How Our Surroundings Can Help or Hinder Active Lifestyles
Whether it’s biking to work or taking the stairs, walking the dog or parking farther away from the store, being physically active offers countless benefits. Research shows that regular exercise makes people leaner, stronger, smarter, and healthier. So why aren’t more people making physical activity a daily habit? Myriad reasons keep many people off their feet, but the so-called “built environment” our man-made world, with its cities and neighborhoods, streets and buildings, parks and paths-plays a major role. Our social surroundings matter, too: Supportive families and coworkers, for example, may make it easier for people to get up and get moving. Where we live, learn, work, and play appears to have a great deal to do with how active we are. (1–6)
This article briefly reviews research on how various settings influence our activity levels, the policies that shape them, and their roles in perpetuating disparities in obesity rates.
Physical Activity Environment Research by Setting
Family can be the seedbed for a physically active life. (7,8) Studies show that parents are particularly important as models, encouragers, and facilitators of physical activity in children and adolescents. Their roles include everything from buying sports equipment and taking kids to practice to paying fees and doling out praise. (9,10) Other important factors in raising active children include paternal activity levels and positive reinforcement, maternal participation, sibling involvement, time spent outdoors, and family income. (8,10)
What are the best ways to reach out to parents and in turn, get kids moving? Most family-based programs studied to date have had only limited success in increasing children’s activity levels. (11,12) But programs that take place in the home show some promise, as do programs that include face-to-face meetings or phone calls with parents.
Worksites and Active Commuting to Work
At the same time, worksites are ideal settings to test physical activity programs-controlled environments with easy access to employees through existing channels of communication and support networks. Employers can make stairwells more attractive, safer, and easier to use than elevators, and can put signs by elevators encouraging employees to take the stairs. (17–19) They can build onsite gyms, adopt policies that encourage exercise breaks during the workday, compensate employees for joining gyms, or offer health insurance incentives for physical activity. (14,20)
The U.S. Task Force on Community Preventive Services has found that worksite nutrition and physical activity programs can achieve modest improvements in employee weight; few of those studies, however, changed the work environment to make it easier to be active. (21) Worksite programs that aim to integrate short bouts of activity into the workday routine, through exercise breaks, pedometers, and similar efforts, also show promise for increasing activity. (22)
The built environment is a decisive factor in how people get to work. Sidewalks and protected bike lanes, or the availability of bike storage, may make it easier for people to have active commutes; similarly, access to public transportation may also increase physical activity, since it gives people a chance to walk to and from a train station or bus stop. Lachapelle and Frank (23) found that Atlanta residents who had employer-sponsored transit passes were more likely to meet physical activity time recommendations than those who did not. Another small study found that employees who had bicycle storage in the workplace, as well as cultural support for active commuting, were more likely to walk or bike to work. (24)
Schools and Active Commuting to School
Schools, like worksites, are ideal settings to test programs for boosting student fitness. Nearly all children and adolescents spend the better part of their days in classes, and most sites already have scheduled recess periods and sports facilities that can be used to make physical activity part of the school day. (14) A recent Cochrane Review of 55 child obesity prevention studies found that increasing physical activity sessions and developing physical activity skills during the school week were among the promising strategies for obesity prevention. (25) Programs that combine nutrition and physical activity seem to be more effective at reducing children’s body weight than those that focus on physical activity alone. (26)
Schools’ sports facilities can also serve the community at large. A pilot study found that opening an after-hours supervised schoolyard increased the outdoor activity levels of inner-city children by 84 percent compared with a matched control community. (27)
Active travel to school has also received attention as an obesity prevention strategy: In 1969, about half of U.S. elementary and middle school children walked or biked to school; in 2009, however, only about 13 percent of elementary and middle school children did. (28) Some, but not all, studies find a link between active school commutes and healthy weight. (29) For example, a recent nationally representative U.S. study found that youth who walk or bike to school tended to be leaner and log more minutes of moderate to vigorous physical activity each day. (30) The study, like many studies of active transport to school, (29) evaluated children at one point in time, however, so it can’t tease out cause and effect.
Where we live affects how we live. Sidewalks, protected bike lanes, street designs that slow traffic and make it safe to cross, parks, gyms, shops and other destinations within walking distance-all of these neighborhood features can make a difference in how active we are. Research on exactly how neighborhood characteristics affect physical activity is growing. But the field is still in its early stages, with limited data from long-term studies. (31) So-called “self-selection bias” remains a concern: Do active people move to neighborhoods with sidewalks and parks, or does living in a neighborhood with sidewalks and parks make it more likely that people will be active? Also, most studies have been carried out in the United States and other developed nations, so results may differ in rural areas and developing countries.
