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== Introduction ==
== Introduction ==
The environment is integral to encouraging physical activity.<ref>Goldstein B. The environment and health:a conversation with CDC chief Jeffrey Koplan; tracing intersections between behaviour and environment fascinates this top health officer. Health Affairs 2002;21:179-184  [Pub Med]</ref>  The built environment is an aspect of the environment that is increasingly receiving research attention.<ref name=":2">Sallis JF, Floyd MF, Rodriguez DA, Saelens BE. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012;125(5):729-37</ref>  Recommended levels of physical activity can be achieved by including activities such as walking, cycling as part of everyday life. This can be encouraged with a supportive built environment. Even though individual and social factors affect physical activity,<ref>Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin BW. Correlates of Physical Activity: Why are some physically active and others are not? Lancet 2012;380(9838):258-271.</ref> research has shown that a well-designed environment matters.<ref>Brownson RC, Hoehner CM, Day K, Forsyth A, Sallis JF. Measuring the built environment for physical activity: State of Science. ''Am J Prev Med''.2009;36(4 Supplement):S99-S123.e12.</ref><ref name=":1">Ding D, Sallis JF, Kerr J, Lee S, Rosenburg DE. Neighborhood environment and physical activity among youth: A Review. ''Am J Prev Med.''2011;41(4):442-455.</ref><ref name=":3">Sugiyama T, Leslie E, Giles-Corti B, Owen N. Physical activity for recreation or exercise on neighborhod streets: Associations with perceived environmental attributes. Health Place 2009;15(4):1058-1063.</ref> Public health professionals can advocate for policies to help shape the design of cities and suburbs in ways to encourage physical activity.
The environment is integral to encouraging [[Physical activity|physical activity.]]<ref>Goldstein B. The environment and health:a conversation with CDC chief Jeffrey Koplan; tracing intersections between behaviour and environment fascinates this top health officer. Health Affairs 2002;21:179-184  [Pub Med]</ref>  The built environment is an aspect of the environment that is increasingly receiving research attention.<ref name=":2">Sallis JF, Floyd MF, Rodriguez DA, Saelens BE. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012;125(5):729-37</ref>  Recommended levels of physical activity can be achieved by including activities such as walking, cycling as part of everyday life. This can be encouraged with a supportive built environment. Even though individual and social factors affect physical activity,<ref>Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin BW. Correlates of Physical Activity: Why are some physically active and others are not? Lancet 2012;380(9838):258-271.</ref> research has shown that a well-designed environment matters.<ref>Brownson RC, Hoehner CM, Day K, Forsyth A, Sallis JF. Measuring the built environment for physical activity: State of Science. ''Am J Prev Med''.2009;36(4 Supplement):S99-S123.e12.</ref><ref name=":1">Ding D, Sallis JF, Kerr J, Lee S, Rosenburg DE. Neighborhood environment and physical activity among youth: A Review. ''Am J Prev Med.''2011;41(4):442-455.</ref><ref name=":3">Sugiyama T, Leslie E, Giles-Corti B, Owen N. Physical activity for recreation or exercise on neighborhod streets: Associations with perceived environmental attributes. Health Place 2009;15(4):1058-1063.</ref>  


The built environment is defined as the part of the physical environment that is constructed or modified by human activity.<ref name=":0">Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci Sport Exer. 2008;40(7 Suppl):S550-66.</ref> It includes homes, schools, workplaces, parks or recreation areas, green-ways, business areas and transportation systems.<ref>National Institute of Environmental Health Sciences 2004 p 2</ref> In public health, a built environment refers to physical environments that are designed with health and wellness as integral parts of communities and it includes open spaces, footpaths, cycle lanes, parks, trails.<ref>Renalds, A; Smith T; Hale, P (2010). "A Systematic Review of Built Environment And Health". Family and Community Health.'''33:''' 68-78.</ref> The emphasis on the role of built environment is necessary as encouraging people to be more physically active in an environment that is not supportive is less likely to be effective.  
The built environment is defined as the part of the physical environment that is constructed or modified by human activity.<ref name=":0">Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci Sport Exer. 2008;40(7 Suppl):S550-66.</ref> It includes homes, schools, workplaces, parks or recreation areas, green-ways, business areas and transportation systems.<ref>National Institute of Environmental Health Sciences 2004 p 2</ref> In public health, a built environment refers to physical environments that are designed with health and wellness as integral parts of communities and it has features like open spaces, footpaths, cycle lanes, parks, trails.<ref>Renalds, A; Smith T; Hale, P (2010). "A Systematic Review of Built Environment And Health". Family and Community Health.'''33:''' 68-78.</ref> The emphasis on the role of built environment is necessary as encouraging people to be more physically active in an environment that is not supportive is less likely to be effective.  


