Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study
Open accessAbstract
Background Physical inactivity is a global pandemic responsible for over 5 million deaths annually through its effects on multiple non-communicable diseases. We aimed to document how objectively measured attributes of the urban environment are related to objectively measured physical activity, in an international sample of adults.Methods We based our analyses on the International Physical activity and Environment Network (IPEN) adult study, which was a coordinated, international, cross-sectional study. Participants were sampled from neighbourhoods with varied levels of walkability and socioeconomic status. The present analyses of data from the IPEN adult study included 6822 adults aged 18-66 years from 14 cities in ten countries on five continents. Indicators of walkability, public transport access, and park access were assessed in 1·0 km and 0·5 km street network buffers around each participant's residential address with geographic information systems. Mean daily minutes of moderate-to-vigorous-intensity physical activity were measured with 4-7 days of accelerometer monitoring. Associations between environmental attributes and physical activity were estimated using generalised additive mixed models with gamma variance and logarithmic link functions.Results Four of six environmental attributes were significantly, positively, and linearly related to physical activity in the single variable models: net residential density (exp[b] 1·006 [95% CI 1·003-1·009]; p=0·001), intersection density (1·069 [1·011-1·130]; p=0·019), public transport density (1·037 [1·018-1·056]; p=0·0007), and number of parks (1·146 [1·033-1·272]; p=0·010). Mixed land use and distance to nearest public transport point were not related to physical activity. The difference in physical activity between participants living in the most and least activity-friendly neighbourhoods ranged from 68 min/week to 89 min/week, which represents 45-59% of the 150 min/week recommended by guidelines.Interpretation Design of urban environments has the potential to contribute substantially to physical activity. Similarity of findings across cities suggests the promise of engaging urban planning, transportation, and parks sectors in efforts to reduce the health burden of the global physical inactivity pandemic.Funding Funding for coordination of the IPEN adult study, including the present analysis, was provided by the National Cancer Institute of National Institutes of Health (CA127296) with studies in each country funded by different sources.
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Even apart from directly saving health costs from better-quality housing, housing located in activity-friendly neighborhoods may lead to more physical activity and thus generate health benefits, including reductions in the prevalence of obesity.
“For example, even apart from directly saving health costs from better-quality housing, housing located in activity-friendly neighborhoods may lead to more physical activity and thus generate health benefits, including reductions in the prevalence of obesity (146).”
From Review of the Impact of Housing Quality on Inequalities in Health and Well-Being (2023) · cites this paper as [146]
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BackgroundSelf-citationCerin, E., Sallis, J. F., Salvo, D., Hinckson, E. A., Conway, T. L., Owen, N. G., Dyck, D. V., Lowe, M., Higgs, C., Moudon, A. V., et al. (2022) · The Lancet Global Health · doi:10.1016/s2214-109x(22)00068-7 · Cited by 139 · see citing works
“…for differences in associations by sex, age, or city, which reflects previous findings from the same IPEN Adult cohort in relation to objectively measured physical activity, 51 and supports the generalisability of findings to various sociodemographic groups and the diverse global cities studied.”
BackgroundResultSelf-citationMouratidis, K. (2024) · Cities · doi:10.1016/j.cities.2024.105274 · Cited by 138 · see citing works
Stappers, N. E. H., van Kann, D., Ettema, D., de Vries, N. K., & Kremers, S. (2018) · Health & Place · doi:10.1016/j.healthplace.2018.08.002 · Cited by 137 · see citing works
Niedermeier, M., Einwanger, J., Hartl, A. J., & Kopp, M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0177719 · Cited by 134 · see citing works
“Sallis & Cerin [25] emphasized the importance of the city design aiming on the enhancement of physical activity.”