Access to physical activity facilities
Low-income and minority neighborhoods have fewer recreational facilities than wealthier and predominantly white communities, (32–34) a factor that may contribute to racial/ethnic and socioeconomic disparities in obesity rates. (4) One study, for example, looked at access to recreation facilities in neighborhoods across Manhattan and the Bronx, greater Baltimore, and Forsyth County, North Carolina. It found that minority and low-income neighborhoods were three to eight times more likely to lack high-quality recreational facilities than predominantly white or wealthier neighborhoods. (33) There have been mixed findings, however, as to whether simply living in neighborhoods with more recreation facilities actually leads to more active lifestyles. (1,35) It’s possible that other factors, such as cost, may be a barrier to working out, even when people have gyms nearby. (4)
Walkability and Sprawl
A number of studies have looked at whether living in a “walkable” neighborhood-one that has sidewalks, crosswalks, stores, and leisure destinations-has a positive effect on physical activity, and in turn, body weight. Conversely, researchers have looked at whether living in communities that “sprawl” -those with pedestrian-unfriendly streets, spread-out populations, and larger distances between homes and business areas-makes people more likely to drive rather than walk or bike for transportation or leisure. Some studies have found that living in more walkable neighborhoods, or in communities with less sprawl, is linked to higher rates of physical activity (1,36,37) and lower body mass index (BMI) levels (38–40). However, some studies with stronger research designs don’t find a strong relationship between walkability or sprawl and physical activity; (41) the relationship may vary by age, socioeconomic status, race/ethnicity, and other factors. (35,42)
Neighborhood Safety and Social Cohesion
Risks to safety can run the gamut from reckless drivers and “stranger danger” to bullies in the playground. (44) And there’s evidence that if people believe their neighborhoods are unsafe, children are less likely to play outside, and adults are more wary about walking or taking part in other physical activities. (4,45,46) A recent report found that Los Angeles residents who perceived their neighborhoods as dangerous had significantly higher BMIs than those who considered their communities safe. (47)
Studies that used objective measures of neighborhood crime have found that higher levels reduce walking or physical activity, especially among women and young children. (48–50) Conversely, those who live in areas with more trust or “social cohesion” tend to have higher levels of physical activity. (51,52)
Policies That Shape Our Physical Activity Environment
Policy is a powerful tool for shaping our environments and lifestyles. Public health researchers are particularly interested in identifying how policy changes and large-scale investments in transportation infrastructure can increase physical activity. (53,54)
In the U.S., federal housing loans and direct subsidies for highway development are two major policy decisions that fueled the rise of sprawling suburban developments during the last half of the 20th century and the early part of the 21st century. (55) Combined with rapid advances in automotive technology and increased manufacturing capacity, they launched an exodus from the inner cities to the suburbs and changed the residential landscape. Nonetheless, local cities and towns can enact land-use policies, such as zoning regulations and building codes, to create community-wide environments that support physical activity. (54) There’s evidence that “mixed land use”-locating residential areas near shops, schools, offices, and other destinations, rather than spread apart-is related to walking and physical activity levels. (1,35,56)
Access to Public Transportation
Walking to and from public transportation may help sedentary individuals, especially from low-income and minority groups, meet recommended levels of daily physical activity. (57) Indeed, an estimated 90 percent of public transit trips in the U.S. involve walking at the start or end of the trip. (58) While walking is associated with lower risk of obesity, there’s evidence that car travel has the opposite effect: Frank and colleagues found that each additional hour per day spent in a car was associated with a 6 percent increase in the likelihood of obesity. (59) That’s why the Centers for Disease Control and Prevention recommends that communities improve access to public transportation as an obesity prevention strategy, since better access to public transportation may encourage people to use it. (60)
Bike and Pedestrian-Friendly Street Designs and Policies
Cycle Track, New York City
Travel behavior trends in the U.S. could hardly be worse for public health: Recent data finds that U.S. children and adults use bicycles for just 1 percent of all trips. (58) In the Netherlands, by contrast, 27 percent of trips are made by bike. (61) While people in the U.S. are making more trips by walking-10.5 percent of all trips in 2009, up from 8.6 percent in 2001-only about 18 percent walk for transportation, a number that hasn’t budged in the past decade. (58)