Physical activity can be classified into four domains of life that describe how people spend their time: recreational, occupational, transport and household activities. Recreational and transport physical activity are relevant to and driven by the built environment features.<ref>Pratt M, Macera CA, Sallis JF, O'Donnel M, Frank LD. Economic interventions to promote physical activity: application of the SLOTH model. Am J Prev Med.2004;27 suppl 3:136-145.</ref> Physical activity is promoted by the built environment through walkable neighborhoods, presence of sidewalks, walking paths and bike paths and presence of recreational and sports infrastructure including parks, pools, playgrounds, and sport clubs.  
Physical activity can be classified into four domains of life that describe how people spend their time: recreational, occupational, transport and household activities. Recreational and transport physical activity are relevant to and driven by the built environment features.<ref>Pratt M, Macera CA, Sallis JF, O'Donnel M, Frank LD. Economic interventions to promote physical activity: application of the SLOTH model. Am J Prev Med.2004;27 suppl 3:136-145.</ref> Physical activity is promoted by the built environment through walkable neighbourhoods, presence of sidewalks, walking paths and bike paths and presence of recreational and sports infrastructure including parks, pools, playgrounds, and sport clubs.  


Using the built environment as an intervention for improving physical activity offers numerous advantages. Diverse to individual level approaches, developing a supportive environment has the potential to achieve biggest reach for long term, population-wide improvements in physical activity levels and facilitate behavior change maintenance.<ref>Kwansnicka D, Dombrowski SU, White M, Sniehotta F. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychol Rev. 2016;10:277-96.</ref>  Also, physical activity interventions that reach a large numbers of people over a sustained period of time are often more cost effective than individual level interventions.<ref>Wu S, Cohen D, Shi Y, Pearson M, Sturm R. Economic Analysis of physical activity interventions. ''Am J Prev Med''. 2011;40(2):149-58.</ref>  
Using the built environment as an intervention for improving physical activity offers numerous advantages. Diverse to individual level approaches, developing a supportive environment has the potential to achieve biggest reach for long term, population-wide improvements in physical activity levels and facilitate behaviour change maintenance.<ref>Kwansnicka D, Dombrowski SU, White M, Sniehotta F. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychol Rev. 2016;10:277-96.</ref>  Also, physical activity interventions that reach a large numbers of people over a sustained period of time are often more cost effective than individual level interventions.<ref>Wu S, Cohen D, Shi Y, Pearson M, Sturm R. Economic Analysis of physical activity interventions. ''Am J Prev Med''. 2011;40(2):149-58.</ref>  


== Features of Built Environment ==
== Features of Built Environment ==
Built environment features that are hypothesized to be associated with recreational and transport activity have been divided into four categories;
Built environment features that are hypothesised to be associated with recreational and transport activity have been divided into four categories;
# Recreational resources: walking trails, biking trails, parks and open spaces
# Land use characteristics: residential and employment density, land use mix (types of buildings, services and businesses in the community), street connectivity (grid pattern, cul-de-sac and loop holes) and proximity of destinations (shops, employment and services) to residences.
# Neighbourhood form characteristics: availability of sidewalks and street light
# Community environment: mostly contextual features of the environment such as aesthetics, cleanliness, traffic, crime safety or community support or cohesion.
Specific features of the built environment that has been found to correlate with physical activity levels include mixed land use, residential density and street connectivity.<ref name=":5">Gebel K, Bauman AE, Petticrew M. The physical environment and physical activity: a critical appraisal of review articles. ''Am J Prev Med''. 2007;32(5):361-9</ref><ref name=":2" /><ref name=":3" /><ref name=":0" />These features have the potential to influence walking for recreational and travel related physical activity. For instance, presence of sidewalks and streetlights might make recreational activity more appealing. Meanwhile, proximity to destinations and grid like street patterns might make it easier or more pleasant to walk or bicycle for transportation.


