Cited by 1,394Urban Transport and AccessibilityUrban Green Space and HealthPhysical Activity and Health

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Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study

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Sallis, James F, Cerin, Ester, Conway, Terry L, Adams, Marc A, Frank, Lawrence D, Pratt, Michael, Salvo, Deborah, Schipperijn, Jasper, Smith, Graham, Cain, Kelli L, Davey, Rachel, Kerr, Jacqueline, Lai, Poh-Chin, Mitáš, Josef, Reis, Rodrigo, Sarmiento, Olga L, Schofield, Grant, Troelsen, Jens, Van Dyck, Delfien, De Bourdeaudhuij, Ilse, Owen, Neville·2016·The Lancet

DOI 10.1016/s0140-6736(15)01284-2PMC PMC10833440

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Abstract

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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Method
Association between the Physical Activity Behavioral Profile and Sedentary Time with Subjective Well-Being and Mental Health in Chilean University Students during the COVID-19 Pandemic
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“…as well as perceptions of environmental quality, and thus contribute to the health and well-being of urban residents (Bonaiuto et al., 1999; Broberg et al., 2013; Foster and Giles-Corti, 2008; Fornara et al., 2009; Kerr et al., 2012; Kyttä et al., 2013; Sallis et al., 2016; Van Kamp et al., 2003).”
Background
Park use, perceived park proximity, and neighborhood characteristics: Evidence from 11 cities in Latin America
Moran, M. R., Rodrı́guez, D. A., Cortínez-O’Ryan, A., & Miranda, J. J. (2020) · Cities · doi:10.1016/j.cities.2020.102817 · Cited by 56
“These efforts are often guided by socio-ecological models (Sallis et al., 2016; Sreetheran & Van Den Bosch, 2014), according to which human behavior has multiple levels of influences, ranging from environmental conditions (e.”
BackgroundInfluential
Examining activity-friendly neighborhoods in the Norwegian context: green space and walkability in relation to physical activity and the moderating role of perceived safety
Juul, V., & Nordbø, E. C. A. (2023) · BMC Public Health · doi:10.1186/s12889-023-15170-4 · Cited by 59
Can battery electric vehicles meet sustainable energy demands? Systematically reviewing emissions, grid impacts, and coupling to renewable energy
Tuffour, J. P., & Ewing, R. (2024) · Energy Research & Social Science · doi:10.1016/j.erss.2024.103625 · Cited by 55
Countrywide natural experiment links built environment to physical activity
Althoff, T., Ivanovic, B., King, A. C., Hicks, J. L., Delp, S. L., & Leskovec, J. (2025) · Nature · doi:10.1038/s41586-025-09321-3 · Cited by 57
“Understanding these factors is critical for developing optimal public policy 1,8,21 , and for planning cities 5,22 and designing behaviour change interventions 23,24 .”
Influential
Increasing Active Transportation Through E-Bike Use: Pilot Study Comparing the Health Benefits, Attitudes, and Beliefs Surrounding E-Bikes and Conventional Bikes
Hoj, T. H., Bramwell, J. J., Lister, C., Grant, E. A., Crookston, B. T., Hall, C. P., & West, J. H. (2018) · JMIR Public Health and Surveillance · doi:10.2196/10461 · Cited by 54
“Substantial research in the fields of transportation, health, and psychology has helped to identify a variety of factors associated with engaging in active transport behaviors, including features in the built environment [5,6], age and gender [7], and attitudes and beliefs in a culture [8].”
Background
A Generalized Framework for Measuring Pedestrian Accessibility around the World Using Open Data
Liu, S., Higgs, C., Arundel, J., Boeing, G., Cerdera, N., Moctezuma, D., Cerin, E., Adlakha, D., Lowe, M., & Giles‐Corti, B. (2021) · Geographical Analysis · doi:10.1111/gean.12290 · Cited by 53
Self-citation
Investigating the physical activity, health, wellbeing, social and environmental effects of a new urban greenway: a natural experiment (the PARC study)
