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

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends built environment strategies that combine one or more interventions to improve pedestrian or bicycle transportation systems with one or more land use and environmental design interventions to increase physical activity.

Intervention

Built environment interventions to increase physical activity create or modify environmental characteristics in a community to make physical activity easier or more accessible. Coordinated approaches must combine new or enhanced elements of transportation systems with new or enhanced land use and environmental design features. Intervention approaches must be designed to enhance opportunities for active transportation, leisure-time physical activity, or both.

Transportation system interventions include one or more policies and projects designed to increase or improve the following:

  • Street connectivity
  • Sidewalk and trail infrastructure
  • Bicycle infrastructure
  • Public transit infrastructure and access

Land use and environmental design interventions include one or more policies, designs, or projects to create or enhance the following:

  • Mixed land use environments to increase the diversity and proximity of local destinations where people live, work, and spend their recreation and leisure time
  • Access to parks, and other public or private recreational facilities

Additional activities may be implemented to promote physical activity and use of new resources in the community (e.g., Safe Routes to School).

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

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, Physical Activity: Street-Scale Urban Design Land Use Policies, and Physical Activity: Transportation and Travel Policies and Practices.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

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

A systematic review of economic evidence has not been 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

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)
  • 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).

Analytic Framework

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Effectiveness Review

No content is available for this section.

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Adlakha D, Hipp AJ, Marx C, Yang L, Tabak R, Dodson EA, et al. Home and workplace built environment supports for physical activity. American Journal of Preventive Medicine 2015;48(1):104-7.

Adams MA, Ding D, Sallis JF, Bowles HR, Ainsworth BE, Bergman P, et al. Patterns of neighborhood environment attributes related to physical activity across 11 countries: a latent class analysis. International Journal of Behavioral Nutrition and Physical Activity 2013;10(34):10-186.

Aytur SA, Rodriguez DA, Evenson KR, Catellier DJ. Urban containment policies and physical activity: a time series analysis of metropolitan areas, 1990 2002. American Journal of Preventive Medicine 2008;34(4):320-32.

Badland H, Knuiman M, Hooper P, Giles-Corti B. Socio-ecological predictors of the uptake of cycling for recreation and transport in adults: results from the RESIDE study. Preventive Medicine 2013;57(4):396-9.

Bergman P, Grjibovski AM, Hagstr mer M, Sallis JF, Sj str m M. The association between health enhancing physical activity and neighbourhood environment among Swedish adults a population-based cross-sectional study. International Journal of Behavioral Nutrition and Physical Activity 2009;6(1):8.

Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association of the built environment with physical activity and obesity in older persons. American Journal of Public Health 2007;97(3):486-92.

Boarnet MG, Joh K, Siembab W, Fulton W, Nguyen MT. Retrofitting the suburbs to increase walking: Evidence from a land-use-travel study. Urban Studies 2011;48(1):129-59.

Brown SC, Lombard J, Toro M, Huang S, Perrino T, Perez-Gomez G, et al. Walking and proximity to the urban growth boundary and central business district. American Journal of Preventive Medicine 2014;47(4):481-6.

Buehler R, Pucher J. Cycling to work in 90 large American cities: new evidence on the role of bike paths and lanes. Transportation 2012;39(2):409-32.

Calise TV, Dumith SC, DeJong W, Kohl III HW. The effect of a neighborhood built environment on physical activity behaviors. Journal of Physical Activity and Health 2012;9(8):1089-97.

Cao X, Handy SL, Mokhtarian PL. The influences of the built environment and residential self-selection on pedestrian behavior: evidence from Austin, TX. Transportation 2006;33(1):1-20.

Cao XJ. Exploring causal effects of neighborhood type on walking behavior using stratification on the propensity score. Environment and Planning A 2010;42(2):487-504.

Carlson JA, Sallis JF, Conway TL, Saelens BE, Frank LD, Kerr J, et al. Interactions between psychosocial and built environment factors in explaining older adults’ physical activity. Preventive Medicine 2012;54(1):68-73.

Carson V, Rosu A, Janssen I. A cross-sectional study of the environment, physical activity, and screen time among young children and their parents. BMC Public Health 2014;14(1):1.

Cervero R, Duncan M. Walking, bicycling, and urban landscapes: evidence from the San Francisco Bay Area. American Journal of Public Health 2003;93(9):1478-83.

Chaix B, Simon C, Charreire H, Thomas F, Kestens Y, Karusisi N, et al. The environmental correlates of overall and neighborhood based recreational walking (a cross-sectional analysis of the RECORD Study). International Journal of Behavioral Nutrition and Physical Activity 2014;11(1):20.

Chill n P, Hales D, Vaughn A, Gizlice Z, Ni A, Ward DS. A cross-sectional study of demographic, environmental and parental barriers to active school travel among children in the United States. International Journal of Behavioral Nutrition and Physical Activity 2014;11(1):61.

Chomitz VR, McDonald JC, Aske DB, Arsenault LN, Rioles NA, Brukilacchio LB, et al. Evaluation results from an active living intervention in Somerville, Massachusetts. American Journal of Preventive Medicine 2012 30;43(5):S367-78.

Christiansen LB, Toftager M, Schipperijn J, Ersb ll AK, Giles-Corti B, Troelsen J. School site walkability and active school transport association, mediation and moderation. Journal of Transport Geography 2014;34:7-15.

D’Haese S, De Meester F, De Bourdeaudhuij I, Deforche B, Cardon G. Criterion distances and environmental correlates of active commuting to school in children. International Journal of Behavioral Nutrition and Physical Activity 2011;8(1):88.

De Meester F, Van Dyck D, De Bourdeaudhuij I, Deforche B, Cardon G. Do psychosocial factors moderate the association between neighborhood walkability and adolescents’ physical activity? Social Science and Medicine. 2013 Mar 31;81:1-9.