1.      Recreational resources: walking trails, biking trails, parks and open spaces
== Walkable Neighbourhoods ==
The extent to which the built environment is friendly to the presence of people living, shopping, visiting, enjoying or spending time in the area is termed “Walkability.”<ref>Abley, Stephen. “Walkability Scoping Paper” 21 March 2005. Retrieved 4/21/08</ref> A walkable neighbourhood is one that is densely populated, where several businesses and services are present, where the streets are well connected to facilitate easy access by active transportation. Walking and cycling facilities like sidewalks, crosswalks, and bike lanes are also present in a walkable neighbourhood. In contrast, high urban sprawl is characterised by low land use density, low residential density, absence of a downtown and less street connectivity. Walking, cycling and public transport are made impractical with high urban sprawl and as such are associated with sedentary lifestyles.
* Residential density refers to the number of residential units per unit of land area. It means more destinations such as shops, services, and public transport stops nearby.<ref>Lee C, Moudon AV. Correlates of walking for transportation or recreation purposes. J Phys Act Health. 2006;3S77-S98.</ref> <ref name=":4">Saelens BE, Sallis JF, Frank LD: Environmental correlates of waking and cycling: findings from the transportation, urban design and planning literatures. Ann Behav Med 2003, 25: 80-91.</ref>
* Land use mix diversity refers to the level of integration within an area of different types of uses for physical space. This includes residential, office, retail, industry and public space.<ref name=":4" />
* Street connectivity refers to  the ease of travel between two points which is directly related to characteristics of street design. It's characterised by many interconnected streets.<ref name=":4" />
* Accessibility refers to the ease by which desired places or activities can be reached and refers to the land use system and transportation system.<ref>Handy SL: Evaluating neighborhood accessibility: possibilities and praticalities. Journl of transportation and statistics 2001, 4: Dec.</ref>
The design and maintenance of neighbourhoods, streets, parks and people’s perception of those places based on qualities such as aesthetic appeal and perceived safety can affect physical activity in adults and youths. For leisure walking, the perceived aesthetics- visual appeal or pleasantness of an environment- and safety from crime and traffic can affect walking.<ref name=":1" /><ref>Owen N, Humpel N, Leslie E, Bauman A, Sallis JF. Understanding environmental influence on walking: Review and Research Agenda. Am J Prev Med.2004;27(1):67-76</ref> Aesthetic features of the neighbourhood provide an inviting setting for physical activity.


2.      Land use characteristics: residential and employment density, land use mix (types of buildings, services and businesses in the community), street connectivity (grid pattern, cul-de-sac and loop holes) and proximity of destinations (shops, employment and services) to residences.
Studies relating attributes of neighbourhood environments and physical activity particularly within the U.S, Australia and a few European nations found that walkable neighbourhoods characterised by high density, well connected grid-like street networks and accessible and diverse destinations within walking distance<ref name=":0" /><ref>Heath GW, Brownson RC, Miles R, Powell KE, Ramsey LT: Task Forceon Community Preventive Services. The effectiveness of urban design and land use and transport policies to increase physical activity:  systematic review ''J Phys Act Heal'' 2006,3:S55-S76.</ref> were associated with active transportation, particularly walking for transport.<ref name=":0" /><ref>Ewing R, Cervero R: Travel and the Built Environment. J Am Plan Assoc 2010, 76:265-294.</ref> Additionally, access to parks and recreation facilities shows significant associations with recreational physical activity.<ref>Kaczynski AT, Henderson KA (2007).Enviromental correlates of physical activity: a review of evidence about parks and recreation ammenities Leisure Sciences; 29: 315-54.</ref> The presence of existing and new public transportation options in neighbourhoods appears associated with greater physical activity.<ref>MacDonald JM, Stokes RJ, Cohen DA, Kofner A, Ridgeway GK: The effect of light rail transit on body mass index and physical activity. Am J Prev Med 2010, 39:105-112.</ref><ref>Besser LM, Dannenberg AL: Walking to public transit:steps tp meet physical activity recommendations. Am J Prev Med 2005, 29:273-280.</ref>


3.      Neighborhood form characteristics: availability of sidewalks and street light
==  Relationship between Physical Activity and Built Environment ==
Significant positive association between features of the built environment and physical activity has been established by a number of studies.<ref name=":5" /> The relationship may vary on the basis of the domain of physical activity. Recreation and transportation domains of physical activity are mostly influenced by the built environment. It can also have a dissimilar influence on these domains of physical activity. For instance, a highly connected street can be beneficial for walking for transportation to destinations but detrimental for active play in the streets for children. Walking and bicycling for transportation and/ or leisure are a major form of physical activity worldwide<ref>Kruger J, Ham SA, Berrigan D, Ballard-Barbash R: Prevalence of transportation and leisure walking among U.S adults. Prev Med. 2008, 47:329-334</ref> and such activities can meet recommendations for physical activity.


