Effects of a new walking and cycling route on leisure-time physical activity of Brazilian adults: A longitudinal quasi-experiment

Public Open Spaces and Leisure-Time Walking: A Longitudinal Study With Brazilian People in the COVID-19 Pandemic

AIM

To examine whether changes in public open spaces (POS) were associated with leisure-time walking (LTW) between 2014 and 2021.

METHODS

The sample comprised a prospective cohort of individuals living in São Paulo City, Brazil. The baseline sample was collected in 2014/2015 (4042 people aged 12 y or older) and the second wave in 2020/2021 (1431 people aged 18 y or older, 35.4% of total). Changes in POS scores in 500-m network buffers were based on household address, including positive or negative maintenance and increases or decreases in parks, public squares, and bike paths between 2015 and 2020. The International Physical Activity Questionnaire was used to evaluate LTW in the baseline and second wave. To examine the association of LTW with changes in POS, we used multilevel models in 4 levels: health administration areas, census tracts, individuals, and observations of individuals. The exposure was the POS tertiles, and the outcome was LTW.

RESULTS

Changes in LTW prevalence were observed in both periods and according to POS tertiles distributions. When adjusted for time (baseline/second wave), gender, education, and age, the highest POS tertile was significantly associated with a high likelihood for LTW (odds ratio = 1.44; 95% confidence interval, 1.03-2.02).

CONCLUSION

The results showed that people in São Paulo who lived within 500-m buffers with the highest access to POS were more likely to practice LTW between 2014/2015 and 2020/2021. These results have important implications for policies that were implemented in 2014, including the New Master Plan to contribute to São Paulo's good ranking among healthy cities.

A natural experiment to assess how urban interventions in lower socioeconomic areas influence health behaviors: the UrbASanté study

BACKGROUND

Mechanisms underlying the associations between changes in the urban environment and changes in health-related outcomes are complex and their study requires specific approaches. We describe the protocol of the interdisciplinary UrbASanté study, which aims to explore how urban interventions can modify environmental exposures (built, social, and food environments; air quality; noise), health-related behaviors, and self-reported health using a natural experiment approach.

METHODS

The study is based on a natural experiment design using a before/after protocol with a control group to assess changes in environmental exposures, health-risk behaviors, and self-reported health outcomes of a resident adult population before and after the implementation of a time series of urban interventions in four contiguous neighborhoods in Paris (France). The changes in environmental exposures, health-related behaviors, and self-reported health outcomes of a resident adult population will be concurrently monitored in both intervention and control areas. We will develop a mixed-method framework combining substantial fieldwork with quantitative and qualitative analytical approaches. This study will make use of (i) data relating to exposures and health-related outcomes among all participants and in subsamples and (ii) interviews with residents regarding their perceptions of their neighborhoods and with key stakeholders regarding the urban change processing, and (iii) existing geodatabases and field observations to characterize the built, social, and food environments. The data collected will be analyzed with a focus on interrelationships between environmental exposures and health-related outcomes using appropriate approaches (e.g., interrupted time series, difference-in-differences method).

DISCUSSION

Relying on a natural experiment approach, the research will provide new insights regarding issues such as close collaboration with urban/local stakeholders, recruitment and follow-up of participants, identification of control and intervention areas, timing of the planned urban interventions, and comparison of subjective and objective measurements. Through the collaborative work of a consortium ensuring complementarity between researchers from different disciplines and stakeholders, the UrbASanté study will provide evidence-based guidance for designing future urban planning and public health policies.

TRIAL REGISTRATION

This research was registered at the ClinicalTrial.gov (NCT05743257).

Infrastructure, policy and regulatory interventions to increase physical activity to prevent cardiovascular diseases and diabetes: a systematic review

BACKGROUND

Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity at a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.

METHODS

We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.

RESULTS

We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).

CONCLUSIONS

Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.

TRIAL REGISTRATION

PROSPERO 2018 CRD42018093429.