Ding D, Sallis JF, Conway TL, Saelens BE, Frank LD, Cain KL, et al. Interactive effects of built environment and psychosocial attributes on physical activity: a test of ecological models. Annals of Behavioral Medicine 2012;44(3):365-74.

Dunton GF, Intille SS, Wolch J, Pentz MA. Investigating the impact of a smart growth community on the contexts of children’s physical activity using Ecological Momentary Assessment. Health & Place 2012;18(1):76-84.

Dygryn J, Mitas J, Stelzer J. The influence of built environment on walkability using geographic information system. Journal of Human Kinetics 2010;24:93-9.

Ewing R, Handy SL, McCann B. Effect of infrastructure investments on bicycling and walking in two metropolitan areas. Transportation Research Board 89th Annual Meeting 2010:1-17.

Ewing R, Meakins G, Hamidi S, Nelson AC. Relationship between urban sprawl and physical activity, obesity, and morbidity Update and refinement. Health & Place 2014;26:118-26.

Foti F, Waddell P. Modeling walk trips using a multi-modal accessibility framework. Transportation Research Board 93rd Annual Meeting 2014:1-17.

Frank LD, Saelens BE, Powell KE, Chapman JE. Stepping towards causation: do built environments or neighborhood and travel preferences explain physical activity, driving, and obesity? Social Science and Medicine 2007;65(9):1898-914.

Freeman L, Neckerman K, Schwartz-Soicher O, Quinn J, Richards C, Bader MD, et al. Neighborhood walkability and active travel (walking and cycling) in New York City. Journal of Urban Health 2013;90(4):575-85.

Friederichs SA, Kremers SP, Lechner L, de Vries NK. Neighborhood walkability and walking behavior: the moderating role of action orientation. Journal of Physical Activity and Health 2013;10:15-22.

Garrard J, Crawford S. Evaluation of the Victorian Ride2School program: impacts and insights into promoting active travel to school. Australasian Transport Research Forum (ATRF), Canberra, ACT, Australia Sep 2010:1-16.

Gell NM, Wadsworth DD. How do they do it: Working women meeting physical activity recommendations. American Journal of Health Behavior 2014;38(2):208.

Glazier RH et al. Development and validation of an urban walkability index for Toronto, Canada. Edited by Toronto Community Health Profiles Partnership. Toronto, Canada. 2012. Updated from: Glazier RH, Weyman JT, Creatore MI, Gozdyra P, Moineddin R, Matheson FI, Booth GL. Development and validation of an urban walkability index for Toronto, Canada. Canadian Journal of Diabetes 2008;32(4).

Goodman A, Sahlqvist S, Ogilvie D. New walking and cycling routes and increased physical activity: one-and 2-year findings from the UK iConnect Study. American Journal of Public Health 2014;104(9):e38-46.

Graham DJ, Schneider M, Dickerson SS. Environmental resources moderate the relationship between social support and school sports participation among adolescents: a cross-sectional analysis. International Journal of Behavioral Nutrition and Physical Activity 2011;8(34.10):1186.

Greenwald M, Boarnet M. Built environment as determinant of walking behavior: Analyzing nonwork pedestrian travel in Portland, Oregon. Transportation Research Record 2001;(1780):33-41.

Hinckson EA, Garrett N, Duncan S. Active commuting to school in New Zealand Children (2004 2008): A quantitative analysis. Preventive Medicine 2011;52(5):332-6.

Hirsch JA, Diez Roux AV, Moore KA, Evenson KR, Rodriguez DA. Change in walking and body mass index following residential relocation: the multi-ethnic study of atherosclerosis. American Journal of Public Health 2014;104(3):e49-56.

Jack E, McCormack GR. The associations between objectively-determined and self-reported urban form characteristics and neighborhood-based walking in adults. International Journal of Behavioral Nutrition and Physical Activity 2014;11(1):71.

James P, Troped PJ, Hart JE, Joshu CE, Colditz GA, Brownson RC, et al. Urban sprawl, physical activity, and body mass index: nurses’ health study and nurses’ health study II. American Journal of Public Health 2013;103(2):369-75.

Kaczynski AT, Johnson AJ, Saelens BE. Neighborhood land use diversity and physical activity in adjacent parks. Health & Place 2010;16(2):413-5.

Kerr J, Norman G, Millstein R, Adams MA, Morgan C, Langer RD, et al. Neighborhood environment and physical activity among older women. Journal of Physical Activity and Health 2014;11(6):1070-7.

Kinney AM, Hutton L, Carlson B, Perlick LM, Minkler KK, Kimber C. Isanti County active living: measuring change in perception and behavior. American Journal of Preventive Medicine 2012;43(5):S392-4.

Kligerman M, Sallis JF, Ryan S, Frank LD, Nader PR. Association of neighborhood design and recreation environment variables with physical activity and body mass index in adolescents. American Journal of Health Promotion 2007;21(4):274-7.

Laxer RE, Janssen I. The proportion of youths’ physical inactivity attributable to neighbourhood built environment features. International Journal of Health Geographics 2013;12(1):1.

Lee IM, Ewing R, Sesso HD. The built environment and physical activity levels: the Harvard Alumni Health Study. American Journal of Preventive Medicine 2009;37(4):293-8.

Li F, Harmer PA, Cardinal BJ, Bosworth M, Acock A, Johnson-Shelton D, et al. Built environment, adiposity, and physical activity in adults aged 50 75. American Journal of Preventive Medicine 2008;35(1):38-46.