4.      Community environment: mostly contextual features of the environment such as aesthetics, cleanliness, traffic, crime safety or community support or cohesion.
[[File: Infographic.JPG]]


Specific features of the built environment that has been found to correlate with physical activity levels include mixed land use, residential density and street connectivity.<ref name=":5">Gebel K, Bauman AE, Petticrew M. The physical environment and physical activity: a critical appraisal of review articles. ''Am J Prev Med''. 2007;32(5):361-9</ref><ref name=":2" /><ref name=":3" /><ref name=":0" />These features have the potential to influence walking for recreational and travel related physical activity. For instance, presence of sidewalks, streetlights might make recreational activity more appealing. Meanwhile, proximity to destinations and grid like street patterns might make it easier or more pleasant to walk or bicycle for transportation.


== Walkable Neighborhoods ==
Street connectivity is a feature of the built environment that could have direct influence on physical activity, particularly walking. Well connected street networks create routes that are shorter to destinations which ease walking from place to place. Grid streets designs assists pedestrian movement with two characteristics; frequent intersections and orthogonal geometry.  
The extent to which the built environment is friendly to the presence of people living, shopping visiting, enjoying or spending time in the area is termed “Walkability.”<ref>Abley, Stephen. “Walkability Scoping Paper” 21 March 2005. Retrieved 4/21/08</ref> A walkable neighborhood is one that is densely populated, where several businesses and services are present, where the streets are well connected to facilitate easily access by active transportation. Walking and cycling facilities like sidewalks, crosswalks, and bike lanes are also present in a walkable neighborhood. In contrast, high urban sprawl is characterized by low land use density, low residential density, absence of a downtown and less street connectivity. Walking, cycling and public transport are made impractical with high urban sprawl and as such are associated with sedentary lifestyles.
* Residential density refers to the number of residential units per unit of land area. It means more destinations such as shops, services, and public transport stops nearby.<ref>Lee C, Moudon AV. Correlates of walking for transportation or recreation purposes. J Phys Act Health. 2006;3S77-S98.</ref> <ref name=":4">Saelens BE, Sallis JF, Frank LD: Environmental correlates of waking and cycling: findings from the transportation, urban design and planning literatures. Ann Behav Med 2003, 25: 80-91.</ref>
* Land use mix diversity refers to the level of integration within an area of different types of uses for physical space. this includes residential, office, retail, industry and public space.<ref name=":4" />
* Street connectivity refers to the ease of travel between two points which is directly related to characteristics of street design. It's characterized by many interconnected streets.<ref name=":4" />
* Accessibility refers to the ease by which desired places or activities can be reached and refers to the land use system and transportation system.<ref>Handy SL: Evaluating neighborhood accessibility: possibilities and praticalities. Journl of transportation and statistics 2001, 4: Dec.</ref>
The design and maintenance of neighborhoods, streets, parks and people’s perception of those places based on qualities such as aesthetic appeal and perceived safety can affect physical activity in adults and youths. For leisure walking, the perceived aesthetics- visual appeal or pleasantness of an environment- and safety from crime and traffic can affect walking.<ref name=":1" /><ref>Owen N, Humpel N, Leslie E, Bauman A, Sallis JF. Understanding environmental influence on walking: Review and Research Agenda. Am J Prev Med.2004;27(1):67-76</ref> Aesthetic features of the neighborhood provide an inviting setting for physical activity.  