Hunter, R. F., Adlakha, D., Cardwell, C. R., Cupples, M., Donnelly, M., Ellis, G., Gough, A., Hutchinson, G., Kearney, T., Longo, A., et al. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01213-9 · Cited by 51
“These distances have been used in previous physical activity and urban environment literature [44].”
Method
Restoration in mental health after visiting urban green spaces, who is most affected? Comparison between good/poor mental health in four European cities
Grigoletto, A., Toselli, S., Zijlema, W. L., Márquez, S., Mas, M. T., Gidlow, C. J., Gražulevičienė, R., van den Berg, M., Kruize, H., Maas, J., et al. (2023) · Environmental Research · doi:10.1016/j.envres.2023.115397 · Cited by 57
Green space exposure and type 2 diabetes mellitus incidence: A systematic review
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Objectively recorded physical activity in pregnancy and postpartum in a multi-ethnic cohort: association with access to recreational areas in the neighbourhood
Richardsen, K. R., Mdala, I., Berntsen, S., Ommundsen, Y., Martinsen, E. W., Sletner, L., & Jenum, A. K. (2016) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-016-0401-y · Cited by 53
“Securing good access to recreational areas is an important population-level strategy to promote health [51].”
Background
The effects of New Urbanism on public health
Iravani, H., & Rao, V. (2019) · Journal of Urban Design · doi:10.1080/13574809.2018.1554997 · Cited by 53
Neighborhood Built Environment and Socioeconomic Status are Associated with Active Commuting and Sedentary Behavior, but not with Leisure-Time Physical Activity, in University Students
Molina‐García, J., Menescardi, C., Estevan, I., Martinez-Bello, V. E., & Queralt, A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16173176 · Cited by 53
“Neighborhood characteristics are one of the most consistent built environmental factors associated with physical activity behavior in the general adult population [9,15].”
Background
Living Close to Natural Outdoor Environments in Four European Cities: Adults’ Contact with the Environments and Physical Activity
Mas, M. T., Donaire-González, D., Seto, E., Valentín, A., Smith, G., Martinez, D. R., Carrasco‐Turigas, G., Masterson, D., van den Berg, M., Ambrós, A., et al. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14101162 · Cited by 53
“We selected the following a priori covariates based on previous literature: gender [22,30,37,57,58], age [22,30,37,57,58], education completed [22,30,58], living with children younger than 11 years old [13], dog ownership [58], sampling season [58], and neighbourhood socioeconomic status (neighbourhood SES) [30,57].”
BackgroundMethodInfluentialSelf-citation
The influence of social networks and the built environment on physical inactivity: A longitudinal study of urban-dwelling adults
Josey, M. J., & Moore, S. (2018) · Health & Place · doi:10.1016/j.healthplace.2018.08.016 · Cited by 53
“The effects of social isolation on physical inactivity may operate through the lack of social support or social cues for healthy behavioral choices, particularly among older adults (Shankar et al., 2011).”
Community design and hypertension: Walkability and park access relationships with cardiovascular health
Adhikari, B., Delgado‐Ron, J. A., van den Bosch, M. A., Dummer, T., Hong, A., Sandhu, J., Demlow, E., Hu, Y., & Frank, L. D. (2021) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2021.113820 · Cited by 51
Self-citation
Indicator development for sustainable urban park management in Hong Kong
Chan, C., Hoi, F., & Marafa, L. M. (2018) · Urban forestry & urban greening · doi:10.1016/j.ufug.2018.01.025 · Cited by 59
Urban design and Japanese older adults' depressive symptoms
Koohsari, M. J., McCormack, G. R., Nakaya, T., Shibata, A., Ishii, K., Yasunaga, A., Hanibuchi, T., & Oka, K. (2018) · Cities · doi:10.1016/j.cities.2018.09.020 · Cited by 56
“For instance, while several studies suggest that higher population density might lead to increased physical activity (and physical activity reduces depression) (Sallis et al., 2016; Troped, Wilson, Matthews, Cromley, & Melly, 2010), other evidence suggests that crowding in public areas may have negative consequences f…”
