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

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Findings and Recommendations

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.

The full CPSTF Finding and Rationale Statement and supporting documents for Physical Activity: Built Environment Approaches Combining Transportation System Interventions with Land Use and Environmental Design are available in The Community Guide Collection on CDC Stacks.

Intervention

Built environment interventions 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. Interventions 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:

  • 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:

  • Mixed land use environments to increase diversity and proximity of local destinations
  • Access to parks and other public or private recreational facilities

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

About The Systematic Review

The CPSTF finding is based on 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 and 74 cross-sectional studies.

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.

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), and other countries (6 studies)
  • Studies were conducted in urban (25 studies), suburban (5 studies), and mixed (60 studies) areas
  • Study populations mainly included adults ages 18-64 years (31 studies), youth ages 17 and younger (18 studies), and older adults aged 65 and older (6 studies)
  • Approximately 54% of participants were female
  • Included studies evaluated macro-level interventions (50 studies), micro-level interventions (12 studies), or both (28 studies)

Summary of Results

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:

Construction projects: 11 longitudinal studies and 0 cross-sectional 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.

  • One long-term, large-scale study — Residential Environments Project (RESIDE) — compared changes in physical activity among new residents based on built environment characteristics of their different neighborhoods and 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
    • Increased (5 studies)
    • Showed mixed results (1 study)
    • Decreased (1 study)
  • Increased recreation-related walking and biking (2 studies)
  • 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)

Pre-defined neighborhood types: 7 cross-sectional studies and 0 longitudinal studies compared residents from selected neighborhoods that had distinct built environment characteristics (typically based on neighborhood layout or design) that were classified as either more activity-supportive neighborhoods or less activity-supportive neighborhoods.

  • 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)

Existing built environments: 4 longitudinal studies and 62 cross-sectional studies used summary scores from standardized assessments to compare communities with different built environment characteristics.

  • Activity-friendly built environment features were associated with levels of physical activity.
    • Transportation-related walking and biking
      • Studies reported higher levels (21 studies), no difference (5 studies), or lower levels (1 study). Three studies reported mixed results.
    • Recreation-related walking and biking
      • Studies reported higher levels (11 studies) or no difference (5 studies). Three studies reported mixed results.
  • Activity-friendly built environment features were associated with levels of physical activity.
    • 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 (13 studies), no difference (4 studies), or lower levels (2 studies). Two studies reported mixed results.
    • Recommended levels of MVPA
      • Studies reported higher proportions of residents achieved recommended levels (3 studies) or found no difference (2 studies).

Policies restricting sprawl: 1 longitudinal studies and 5 cross-sectional studies compared communities based on built environment characteristics associated with sprawl development or proximity to sprawl-affected areas.

  • Transportation-and recreation-related walking and biking increased significantly following implementation of state-and metropolitan-level policies that restricted or regulated sprawl (1 study).
  • Areas with existing 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)

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:

  • 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

  • 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)?

Implementation Considerations and Resources

Guidelines, policy initiatives, and position statements are available from public health agencies and professional organizations:

Macro-scale interventions can have long-term, sustainable influence on the built environment. Micro-scale interventions can be implemented more rapidly and typically cost less.

In rural communities, micro-level improvements may be a viable first step until macro-level changes can be implemented.

Connecting Routes + Destinations – online resources to help communities implement combined built environment approaches to increase physical activity.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.