Neighborhood environments and objectively measured physical activity in 11 countries.
OBJECTIVE
Environmental changes are potentially effective population-level physical activity (PA) promotion strategies. However, robust multisite evidence to guide international action for developing activity-supportive environments is lacking. We estimated pooled associations of perceived environmental attributes with objectively measured PA outcomes, between-site differences in such associations, and the extent to which perceived environmental attributes explain between-site differences in PA.


METHODS
This was a cross-sectional study conducted in 16 cities located in Belgium, Brazil, Colombia, Czech Republic, Denmark, China, Mexico, New Zealand, Spain, United Kingdom, and United States of America. Participants were 6968 adults residing in administrative units stratified by socioeconomic status and transport-related walkability. Predictors were 10 perceived neighborhood environmental attributes. Outcome measures were accelerometry-assessed weekly minutes of moderate-to-vigorous PA (MVPA) and meeting the PA guidelines for cancer/weight gain prevention (420 min·wk of MVPA).


RESULTS
Most perceived neighborhood attributes were positively associated with the PA outcomes in the pooled, site-adjusted, single-predictor models. Associations were generalizable across geographical locations. Aesthetics and land use mix-access were significant predictors of both PA outcomes in the fully adjusted models. Environmental attributes accounted for within-site variability in MVPA, corresponding to an SD of 3 min·d or 21 min·wk. Large between-site differences in PA outcomes were observed; 15.9%-16.8% of these differences were explained by perceived environmental attributes. All neighborhood attributes were associated with between-site differences in the total effects of the perceived environment on PA outcomes.


CONCLUSIONS
Residents' perceptions of neighborhood attributes that facilitate walking were positively associated with objectively measured MVPA and meeting the guidelines for cancer/weight gain prevention at the within- and between-site levels. Associations were similar across study sites, lending support for international recommendations for designing PA-friendly built environments.
1Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, AUSTRALIA; 2Institute of Human Performance, University of Hong Kong, Hong Kong, CHINA; 3Department of Family and Preventive Medicine, University of California, San Diego, CA; 4Department of Movement and Sport Sciences, Ghent University, Ghent, BELGIUM; 5Auckland University of Technology, Human Potential Centre, Auckland, NEW ZEALAND; 6Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, DENMARK; 7Baker IDI Heart and Diabetes Institute, Melbourne, AUSTRALIA; 8Centre for Research and Action in Public Health, Canberra University, Canberra, Australian Capital Territory, AUSTRALIA; 9Department of Physical Education, Federal University of Paraná, Curitiba, BRAZIL; 10Institute of Active Lifestyle, Faculty of Physical Culture, Palacký University, Olomouc, CZECH REPUBLIC; 11Department of Health Sciences, Public University of Navarra, Pamplona, Navarra, SPAIN; 12Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, MEXICO; 13Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA; 14Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA; and 15Department of Public Health, School of Medicine, Universidad de los Andes, Bogotá, COLOMBIA.
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Sallis
D061725:Accelerometry; D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004779:Environment Design; D015444:Exercise / Q000502:physiology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014186:Transportation; D016138:Walking; D055815:Young Adult