Is environment perception associated with change in leisure-time physical activity in Brazilian older adults? Results of EpiFloripa Idoso cohort study

This study aims to analyze the association between perceived characteristics of the neighborhood environment and changes in leisure-time physical activity in Brazilian older adults. Longitudinal analysis was performed considering a population-based study carried out in 2009/2010 with follow-up in 2013/2014. Changes in leisure-time physical activity, obtained with the International Physical Activity Questionnaire during both waves, were associated with data of environment perception with the Neighborhood Environment Walkability Scale - Abbreviated (baseline only) performing multinomial logistic regression. In total, 1,162 older adults (65.2% women, mean age = 73.7 years) participated. Older adults who perceived flat streets, bicycle paths, and high flow of vehicles in the neighborhood were more likely to remain active in leisure time walking. Those who noticed the presence of flat streets also had a greater chance of becoming active than those who did not notice it. Older adults who perceived bicycle paths and sports events were more likely to maintain moderate and vigorous physical activity during leisure time. Furthermore, older adults who noticed parks and squares close to their residence were 0.49 times less likely to become insufficiently active. Brazilian older adults are more active in neighborhoods with more favorable attributes regarding leisure-time physical activity.

Exploring ways to respond to rising obesity and diabetes in the Caribbean using a system dynamics model

Diabetes and obesity present a high and increasing burden of disease in the Caribbean that have failed to respond to prevention policies and interventions. These conditions are the result of a complex system of drivers and determinants that can make it difficult to predict the impact of interventions. In partnership with stakeholders, we developed a system dynamics simulation model to map the system driving diabetes and obesity prevalence in the Caribbean using Jamaica as a test case. The study aims to use the model to assess the magnitude changes necessary in physical activity and dietary intake to achieve global targets set by the WHO Global Action plan and to test scenarios for interventions to reduce the burden of diabetes and obesity. Continuing current trends in diet, physical activity, and demographics, the model predicts diabetes in Jamaican adults (20+ years) to rise from 12% in 2018 to 15.4% in 2030 and 20.9% by 2050. For obesity, it predicts prevalence to rise from 28.6% in 2018 to 32.1% by 2030 and 39.2% by 2050. The magnitude change necessary to achieve the global targets set by the World Health Organization is so great as to be unachievable. However, a combination of measures both upstream (including reducing the consumption of sugar sweetened beverages and ultra processed foods, increasing fruit and vegetable intake, and increasing moderate-to-vigorous activity) at the population level, and downstream (targeting people at high risk and with diabetes) can significantly reduce the future burden of diabetes and obesity in the region. No single intervention reduces the prevalence of these conditions as much as a combination of interventions. Thus, the findings of this model strongly support adopting a sustained and coordinated approach across various sectors to synergistically maximise the benefits of interventions.

Use of an Elevated Avenue for Leisure-Time Physical Activity by Adults from Downtown São Paulo, Brazil

Leisure-time physical activity (LTPA) is associated with access and use of public open spaces. The President João Goulart Elevated Avenue, currently denominated Minhocão, is a facility for leisure activities that is open for people during the night and weekends. The aim of this study was to examine if the prevalence of LTPA among individuals living in the surroundings of Minhocão is different according to proximity to, and use of, the facility. We conducted a cross-sectional study with cluster sampling with people aged ≥18 years who lived in households up to 500 m, and between 501 m and 1500 m of Minhocão. The survey was conducted between December 2017 and March 2019 using an electronic questionnaire. We conducted a bivariate analysis and Poisson regression to examine possible differences in LTPA according to the proximity of residences and use of Minhocão. The analysis used post-stratification weights. A total of 12,030 telephone numbers of people were drawn (≤500 m = 6942; and >500 m to ≤1500 m = 5088). The final sample included 235 residents who returned the questionnaires. There was a higher prevalence of individuals engaging in at least 150 min per week of LTPA among users than non-users (Prevalence Ratio = 2.19, IC95% 1.66 to 2.90), independently of sex, age, education, the distance of houses to nearest accesses and number of barriers. The main five barriers related to the usage of the Minhocão were safety issues in and around the Minhocão, rainy weather, lack of vegetation, and lack of facilities. People who used the park had higher prevalence of all types of LTPA than non-users. The results can serve to inform government decision-making on the future of Minhocão.

Studies of the effectiveness of transport sector interventions in low- and middle-income countries: An evidence and gap map

Background

There are great disparities in the quantity and quality of infrastructure. European countries such as Denmark, Germany, Switzerland, and the UK have close to 200 km of road per 100 km2, and the Netherlands over 300 km per 100 km2. By contrast, Kenya and Indonesia have <30, Laos and Morocco <20, Tanzania and Bolivia <10, and Mauritania only 1 km per 100 km2. As these figures show, there is a significant backlog of transport infrastructure investment in both rural and urban areas, especially in sub-Saharan Africa. This situation is often exacerbated by weak governance and an inadequate regulatory framework with poor enforcement which lead to high costs and defective construction.The wellbeing of many poor people is constrained by lack of transport, which is called "transport poverty". Lucas et al. suggest that up to 90% of the world's population are transport poor when defined as meeting at least one of the following criteria: (1) lack of available suitable transport, (2) lack of transport to necessary destinations, (3) cost of necessary transport puts household below the income poverty line, (4) excessive travel time, or (5) unsafe or unhealthy travel conditions.