Based on successful support of active transport in Europe, a number of policy options have been proposed. Some focus on making streets safer for walking and biking: Reduced speed limits, longer pedestrian crossing times, wider sidewalks, the use of traffic-calming devices (such as plantings) in roadways, auto-free city zones, and protected, dedicated bike lanes are a few approaches. (2,62,63) Other options include offering incentives for leaving the car at home, or making it easier to walk or bike to public transit. London, for example, made comprehensive bike path, bike parking, and traffic safety improvements in the early 2000s, and congestion pricing-where drivers are charged a fee to enter the city-in 2003. These changes have been accompanied by a doubling in bicycle trips and a 12 percent reduction in serious cycling injuries from 2000 to 2008. (64)
In the U.S., the National Complete Streets Coalition advocates for a comprehensive list of policies that local, state, and federal governments can use to make streets safer for drivers, cyclists, and pedestrians. (65) One area of controversy is related to different views on the safest way to accommodate bicycling. Cycle tracks-barrier-protected, bicycle-only travel lanes located next to sidewalks-are one approach used in the Netherlands, which has much lower rates of bicycle injuries than the U.S. Cycle tracks are less common in North America, where transportation guidelines favor cycling on striped bike lanes in the street. A recent study in Montreal, however, finds that biking in cycle tracks is safer than biking on the street. (66)
The Bottom Line: Building an Environment that Supports Active Lifestyles
Our surroundings and the policies that shape them have a substantial impact on where, when, how, and how much physical activity we get on a daily basis. Just as our lack of physical activity is a major contributor to the obesity epidemic, creating an activity-friendly environment is one way to help turn around the epidemic. There are many elements to an activity-friendly environment: buildings, streets, and communities that encourage walking and biking; parks and playgrounds that are plentiful and appealing; and neighborhoods where people feel-and are-safe, to name a few. How can communities begin the task of creating spaces and places that promote activity? They can start by considering the health impact of development and transportation projects, much the same way they consider the environmental impact of these projects. (67) Such changes will be essential to achieve the goal of making physical activity a regular and natural part of people’s daily lives.
1. Ding D, Sallis JF, Kerr J, Lee S, Rosenberg DE. Neighborhood environment and physical activity among youth, a review. Am J Prev Med. 2011;41:442-55.
2. Pucher J, Buehler R, Seinen M. Bicycling renaissance in North America? An update and re-appraisal of cycling trends and policies. Transportation Research Part A: Policy and Practice. 2011; 45:451–475
3. Papas MA, Alberg AJ, Ewing R, Helzlsouer KJ, Gary TL, Klassen AC. The built environment and obesity. Epidemiol Rev. 2007;29:129-43.
4. Lovasi GS, Hutson MA, Guerra M, Neckerman KM. Built environments and obesity in disadvantaged populations. Epidemiol Rev. 2009;31:7-20.
5. Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q. 2009;87:123-54.
6. Brownson RC, Chriqui JF, Burgeson CR, Fisher MC, Ness RB. Translating epidemiology into policy to prevent childhood obesity: the case for promoting physical activity in school settings. Ann Epidemiol. 2010;20:436-44.
7. Eyler AA, Brownson RC, Donatelle RJ, King AC, Brown D, Sallis JF. Physical activity social support and middle- and older-aged minority women: results from a US survey. Soc Sci Med. 1999;49:781-9.
8. Ferreira I, van der Horst K, Wendel-Vos W, Kremers S, van Lenthe FJ, Brug J. Environmental correlates of physical activity in youth—a review and update. Obes Rev. 2007;8:129-54.
9. Beets MW, Cardinal BJ, Alderman BL. Parental social support and the physical activity-related behaviors of youth: a review. Health Educ Behav. 2010;37:621-44.
10. Cleland V, Timperio A, Salmon J, Hume C, Telford A, Crawford D. A longitudinal study of the family physical activity environment and physical activity among youth. Am J Health Promot. 2011;25:159-67.
11. van Sluijs EM, Kriemler S, McMinn AM. The effect of community and family interventions on young people’s physical activity levels: a review of reviews and updated systematic review. Br J Sports Med. 2011;45:914-22.
12. O’Connor TM, Jago R, Baranowski T. Engaging parents to increase youth physical activity a systematic review. Am J Prev Med. 2009;37:141-9.
13. Schulte PA, Wagner GR, Ostry A, et al. Work, obesity, and occupational safety and health. Am J Public Health. 2007;97:428-36.
14. Katz DL, O’Connell M, Yeh MC, et al. Public health strategies for preventing and controlling overweight and obesity in school and worksite settings: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep. 2005;54:1-12.
15. Atkinson G, Fullick S, Grindey C, Maclaren D. Exercise, energy balance and the shift worker. Sports Med. 2008;38:671-85.
16. Zhao I, Bogossian F, Song S, Turner C. The Association Between Shift Work and Unhealthy Weight: A Cross-Sectional Analysis From the Nurses and Midwives’ e-Cohort Study. J Occup Environ Med. 2011.
