Active transportation to
school supplements, and does not replace, other physical activity.56
Many of the built environment characteristics described often occur simultaneously in urban
areas. Places with high density usually are well-connected, have destinations close by, and
are well-served by infrastructure for walking, bicycling, and public transportation. This covariation suggests that isolating the effects of built environment characteristics on physical
activity outcomes is methodologically difficult and may be conceptually unwise because
cumulative effects of several environmental attributes may be required to have a large effect
on behavior. Some studies have focused on the package of attributes by sampling
individuals from neighborhoods deemed a priori as highly supportive or unsupportive of
physical activity. Although not unanimous,22 the evidence consistently indicates that
walking is higher in high-walkable neighborhoods than in low-walkable neighborhoods. A
walkable environment was defined based on its land use mix, street connectivity, residential
density, and retail intensity. In a study of 32 neighborhoods in Seattle (WA) and Baltimore
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(MD) regions, neighborhood walkability was related to both higher reported walking for
transportation (20–40 more minutes per week) and higher objectively-measured total
physical activity (35–49 more minutes per week).61 An international study showed adults in
the most activity-supportive environments were twice as likely to meet physical activity
guidelines as those in the least-supportive neighborhoods.51
There are fewer studies focusing on rural populations, even though rural residents are at high
risk of poor health outcomes.62 For rural residents, traffic safety, recreation facilities, and
trails were most consistently associated with physical activity.
Built environments and obesity
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Studies on associations between the built environment and obesity have produced mixed
findings in adults. Although some neighborhood studies found that walkable neighborhoods
protect against overweight and obesity,61,63 a review concluded there are inconsistent
associations of walkable neighborhoods and their components with obesity-related
outcomes.46 Body fat accumulates over time, so studies of cumulative exposures rather than
cross-sectional associations may be more likely to detect impacts of the built environment.
Alternatively, cross-sectional associations could be due to self-selection bias and not be
confirmed in longitudinal studies. A large study showed significant cross-sectional, but not
longitudinal associations between built environments and weight status.64 It is possible that
longitudinal changes in built environments must be substantial and well-measured to detect
associations with BMI change.
Among children, the evidence on associations between the built environment and obesity or
overweight appears equally mixed. Galvez et al65 reported that, although most built
environment variables were not associated with childhood obesity in 15 studies, distance to
playgrounds and density of rail stations were associated with obesity in the anticipated
direction. In a prospective study, active commuters to school had significantly lower BMI
than non-active commuters, but active commuting to school was not associated with BMI
change.66
Interventions and active transportation
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Although bricks and mortar solutions are important, research has emphasized the importance
of programming and policies to support infrastructure changes. Programming for active
transportation to schools (such as safe routes to school and the walking school bus) has been
associated with increased physical activity among children, though the studies are
methodologically weak.67 Policies play a crucial role in encouraging active transportation. A
review concluded there is sufficient evidence that community-scale land use regulations and
policies can be effective in increasing walking and bicycling.68 Policies also support
complementary strategies such as programs and promotions to encourage active
transportation. This is particularly apparent in interventions to promote bicycling in which
single strategies had little effect, but uncontrolled evaluations of cities that used multiple
strategies, including protected bicycle facilities, bicycle sharing, and policies favoring
cyclists, appeared to be consistently effective.69
Disparities in Access to Activity-Supportive Built Environments
Disparities in access to parks and recreation facilities
In light of the potential of parks and recreation facilities to increase physical activity,
understanding the extent of their availability and quality in low income and racial/ethnic
minority communities is of importance in efforts to eliminate health disparities. A national
study34 showed that areas with college educated populations were 3 and 4 times more likely,
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respectively, to have at least 1 park or other outdoor recreation resource than areas with less
educated residents. Neighborhoods with populations that were 95% minority and
overwhelmingly without college education (5% or less) had 46% lower odds of having at
least one recreation facility. Having a recreation facility nearby is only one aspect of
addressing income and ethnic disparity. Quality of facilities, safety, and recreation
preferences of community member should also be considered.
Disparities in built environments relevant to active transportation
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It appears that disparities in access to activity-supportive community environments vary
across attributes. There is little evidence that Hispanics and Blacks, or that low income
populations, are disadvantaged with respect to the density of areas in which they live.70,71
Racial and ethnic minority and low-SES groups may be particularly sensitive to the built
environment. In a review, light traffic, safety from crime, and sidewalks were most
consistently associated with physical activity among Black Americans.71 However, low-SES
or high-minority neighborhoods appear to have less supportive environmental conditions for
active transportation. A review concluded that disadvantaged neighborhoods had poorer
aesthetics and worse conditions related to traffic safety and crime safety.71 For example, a
study of two US regions found that lower- and higher-income neighborhoods did not differ
substantially on commonly assessed walkability variables, but lower-income neighborhoods
had less favorable values on pedestrian/cycling facilities, aesthetics, access to recreation
facilities, traffic safety, and crime safety.72 These poor conditions could potentially
overcome the beneficial effects of living in a walkable low-income neighborhood.