Objectives

The aim of this evidence and gap map (EGM) is to identify, map, and describe existing evidence from studies reporting the quantitative effects of transport sector interventions related to all means of transport (roads, rail, trams and monorail, ports, shipping, and inland waterways, and air transport).

Methods

The intervention framework of this EGM reframes Berg et al's three categories (infrastructure, prices, and regulations) broadly as infrastructure, incentives, and institutions as subcategories for each intervention category which are each mode of transport (road, rail trams and monorail, ports, shipping, and inlands waterways, and air transport). This EGM identifies the area where intervention studies have been conducted as well as the current gaps in the evidence base.This EGM includes ongoing and completed impact evaluations and systematic reviews (SRs) of the effectiveness of transport sector interventions. This is a map of effectiveness studies (impact evaluations). The impact evaluations include experimental designs, nonexperimental designs, and regression designs. We have not included the before versus after studies and qualitative studies in this map. The search strategies included both academic and grey literature search on organisational websites, bibliographic searches and hand search of journals.An EGM is a table or matrix which provides a visual presentation of the evidence in a particular sector or a subsector. The map is presented as a matrix in which rows are intervention categories (e.g., roads) and subcategories (e.g., infrastructure) and the column outcome domains (e.g., environment) and subcategories as (e.g., air quality). Each cell contains studies of the corresponding intervention for the relevant outcome, with links to the available studies. Included studies were coded according to the intervention and outcomes assessed and additional filters as region, population, and study design. Critical appraisal of included SR was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR -2) rating scale.

Selection Criteria

The search included both academic and grey literature available online. We included impact evaluations and SRs that assessed the effectiveness of transport sector interventions in low- and middle-income countries.

Results

This EGM on the transport sector includes 466 studies from low- and middle-income countries, of which 34 are SRs and 432 impact evaluations. There are many studies of the effects of roads intervention in all three subcategories-infrastructure, incentives, and institutions, with the most studies in the infrastructure subcategories. There are no or fewer studies on the interventions category ports, shipping, and waterways and for civil aviation (Air Transport).In the outcomes, the evidence is most concentrated on transport infrastructure, services, and use, with the greatest concentration of evidence on transport time and cost (193 studies) and transport modality (160 studies). There is also a concentration of evidence on economic development and health and education outcomes. There are 139 studies on economic development, 90 studies on household income and poverty, and 101 studies on health outcomes.The major gaps in evidence are from all sectors except roads in the intervention. And there is a lack of evidence on outcome categories such as cultural heritage and cultural diversity and very little evidence on displacement (three studies), noise pollution (four studies), and transport equity (2). There is a moderate amount of evidence on infrastructure quantity (32 studies), location, land use and prices (49 studies), market access (29 studies), access to education facilities (23 studies), air quality (50 studies), and cost analysis including ex post CBA (21 studies).The evidence is mostly from East Asia and the Pacific Region (223 studies (40%), then the evidence is from the sub-Saharan Africa (108 studies), South Asia (96 studies), Latin America & Caribbean (79 studies). The least evidence is from Middle East & North Africa (30 studies) and Europe & Central Asia (20 studies). The most used study design is other regression design in all regions, with largest number from East Asia and Pacific (274). There is total 33 completed SRs identified and one ongoing, around 85% of the SR are rated low confidence, and 12% rated as medium confidence. Only one review was rated as high confidence. This EGM contains the available evidence in English.

Conclusion

This map shows the available evidence and gaps on the effectiveness of transport sector intervention in low- and middle-income countries. The evidence is highly concentrated on the outcome of transport infrastructure (especially roads), service, and use (351 studies). It is also concentrated in a specific region-East Asia and Pacific (223 studies)-and more urban populations (261 studies). Sectors with great development potential, such as waterways, are under-examined reflecting also under-investment.The available evidence can guide the policymakers, and government-related to transport sector intervention and its effects on many outcomes across sectors. There is a need to conduct experimental studies and quality SRs in this area. Environment, gender equity, culture, and education in low- and middle-income countries are under-researched areas in the transport sector.