Lyons W, Rasmussen B, Daddio D, Fijalkowski J, Simmons E. Nonmotorized Transportation Pilot Program: Continued progress in developing walking and bicycling networks. U.S. Department of Transportation, John A. Volpe National Transportation Systems Center (MA) and Federal Highway Administration (DC); May 2014.

Maddison R, Hoorn SV, Jiang Y, Mhurchu CN, Exeter D, Dorey E, et al. The environment and physical activity: The influence of psychosocial, perceived and built environmental factors. International Journal of Behavioral Nutrition and Physical Activity 2009;6(1):19.

McDonald K, Hearst M, Farbakhsh K, Patnode C, Forsyth A, Sirard J, et al. Adolescent physical activity and the built environment: a latent class analysis approach. Health & Place 2012;18(2):191-8.

Muhs CD, Clifton KJ. Bicycling is different: Built environment relationships to non-work travel. Transportation Research Board 93rd Annual Meeting 2014:1-19.

Mumford KG, Contant CK, Weissman J, Wolf J, Glanz K. Changes in physical activity and travel behaviors in residents of a mixed-use development. American Journal of Preventive Medicine 2011;41(5):504-7.

Nathan A, Wood L, Giles-Corti B. Exploring socioecological correlates of active living in retirement village residents. Journal of Aging and Physical Activity 2014;22(1):1-5.

Nelson MC, Gordon-Larsen P, Song Y, Popkin BM. Built and social environments: associations with adolescent overweight and activity. American Journal of Preventive Medicine 2006;31(2):109-17.

Nelson NM, Woods CB. Neighborhood perceptions and active commuting to school among adolescent boys and girls. Journal of Physical Activity and Health 2010;7(2):257.

Norman GJ, Adams MA, Kerr J, Ryan S, Frank LD, Roesch SC. A latent profile analysis of neighborhood recreation environments in relation to adolescent physical activity, sedentary time, and obesity. Journal of Public Health Management and Practice 2010;16(5):411.

Oliver M, Badland H, Mavoa S, Witten K, Kearns R, Ellaway A, et al. Environmental and socio-demographic associates of children’s active transport to school: a cross-sectional investigation from the URBAN Study. International Journal of Behavioral Nutrition and Physical Activity 2014;11(1):70.

Panter J, Jones A, van Sluijs E, Griffin S, Wareham N. Environmental and psychological correlates of older adult’s active commuting. Medicine and Science in Sports and Exercise 2011;43(7).

Panter JR, Jones AP. Associations between physical activity, perceptions of the neighbourhood environment and access to facilities in an English city. Social Science and Medicine 2008;67(11):1917-23.

Perry CK, Herting JR, Berke EM, Nguyen HQ, Moudon AV, Beresford SA, et al. Does neighborhood walkability moderate the effects of intrapersonal characteristics on amount of walking in post-menopausal women? Health & Place 2013;21:39-45.

Pikora TJ, Giles-Corti B, Knuiman MW, Bull FC, Jamrozik K, Donovan RJ. Neighborhood environmental factors correlated with walking near home: Using SPACES. Medicine and Science in Sports and Exercise 2006;38(4):708-14.

Rajamani J, Bhat C, Handy S, Knaap G, Song Y. Assessing impact of urban form measures on nonwork trip mode choice after controlling for demographic and level-of-service effects. Transportation Research Record 2003;(1831):158-65.

Reyer M, Fina S, Siedentop S, Schlicht W. Walkability is only part of the story: Walking for transportation in Stuttgart, Germany. International Journal of Environmental Research and Public Health 2014;11(6):5849-65.

Riley DL, Mark AE, Kristjansson E, Sawada MC, Reid RD. Neighbourhood walkability and physical activity among family members of people with heart disease who participated in a randomized controlled trial of a behavioural risk reduction intervention. Health & Place 2013;21:148-55.

Robertson LB, Ward Thompson C, Aspinall P, Millington C, McAdam C, Mutrie N. The influence of the local neighbourhood environment on walking levels during the Walking for Wellbeing in the West pedometer-based community intervention. Journal of Environmental and Public Health 2012;2012.

Rodr guez DA, Khattak AJ, Evenson KR. Can new urbanism encourage physical activity?: Comparing a new Urbanist neighborhood with conventional suburbs. Journal of the American Planning Association 2006;72(1):43-54.

Sayers SP, LeMaster JW, Thomas IM, Petroski GF, Ge B. Bike, Walk, and Wheel: a way of life in Columbia, Missouri, revisited. American Journal of Preventive Medicine 2012;43(5):S379-83.

Sallis JF, Saelens BE, Frank LD, Conway TL, Slymen DJ, Cain KL, et al. Neighborhood built environment and income: examining multiple health outcomes. Social Science and Medicine 2009;68(7):1285-93.

Scheepers E, Wendel-Vos W, van Kempen E, Panis LI, Maas J, Stipdonk H, et al. Personal and environmental characteristics associated with choice of active transport modes versus car use for different trip purposes of trips up to 7.5 kilometers in The Netherlands. PloS One 2013;8(9):e73105.

Schoner J, Cao X. Walking for Purpose and Pleasure: Influences of Light Rail, Built Environment, and Residential Self-Selection on Pedestrian Travel. Transportation Research Record 2014;2464:67-76.

Shimura H, Winkler E, Owen N. Individual, psychosocial, and environmental correlates of 4-year declines in walking among middle-to-older aged adults. Journal of Physical Activity and Health 2014;11(6):1078-84.

Siceloff ER, Coulon SM, Wilson DK. Physical activity as a mediator linking neighborhood environmental supports and obesity in African Americans in the path trial. Health Psychology 2014;33(5):481.

Siu VW, Lambert WE, Fu R, Hillier TA, Bosworth M, Michael YL. Built environment and its influences on walking among older women: use of standardized geographic units to define urban forms. Journal of Environmental and Public Health 2012;2012.