Studies relating attributes of neighborhood environments and physical activity particularly within the U.S, Australia and a few European nations found that walkable neighborhoods characterized by high density, well connected grid-like street networks and accessible and diverse destinations within walking distance<ref name=":0" /><ref>Heath GW, Brownson RC, Miles R, Powell KE, Ramsey LT: Task Forceon Community Preventive Services. The effectiveness of urban design and land use and transport policies to increase physical activity:  systematic review ''J Phys Act Heal'' 2006,3:S55-S76.</ref> were associated with active transportation, particularly walking for transport.<ref name=":0" /><ref>Ewing R, Cervero R: Travel and the Built Environment. J Am Plan Assoc 2010, 76:265-294.</ref> Additionally, access to parks and recreation facilities shows significant associations with recreational physical activity.<ref>Kaczynski AT, Henderson KA (2007).Enviromental correlates of physical activity: a review of evidence about parks and recreation ammenities Leisure Sciences; 29: 315-54.</ref> The presence of existing and new public transportation options in neighborhoods appears associated with greater physical activity.<ref>MacDonald JM, Stokes RJ, Cohen DA, Kofner A, Ridgeway GK: The effect of light rail transit on body mass index and physical activity. Am J Prev Med 2010, 39:105-112.</ref><ref>Besser LM, Dannenberg AL: Walking to public transit:steps tp meet physical activity recommendations. Am J Prev Med 2005, 29:273-280.</ref>
Sidewalks and bike paths in neighbourhoods promotes active transportation. People feel safer and enjoy activity more with these features.   Placing residential and commercial areas in close proximity helps to reduce reliance on automobiles while encouraging active transportation.The routes linking destinations should encourage biking and walking. Having bike paths that separate bicycles from traffic is sometimes associated with increased bike use. When public bus and rail stops are nearby, it promotes active transport by ensuring people walk to and fro public transit.  


==  Relationship between Physical Activity and Built Environment ==
Public open spaces encourage physical activity during leisure time among the populace. They provide places for individuals to walk to as a destination and also have facilities for sports, exercise and other vigorous activities. They must be located nearby, easily accessed by residents and have amenities of good quality. Playgrounds and parks are more attractive for physical activity when people's perception of them is safe and pleasant. Children, families and organisations prefer to visit and spend time in appealing places.  
Quite a number of studies have found significant positive association between features of the built environment and physical activity.<ref name=":5" /> The relationship between the built environment and physical activity may vary according to the domain of physical activity- recreation, transportation. It can also have a dissimilar impact on different domains of physical activity. For instance, a highly connected street can be beneficial for walking for transportation to destinations but detrimental for active play in the streets for children. Walking and bicycling for transportation and or leisure are a major form of physical activity worldwide<ref>Kruger J, Ham SA, Berrigan D, Ballard-Barbash R: Prevalence of transportation and leisure walking among U.S adults. Prev Med. 2008, 47:329-334</ref> and such activities can meet recommendations for physical activity.


Street connectivity is a built environment feature that could have direct influence on physical activity, particularly walking. Well connected street networks create more and shorter routes to destinations and also ease walking from place to place. Grid streets designs assists pedestrian movement  with two inherent characteristics; frequent intersections and orthogonal geometry. Placing residential and commercial areas in close proximity helps to reduce reliance on private motor vehicles while encouraging active transportation.
Attractiveness of the neighbourhood environment is also associated with recreational walking. Neighbourhood aesthetics such as cleanliness, attractive natural sights- landscaping and views promotes walking for recreation. Walking is pleasant for residents with aesthetic neighbourhoods.  


Transportation facilities such as sidewalks and bike paths in neighborhoods promotes active transportation particularly when several destinations- business, schools etc are located close to homes and the routes linking them encourage biking, walking and public transit. Having bike paths that separate bicycles from traffic is sometimes associated with increased bike use. Public bus and rail stops nearby also promotes active transport by ensuring people walk to and fro from public transit.
Finally, a built environment that is safe, attractive, promotes easy access to healthy food and variety of opportunities to be physically active daily is considered conducive to the adoption of healthy lifestyles.


Availability, proximity and quality of public open spaces and parks encourage people to be physically active during leisure time. Attractiveness of the neighborhood environment is also associated with recreational walking. Neighborhood aesthetics such as enjoyable scenery, pleasant neighborhood and attractive appearance promotes walking for recreation. Children, families and organizations prefer to visit and spend time in appealing places. Playgrounds and parks are more attractive for physical activity when people's perception of them is safe and pleasant.
== Recommendations for Environment and Policy Change  ==
Public health professionals need to build collaborations across multiple disciplines such as transportation, urban planning, architecture and public health law that would help to encourage healthy community design. Policies that recommend changing the built environment to increase population level physical activity are influenced by evidence based data. Hence, the need for high quality data on the broader impacts of the built environment on physical activity.  


A built environment that is safe, attractive, promotes easy access to healthy food, and variety of opportunities to be physically active in their daily lives is considered conducive to the adoption of healthy lifestyles.
Physiotherapists use exercise- a subcategory of physical activity as part of therapy for rehabilitation, PTs should endeavour to educate their patients on the use of the built environment for physical activity. It's not sufficient to have the built environment favourable for physical activity, people have to put it to its best use.


