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Physical Activity: Community-Scale Urban Design and Land Use Policies


What the Task Force Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review of 12 studies (search period 1993 - 2003).

The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity.


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Summary of Results

Information about data variability is available in the published evidence review.

Twelve studies were included in the review. They evaluated a variety of results.

  • Overall, the median improvement in some aspect of physical activity (e.g., number of walkers or bicyclists) was 161%.
  • Additional benefits that may have resulted from these interventions:
    • More attractive green space
    • Increased sense of community and decreased isolation
    • Increased consumer choice for places to live
    • Reduced crime and stress

Summary of Economic Evidence

An economic review of this intervention was not conducted.


  • Results from this systematic review should be applicable to diverse settings and populations if the intervention approach is adapted to the target population.
  • Because included studies were carried out in urban or suburban environments, it is unclear whether findings can be applied to rural settings. Many of the design features noted in the included studies, however, can be found in small towns and cities in rural regions.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base. (What are evidence gaps?)

  • What characteristics of a community are necessary for optimal implementation of policy and environmental interventions?
  • Does the effectiveness vary by type of access (e.g., worksite facility or community facility) or socioeconomic group?
  • How can the necessary political and social support for this intervention approach be created or increased?
  • Does creating or improving access motivate sedentary people to become more active, give those who are already active an increased opportunity to be active or both?
  • If you build it, will they come? In other words, is enhanced access to places for activity enough to create higher physical activity levels or are other intervention activities also necessary?
  • Do these interventions increase awareness of opportunities for and benefits of physical activity?
  • What are the effects of creating new places for physical activity versus enhancing existing facilities?
  • Which neighborhood features (e.g., sidewalks, parks, traffic flow, nearness to shopping) are the most crucial in influencing activity patterns?
  • How does closeness of places, such as trails or parks to residences, affect ease and frequency?
  • How do interventions affect various population subgroups, such as age, gender, race, or ethnicity?
  • Are there any key harms?
  • What are the barriers to implementing these interventions (e.g., political, social, time, money)?
  • Physical activity is difficult to measure consistently across studies and populations. Although several good measures have been developed, reliable and valid measures are needed for the spectrum of physical activity including moderate or light activity.
  • What is the cost-effectiveness of each of these interventions? What combinations of components are most cost-effective?
  • How can effectiveness in terms of health outcomes or quality-adjusted health outcomes be better measured, estimated, or modeled?
  • How can the cost benefit of these programs be estimated?
  • How do specific characteristics of interventions contribute to economic efficiency?

Study Characteristics

  • All included studies used cross-sectional designs.
  • Included studies were conducted in the U.S. (11 studies) and Canada (1 study).
  • Studies compared communities with grid/rectilinear street design with communities with cul-de-sac street design, or pedestrian-friendly environments (e.g., ease of crossing street, topography, continuity of sidewalks) with non-pedestrian-friendly environments.


Heath GW, Brownson RC, Kruger J, Miles R, Powell KE, Ramsey LT, Task Force on Community Services. The effectiveness of urban design and land use and transport policies and practices to increase physical activity: a systematic review. Journal of Physical Activity and Health. 2006;3(Suppl 1):S55-76.