Slater SJ, Ewing R, Powell LM, Chaloupka FJ, Johnston LD, O’Malley PM. The association between community physical activity settings and youth physical activity, obesity, and body mass index. Journal of Adolescent Health 2010;47(5):496-503.

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Tappe KA, Glanz K, Sallis JF, Zhou C, Saelens BE. Children’s physical activity and parents’ perception of the neighborhood environment: neighborhood impact on kids study. International Journal of Behavioral Nutrition and Physical Activity 2013;10(39):1479-5868.

Troped PJ, Starnes HA, Puett RC, Tamura K, Cromley EK, James P, et al. Relationships between the built environment and walking and weight status among older women in three U.S. States. Journal of Aging and Physical Activity 2014;22(1):114-25.

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Van Dyck D, Cardon G, Deforche B, De Bourdeaudhuij I. Do adults like living in high-walkable neighborhoods? Associations of walkability parameters with neighborhood satisfaction and possible mediators. Health & Place 2011;17(4):971-7.

Van Dyck D, Cardon G, Deforche B, De Bourdeaudhuij I. Lower neighbourhood walkability and longer distance to school are related to physical activity in Belgian adolescents. Preventive Medicine 2009;48(6):516-8.

Van Dyck D, Cardon G, Deforche B, De Bourdeaudhuij I. Urban rural differences in physical activity in Belgian adults and the importance of psychosocial factors. Journal of Urban Health 2011;88(1):154-67.

Van Dyck D, De Meester F, Cardon G, Deforche B, De Bourdeaudhuij I. Physical environmental attributes and active transportation in Belgium: What about adults and adolescents living in the same neighborhoods? Health Promotion 2013;27(5):330-8.

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Additional Materials

Webinars

Implementation Product

  • Real-World Examples [PDF – 220 kB]
    Developed by CDC’s Division of Nutrition, Physical Activity, and Obesity in collaboration with The Community Guide
  • CDC’s High-Impact in 5 years initiative recommends public transportation systems based on evidence they reduce motor vehicle crashes and air pollution and increase physical activity within five years and have economic value.

Guidance from Government Agencies

CDC’s Healthy Places

  • Healthy Community Design Checklist Toolkit
    This website from CDC’s Division of Emergency and Environmental Health Services helps planners, public health professionals, and the general public to include health in the community planning process.

CDC’s Making Healthy Living Easier

  • The Built Environment: An Assessment Tool and Manual
    This how-to guide from CDC’s Division of Community Health measures the core features and qualities of the built environment that affect health especially walking, biking, and other types of physical activity.

U.S. Environmental Protection Agency (EPA) Smart Growth
The website provides information to help communities develop and support sustainable neighborhoods and localities while increasing economic competitiveness and directing resources toward places with existing infrastructure.

Surgeon Generals Step It Up!

State Departments of Health
  • Active Community Environment Toolkit
    This guide from Washington is designed to provide local physical activity coordinators, transportation coordinators, and planners with the steps needed to create successful, active, community environments.
  • Healthy Communities Toolkit
    The Michigan Department of Community Health offers resources to help communities develop built environments.

Guidance from Professional Associations, Organizations, and Partnerships

American Association of State Highway and Transportation Officials (AASHTO)
The website provides information on the development, operation, and maintenance of an integrated national transportation system.

American Planning Association (APA)

  • Planning and Community Health Center
    This website provides tools and technical support to members so they can integrate health into planning practice at all levels (e.g., development patterns, zoning, and land use impact walkability and transportation options).
  • The Sustaining Places Initiative
    This is a program for human settlement sustainability.
  • Healthy Communities Policy Guide
    The guide features policy ideas to help local, state, and national decision makers improve community health and quality of living through planning. It emphasizes the value of using evidence-based approaches to address challenges derived from our built, social, and natural environments, and recommends policies that address social determinants of health by improving opportunities for physical activity and access to healthy food.

The American Public Health Association (APHA) Healthy Community Design Initiative

  • Transportation and Health Tool
    APHA prepared this guide in partnership with the U.S. Department of Transportation and CDC to help practitioners examine the health impacts of transportation systems.

America Walks
This organization leads a coalition of national, state, and local advocacy groups who mobilize individuals, organizations, and businesses to increase walking and walkability. The website includes resources specific to key audiences (e.g., health professionals, community groups, decision makers).

  • Resources
    This webpage provides information to help planners, architects, and engineers apply best practices to the design and retrofit of existing neighborhoods, business districts, and cities to make a more walkable built environment.

Complete Streets and the National Complete Streets Coalition

The Institute of Transportation Engineers (ITE)
The website emphasizes thoroughfares in walkable communities (e.g., compact, pedestrian-scaled villages, neighborhoods, town centers, urban centers, urban cores) where walking, bicycling and transit are encouraged.

  • Designing Walkable Urban Thoroughfares: A Context Sensitive Approach
    This report describes the principles and benefits of context sensitive solutions and how to apply them.

The National Association of City Transportation Officials (NACTO)
The website provides guidance on the design and redesign of city and community spaces where people can safely walk, bicycle, drive, take transit, and socialize.

The National Association of Development Organizations (NADO)
The website provides education, research, and training for the nation’s regional development organizations.

Rails to Trails Conservancy
The website offers guides for diverse constituencies to help them design and mobilize public policy for trail development.

  • Resource Library
  • Trail Building
    The website provides guidance to transform unused rail corridors into vibrant public spaces.
  • Policy
    The website provides guidance for investments at the federal and state level to support safe trail, walking, and bicycling networks.

Smart Growth America (SGA)
This organization engages elected officials, real estate developers, chambers of commerce, and transportation and urban planning professionals in the urban planning and development process to build better communities.