BackgroundPapa, E., & Ferreira, A. (2018) · Urban Science · doi:10.3390/urbansci2010005 · Cited by 128 · see citing works
Cerin, E., Conway, T. L., Adams, M. A., Barnett, A. H., Cain, K. L., Owen, N. G., Christiansen, L. B., Dyck, D. V., Mitáš, J., Sarmiento, O. L., et al. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.06.034 · Cited by 127 · see citing works
Self-citationCzepkiewicz, M., Heinonen, J. T., & Ottelin, J. (2018) · Environmental Research Letters · doi:10.1088/1748-9326/aac9d2 · Cited by 126 · see citing works
Chan, E. T. H., Schwanen, T., & Banister, D. (2019) · Transportation · doi:10.1007/s11116-019-10062-2 · Cited by 126 · see citing works
Li, X., Zhang, W., Zhang, W., Tao, K., Ni, W., Wang, K., Li, Z., Liu, Q., & Lin, J. (2020) · BMC Public Health · doi:10.1186/s12889-020-09671-9 · Cited by 129 · see citing works
“One hypothesis is that more abundant public facilities reflects a more favourable physical environment, but not all environmental attributes are positively related to PA [40].”
BackgroundLaddu, D., Paluch, A. E., & LaMonte, M. J. (2021) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.12.009 · Cited by 131 · see citing works
Chen, L., Zhao, L., Xiao, Y., & Lü, Y. (2022) · Computers Environment and Urban Systems · doi:10.1016/j.compenvurbsys.2022.101827 · Cited by 121 · see citing works
Transforming Our Cities: Best Practices towards Clean Air and Active Transportation
Glazener, A., & Khreis, H. (2019) · Current Environmental Health Reports · doi:10.1007/s40572-019-0228-1 · Cited by 124 · see citing works
Molina‐García, J., Queralt, A., Adams, M. A., Conway, T. L., & Sallis, J. F. (2017) · Preventive Medicine · doi:10.1016/j.ypmed.2017.08.026 · Cited by 119 · see citing works
Self-citationThe Built Environment and Child Health: An Overview of Current Evidence
Gascón, M., Vrijheid, M., & Nieuwenhuijsen, M. J. (2016) · Current Environmental Health Reports · doi:10.1007/s40572-016-0094-z · Cited by 116 · see citing works
Association between urbanisation and type 2 diabetes: an ecological study
Gassasse, Z., Smith, D. M., Finer, S., & Gallo, V. (2017) · BMJ Global Health · doi:10.1136/bmjgh-2017-000473 · Cited by 119 · see citing works
“move towards a more urban environment, higher rates of obesity and T2D have been observed, 7 likely as a consequence of changes in lifestyles and health behaviours (ie, diet and physical activity) 8–10 but perhaps also due to the changing socioeconomic make-up of these new urban populations.”
BackgroundHowell, N. A., Tu, J. V., Moineddin, R., Chu, A., & Booth, G. L. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.119.013146 · Cited by 113 · see citing works
“19,20,43 In sum, we found that individuals living in less walkable neighborhoods have a higher predicted risk of cardiovascular disease events.”
Cacciatore, S., Mao, S., Nuñez, M. V., Massaro, C., Spadafora, L., Bernardi, M., Perone, F., Sabouret, P. F., Biondi‐Zoccai, G., Banach, M., et al. (2025) · Aging Clinical and Experimental Research · doi:10.1007/s40520-025-03052-1 · Cited by 129 · see citing works
“In contrast, low-income areas frequently lack safe, accessible recreational spaces, limiting opportunities for physical activity [29].”
Urban Health Indicator Tools of the Physical Environment: a Systematic Review
Pineo, H., Glonti, K., Rutter, H., Zimmermann, N., Wilkinson, P., & Davies, M. (2018) · Journal of Urban Health · doi:10.1007/s11524-018-0228-8 · Cited by 112 · see citing works
“During the screening stage, we decided to include tools which measured the impact of the physical urban environment on walkability/physical activity (PA) as this is an important contribution of the built environment toward promoting good health [32, 33].”
MethodNatural movement: A space syntax theory linking urban form and function with walking for transport
Koohsari, M. J., Oka, K., Owen, N. G., & Sugiyama, T. (2019) · Health & Place · doi:10.1016/j.healthplace.2019.01.002 · Cited by 112 · see citing works
““Active living research,” which aims to create activity-friendly communities, has shown that neighborhood built environment attributes are related to residents’ walking for transport (Giles-Corti et al., 2016; Sallis et al., 2016; Sallis and Owen, 2015).”
BackgroundSelf-citationMouratidis, K. (2019) · Journal of Transport Geography · doi:10.1016/j.jtrangeo.2019.102491 · Cited by 112 · see citing works
Nurwanti, E., Hadi, H., Chang, J., Chao, J. C.-J., Paramashanti, B. A., Gittelsohn, J., & Bai, C. (2019) · Nutrients · doi:10.3390/nu11112813 · Cited by 112 · see citing works
“However, living in urban areas may also present certain challenges related to physical activity due to the residential and public transport density, and the availability of public parks [29].”