Background
On the sustainability of electric vehicles: What about their impacts on land use?
Orsi, F. (2020) · Sustainable Cities and Society · doi:10.1016/j.scs.2020.102680 · Cited by 55
Are park availability and satisfaction with neighbourhood parks associated with physical activity and time spent outdoors?
Veitch, J., Rodwell, L., Abbott, G., Carver, A., Flowers, E. P., & Crawford, D. A. (2021) · BMC Public Health · doi:10.1186/s12889-021-10339-1 · Cited by 51
Compact cities and the Covid-19 pandemic: Systematic review of the associations between transmission of Covid-19 or other respiratory viruses and population density or other features of neighbourhood design
Zhang, X., Sun, Z., Ashcroft, T., Dozier, M., Ostrishko, K., Krishan, P., McSwiggan, E., Keller, M., & Douglas, M. (2022) · Health & Place · doi:10.1016/j.healthplace.2022.102827 · Cited by 51
A European perspective on GIS-based walkability and active modes of transport
Grasser, G., Dyck, D. V., Titze, S., & Stronegger, W. J. (2016) · European Journal of Public Health · doi:10.1093/eurpub/ckw118 · Cited by 51
Correlates of physical activity and sedentary behaviour in the Thai population: a systematic review
Liangruenrom, N., Craike, M. J., Biddle, S., Suttikasem, K., & Pedišić, Ž. (2019) · BMC Public Health · doi:10.1186/s12889-019-6708-2 · Cited by 54
Objectively measuring the association between the built environment and physical activity: a systematic review and reporting framework
Pontin, F. L., Jenneson, V. L., Morris, M. A., Clarke, G., & Lomax, N. (2022) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-022-01352-7 · Cited by 52
Perceived built environment characteristics associated with walking and cycling across 355 communities in 21 countries
Boakye, K., Bovbjerg, M. L., Schuna, J. M., Branscum, A. J., Nasir, N. M., Bahonar, A., Барбараш, О. Л., Yusuf, R., López-Jaramillo, P. A., Pamela Serón, S., et al. (2022) · Cities · doi:10.1016/j.cities.2022.104102 · Cited by 50
Nature as a facilitator for physical activity: Defining relationships between the objective and perceived environment and physical activity among community-dwelling older people
Keskinen, K. E., Rantakokko, M., Suomi, K., Rantanen, T., & Portegijs, E. (2018) · Health & Place · doi:10.1016/j.healthplace.2017.12.003 · Cited by 50
Exploring the Health-Promoting Potential of the “parkrun” Phenomenon: What Factors are Associated With Higher Levels of Participation?
Cleland, V. J., Nash, M., Sharman, M. J., & Claflin, S. B. (2018) · American Journal of Health Promotion · doi:10.1177/0890117118770106 · Cited by 50
Physical activity-related health and economic benefits of building walkable neighbourhoods: a modelled comparison between brownfield and greenfield developments
Zapata-Diomedi, B., Boulangé, C., Giles‐Corti, B., Phelan, K., Washington, S. P., Veerman, L. J., & Gunn, L. (2019) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-019-0775-8 · Cited by 55
GPS-based built environment measures associated with adult physical activity
Boakye, K., Amram, O., Schuna, J. M., Duncan, G. E., & Hystad, P. (2021) · Health & Place · doi:10.1016/j.healthplace.2021.102602 · Cited by 52
Do population density, socio-economic ranking and Gini Index of cities influence infection rates from coronavirus? Israel as a case study
Arbel, Y., Fialkoff, C., Kerner, A., & Kerner, M. (2021) · The Annals of Regional Science · doi:10.1007/s00168-021-01073-y · Cited by 49
Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association
Rajagopalan, S., Ramaswami, A., Bhatnagar, A., Brook, R. D., Fenton, M., Gardner, C. D., Neff, R., Russell, A. G., Seto, K. C., & Whitsel, L. P. (2024) · Circulation · doi:10.1161/cir.0000000000001217 · Cited by 49
“40 No prospective studies have examined the impact of urban design elements or land use.”
Background