STAR Community Rating System
This webpage is a framework of sustainability goals, objectives, and evaluation measures built by and for local governments.

Urban Land Institute’s Building Healthy Places Initiative
This initiative leverages the power of a global network to shape projects and places in ways that improve the health of people and communities.

Walk Score*
This is a large-scale, public access walkability index that assigns a numerical walkability score to any address in the United States, Canada, and Australia.

* Resource includes paid products or a combination of paid and free, publicly available resources.

Search Strategies

Effectiveness Review

For this review, the search strategy was implemented in different phases. The CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) searched the following databases for evidence related to all of the Community Guide physical activity reviews published through August of 2008: CSA Sociological Abstracts, Allied & Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, PsycINFO, Sportdiscus, and Transportation Research Information Services (TRIS).

Subsequently, under a contract from CDC’s Community Guide branch for work on physical activity and the built environment, the Kaiser Evidence-based Practice Center conducted three separate searches in January, 2013 (Search 1); January, 2014 (Search 2); and June, 2014 (Search 3). The following databases were searched at all three time points and collectively covered literature indexed from January 2008 through June, 2014: MEDLINE, PubMed, CINAHL, PsycINFO, CENTRAL, Sociological Abstracts, Environment Abstracts, and Transport Research International Documentation (TRID).

These databases covered publications in biomedical, behavioral, environmental, and transportation sciences. The types of documents searched in the databases included journal articles, books, book chapters, reports, conference papers, and dissertations.

Search strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software. In addition, the bibliographies of all reviewed articles were used to identify any further literature.