BackgroundDuan, Y., Wagner, P., Zhang, R., Wulff, H., & Brehm, W. (2018) · Landscape and Urban Planning · doi:10.1016/j.landurbplan.2018.06.009 · Cited by 110 · see citing works
Scholes, S., & Bann, D. (2018) · BMC Public Health · doi:10.1186/s12889-018-5857-z · Cited by 110 · see citing works
Zhang, L., Zhou, S., Kwan, M., Chen, F., & Lin, R. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15102323 · Cited by 109 · see citing works
Transportation sustainability in the urban context: a comprehensive review
Sultana, S., Salon, D., & Kuby, M. (2017) · Urban Geography · doi:10.1080/02723638.2017.1395635 · Cited by 107 · see citing works
“Active transportation promotes health (Bertolini, Le Clercq, & Kapoen, 2005; Sallis et al., 2016).”
BackgroundFrank, L. D., Adhikari, B., White, K., Dummer, T., Sandhu, J., Demlow, E., Hu, Y., Hong, A., & van den Bosch, M. A. (2021) · Environment International · doi:10.1016/j.envint.2021.106959 · Cited by 108 · see citing works
Self-citationMarquet, O., Hirsch, J. A., Kerr, J., Jankowska, M. M., Mitchell, J. A., Hart, J. E., Laden, F., Hipp, J. A., & James, P. (2022) · Environment International · doi:10.1016/j.envint.2022.107317 · Cited by 105 · see citing works
“Use of accelerometry data is starting to provide new evidence on the association between walkability and physical activity worldwide (Sallis et al., 2016; Vanhelst et al., 2013), in dense urban spaces (Rundle et al.”
BackgroundSelf-citationGPS-Based Exposure to Greenness and Walkability and Accelerometry-Based Physical Activity
James, P., Hart, J. E., Hipp, J. A., Mitchell, J. A., Kerr, J., Hurvitz, P. M., Glanz, K., & Laden, F. (2017) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-16-0925 · Cited by 104 · see citing works
“We also aimed to determine if these associations were linear (26), to examine interactions between walkability and greenness, and to assess effect modification by measures of age, race, and socioeconomic status.”
BackgroundSelf-citationZijlema, W. L., Ávila-Palència, I., Mas, M. T., Gidlow, C. J., Maas, J., Kruize, H., Andrušaitytė, S., Gražulevičienė, R., & Nieuwenhuijsen, M. J. (2018) · Environment International · doi:10.1016/j.envint.2018.10.002 · Cited by 103 · see citing works
Persistence of walking in Chile: lessons for urban sustainability
Herrmann‐Lunecke, M. G., Mora, R., & Sagaris, L. (2020) · Transport Reviews · doi:10.1080/01441647.2020.1712494 · Cited by 105 · see citing works
Kabisch, N., & Kraemer, R. (2020) · Environmental Science & Policy · doi:10.1016/j.envsci.2020.02.008 · Cited by 102 · see citing works
Lorås, H. W. (2020) · Sports · doi:10.3390/sports8060088 · Cited by 102 · see citing works
“As substantial numbers of children and adolescents are dropping out of sports [75], have a lack of recreational areas for physical activity near their homes, and rely mainly on motorized transportation [76,77], physical education in schools emerges as an essential subject for experiencing and developing health-promoti…”
BackgroundSchmidt, T., Kerr, J., & Schipperijn, J. (2019) · Geriatrics · doi:10.3390/geriatrics4030041 · Cited by 105 · see citing works
“Contradictory, previous studies investigating different built environmental features and its association with walking in older adults, recommend rather extensive and costly neighborhood changes like improving the street connectivity and greater land-use mix [13,26,63,64].”
