Physical Environment Correlates of Physical Activity in Developing Countries: A Review

The Lancet, 378(9793), 804-814

The past decade has seen a dramatic increase in empirical investigation into the relations between built environment and physical activity. To create places that facilitate and encourage walking, practitioners need an understanding of the specific characteristics of the built environment that correlate most strongly with walking. This article reviews evidence on the built environment correlates with walking. Included in this review were 13 reviews published between 2002 and 2006 and 29 original studies published in 2005 and up through May 2006. Results were summarized based on specific characteristics of the built environment and transportation walking versus recreational walking. Previous reviews and newer studies document consistent positive relations between walking for transportation and density, distance to nonresidential destinations, and land use mix; findings for route/network connectivity, parks and open space, and personal safety are more equivocal. Results regarding recreational walking were less clear. More recent evidence supports the conclusions of prior reviews, and new studies address some of the limitations of earlier studies. Although prospective studies are needed, evidence on correlates appears sufficient to support policy changes.

Physical inactivity is an important risk factor for chronic diseases, but for many (mainly developing) countries, no prevalence data have ever been published. To present data on the prevalence of physical inactivity for 51 countries and for different age groups and settings across these countries. Data analysis (conducted in 2007) included data from 212,021 adult participants whose questionnaires were culled from 259,526 adult observations from 51 countries participating in the World Health Survey (2002-2003). The validated International Physical Activity Questionnaire (IPAQ) was used to assess days and duration of vigorous, moderate, and walking activities during the last 7 days. Country prevalence of physical inactivity ranged from 1.6% (Comoros) to 51.7% (Mauritania) for men and from 3.8% (Comoros) to 71.2% (Mauritania) for women. Physical inactivity was generally high for older age groups and lower in rural as compared to urban areas. Overall, about 15% of men and 20% of women from the 51 countries analyzed here (most of which are developing countries) are at risk for chronic diseases due to physical inactivity. There were substantial variations across countries and settings. The baseline information on the magnitude of the problem of physical inactivity provided by this study can help countries and health policymakers to set up interventions addressing the global chronic disease epidemic.