Search for Evidence: January, 2008 June, 2014
Ovid MEDLINE
  1. physical activit$.ti,ab.
  2. Exercise/
  3. exercise$.ti.
  4. Physical Fitness/
  5. physical inactivity.ti,ab.
  6. Leisure Activities/
  7. Recreation/
  8. moderate activity.ti,ab.
  9. vigorous activity.ti,ab.
  10. Walking/
  11. walking.ti.
  12. Running/
  13. running.ti.
  14. Jogging/
  15. jogging.ti.
  16. Bicycling/
  17. bicycl$.ti.
  18. Resistance Training/
  19. Motor Activity/
  20. or/1-19
  21. health promotion/
  22. health promotion.ti,ab.
  23. healthy people programs/
  24. Health Behavior/
  25. motivational interview$.ti,ab.
  26. ((lifestyle or life style) adj (chang$ or intervention$)).ti,ab.
  27. (behavio$ chang$ or behavio$ modification$).ti,ab.
  28. behavio$ intervention$.ti,ab.
  29. Attitude to Health/
  30. Health Knowledge, Attitudes, Practice/
  31. “Physical Education and Training”/
  32. physical education.ti,ab.
  33. Health Education/
  34. health education.ti,ab.
  35. school based.ti,ab.
  36. recess.ti.
  37. recess.ti,ab. and school$.ti,ab,hw.
  38. (after school or afterschool).ti,ab.
  39. child care/ or child day care centers/
  40. (childcare or child care).ti.
  41. (worksite$ or work site$ or workplace$ or work place$).ti,ab.
  42. (community or communities).ti,ab.
  43. neighborhood$.ti,ab.
  44. fitness centers/
  45. Social Support/
  46. social environment/
  47. community networks/
  48. Environment Design/
  49. City Planning/
  50. physical environment.ti,ab.
  51. built environment.ti,ab.
  52. Transportation/
  53. active commut$.ti,ab.
  54. Telephone/
  55. (web based or website$ or computer based).ti,ab.
  56. social media.ti,ab.
  57. blog$.ti,ab.
  58. text messaging/ or text message$.ti,ab.
  59. video games/
  60. ((active or motion) adj3 (game$ or gaming)).ti,ab.
  61. Social Marketing/
  62. campaign$.ti,ab.
  63. (intervention$ or program).ti.
  64. or/21-63
  65. 20 and 64
  66. limit 65 to english language
  67. limit 66 to humans
  68. limit 66 to animals
  69. 68 not 67
  70. 66 not 69
  71. limit 70 to yr=”2008 -Current”
PubMed
  1. Search “physical activity”[tiab]
  2. Search “physical activities”[tiab]
  3. Search exercise*[ti]
  4. Search “physical inactivity”[tiab]
  5. Search moderate activity[tiab]
  6. Search vigorous activity[tiab]
  7. Search walking[ti]
  8. Search running[ti]
  9. Search jogging[ti]
  10. Search bicycl*[ti]
  11. Search #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10
  12. Search motivational interview*[tiab]
  13. Search (lifestyle[tiab] OR “life style”[tiab]) AND (chang*[tiab] OR intervention*[tiab])
  14. Search behavio* chang*[tiab] OR behavio* modification*[tiab]
  15. Search behavio* intervention*[tiab]
  16. Search “health promotion”[tiab]
  17. Search “Physical Education”[tiab]
  18. Search “health Education”[tiab]
  19. Search school based[tiab]
  20. Search recess[ti]
  21. Search recess[tiab] AND school*[tiab]
  22. Search after school[tiab] OR afterschool[tiab]
  23. Search childcare[ti] OR “child care”[ti]
  24. Search worksite*[tiab] OR work site*[tiab] OR workplace*[tiab] OR work place*[tiab]
  25. Search community[tiab] OR communities[tiab]
  26. Search neighborhood*[tiab]
  27. Search “physical environment”[tiab]
  28. Search “built environment”[tiab]
  29. Search active commut*[tiab]
  30. Search web based[tiab] OR website*[tiab] OR computer based[tiab]
  31. Search social media[tiab]
  32. Search blog*[tiab]
  33. Search text message*[tiab]
  34. Search (active[tiab] OR motion[tiab]) AND (game*[tiab] OR gaming[tiab])
  35. Search campaign*[tiab]
  36. Search intervention*[ti] OR program[ti]
  37. Search #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR #25 OR #26 OR #27 OR #28 OR #29 OR #30 OR #31 OR #32 OR #33 OR #34 OR #35 OR #36
  38. Search #11 AND #37
  39. Search #11 AND #37 AND publisher[sb]
  40. Search #11 AND #37 AND publisher[sb] Filters: English
  41. Search #11 AND #37 AND publisher[sb] Filters: Publication date from 2008/01/01; English Sort by: PublicationDate
Cumulative Index to Nursing and Allied Health Literature
  1. (MH “Exercise”) OR (MH “Walking”) OR (MH “Physical Activity”) OR (MH “Cycling”) OR (MH “Physical Fitness”)
  2. (MH “Leisure Activities”) OR (MH “Recreation”)
  3. (MH “Running”) OR (MH “Jogging”)
  4. 1 OR 2 OR 3
  5. (MH “Health Promotion”)
  6. (MH “Health Education”)
  7. (MH “Health Behavior”)
  8. (MH “Motivational Interviewing”)
  9. (MH “Life Style Changes”)
  10. (MH “Behavior Modification”)
  11. (MH “Attitude to Health”)
  12. (MH “Health Knowledge”)
  13. (MH “Physical Education and Training”)
  14. school and recess
  15. “after school” OR afterschool
  16. (MH “Child Care”) OR (MH “Child Day Care”)
  17. worksite OR workplace OR “work site” OR “work place”
  18. (MH “Communities”) OR (MH “Poverty Areas”) OR (MH “Rural Areas”) OR (MH “Suburban Areas”) OR (MH “Urban Areas”)
  19. neighborhood*
  20. (MH “Fitness Centers”)
  21. (MH “Support, Psychosocial”)
  22. (MH “Social Environment”)
  23. (MH “Community Networks”)
  24. (MH “Transportation”) OR (MH “Bicycles”)
  25. (MH “Telephone”)
  26. (MH “Blogs”)
  27. (MH “World Wide Web”) OR (MH “World Wide Web Applications”)
  28. (MH “Instant Messaging”)
  29. (MH “Video Games”)
  30. (MH “Social Marketing”)
  31. “campaigns”
  32. TI intervention* OR TI program
  33. (TI intervention* OR TI program OR 5 OR 6 OR 7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18 OR 19 OR 20 OR 21 OR 22 OR 23 OR 24 OR 25 OR 26 OR 27 OR 28 OR 29 OR 30 OR 31 OR 32) AND 4
  34. (ZR “2008”) or (ZR “2009”) or (ZR “2010”) or (ZR “2011”) or (ZR “2012”) or (ZR “2013”)
  35. 33 AND 34
  36. (33 AND 34 ) AND LA english
PsycINFO
  1. Physical Activity/
  2. Exercise/
  3. Physical Fitness/
  4. Recreation/
  5. Walking/
  6. Running/
  7. bicycl$.ti.
  8. or/1-7
  9. Health Promotion/
  10. Health Behavior/
  11. Active Living/
  12. Motivational Interviewing/
  13. Behavior Change/
  14. Lifestyle Changes/
  15. behavio$ intervention$.ti,ab.
  16. Health Knowledge/
  17. Health Education/
  18. Physical Education/
  19. School Based Intervention/
  20. recess.ti.
  21. recess.ti,ab. and school$.ti,ab,hw.
  22. After School Programs/
  23. Child Care/
  24. Child Day Care/
  25. Working Conditions/
  26. (worksite$ or work site$ or workplace$ or work place$).ti.
  27. Communities/
  28. Neighborhoods/
  29. Social Support/
  30. Social Networks/
  31. Social Environments/
  32. Environmental Planning/
  33. Urban Planning/
  34. Built Environment/
  35. Urban Environments/
  36. Suburban Environments/
  37. Transportation/
  38. Public Transportation/
  39. “Commuting (Travel)”/
  40. active commut$.ti,ab.
  41. Websites/
  42. (web based or computer based).ti,ab.
  43. Computer Mediated Communication/
  44. Social Media/
  45. blog$.ti,ab.
  46. text messag$.ti,ab.
  47. Computer Games/
  48. ((active or motion) adj3 (game$ or gaming)).ti,ab.
  49. Social Marketing/
  50. campaign$.ti,ab.
  51. (intervention$ or program).ti.
  52. or/9-51
  53. 8 and 52
  54. limit 53 to english language
  55. limit 54 to yr=”2008 -Current”
Cochrane Central Register of Controlled Trials
  1. physical next activity:ti,ab,kw from 2008 to 2013, in Trials
  2. exercise*:ti,kw from 2008 to 2013, in Trials
  3. physical next fitness:ti,kw from 2008 to 2013, in Trials
  4. physical next inactivity:ti,ab from 2008 to 2013, in Trials
  5. leisure next activities:ti,kw from 2008 to 2013, in Trials
  6. recreation:ti,kw from 2008 to 2013, in Trials
  7. moderate next activity:ti,ab,kw from 2008 to 2013, in Trials
  8. vigorous next activity:ti,ab,kw from 2008 to 2013, in Trials
  9. walking:ti,kw from 2008 to 2013, in Trials
  10. running:ti,kw from 2008 to 2013, in Trials
  11. jogging:ti,kw from 2008 to 2013, in Trials
  12. bicycl*:ti,kw from 2008 to 2013, in Trials
  13. resistance next training:ti,kw from 2008 to 2013, in Trials
  14. motor next activity:ti,kw from 2008 to 2013, in Trials
  15. {or 1-14} from 2008 to 2013, in Trials
  16. health next promotion:ti,ab,kw from 2008 to 2013, in Trials
  17. health next behavior:ti,kw from 2008 to 2013, in Trials (Word variations have been searched)
  18. motivational next interview*:ti,ab,kw from 2008 to 2013, in Trials
  19. (lifestyle:ti,ab,kw or life next style:ti,ab,kw) and (chang*:ti,ab,kw or intervention*:ti,ab,kw) from 2008 to 2013, in Trials
  20. behavio* next chang*:ti,ab,kw from 2008 to 2013, in Trials
  21. behavio* next modification*:ti,ab,kw from 2008 to 2013, in Trials
  22. behavio* next intervention*:ti,ab,kw from 2008 to 2013, in Trials
  23. “attitude to health”:ti,ab,kw from 2008 to 2013, in Trials
  24. “health knowledge”:ti,ab,kw from 2008 to 2013
  25. physical next education:ti,ab,kw from 2008 to 2013, in Trials
  26. school next based:ti,ab,kw from 2008 to 2013, in Trials
  27. recess:ti,ab,kw and school*:ti,ab,kw from 2008 to 2013, in Trials
  28. after next school:ti,ab,kw or afterschool:ti,ab,kw from 2008 to 2013, in Trials
  29. child next care:ti,ab,kw or childcare:ti,ab,kw from 2008 to 2013, in Trials
  30. child:ti,ab,kw and (day next care:ti,ab,kw or daycare:ti,ab,kw) from 2008 to 2013, in Trials
  31. worksite:ti,ab,kw or work next site:ti,ab,kw from 2008 to 2013, in Trials
  32. workplace:ti,ab,kw or work next place:ti,ab,kw from 2008 to 2013, in Trials
  33. community:ti,ab,kw or communities:ti,ab,kw from 2008 to 2013, in Trials
  34. neighborhood*:ti,ab,kw from 2008 to 2013, in Trials
  35. fitness next center*:ti,ab,kw from 2008 to 2013, in Trials
  36. social next support:ti,ab,kw from 2008 to 2013, in Trials
  37. social next environment:ti,ab,kw from 2008 to 2013, in Trials
  38. environment* next design:ti,ab,kw from 2008 to 2013, in Trials
  39. city next planning:ti,ab,kw from 2008 to 2013, in Trials
  40. physical next environment:ti,ab,kw from 2008 to 2013, in Trials
  41. built environment:ti,ab,kw from 2008 to 2013, in Trials
  42. transportation:ti,ab,kw from 2008 to 2013, in Trials
  43. active next commut*:ti,ab,kw from 2008 to 2013, in Trials
  44. telephone:ti,kw or phone:ti,kw from 2008 to 2013, in Trials
  45. web next based:ti,ab,kw or website:ti,ab,kw from 2008 to 2013, in Trials
  46. social next media:ti,ab,kw from 2008 to 2013, in Trials
  47. blog*:ti,ab,kw from 2008 to 2013, in Trials
  48. text next messag*:ti,ab,kw from 2008 to 2013, in Trials
  49. video next game*:ti,ab,kw from 2008 to 2013, in Trials
  50. active near gam*:ti,ab,kw from 2008 to 2013, in Trials
  51. motion near gam*:ti,ab,kw from 2008 to 2013, in Trials
  52. social next marketing:ti,ab,kw from 2008 to 2013, in Trials
  53. campaign*:ti,ab,kw from 2008 to 2013, in Trials
  54. intervention*:ti or program:ti from 2008 to 2013, in Trials
  55. {or 16-54} from 2008 to 2013, in Trials
  56. 15 and 55 from 2008 to 2013, in Trials
Sociological Abstracts and Environment Abstracts