17. Meyer P, Kayser B, Kossovsky MP, et al. Stairs instead of elevators at workplace: cardioprotective effects of a pragmatic intervention. Eur J Cardiovasc Prev Rehabil. 2010;17:569-75.
18. Nicoll G, Zimring C. Effect of innovative building design on physical activity. J Public Health Policy. 2009;30 Suppl 1:S111-23.
19. Soler RE, Leeks KD, Buchanan LR, Brownson RC, Heath GW, Hopkins DH. Point-of-decision prompts to increase stair use. A systematic review update. Am J Prev Med. 2010;38:S292-300.
20. Herman CW, Musich S, Lu C, Sill S, Young JM, Edington DW. Effectiveness of an incentive-based online physical activity intervention on employee health status. J Occup Environ Med. 2006;48:889-95.
21. Anderson LM, Quinn TA, Glanz K, et al. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review. Am J Prev Med. 2009;37:340-57.
22. Barr-Anderson DJ, AuYoung M, Whitt-Glover MC, Glenn BA, Yancey AK. Integration of short bouts of physical activity into organizational routine, a systematic review of the literature. Am J Prev Med. 2011;40:76-93.
23. Lachapelle U, Frank LD. Transit and health: mode of transport, employer-sponsored public transit pass programs, and physical activity. J Public Health Policy. 2009;30 Suppl 1:S73-94.
24. Kaczynski AT, Bopp MJ, Wittman P. Association of workplace supports with active commuting. Prev Chronic Dis. 2010;7:A127.
25. Waters E, de Silva-Sanigorski A, Hall BJ, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;12:CD001871.
26. Katz DL, O’Connell M, Njike VY, Yeh MC, Nawaz H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int J Obes (Lond). 2008;32:1780-9.
27. Farley TA, Meriwether RA, Baker ET, Watkins LT, Johnson CC, Webber LS. Safe play spaces to promote physical activity in inner-city children: results from a pilot study of an environmental intervention. Am J Public Health. 2007;97:1625-31.
28. McDonald NC, Brown AL, Marchetti LM, Pedroso MS. U.S. school travel, 2009 an assessment of trends. Am J Prev Med. 2011;41:146-51.
29. Lubans DR, Boreham CA, Kelly P, Foster CE. The relationship between active travel to school and health-related fitness in children and adolescents: a systematic review. Int J Behav Nutr Phys Act. 2011;8:5.
30. Mendoza JA, Watson K, Nguyen N, Cerin E, Baranowski T, Nicklas TA. Active commuting to school and association with physical activity and adiposity among US youth. J Phys Act Health. 2011;8:488-95.
31. Ding D, Gebel K. Built environment, physical activity, and obesity: What have we learned from reviewing the literature? Health Place. 2011.
32. Hannon C, Cradock A, Gortmaker SL, et al. Play Across Boston: a community initiative to reduce disparities in access to after-school physical activity programs for inner-city youths. Prev Chronic Dis. 2006;3:A100.
33. Moore LV, Diez Roux AV, Evenson KR, McGinn AP, Brines SJ. Availability of recreational resources in minority and low socioeconomic status areas. Am J Prev Med. 2008;34:16-22.
34. Powell LM, Slater S, Chaloupka FJ, Harper D. Availability of physical activity-related facilities and neighborhood demographic and socioeconomic characteristics: a national study. Am J Public Health. 2006;96:1676-80.
35. Feng J, Glass TA, Curriero FC, Stewart WF, Schwartz BS. The built environment and obesity: a systematic review of the epidemiologic evidence. Health Place. 2010;16:175-90.
36. Frank LD, Schmid TL, Sallis JF, Chapman J, Saelens BE. Linking objectively measured physical activity with objectively measured urban form: findings from SMARTRAQ. Am J Prev Med. 2005;28:117-25.
37. Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association of the built environment with physical activity and obesity in older persons. Am J Public Health. 2007;97:486-92.
38. Ewing R, Schmid T, Killingsworth R, Zlot A, Raudenbush S. Relationship between urban sprawl and physical activity, obesity, and morbidity. Am J Health Promot. 2003;18:47-57.
39. Li F, Harmer P, Cardinal BJ, et al. Built environment and 1-year change in weight and waist circumference in middle-aged and older adults: Portland Neighborhood Environment and Health Study. Am J Epidemiol. 2009;169:401-8.
40. Rundle A, Roux AV, Free LM, Miller D, Neckerman KM, Weiss CC. The urban built environment and obesity in New York City: a multilevel analysis. Am J Health Promot. 2007;21:326-34.