BackgroundResultSelf-citationHuang, D., Jiang, B., & Yuan, L. (2022) · Urban forestry & urban greening · doi:10.1016/j.ufug.2022.127480 · Cited by 99 · see citing works
Huang, X., Yang, J., Li, J., & Wen, D. (2021) · ISPRS Journal of Photogrammetry and Remote Sensing · doi:10.1016/j.isprsjprs.2021.03.019 · Cited by 98 · see citing works
Gubbels, J. S., Kremers, S., Droomers, M., Hoefnagels, C., Stronks, K., Hosman, C. M. H., & de Vries, S. (2016) · Health & Place · doi:10.1016/j.healthplace.2016.06.002 · Cited by 96 · see citing works
Veitch, J., Salmon, J., Crawford, D. A., Abbott, G., Giles‐Corti, B., Carver, A., & Timperio, A. F. (2018) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-017-0625-5 · Cited by 96 · see citing works
“This method is also known as difference-in-difference analysis [3].”
MethodSarkar, C., Webster, C. J., & Gallacher, J. (2018) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2018.01.009 · Cited by 95 · see citing works
Liu, Y., Zhang, Y., Jin, S. T., & Liu, Y. (2019) · Sustainable Cities and Society · doi:10.1016/j.scs.2019.101806 · Cited by 94 · see citing works
Physical activity profile of the Iranian population: STEPS survey, 2016
Mohebi, F., Mohajer, B., Yoosefi, M., Sheidaei, A., Zokaei, H., Damerchilu, B., Mehregan, A., Shahbal, N., Rezaee, K., Khezrian, M., et al. (2019) · BMC Public Health · doi:10.1186/s12889-019-7592-5 · Cited by 95 · see citing works
Yu, R., Cheung, O., Lau, K. K., & Woo, J. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14101199 · Cited by 93 · see citing works
“Nevertheless, in a recent multi-country study, walkability defined by residential density, intersection density, public transport density, and number of parks was associated with total moderate to vigorous intensity physical activity in adults aged 18–66 years [10].”
BackgroundWalking distances to public transport in smaller and larger Norwegian cities
Tennøy, A., Knapskog, M., & Wolday, F. (2022) · Transportation Research Part D Transport and Environment · doi:10.1016/j.trd.2022.103169 · Cited by 92 · see citing works
Zhao, P., Kwan, M., & Zhou, S. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15020308 · Cited by 89 · see citing works
“Residential density (RD) is commonly defined as the density of residences within an individual’s 1 km home buffer [34,48].”
BackgroundSteinmetz-Wood, M., Velauthapillai, K., O’Brien, G. A., & Ross, N. A. (2019) · BMC Public Health · doi:10.1186/s12889-019-7460-3 · Cited by 88 · see citing works
“Background Evidence suggests that neighborhood built environments can support active living [1] and improve health outcomes [2, 3].”
BackgroundRole of Built Environments on Physical Activity and Health Promotion: A Review and Policy Insights
Zhong, J., Liu, W., Niu, B., Lin, X., & Deng, Y. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.950348 · Cited by 92 · see citing works
Frank, L. D., Fox, E. H., Ulmer, J. M., Chapman, J. E., Kershaw, S. E., Sallis, J. F., Conway, T. L., Cerin, E., Cain, K. L., Adams, M. A., et al. (2017) · International Journal of Health Geographics · doi:10.1186/s12942-017-0077-9 · Cited by 88 · see citing works
Self-citationRinne, T. E., Hasanzadeh, K., & Kyttä, M. (2018) · International Journal of Health Geographics · doi:10.1186/s12942-018-0149-5 · Cited by 87 · see citing works
“Additionally, a recent large international comparison found LUM not being related to PA [7].”