Objectively Measured Neighborhood Walkability and Change in Physical Activity in Older Japanese Adults: A Five-Year Cohort Study
Kikuchi, H., Nakaya, T., Hanibuchi, T., Fukushima, N., Amagasa, S., Oka, K., Sallis, J. F., & Inoue, S. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15091814 · Cited by 50
“In an international study of adults that did not include rural areas, walkability was positively and linearly related to objectively assessed MVPA [38].”
BackgroundSelf-citation
Built environmental factors and adults' travel behaviors: Role of street layout and local destinations
Koohsari, M. J., Owen, N. G., Cole, R. L., Mavoa, S., Oka, K., Hanibuchi, T., & Sugiyama, T. (2016) · Preventive Medicine · doi:10.1016/j.ypmed.2016.12.021 · Cited by 49
Self-citation
Environmental, Individual and Personal Goal Influences on Older Adults’ Walking in the Helsinki Metropolitan Area
Rinne, T. E., Haybatollahi, M., & Kyttä, M. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16010058 · Cited by 56
“Other previous studies have found PA in general and AT in particular positively associated with residential density, connectivity and density of destinations [6,31,66].”
Background
How Does Walkability Change Behavior? A Comparison between Different Age Groups in the Netherlands
Liao, B., van den Berg, P., van Wesemael, P. J. V., & Arentze, T. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17020540 · Cited by 48
Neighbourhood environment and dementia in older people from high-, middle- and low-income countries: results from two population-based cohort studies
Wu, Y., Brayne, C., Liu, Z., Huang, Y., Sosa, A. L., Acosta, D. M., & Prina, M. A. (2020) · BMC Public Health · doi:10.1186/s12889-020-09435-5 · Cited by 51
“Cross-country studies using the same research methods are important to clarify how cultural, social and other environmental factors might modify the relationships between the built environment and the health of older people [36].”
Background
Associations of neighborhood environment with brain imaging outcomes in the Australian Imaging, Biomarkers and Lifestyle cohort
Cerin, E., Rainey‐Smith, S. R., Ames, D. J., Lautenschlager, N. T., Macaulay, S. L., Fowler, C. J., Robertson, J. S., Rowe, C. C., Maruff, P. T., Martins, R. N., et al. (2016) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2016.06.2364 · Cited by 49
Self-citation
AACR White Paper: Shaping the Future of Cancer Prevention – A Roadmap for Advancing Science and Public Health
Lippman, S. M., Abate-Shen, C. T., Maresso, K. C., Colditz, G. A., Dannenberg, A. J., Davidson, N. E., Disis, M. L., DuBois, R. N., Szabo, E. M., Giuliano, A. R., et al. (2018) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-18-0421 · Cited by 48
“Nationally, this work was cited as part of the CDC's guide to community preventive services endorsement of built environment strategies for promoting health (128).”
Background
Effectiveness of Approaches to Increase Physical Activity Behavior to Prevent Chronic Disease in Adults: A Brief Commentary
Schwartz, J., Rhodes, R. E., Bredin, S. S. D., OH, P. I., & Warburton, D. E. R. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8030295 · Cited by 49
“In that regard, proximity to nearby parks, as well as access to public transportation play an important role [72].”
Background

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: Sallis, James F
Cerin, Ester
Conway, Terry L
Adams, Marc A
Frank, Lawrence D
Pratt, Michael
Salvo, Deborah
Schipperijn, Jasper
Cain, Kelli L
Davey, Rachel
Kerr, Jacqueline
Mitáš, Josef
Reis, Rodrigo
Sarmiento, Olga L
Schofield, Grant
Troelsen, Jens
Owen, Neville
Venue: The Lancet
Publisher: Elsevier BV
Published: 2016-05
Volume: 387
Issue: 10034
Pages: 2207-2217
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(15)01284-2
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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
Social Sciences › Urban Studies › Urban Green Space and Health
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study

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