== Recommendations for Environment and Policy Change ==
== Resources ==
Policy recommendations that advocate changing the built environment to increase population level physical activity are influenced by evidence regarding the association of the built environment with physical activity. Building collaborations across multiple disciplines such as transportation, urban planning, architecture and public health law would help to encourage healthy community design.
[https://www,nice.org.uk/guidance/ph8/chapter1-Recommendations#transport National Institute for Health and Clinical Excellence (NICE) recommendations]


Physiotherapists come to play by serving as educators to promote use of those environment. We often come across patients that need exercise as part of their rehabilitation, ensuring to inform them about the built environment as an option to engage in physical activity is key.
[[Whole System Approach to Increasing Physical Activity|WHO whole systems approach]]


National Institute for Health and Clinical Excellence (NICE) recommendations: [https://www.nice.org.uk/guidance/ph8/chapter/1-Recommendations#transport https://www,nice.org.uk/guidance/ph8/chapter1-Recommendations#transport]
[https://www.who.int/publications/i/item/9789240059153 World Health Organization: Global status report on physical activity 2022]
==  Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==
<div class="researchbox">
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss>
</div>
== References  ==
== References  ==
References will automatically be added here, see [[Adding References|adding references tutorial]].


<references />
<references />
[[Category:Physical Activity]] 
[[Category:Physical Activity Content Development Project]]
[[Category:Course Pages]]

Latest revision as of 21:43, 26 October 2022

Original Editor - Simisola Ajeyalemi

Top Contributors - Simisola Ajeyalemi, Kim Jackson, Admin, Wendy Walker, Rucha Gadgil and Robin Tacchetti  

Introduction[edit | edit source]

The environment is integral to encouraging physical activity.[1]  The built environment is an aspect of the environment that is increasingly receiving research attention.[2]  Recommended levels of physical activity can be achieved by including activities such as walking, cycling as part of everyday life. This can be encouraged with a supportive built environment. Even though individual and social factors affect physical activity,[3] research has shown that a well-designed environment matters.[4][5][6]

The built environment is defined as the part of the physical environment that is constructed or modified by human activity.[7] It includes homes, schools, workplaces, parks or recreation areas, green-ways, business areas and transportation systems.[8] In public health, a built environment refers to physical environments that are designed with health and wellness as integral parts of communities and it has features like open spaces, footpaths, cycle lanes, parks, trails.[9] The emphasis on the role of built environment is necessary as encouraging people to be more physically active in an environment that is not supportive is less likely to be effective.

Physical activity can be classified into four domains of life that describe how people spend their time: recreational, occupational, transport and household activities. Recreational and transport physical activity are relevant to and driven by the built environment features.[10] Physical activity is promoted by the built environment through walkable neighbourhoods, presence of sidewalks, walking paths and bike paths and presence of recreational and sports infrastructure including parks, pools, playgrounds, and sport clubs.

Using the built environment as an intervention for improving physical activity offers numerous advantages. Diverse to individual level approaches, developing a supportive environment has the potential to achieve biggest reach for long term, population-wide improvements in physical activity levels and facilitate behaviour change maintenance.[11] Also, physical activity interventions that reach a large numbers of people over a sustained period of time are often more cost effective than individual level interventions.[12]

Features of Built Environment[edit | edit source]

Built environment features that are hypothesised to be associated with recreational and transport activity have been divided into four categories;

  1. Recreational resources: walking trails, biking trails, parks and open spaces
  2. Land use characteristics: residential and employment density, land use mix (types of buildings, services and businesses in the community), street connectivity (grid pattern, cul-de-sac and loop holes) and proximity of destinations (shops, employment and services) to residences.
  3. Neighbourhood form characteristics: availability of sidewalks and street light
  4. Community environment: mostly contextual features of the environment such as aesthetics, cleanliness, traffic, crime safety or community support or cohesion.

Specific features of the built environment that has been found to correlate with physical activity levels include mixed land use, residential density and street connectivity.[13][2][6][7]These features have the potential to influence walking for recreational and travel related physical activity. For instance, presence of sidewalks and streetlights might make recreational activity more appealing. Meanwhile, proximity to destinations and grid like street patterns might make it easier or more pleasant to walk or bicycle for transportation.

