Built environment correlates of physical activity in low- and middle-income countries: A systematic review

Abstract

Insufficient physical activity (PA) is the fourth major risk factor for many non-communicable diseases and premature mortality worldwide. Features of the built environment (BE) play a considerable role in determining population PA behaviors. The majority of evidence for PA-BE relationships comes from high-income countries and may not be generalizable to lowand middle-income countries (LMICs). We aim to systematically review the literature and assess the associations between perceived and/or objective BE characteristics and PA domains in LMICs. This review adopted a systematic search strategy for English language articles published between January 2000 and June 2019 from four electronic databases-Medline, Embase, Web of Science and PubMed-adhering to the PRISMA guidelines. Studies addressing the associations between self-reported and/or objective BE and PA were only included if they were conducted in LMICs, according to the World Bank classification list. Articles investigating PA-BE relationships across any age groups were included, and all study designs were eligible, except for qualitative studies and reviews. Thirty-three studies were included for evidence synthesis. Cross-sectional studies were the most prevailing study design (97%), revealing a notable gap in longitudinal PA-BE research in LMICs. A majority of the BE factors were not associated with different PA domains while others (e.g., density, proximity to services, aesthetics) exhibited an inconsistent association. Land-use mix diversity was positively associated with transport PA and the presence of recreation facilities resulted in an increase in PA during leisure-time. Increased safety from crime at night consistently increased total PA and walking levels. Research exploring the associations between BE attributes and PA behaviors in LMICs appears to be limited and is primarily cross-sectional. Longitudinal research studies with objective measures are needed for inferring well-grounded PA-BE causal relationships and informing the design of evidence-based environmental interventions for increasing PA levels in LMICs.

Associations between the built environment and dietary intake, physical activity, and obesity: A scoping review of reviews

“…Three meta‐analyses, 45–47 38 systematic reviews, 27–31,34,36,37,48–77 and five combined systematic reviews and meta‐analyses 78–82 investigated associations between built environment factors and physical activity. Figure 2 summarizes the associations between built environment factors and physical activity across all included reviews (i.e., whether the studies included in reviews were primarily/leaning toward support of a significant association, truly mixed, or primarily/leaning null).…”

“…This review concluded that results across countries could be summarized as mixed at best; however, a greater proportion of studies conducted in the United States demonstrated significant associations in the expected direction between fast‐food restaurants and weight status (59% of studies conducted in the United States versus 40% of those conducted in other countries). A review by Elshahat and colleagues 74 focused on associations between built environment features and physical activity in adults residing in low‐ and middle‐income countries. The authors noted that the primary difference between their results and results from other reviews of studies conducted in high‐income countries was the lack of a significant association between nearby transit options and physical activity (which, the authors noted, may be due to the wide availability of alternative transportation options such as private minibuses, taxis, and rickshaws in low‐ and middle‐income countries).…”

Designing Age-Friendly Communities: Exploring Qualitative Perspectives on Urban Green Spaces and Ageing in Two Indian Megacities

“…The built environment exerts an important impact on health, which can either facilitate or hinder participation in activities of daily living and healthy behaviour [ 10 , 11 ]. Activity-friendly neighbourhoods, with easy access to destinations and services, are known to be positively associated with higher levels of physical activity and walking among older adults [ 12 ].…”

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

“…However, longitudinal studies are required to avoid potential self-selection bias [19] and to obtain robust evidence on the effects of the built environment on health outcomes, especially in low-and middle-income countries undergoing rapid societal transition processes [12]. Well-established examples of longitudinal studies conducted in high-income countries are the "RESIDential Environment Study (RESIDE)" [20] and the "How Areas in Brisbane Influence Health and Activity (HABI-TAT)" [41], both in Australia, and the I-Connect [21], in the United Kingdom.…”

“…However, most of the studies on the role of cities' built environment on leisure-time and transport-related physical activity have been conducted in high-income countries, which present socioeconomic and cultural aspects that are different from low-and medium-income countries [12]. Besides, most studies published in low-and middle-income countries are based on cross-sectional data, limiting their capacity to answer whether different built environment features can affect physical activity behavior [12]. A systematic review published in 2012 indicated that 89% of the studies identified a significant association between features from the built environment and physical activity level in diverse populations [13].…”