BackgroundInfluentialYu, R., Wong, M., & Woo, J. (2018) · Journal of Urban Health · doi:10.1007/s11524-018-00331-3 · Cited by 87 · see citing works
Cain, K. L., Geremia, C. M., Conway, T. L., Frank, L. D., Chapman, J. E., Fox, E. H., Timperio, A. F., Veitch, J., Dyck, D. V., Verhoeven, H., et al. (2018) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-018-0650-z · Cited by 86 · see citing works
Self-citationRegis, M. F., de Oliveira, L. M. F. T., dos Santos, A. R. M., Leonídio, A. D. C. R., Diniz, P. R. B., de Freitas, C. M. S. M., Centro Universitário Asces-Unita, B., & Faculdade Boa Viagem, B. (2016) · Einstein (São Paulo) · doi:10.1590/s1679-45082016ao3788 · Cited by 88 · see citing works
“(12) Greater availability of equipment and public leisure spaces in urban areas, such as squares, courts, pedestrian boulevards and bike paths, may be associated with high levels of physical activity.(5,13) Urban and rural areas may be associated with two different lifestyles(14) and environment characteristics may co…”
BackgroundHowell, N. A., Tu, J. V., Moineddin, R., Chen, H., Chu, A., Hystad, P., & Booth, G. L. (2019) · Environment International · doi:10.1016/j.envint.2019.04.070 · Cited by 85 · see citing works
Mind the gap: Gender differences in walkability, transportation and physical activity in urban India
Adlakha, D., & Parra, D. C. (2020) · Journal of Transport & Health · doi:10.1016/j.jth.2020.100875 · Cited by 88 · see citing works
Murgante, B., Patimisco, L., & Annunziata, A. (2024) · Cities · doi:10.1016/j.cities.2023.104765 · Cited by 84 · see citing works
Cerin, E., Barnett, A. H., Zhang, C. J. P., Lai, P., Sit, C. H. P., & Lee, R. S. Y. (2020) · International Journal of Health Geographics · doi:10.1186/s12942-020-00210-8 · Cited by 82 · see citing works
Self-citation
- Authors
- Sallis, J. F., Cerin, E., Conway, T. L., Adams, M. A., Frank, L. D., Pratt, M., Salvo, D., Schipperijn, J., Smith, G., Cain, K. L., Davey, R., Kerr, J., Lai, P.-C., Mitáš, J., Reis, R., Sarmiento, O. L., Schofield, G., Troelsen, J., Van Dyck, D., De Bourdeaudhuij, I., & Owen, N.
- Affiliations
- University of California San Diego (US)
- Australian Catholic University (AU)
- Arizona State University (US)
- University of British Columbia (CA)
- Emory University (US)
- Instituto Nacional de Salud Pública (MX)
- University of Southern Denmark (DK)
- University of Staffordshire (GB)
- University of Canberra (AU)
- Palacký University Olomouc (CZ)
- Pontifícia Universidade Católica do Paraná (BR)
- Universidad de Los Andes (CO)
- Auckland University of Technology (NZ)
- Baker Heart and Diabetes Institute (AU)
- Corresponding author
- Sallis, James F
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 387
- Issue
- 10034
- Pages
- 2207-2217
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC10833440
- OpenAlex
- W2323455124
- Cited by
- 1,394
- References
- 30
- Citations by year
- 2026: 202 · 2025: 157 · 2024: 127 · 2023: 125 · 2022: 127 · 2021: 142 · 2020: 153 · 2019: 116 · 2018: 127 · 2017: 88 · 2016: 30
- FWCI
- 198.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- The HKU Scholars Hub (University of Hong Kong) (acceptedVersion, cc-by-nc-nd)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by-nc-nd)
- Research Bank (Australian Catholic University) (submittedVersion)
- University of Canberra Research Portal (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Staffordshire Online Repository (Staffordshire University) (submittedVersion)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Funders
- National Cancer Institute (NCI)
- National Institutes of Health (NIH)
- HK Research Grants Council (HKU740907H, 747807H)
- University of Hong Kong University Research Council
- NIH (R01 HL67350)
- National Heart, Lung, and Blood Institute (R01 CA127296 (NCI))
- Colciencias (519_2010)
- Australian Research Council (FT3 140100085)
- National Health and Medical Research Council (569940)
- NHMRC
- Victorian Government
- Ministry of Education, Youth and Sports (MSM 6198959221)
- Health Research Council of New Zealand (07/356)
- Centers for Disease Control and Prevention (CDC) Foundation
- Medical Research Council
- CDC Foundation
- Topics
- Social Sciences › Transportation › Urban Transport and Accessibility
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Urban Green Space and Health
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- physical activity, urban environment, walkability, housing density, intersection density, public transport accessibility, park accessibility, land use, physical inactivity, neighbourhood design, urban planning, accelerometer-measured activity, cross-city comparison, non-communicable diseases, socioeconomic status, mixed land use, parks and recreation, transport infrastructure, built environment and health
- MeSH terms
- Adolescent, Adult, Aged, Cities, City Planning, Cross-Sectional Studies, Environment Design, Female, Humans, Male, Middle Aged, Urban Health, Exercise, Walking, Monitoring, Ambulatory, Young Adult
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