Walkable Neighbourhoods[edit | edit source]

The extent to which the built environment is friendly to the presence of people living, shopping, visiting, enjoying or spending time in the area is termed “Walkability.”[14] A walkable neighbourhood is one that is densely populated, where several businesses and services are present, where the streets are well connected to facilitate easy access by active transportation. Walking and cycling facilities like sidewalks, crosswalks, and bike lanes are also present in a walkable neighbourhood. In contrast, high urban sprawl is characterised by low land use density, low residential density, absence of a downtown and less street connectivity. Walking, cycling and public transport are made impractical with high urban sprawl and as such are associated with sedentary lifestyles.

  • Residential density refers to the number of residential units per unit of land area. It means more destinations such as shops, services, and public transport stops nearby.[15] [16]
  • Land use mix diversity refers to the level of integration within an area of different types of uses for physical space. This includes residential, office, retail, industry and public space.[16]
  • Street connectivity refers to the ease of travel between two points which is directly related to characteristics of street design. It's characterised by many interconnected streets.[16]
  • Accessibility refers to the ease by which desired places or activities can be reached and refers to the land use system and transportation system.[17]

The design and maintenance of neighbourhoods, streets, parks and people’s perception of those places based on qualities such as aesthetic appeal and perceived safety can affect physical activity in adults and youths. For leisure walking, the perceived aesthetics- visual appeal or pleasantness of an environment- and safety from crime and traffic can affect walking.[5][18] Aesthetic features of the neighbourhood provide an inviting setting for physical activity.

Studies relating attributes of neighbourhood environments and physical activity particularly within the U.S, Australia and a few European nations found that walkable neighbourhoods characterised by high density, well connected grid-like street networks and accessible and diverse destinations within walking distance[7][19] were associated with active transportation, particularly walking for transport.[7][20] Additionally, access to parks and recreation facilities shows significant associations with recreational physical activity.[21] The presence of existing and new public transportation options in neighbourhoods appears associated with greater physical activity.[22][23]

Relationship between Physical Activity and Built Environment[edit | edit source]

Significant positive association between features of the built environment and physical activity has been established by a number of studies.[13] The relationship may vary on the basis of the domain of physical activity. Recreation and transportation domains of physical activity are mostly influenced by the built environment. It can also have a dissimilar influence on these domains of physical activity. For instance, a highly connected street can be beneficial for walking for transportation to destinations but detrimental for active play in the streets for children. Walking and bicycling for transportation and/ or leisure are a major form of physical activity worldwide[24] and such activities can meet recommendations for physical activity.

Infographic.JPG


Street connectivity is a feature of the built environment that could have direct influence on physical activity, particularly walking. Well connected street networks create routes that are shorter to destinations which ease walking from place to place. Grid streets designs assists pedestrian movement with two characteristics; frequent intersections and orthogonal geometry.

Sidewalks and bike paths in neighbourhoods promotes active transportation. People feel safer and enjoy activity more with these features. Placing residential and commercial areas in close proximity helps to reduce reliance on automobiles while encouraging active transportation.The routes linking destinations should encourage biking and walking. Having bike paths that separate bicycles from traffic is sometimes associated with increased bike use. When public bus and rail stops are nearby, it promotes active transport by ensuring people walk to and fro public transit.

Public open spaces encourage physical activity during leisure time among the populace. They provide places for individuals to walk to as a destination and also have facilities for sports, exercise and other vigorous activities. They must be located nearby, easily accessed by residents and have amenities of good quality. Playgrounds and parks are more attractive for physical activity when people's perception of them is safe and pleasant. Children, families and organisations prefer to visit and spend time in appealing places.

Attractiveness of the neighbourhood environment is also associated with recreational walking. Neighbourhood aesthetics such as cleanliness, attractive natural sights- landscaping and views promotes walking for recreation. Walking is pleasant for residents with aesthetic neighbourhoods.

Finally, a built environment that is safe, attractive, promotes easy access to healthy food and variety of opportunities to be physically active daily is considered conducive to the adoption of healthy lifestyles.

Recommendations for Environment and Policy Change[edit | edit source]

Public health professionals need to build collaborations across multiple disciplines such as transportation, urban planning, architecture and public health law that would help to encourage healthy community design. Policies that recommend changing the built environment to increase population level physical activity are influenced by evidence based data. Hence, the need for high quality data on the broader impacts of the built environment on physical activity.

Physiotherapists use exercise- a subcategory of physical activity as part of therapy for rehabilitation, PTs should endeavour to educate their patients on the use of the built environment for physical activity. It's not sufficient to have the built environment favourable for physical activity, people have to put it to its best use.