((TI(“physical activity”) OR TI((exercise* OR “physical fitness”)) OR TI((“physical inactivity” OR “leisure activities”)) OR TI((recreation OR “moderate activity”)) OR TI((“vigorous activity” OR walking)) OR TI((running OR jogging)) OR TI((bicycl* OR “resistance training”)) OR TI(“motor activity”)) OR all(recess AND school*))

AND

((all(“health promotion”) OR all((“health behavior” OR “health behaviour”)) OR all((“motivational interview*” OR lifestyle NEAR/2 chang*)) OR all((lifestyle NEAR/2 intervention* OR “life style” NEAR/2 chang*)) OR all((“life style” NEAR/2 intervention* OR behavio* NEAR/2 chang*)) OR all((behavio* NEAR/2 intervention* OR behavio* NEAR/2 modification*)) OR all((“attitude to health” OR “health knowledge”)) OR all((“physical education” OR “school based”)) OR all((recess AND school* OR “after school”)) OR all(afterschool)) OR (all(“child care”) OR all((childcare OR child AND “day care”)) OR all((child AND daycare OR worksite*)) OR all((“work site*” OR workplace*)) OR all((“work place*” OR community)) OR all((communities OR neighborhood*)) OR all((“fitness center*” OR “social support”)) OR all((“social environment” OR “environment* design”)) OR all((“city planning” OR “physical environment”)) OR all((“built environment” OR transportation))) OR (all(“active commut*”) OR all((telephone OR phone)) OR all((“web based” OR website)) OR all((“social media” OR blog*)) OR all((“test messag*” OR “video game*”)) OR all((active NEAR/3 gam* OR motion NEAR/3 gam*)) OR all((“social marketing” OR campaign*)) OR ti((intervention* OR program))))

Transport Research International Documentation

Index Terms:
Bicycle commuting OR
Bicycling OR
Cyclists OR
Bicycle travel OR
Physical fitness OR
Walking OR

Title:
bike* OR
bicycl* OR
walking OR

Keywords:
“physical activity” OR
“physical inactivity” OR
“physical exercise” OR
jogging