41. Lee IM, Ewing R, Sesso HD. The built environment and physical activity levels: the Harvard Alumni Health Study. Am J Prev Med. 2009;37:293-8.
42. Dunton GF, Kaplan J, Wolch J, Jerrett M, Reynolds KD. Physical environmental correlates of childhood obesity: a systematic review. Obes Rev. 2009;10:393-402.
43. Stark Casagrande S, Gittelsohn J, Zonderman AB, Evans MK, Gary-Webb TL. Association of walkability with obesity in Baltimore City, Maryland. Am J Public Health. 2010.
44. Carver A, Timperio A, Crawford D. Playing it safe: the influence of neighbourhood safety on children’s physical activity. A review. Health Place. 2008;14:217-27.
45. Harrison RA, Gemmell I, Heller RF. The population effect of crime and neighbourhood on physical activity: an analysis of 15,461 adults. J Epidemiol Community Health. 2007;61:34-9.
46. Molnar BE, Gortmaker SL, Bull FC, Buka SL. Unsafe to play? Neighborhood disorder and lack of safety predict reduced physical activity among urban children and adolescents. Am J Health Promot. 2004;18:378-86.
47. Fish JS, Ettner S, Ang A, Brown AF. Association of perceived neighborhood safety on body mass index. Am J Public Health. 2010;100:2296-303.
48. Gomez JE, Johnson BA, Selva M, Sallis JF. Violent crime and outdoor physical activity among inner-city youth. Prev Med. 2004;39:876-81.
49. Brown HS, 3rd, Perez A, Mirchandani GG, Hoelscher DM, Kelder SH. Crime rates and sedentary behavior among 4th grade Texas school children. Int J Behav Nutr Phys Act. 2008;5:28.
50. Bennett GG, McNeill LH, Wolin KY, Duncan DT, Puleo E, Emmons KM. Safe to walk? Neighborhood safety and physical activity among public housing residents. PLoS Med. 2007;4:1599-606; discussion 607.
51. Cradock AL, Kawachi I, Colditz GA, Gortmaker SL, Buka SL. Neighborhood social cohesion and youth participation in physical activity in Chicago. Soc Sci Med. 2009;68:427-35.
52. Lindstrom M, Hanson BS, Ostergren PO. Socioeconomic differences in leisure-time physical activity: the role of social participation and social capital in shaping health related behaviour. Soc Sci Med. 2001;52:441-51.
53. Saelens BE, Sallis JF, Frank LD. Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literatures. Ann Behav Med. 2003;25:80-91.
54. Heath GW, Brownson RC, Kruger J, Miles R, Powell KE, Ramsey LT. The effectiveness of urban design and land use and transport policies and practicies to increase physical actvity: a systematic review. Journal of Physical Activity and Health. 2006;3:S55-S76.
55. Hayden D. Building Suburbia: Green Fields and Urban Growth, 1820-2000. New York: Pantheon; 2003.
56. Durand CP, Andalib M, Dunton GF, Wolch J, Pentz MA. A systematic review of built environment factors related to physical activity and obesity risk: implications for smart growth urban planning. Obes Rev. 2011;12:e173-82.
57. Besser LM, Dannenberg AL. Walking to public transit: steps to help meet physical activity recommendations. Am J Prev Med. 2005;29:273-80.
58. Pucher J, Buehler R, Merom D, Bauman A. Walking and cycling in the United States, 2001-2009: evidence from the National Household Travel Surveys. Am J Public Health. 2011;101 Suppl 1:S310-7.
59. Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med. 2004;27:87-96.
60. Khan LK, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevent obesity in the United States. MMWR Recomm Rep. 2009;58:1-26.
61. Maibach E, Steg L, Anable J. Promoting physical activity and reducing climate change: opportunities to replace short car trips with active transportation. Prev Med. 2009;49:326-7.
62. Woodcock J, Banister D, Edwards P, Prentice AM, Roberts I. Energy and transport. Lancet. 2007;370:1078-88.
63. Pucher J, Dijkstra L. Promoting safe walking and cycling to improve public health: lessons from The Netherlands and Germany. Am J Public Health. 2003;93:1509-16.
64. Pucher J, Dill J, Handy S. Infrastructure, programs, and policies to increase bicycling: an international review. Prev Med. 2010;50 Suppl 1:S106-25.
65. National Complete Streets Coalition. Complete Streets. Accessed January 30, 2012.
66. Lusk AC, Furth PG, Morency P, Miranda-Moreno LF, Willett WC, Dennerlein JT. Risk of injury for bicycling on cycle tracks versus in the street. Inj Prev. 2011;17:131-5.
67. Centers for Disease Control and Prevention. Health Impact Assessment. Accessed January 30, 2012.