Recommendations for Environment and Policy Change
Recent recommendations for increasing physical activity and reducing obesity and CVD risk
retain some educational focus (e.g., benefits of physical activity, behavior change skills), but
most emphasize more sustainable and broader reaching environmental and policy changes.
Various organizations’ recommendations15,16,73–77 in these areas are provided in Table 1,
with sample strategies that target environmental or policy change. These recommendations
have different desired outcomes (e.g., obesity prevention versus physical activity promotion
only), but considerable overlap in the types of proposed intervention strategies.
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As seen in Table 1, the recommendations target many of the contexts encountered in daily
living, such as transportation systems, neighborhood built environments, schools, worksites,
and the media. These recommended strategies are also broad in type, targeting changes in
physical activity across multiple domains, from encouraging changes to the availability of
resources for leisure time physical activity (e.g., more parks and green space) to changes in
zoning and land use patterns expected to impact transportation choices.
An example set of recommendations is the American Heart Association’s (AHA) recent
policy strategies for achieving ideal cardiovascular health published in Circulation.15 In
addition to an emphasis on the healthcare system, the recommendations include strategies
for targeting built environment (e.g., walk/bike trails, safe routes to schools) and policy
interventions (e.g., shared use agreements for recreation facility use between schools and
communities). The predecessor to these strategies within AHA appears to be the 2003 guide
for improving cardiovascular health at the community level,5 which included many of the
same environment and policy recommendations. It is noteworthy that the more recent
recommendations had considerably less focus on individual-level education (e.g., school
curriculum about CVD risks), perhaps recognizing the need to prioritize environment and
policy changes before expecting educational interventions to be effective.
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From recommendations to interventions
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Recommendations summarized in Table 1, based on limited evidence and often expert
opinion, have guided large-scale initiatives to implement change in built environments and
policy. Some evidence regarding environment and policy interventions does exist. The
December 2009 supplement to American Journal of Preventive Medicine highlighted
outcomes from communities engaging in environment and policy change through the Robert
Wood Johnson Foundation’s Active Living by Design program. For example, Jackson,
Michigan developed “Project U-Turn”. In addition to physical activity education and
programming, changes in the physical environment (e.g., construction of a rail-trail) and
policy (e.g., streets must accommodate all modes of travel –including pedestrians and
bicyclists) around physical activity were realized, with corresponding increases in active
transportation.78
The “Shape Up Somerville” trial compared community-wide interventions for childhood
obesity in Somerville, Massachusetts to two non-intervention cities matched on sociodemographic factors. “Shape Up Somerville” interventions cut across levels of the
ecological model and included pedestrian infrastructure/safety, walk to/from school
campaigns, and new school play equipment. Most notable is that this comprehensive set of
community-wide interventions had a documented impact on reducing child overweight/
obesity prevalence79 and increasing physical activity80 at the population level.
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Among the largest initiatives was the CDC's Communities Putting Prevention to Work
(CPPW) grant program, which awarded over $250 million in 2010 to change environments
and policies to improve nutrition and physical activity and prevent obesity.
(http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/communities/index.htm).81
Recommended strategies were based on MAPPS: Media, Access, Point of decision
information, Price, and Social support/services
(http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/strategies/index.htm).74
Strategies ranged from improving physical activity in school physical education (access) to
subsidizing memberships to recreational facilities (price) to promoting safe routes to school
(e.g., social support/services) (Table 1). Experience with these initiatives, and systematic
evaluations, will lead to a better understanding of how to accomplish policy and
environmental change in diverse communities and provide important information about the
impact of these changes.
Summary and Conclusions
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There is a growing consensus that large changes in population levels of physical activity and
other behaviors required to improve cardiovascular health will require major modifications
in environments and policies. Ecological models are the conceptual basis for comprehensive
interventions that emphasize environmental and policy changes and that can have
widespread and sustainable effects. These interventions are complemented with individual
education and motivation and efforts to change social support and norms. Physical activityspecific ecological models indicate which environmental factors are expected to be related
to physical activity in multiple life domains: leisure/recreation/exercise, occupation (school
for youth), transportation, and household. Over the past decade, a proliferation of
interdisciplinary research has generally supported hypotheses derived from ecological
models and identified specific built environment attributes and combinations of attributes
that are related to physical activity, mainly for recreation and transportation purposes, and
obesity. It is becoming clear that racial-ethnic minority and low-income communities are
disadvantaged in access to recreation facilities, positive aesthetics, and protection from
traffic. These results provide an empirical rationale for intervention.
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There are recent examples of environmental changes or community-wide multi-level
interventions that had positive effects on physical activity or obesity. Continuing research
needs are to improve the rigor of study designs, confirm subgroup- or context-specific built
environment associations, identify optimal combinations of attributes, improve
understanding of the policy change processes required to achieve environmental changes,
and evaluate multi-level interventions.