Tunneling a crosstown highway: a natural experiment testing the longitudinal effect on physical activity and active transport

Background

In the city of Maastricht in the Netherlands, a highway crossing several deprived neighborhoods was tunneled in 2016. The vacant space on top of this tunnel was redesigned and prioritized for pedestrians and cyclists. The aim of this study was to evaluate the effect of this major infrastructural change, named the Green Carpet, on total and transport-based physical activity (PA) levels.

Methods

Participants (≥18 years) were part of one of three area-based exposure groups. The maximal exposure group lived in neighborhoods directly bordering the Green Carpet. The minimal exposure group consisted of individuals living at the other side of the city, and the no exposure group consisted of individuals living in a nearby city. Actual use of the new infrastructure was incorporated as a second measure of exposure. Data were collected before and 3-15 months after the opening of the Green Carpet. Device-based measurements were conducted to obtain PA levels and collect location data. Changes in PA over time and intervention effects were determined using linear mixed models.

Results

PA levels in the Green Carpet area increased for the maximal and minimal exposure groups, but did not lead to an increase in total or transport-based PA. For the no exposure group, transport-based MVPA decreased and transport-based SB increased. The significant interaction (time x exposure) for transport-based SB, indicated differences in trends between the no exposure and maximal exposure group (B=-3.59, 95% CI - 7.15; -0.02) and minimal exposure group (B= -4.02, 95% CI -7.85, -0.19). Trends in the results based on analyses focusing on actual use and non-use of the new infrastructure were similar to those of the area-based analyses.

Conclusions

Results suggest that the Green Carpet led to more PA in this specific area, but did not increase the total volume of PA. The area-based differences might reflect the differences between users and non-users, but we should be careful when interpreting these results, due to possible interference of selective mobility bias. This paper reflects that the relationship between infrastructure and PA is not unambiguous.

Trial registration

This research was retrospectively registered at the Netherlands Trial Register (NL8108).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01180-1.

Study protocol: health survey of Sao Paulo: ISA-Physical Activity and Environment

Background

Many studies have investigated the association between the built environment and physical activity behavior in urban settings. However, most of the studies conducted in low- and middle-income countries were cross-sectional, which are limited to identify behavioral determinants. We propose a prospective cohort study to verify the relationship between built environment features and leisure-time and transport-related physical activity in adults from Sao Paulo city, Brazil.

Methods

Prospective multilevel cohort, denominated “ISA-Physical Activity and Environment”. It will build on the Health Survey of Sao Paulo in 2015 (“Inquérito de Saúde de São Paulo (ISA)” in Portuguese). The Health Survey of Sao Paulo, originally designed as a cross-sectional survey, had a multi-stage sample, covering 150 census tracts distributed in five health administrative areas. Data collection was performed by face-to-face interviews until December 2015 and the sample comprised 4043 individuals aged 12 years or more. The ISA-Physical Activity and Environment study will reassess people who are aged 18 years or more in 2020, including telephone and household interviews. The primary outcome will be leisure-time and transport-related physical activity, assessed through the International Physical Activity Questionnaire long version. Exposure variables will be built environment features in the areas participants live and work in the follow-up. Data analysis will include multivariate multilevel linear and logistic models. We will also conduct cost-effectiveness analysis and develop agent-based models to help inform decision-makers. The study will be conducted by an interdisciplinary research team specialized in physical activity epidemiology, nutritional epidemiology, georeferencing applied to health, statistics, agent-based modeling, public health policy, and health economics.

Discussion

There are few longitudinal studies on the relationship between the built environment and physical activity behavior in low- and middle-income countries. We believe that the ISA-Physical Activity and Environment study will contribute with important results for the progress of the knowledge in this field and for the implementation of policies that promote leisure-time physical activity and active travel in Sao Paulo and similar cities across the world.

Validation of the Urban Walkability Perception Questionnaire (UWPQ) in the Balearic Islands

Within the context of promoting the "healthy routes" program, the aim of this study was to validate the urban walkability perception questionnaire (UWPQ) in the Balearic Islands to determine the characteristics of the urban environment that promote walking among the population. The UWPQ measures pedestrian facilities, infrastructures of the environment, perception of safety and a participant's general opinion. This process was performed in 12 routes predefined by a community participation program and set around the primary health centers. Degree of correlation between the items was calculated. The final internal consistency was 0.8 in all blocks according to the Cronbach's alpha test (p < 0.01). Goodman and Kruskal-gamma correlation coefficient (γ) between the item measuring the general opinion and the rest of the items was significant. The items from the perception of safety and pedestrian facilities blocks were the ones that most affected the final assessment. Those regarding the pedestrianonly pavements, clearly marked pavements, noise, traffic density and parks condition obtained the lowest coefficients. To conclude, the results showed that the UWPQ is a suitable instrument to assess the degree of adequacy of the urban environment for walking. It could contribute to create healthy environments as well as to improve public policies.