Resources[edit | edit source]

National Institute for Health and Clinical Excellence (NICE) recommendations

WHO whole systems approach

World Health Organization: Global status report on physical activity 2022

References[edit | edit source]

  1. ↑ Goldstein B. The environment and health:a conversation with CDC chief Jeffrey Koplan; tracing intersections between behaviour and environment fascinates this top health officer. Health Affairs 2002;21:179-184 [Pub Med]
  2. ↑ 2.0 2.1 Sallis JF, Floyd MF, Rodriguez DA, Saelens BE. Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation. 2012;125(5):729-37
  3. ↑ Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin BW. Correlates of Physical Activity: Why are some physically active and others are not? Lancet 2012;380(9838):258-271.
  4. ↑ Brownson RC, Hoehner CM, Day K, Forsyth A, Sallis JF. Measuring the built environment for physical activity: State of Science. Am J Prev Med.2009;36(4 Supplement):S99-S123.e12.
  5. ↑ 5.0 5.1 Ding D, Sallis JF, Kerr J, Lee S, Rosenburg DE. Neighborhood environment and physical activity among youth: A Review. Am J Prev Med.2011;41(4):442-455.
  6. ↑ 6.0 6.1 Sugiyama T, Leslie E, Giles-Corti B, Owen N. Physical activity for recreation or exercise on neighborhod streets: Associations with perceived environmental attributes. Health Place 2009;15(4):1058-1063.
  7. ↑ 7.0 7.1 7.2 7.3 Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci Sport Exer. 2008;40(7 Suppl):S550-66.
  8. ↑ National Institute of Environmental Health Sciences 2004 p 2
  9. ↑ Renalds, A; Smith T; Hale, P (2010). "A Systematic Review of Built Environment And Health". Family and Community Health.33: 68-78.
  10. ↑ Pratt M, Macera CA, Sallis JF, O'Donnel M, Frank LD. Economic interventions to promote physical activity: application of the SLOTH model. Am J Prev Med.2004;27 suppl 3:136-145.
  11. ↑ Kwansnicka D, Dombrowski SU, White M, Sniehotta F. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychol Rev. 2016;10:277-96.
  12. ↑ Wu S, Cohen D, Shi Y, Pearson M, Sturm R. Economic Analysis of physical activity interventions. Am J Prev Med. 2011;40(2):149-58.
  13. ↑ 13.0 13.1 Gebel K, Bauman AE, Petticrew M. The physical environment and physical activity: a critical appraisal of review articles. Am J Prev Med. 2007;32(5):361-9
  14. ↑ Abley, Stephen. “Walkability Scoping Paper” 21 March 2005. Retrieved 4/21/08
  15. ↑ Lee C, Moudon AV. Correlates of walking for transportation or recreation purposes. J Phys Act Health. 2006;3S77-S98.
  16. ↑ 16.0 16.1 16.2 Saelens BE, Sallis JF, Frank LD: Environmental correlates of waking and cycling: findings from the transportation, urban design and planning literatures. Ann Behav Med 2003, 25: 80-91.
  17. ↑ Handy SL: Evaluating neighborhood accessibility: possibilities and praticalities. Journl of transportation and statistics 2001, 4: Dec.
  18. ↑ Owen N, Humpel N, Leslie E, Bauman A, Sallis JF. Understanding environmental influence on walking: Review and Research Agenda. Am J Prev Med.2004;27(1):67-76
  19. ↑ Heath GW, Brownson RC, Miles R, Powell KE, Ramsey LT: Task Forceon Community Preventive Services. The effectiveness of urban design and land use and transport policies to increase physical activity: systematic review J Phys Act Heal 2006,3:S55-S76.
  20. ↑ Ewing R, Cervero R: Travel and the Built Environment. J Am Plan Assoc 2010, 76:265-294.
  21. ↑ Kaczynski AT, Henderson KA (2007).Enviromental correlates of physical activity: a review of evidence about parks and recreation ammenities Leisure Sciences; 29: 315-54.
  22. ↑ MacDonald JM, Stokes RJ, Cohen DA, Kofner A, Ridgeway GK: The effect of light rail transit on body mass index and physical activity. Am J Prev Med 2010, 39:105-112.
  23. ↑ Besser LM, Dannenberg AL: Walking to public transit:steps tp meet physical activity recommendations. Am J Prev Med 2005, 29:273-280.
  24. ↑ Kruger J, Ham SA, Berrigan D, Ballard-Barbash R: Prevalence of transportation and leisure walking among U.S adults. Prev Med. 2008, 47:329-334
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