AND

Languages:
English

AND

Published/started date range:
2008 to 2013

Search for Evidence: Through July, 2008
MEDLINE
  1. physical activity.mp
  2. exp *exercise/
  3. exp *physical fitness/
  4. cardiorespiratory fitness.mp.
  5. exp *exertion/
  6. aerobic capacity.mp.
  7. exp *motor activity/
  8. sedentary$.mp.
  9. physical inactivity.mp.
  10. exp *leisure activities/
  11. exp *recreation/
  12. moderate activity.mp.
  13. vigorous activity.mp.
  14. exp *running/
  15. exp *jogging/
  16. exp *walking/
  17. climb$.mp.
  18. stair$.mp.
  19. occupational physical activity.mp.
  20. exp *housekeeping/
  21. household physical activity.mp.
  22. or/1-21
  23. exp *health promotion/
  24. exp *healthy people programs/
  25. 23 or 24
  26. 22 and 25
  27. exp *health behavior/
  28. exp *attitude to health/
  29. exp *Health Knowledge, Attitudes, Practice/
  30. (behavior and behavior mechanism).mp.
  31. (physical phenomena and processes).mp.
  32. 27 or 28 or 29 or 30 or 31
  33. 22 and 32
  34. exp *”Physical Education and Training”/
  35. exp *health education/
  36. school health education.mp.
  37. classroom health education.mp.
  38. 34 or 35 or 36 or 37
  39. 22 and 38
  40. TV viewing.mp.
  41. video game playing.mp.
  42. 40 or 41
  43. 22 and 42
  44. college physical education.mp.
  45. college health education.mp.
  46. 44 or 45
  47. 22 and 46
  48. exp *social support/
  49. exp *family health/
  50. exp *social environment/
  51. 48 or 49 or 50
  52. 22 and 51
  53. decision.mp.
  54. point$ of decision$.mp.
  55. 53 or 54
  56. 22 and 55
  57. exp *environment/
  58. exp *environment design/
  59. exp *urban population/
  60. pedestrian*.mp.
  61. exp *urban health/
  62. environmental change$.mp.
  63. environmental interventionS.mp.
  64. 57 or 58 or 59 or 60 or 61 or 62 or 63
  65. 22 and 64
  66. exp *fitness centers/
  67. 22 and 66
  68. exp *occupational health/
  69. 22 and 68
  70. exp *transportation/
  71. 22 and 70
  72. exp *mass media/
  73. mass media.mp.
  74. exp *communications media/
  75. exp *communication/
  76. exp *information dissemination/
  77. exp *diffusion of innovation/
  78. exp *telecommunications/
  79. exp *radio/
  80. exp *telephone/
  81. exp *television/
  82. exp *computer-assisted instruction/
  83. exp *internet/
  84. exp *marketing/
  85. exp *marketing of health services/
  86. exp *social marketing/
  87. campaign.mp.
  88. advertising.mp.
  89. 72 or 73 or 74 or 75 or 76 or 77 or 78 or 79 or 80 or 81 or 82 or 83 or 84 or 85 or 86 or 87 or 88
  90. 22 and 89
  91. community.mp.
  92. 22 and 91
  93. college.mp.
  94. 22 and 93
  95. classroom.mp.
  96. 22 and 95
  97. strength training.mp.
  98. resistance training.mp.
  99. weight lifting.mp.
  100. 97 or 98 or 99
  101. 22 and 100
  102. exp *Bicycling/
  103. 22 and 102
  104. 39 or 43 or 47 or 52 or 56 or 65 or 67 or 69 or 71 or 90 or 92 or 94 or 96 or 101 or 103

Review References

McCann B. Complete streets: We can get there from here. Institute of Transportation Engineers. ITE Journal 2008;78(5):24. http://smartgrowthamerica.us/documents/cs/resources/cs-ite-may08.pdf

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.
  • A broad range of guidelines, policy and program initiatives, and position statements are available from public health agencies and professional organizations in community planning and development. These guidelines are written to allow local creativity and flexibility for urban planners, designers, policy makers, and engineers.
    • Healthy Communities Policy Guide, developed by the American Planning Association, features policy ideas to help local, state, and national decision makers improve community health and quality of living through planning. The guide emphasizes the value of using evidence-based approaches to address challenges derived from our built, social, and natural environments, and recommends policies that address social determinants of health by improving opportunities for physical activity and access to healthy food.
    • Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities identifies goals and strategies to promote walking and walkability in urban, suburban, and rural settings. Policy makers and community planners should consider diverse approaches and strategies (e.g., well-maintained sidewalks, pedestrian-friendly streets, access to public transit, adequate lighting, desirable destinations that are close to home).
    • The Sustaining Places Initiative, developed by the American Planning Association, is a program for human settlement sustainability. It provides a comprehensive plan including designs that can be tailored to different communities and jurisdictions to make them more walkable and bikable.
    • Complete Streets and the National Complete Streets Coalition provide a framework for urban street design that encourages a safe and health-promoting environment for pedestrians and cyclists. A range of tools and performance measures are available to assess, plan, design, and implement approaches (McCann 2008).
    • See the Additional Materials section for a longer list of available guidelines.
  • Macro-scale interventions can have a long term, sustainable influence on the built environment. Micro-scale interventions, although effective across a smaller body of evidence, can be implemented more rapidly and typically cost less.
  • In rural communities, barriers to built environment intervention approaches include isolation, longer travel distances, and lack of transportation infrastructure and recreation facilities. Micro-level improvements may be a viable first step until macro-level changes can be implemented through infrastructure and policy improvements.

Connecting Routes + Destinations This package of online resources is designed to help communities implement combined built environment approaches to increase physical activity. By improving and connecting routes to destinations, communities can make it easier for people to choose to be physically active.