A systematic review of empirical and simulation studies evaluating the health impact of transportation interventions

Urban transportation is an important determinant of health and environmental outcomes, and therefore essential to achieving the United Nation's Sustainable Development Goals. To better understand the health impacts of transportation initiatives, we conducted a systematic review of longitudinal health evaluations involving: a) bus rapid transit (BRT); b) bicycle lanes; c) Open Streets programs; and d) aerial trams/cable cars. We also synthesized systems-based simulation studies of the health-related consequences of walking, bicycling, aerial tram, bus and BRT use. Two reviewers screened 3302 unique titles and abstracts identified through a systematic search of MEDLINE (Ovid), Scopus, TRID and LILACS databases. We included 39 studies: 29 longitudinal evaluations and 10 simulation studies. Five studies focused on low- and middle-income contexts. Of the 29 evaluation studies, 19 focused on single component bicycle lane interventions; the rest evaluated multi-component interventions involving: bicycle lanes (n = 5), aerial trams (n = 1), and combined bicycle lane/BRT systems (n = 4). Bicycle lanes and BRT systems appeared effective at increasing bicycle and BRT mode share, active transport duration, and number of trips using these modes. Of the 10 simulation studies, there were 9 agent-based models and one system dynamics model. Five studies focused on bus/BRT expansions and incentives, three on interventions for active travel, and the rest investigated combinations of public transport and active travel policies. Synergistic effects were observed when multiple policies were implemented, with several studies showing that sizable interventions are required to significantly shift travel mode choices. Our review indicates that bicycle lanes and BRT systems represent promising initiatives for promoting population health. There is also evidence to suggest that synergistic effects might be achieved through the combined implementation of multiple transportation policies. However, more rigorous evaluation and simulation studies focusing on low- and middle-income countries, aerial trams and Open Streets programs, and a more diverse set of health and health equity outcomes is required.

Built and Social Environment by Systematic Social Observation and Leisure-Time Physical Activity Report among Brazilian Adults: a Population-Based Study

The aim of this study was to investigate the relationship between built and social environment and leisure-time physical activity (LTPA) among adults living in an urban center. The individual data was from the household survey and the environmental data was assessed through systematic social observation by trained observers on street segments of respondents' residences. The relationship between environmental factors and LTPA was examined using multilevel logistic regression. The prevalence of LTPA was 30.2% (95% CI 27.4-32.9%). Individuals living in census tracts with higher walking environment indicators (OR = 1.20; 95% CI 1.02 to 1.40) and safety (OR = 1.18; 95% CI 1.01 to 1.38) were more likely to be active during leisure time, even after adjusting for individual variables. Improving the built and social environment is an important step for achieving higher levels of LTPA in the population in a middle-income country.

What works to promote walking at the population level? A systematic review

OBJECTIVE

Interventions to promote walking have focused on individual or group-based approaches, often via the randomised controlled trial design. Walking can also be promoted using population health approaches. We systematically reviewed the effectiveness of population approaches to promote walking among individuals and populations.

DESIGN

A systematic review.

DATA SOURCES

10 electronic databases searched from January 1990 to March 2017.

ELIGIBILITY CRITERIA

Eligibility criteria include pre-experimental and postexperimental studies of the effects of population interventions to change walking, and the effects must have been compared with a 'no intervention', or comparison group/area/population, or variation in exposure; duration of ≥12 months of follow up; participants in free-living populations; and English-language articles.

RESULTS

12 studies were identified from mostly urban high-income countries (one focusing on using tax, incentivising the loss of parking spaces; and one using policy only, permitting off-leash dogs in city parks). Five studies used mass media with either environment (n=2) or community (n=3) approaches. Four studies used environmental changes that were combined with policies. One study had scaled up school-based approaches to promote safe routes to schools. We found mass media, community initiatives and environmental change approaches increased walking (range from 9 to 75 min/week).

Neighborhood-based physical activity differences: Evaluation of the effect of health promotion program

Introduction

The practice of physical activity is an important factor in the prevention of health problems. However, a small portion of the population is physically active. Recent reviews show that physical activity classes in community settings have the potential to increase population levels of physical activity and reduce health inequalities.

