In industrialized nations like the United States and Sweden, the vast majority of adults do not meet the physical activity guidelines of 150 minutes per week.1 Inactive lifestyles put most adults at risk of cardiovascular diseases (CVD), diabetes, obesity, some cancers, osteoporosis, and psychological disorders.2 Physical activity can be effective at all phases of chronic disease management, from primordial prevention (prevention of risk factors) through treatment and rehabilitation.2 There is particular interest in the potential for physical activity to prevent chronic diseases, thereby improving quality of life and reducing health care costs.3 In the past decade, limitations of prevention approaches that target mainly individuals with educational and motivational programs have been recognized, triggering a trend to consider influences on behavior that are outside the person, such as the built environment.4,5 The purposes of the present paper are to describe multilevel ecological models of behavior as they apply to physical activity, describe key concepts, summarize evidence on the relation of built environment attributes to physical activity and obesity, and provide recommendations for built environment changes that could increase physical activity. The intent of this non-systematic review is to present conclusions from previous reviews then illustrate results by highlighting selected studies.

SummaryThe frequent consumption of energy-dense fast food is associated with increased body mass index. This systematic review aims to examine the methodology and current evidence on fast food access and its associations with outcomes. Six databases were searched using terms relating to fast food. Only peer-reviewed studies published in English during a 10-year period, with data collection and analysis regarding fast food access were included. Forty articles met the aforementioned criteria. Nearly half of the studies (n = 16) used their own set of features to define fast food. Studies predominantly examined the relationship between fast food access and socioeconomic factors (n = 21) and 76% indicated fast food restaurants were more prevalent in low-income areas compared with middle-to higher-income areas. Ten of 12 studies found fast food restaurants were more prevalent in areas with higher concentrations of ethnic minority groups in comparison with Caucasians. Six adult studies found higher body mass index was associated with living in areas with increased exposure to fast food; four studies, however, did not find associations. Further work is needed to understand if and how fast food access impacts dietary intake and health outcomes; and if fast food access has disparate socioeconomic, race/ethnicity and age associations.

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The built environment may be responsible for making nonmotorized transportation inconvenient, resulting in declines in physical activity. However, few studies have assessed both the perceived and objectively measured environment in association with physical activity outcomes. The purpose of this study was to describe the associations between perceptions and objective measures of the built environment and their associations with leisure, walking, and transportation activity. Perception of the environment was assessed from responses to 1,270 telephone surveys conducted in Forsyth County, NC and Jackson, MS from January to July 2003. Participants were asked if high-speed cars, heavy traffic, and lack of crosswalks or sidewalks were problems in their neighborhood or barriers to physical activity. They were also asked if there are places to walk to instead of driving in their neighborhood. Speed, volume, and street connectivity were assessed using Geographic Information Systems (GIS) for both study areas. Locations of crashes were measured using GIS for the NC study area as well. Objective and perceived measures of the built environment were in poor agreement as calculated by kappa coefficients. Few associations were found between any of the physical activity outcomes and perception of speed, volume, or presence of sidewalks as problems in the neighborhood or as barriers to physical activity in regression analyses. Associations between perceptions of having places to walk to and presence of crosswalks differed between study sites. Several associations were found between objective measures of traffic volume, traffic speed, and crashes with leisure, walking, and transportation activity in Forsyth County, NC; however, in Jackson, MS, only traffic volume was associated with any of the physical activity outcomes. When both objective and perceived measures of the built environment were combined into the same model, we observed independent associations with physical activity; thus, we feel that evaluating both objective and perceived measures of the built environment may be necessary when examining the relationship between the built environment and physical activity.

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Data recorded by portable GPS units is sufficiently precise to track participants' movements. Successful matching of activity monitor and locational data suggests GPS is a promising tool for complementing accelerometry-based physical activity measures. Our pilot analysis shows evidence that the relationship between environment and activity can be clarified by examining where physical activity occurs.

Context Some evidence suggests that treating vascular risk factors and performing mentally stimulating activities may delay cognitive impairment onset in older adults. Exposure to a complex neighborhood environment may be one mechanism to help delay cognitive decline. Evidence acquisition PubMed, Web of Science, and ProQuest Dissertation and Theses Global database were systematically reviewed, identifying 25 studies published from February 1, 1989 to March 5, 2016 (data synthesized, May 3, 2015–October 7, 2016). The review restricted to quantitative studies focused on: (1) neighborhood social and built environment and cognition; and (2) community-dwelling adults aged ≥45 years. Evidence synthesis The majority of studies were cross-sectional, U.S.-based, and found at least one significant association. The diversity of measures and neighborhood definitions limited the synthesis of findings in many instances. Evidence was moderately strong for an association between neighborhood SES and cognition and modest for associations between neighborhood demographics, design, and destination accessibility and cognition. Most studies examining effect modification found significant associations, with some evidence for effect modification of the neighborhood SES–cognition association by individual-level SES. No studies had low risk of bias and many tested multiple associations that increased the chance of a statistically significant finding. Considering the studies to date, the evidence for an association between neighborhood characteristics and cognition is modest. Conclusions Future studies should include longitudinal measures of neighborhood characteristics and cognition, examine potential effect modifiers such as sex and disability, and study mediators that may help elucidate the biological mechanisms linking neighborhood environment and cognition.