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Both research teams and community-based initiatives are collaborating with a wide range of
professionals and sectors of society, such as recreation, transportation, city planning,
architecture, landscape architecture, geography, criminal justice, and law, in addition to
health professionals and behavioral scientists. These diverse teams have stimulated
innovations in research, new approaches to intervention, and improved connections with
decision makers who can make environment and policy changes in non-health sectors of
society. The practice of physical activity promotion, obesity prevention, and CVD risk
reduction has changed to reflect the shift to multi-level interventions. Major foundations and
public health agencies are implementing community-based interventions targeting
environment and policy change. Continuing challenges for these community-wide
interventions are to maintain support for the multi-sector, long-term efforts required to
change environments, evaluate interventions so they become ever more evidence-based, and
integrate explicit chronic disease prevention objectives into professional practices of diverse
disciplines, government agencies, and industries whose primary work can affect physical
activity and health.
Acknowledgments
Lisa Husak assisted with preparation of this manuscript.
Funding Sources
Sallis: Active Living Research, a program of The Robert Wood Johnson Foundation, NIH Grants R01 CA127296,
R01 HL083454, R01 HL67350.
Floyd: IPARC Initiative, North Carolina State Natural Resources Foundation, Inc. and USDA Forest Service Grant
10-DG-11420004-002
Rodríguez: NIH Grants R01 HL071244 , R01 HL092569.
Saelens: NIH Grant R01 ES014240
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Figure 1.
An Ecological Model of Four Domains of Physical Activity
Adapted from reference 14
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Figure 2.
Mean energy expenditure (kcal/kg/min) per park in 10 Tampa FL neighborhood parks by
activity zones (N=6,922)
Adapted from reference 39
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Figure 3.
Relative odds of overweight and >5 bouts of moderate to vigorous physical activity (MVPA)
with increasing number of recreation facilities per block group, adjusted for population
density
Adapted from reference 34
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Table 1
NIH-PA Author Manuscript
Recent U.S.-based recommendations for modifying built environments and/or policies for physical activity
promotion, obesity prevention, and cardiovascular disease risk reduction
NIH-PA Author Manuscript
NIH-PA Author Manuscript
Source
Primary
target(s)
Levels of
intervention
Example built
environment or
policy
recommendation
for increasing
physical
activity
Web access
American
Academy
of
Pediatrics
(2009)73
Physical
activity
promotion in
children
Community
“Create and
maintain
playgrounds,
parks, and green
spaces …[and]
means to access
them safely”
http://aappolicy.aappublications.org/cgi/collection/committee_on_environmental_health
American
Heart
Association
Policy
Strategies
(2011)15
Ideal
cardiovascular
health
Community,
food supply,
healthcare
system,
media,
restaurants,
schools,
worksites
“Implement
zoning/building
ordinances that
encourage
…pedestrianfriendly streets
and roadways
with appropriate
crosswalks,
sidewalks, traffic
lights, etc and
slower speed
limits in
walking/biking
areas”
http://circ.ahajournals.org/cgi/content/full/123/7.816
CDC*
MAPPS†
interventions
for
CPPW‡,
Obesity
prevention
Community,
food
retailers,
media,
recreational
facilities,
restaurants,
schools,
worksites
Provide
“incentives for
active transit”
http://www.cdc.gov/CommunitiesPuttingPreventiontoWork/strategies/index.htm
CDC*
Recommended
Strategies
for
Obesity
Prevention
(2009)75
Obesity
prevention
Community,
public
service
venues,
schools
“Zone for mixedused
development”
www.cdc.gov/obesity/downloads/community_strategies_guide.pdf
Institute
of
Medicine
(2009)16
Childhood
obesity
prevention
Community,
retail food
outlets and
restaurants,
worksites,
childcare,
government
nutrition
assistance
programs,
“Adopt
community
policing
strategies that
improve safety
and security for
park use,
especially in
higher crime
neighborhoods”
http://www.nap.edu/catalog/12674.html
National
Physical
Activity
Plan76
Physical
activity
promotion
“Increase
accountability of
project planning
and selection to
ensure
infrastructure
supporting active
transportation
and other forms
http://www.physicalactivityplan.org/
74
Circulation. Author manuscript; available in PMC 2013 February 7.
Sallis et al.
Source
Page 18
Primary
target(s)
Levels of
intervention
NIH-PA Author Manuscript
Example built
environment or
policy
recommendation
for increasing
physical
activity
Web access
of physical
activity”
White
House
Task
Force on
Childhood
Obesity
(2010)77
Childhood
obesity
Federal and
state
government
and
agencies,
and local
community,
schools,
local
businesses
and other
private
sector
partners
(e.g.,
entertainment
companies)
“The
Environmental
Protection
Agency should
assist school
districts that may
be interested in
siting guidelines
for new schools
that consider the
promotion of
physical activity,
including
whether students
will be able to
walk or bike to
school”
http://www.letsmove.gov/white-house-task-force-childhood-obesity-report-president
*
NIH-PA Author Manuscript
CDC = Centers for Disease Control and Prevention
†
MAPPS = Media, Access, Point of decision information, Price, and Social support/services
‡
CPPW = Communities Putting Prevention to Work
NIH-PA Author Manuscript
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