Objective

To evaluate the effect of the Academias da Cidade Program in Belo Horizonte on the practice of physical activity in leisure time (PALT) by non-users living near the program centers.

Methods

We conducted a home-based health survey in Belo Horizonte (2008–2009) with 1,581 adults who were non-users of the program and who lived within a 1,500-meter radius of one active program center (exposed group) and two nonoperational centers with sites reserved for their construction (unexposed group). We collected data on PALT levels (≥150 minutes/week), which was measured with the Physical Activity International Questionnaire and analyzed with binary logistic regression using the Generalized Estimating Equations method. The propensity score was used as an adjustment variable to control the potential confusion in the measures of effect of exposure studied.

Results

The overall prevalence of the PALT was 26.5% in the exposed group and 22.7% in the unexposed group. The exposed group was more likely to be active in leisure time (OR = 1.05; CI 95%: 1.01–1.10). When considering the interaction between exposed group and distance, individuals in the exposed group who lived less than 500 meters from the program center were more likely to be active in leisure time (OR = 1.18, CI 95%: 1.03–1.35) compared to their counterparts.

Conclusion

Promoting physical activity in the community can favorably affect PALT levels among residents, especially those living closest to intervention centers. We believe the Academias da Cidade Program is a promising strategy to facilitate the access to appropriate spaces for the practice of physical activity and contribute to increase the levels physical activity within populations.

Do Natural Experiments of Changes in Neighborhood Built Environment Impact Physical Activity and Diet? A Systematic Review

Physical activity and diet are major modifiable risk factors for chronic disease and have been shown to be associated with neighborhood built environment. Systematic review evidence from longitudinal studies on the impact of changing the built environment on physical activity and diet is currently lacking. A systematic review of natural experiments of neighborhood built environment was conducted. The aims of this systematic review were to summarize study characteristics, study quality, and impact of changes in neighborhood built environment on physical activity and diet outcomes among residents. Natural experiments of neighborhood built environment change, exploring longitudinal impacts on physical activity and/or diet in residents, were included. From five electronic databases, 2084 references were identified. A narrative synthesis was conducted, considering results in relation to study quality. Nineteen papers, reporting on 15 different exposures met inclusion criteria. Four studies included a comparison group and 11 were pre-post/longitudinal studies without a comparison group. Studies reported on the impact of redeveloping or introducing cycle and/or walking trails (n = 5), rail stops/lines (n = 4), supermarkets and farmers' markets (n = 4) and park and green space (n = 2). Eight/15 studies reported at least one beneficial change in physical activity, diet or another associated health outcome. Due to limitations in study design and reporting, as well as the wide array of outcome measures reported, drawing conclusions to inform policy was challenging. Future research should consider a consistent approach to measure the same outcomes (e.g., using measurement methods that collect comparable physical activity and diet outcome data), to allow for pooled analyses. Additionally, including comparison groups wherever possible and ensuring high quality reporting is essential.

Walkability, complete streets, and gender: Who benefits most?

Does street walkability and a new complete street renovation relate to street use and gender composition? We audited two mixed-walkability complete streets ("complete less-urban" and "complete-urban"), one low-walkable street, and one high-walkable street at pre-renovation and twice post-renovation. Complete street users increased, especially for the complete-less urban street. Typically, the high-walkable street attracted the most and the low-walkable street attracted the fewest total people, males, and females; complete streets were in between. On blocks with people, females were only 29% of users; females were much less common on low- walkable streets. Street improvements might enhance gender equity.

Public Open Spaces and Leisure-Time Walking in Brazilian Adults

Access to public open space is important to increase leisure-time walking (LTW) in high-income countries, but there is little evidence in middle-income countries. We conducted a cross-sectional analysis to examine the relationship between LTW and the presence of different public open spaces (parks, bike paths, and squares) and the mix of these recreational destinations near the homes of adults participating in the Sao Paulo Health Survey (n = 3145). LTW was evaluated by a questionnaire. We delineated buffers (500, 1000, and 1500 m) from the geographic coordinates of the adults’ residential addresses using a geographic information system. We used multilevel logistic regression taking account of clustering by census tracts and households, and with adjustment for social, demographics, and health characteristics. The main results showed that the presence of at least two recreational destinations within a 500-m buffer of participants’ homes were associated with an increased odds of LTW compared with no destinations present (OR = 1.65; 95% CI 1.09–2.55). No associations were found for destinations further away. These results support actions outlined in the new urban plan for Sao Paulo city and could be used to highlight the importance access to a mix of public open spaces to promote physical activity in megacities of middle-income countries.