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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“For example, in addition to directly saving health costs from better quality housing, better located housing in well, connected, walkable and activity-friendly neighbourhoods can also lead to more physical activity and thereby generate health bene ﬁ ts including less obesity (Sallis et al. 2016).”
Background
Development and testing of a multicomponent obesogenic built environment measure for youth using kernel density estimations
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“Where individuals live has emerged as an important determinant for obesity and other chronic diseases (Diez Roux, 2001; Sallis et al., 2016).”
Neighborhood walkability and pre-diabetes incidence in a multiethnic population
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“7 14 Findings from our study revealed that the benefits of walk-ability may extend to the earliest stages of type 2 diabetes development—prior to even the mildest elevation in glucose.”
Towards remote monitoring in pediatric care and clinical trials—Tolerability, repeatability and reference values of candidate digital endpoints derived from physical activity, heart rate and sleep in healthy children
Kruizinga, M. D., van der Heide, N., Moll, A., Zhuparris, A., Yavuz, Y., de Kam, M. L., Stuurman, F. E., Cohen, A. F., & Driessen, G. J. A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0244877 · Cited by 25
“Some of the reported relationships (age, sex) with physical activity have been reported extensively the past as well [22], including the relationship between population density and step count [23].”
Background
Walking in China’s Historical and Cultural Streets: The Factors Affecting Pedestrian Walking Behavior and Walking Experience
Tian, M., Li, Z., Xia, Q., Peng, Y., Cao, T., Du, T., & Xing, Z. (2022) · Land · doi:10.3390/land11091491 · Cited by 24
Creating active urban environments: insights from expert interviews
van Renswouw, L., Lallemand, C., van Wesemael, P. J. V., & Vos, S. B. (2022) · Cities & Health · doi:10.1080/23748834.2022.2132585 · Cited by 24
Where are the people? Counting people in millions of street-level images to explore associations between people’s urban density and urban characteristics
Garrido-Valenzuela, F., Cats, O., & van Cranenburgh, S. (2023) · Computers Environment and Urban Systems · doi:10.1016/j.compenvurbsys.2023.101971 · Cited by 24
Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study
Matzke, I., Huhn, S., Koch, M., Maggioni, M. A., Munga, S., Muma, J. O., Odhiambo, C. O., Kwaro, D., Obor, D., Bärnighausen, T., et al. (2024) · JMIR mhealth and uhealth · doi:10.2196/54669 · Cited by 22
“The criteria for data completeness were based on existing literature (detailed in Multimedia Appendix 2 [15,22-28]).”
Method
Large walking and wellbeing behaviour benefits of co-designed sustainable park improvements: A natural experimental study in a UK deprived urban area
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Results from a natural experiment: initial neighbourhood investments do not change objectively-assessed physical activity, psychological distress or perceptions of the neighbourhood
Dubowitz, T., Dastidar, M. G., Richardson, A. S., Colabianchi, N., Beckman, R., Hunter, G., Sloan, J., Nugroho, A. K., & Collins, R. L. (2019) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-019-0793-6 · Cited by 24
Public open spaces and physical activity: disparities of resources in Florianópolis
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Self-citation
A systematic review on the associations between the built environment and adult’s physical activity in global tropical and subtropical climate regions
Nigg, C., Alothman, S., Alghannam, A. F., Schipperijn, J., AlAhmed, R. S., Alsukait, R. F., Rakić, S., Çetinkaya, V., Al-Hazzaa, H. M., & Alqahtani, S. A. (2024) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-024-01582-x · Cited by 24
“…study, including up to 17 cities in twelve middle-and high-income countries across culturally different countries (e.g., Brazil, China, Denmark, and Australia), showed that associations between built environment attributes and physical activity were largely generalizable across cities [138, 139].”
BackgroundSelf-citation
Relationships between Green Space Perceptions, Green Space Use, and the Multidimensional Health of Older People: A Case Study of Fuzhou, China
Wu, Y., Zhou, W., Zhang, H., Liu, Q., Yan, Z., & Lan, S. (2024) · Buildings · doi:10.3390/buildings14061544 · Cited by 23
“Given the positive impact of green space usage on social health, spaces should be designed to encourage social interaction among older adults, and activities like health exercises and tai chi should be regularly organized.”
Background
Environmental Hypertensionology and the Mosaic Theory of Hypertension
Rajagopalan, S., Brook, R. D., & Münzel, T. F. (2025) · Hypertension · doi:10.1161/hypertensionaha.124.18733 · Cited by 26
Evaluating Accessibility and Equity of Multi-Level Urban Public Sports Facilities at the Residential Neighborhood Scale
Wang, W., Cai, Y., Xiong, X., & Xu, G. (2025) · Buildings · doi:10.3390/buildings15101640 · Cited by 23
Rationale, design, and baseline characteristics of WalkIT Arizona: A factorial randomized trial testing adaptive goals and financial reinforcement to increase walking across higher and lower walkable neighborhoods
Adams, M. A., Hurley, J. C., Phillips, C. B., Todd, M. W., Angadi, S. S., Berardi, V., Hovell, M. F., & Hooker, S. P. (2019) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.05.001 · Cited by 23
“Observational studies consistently show that PA is sensitive to the design of neighborhood environments [21, 22].”
BackgroundSelf-citation
Mental Health and Recreation Opportunities
Lee, K. H. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249338 · Cited by 23
Role of Environmental Quality of Life in Physical Activity Status of Individuals with and without Physical Disabilities in Saudi Arabia
Zahra, A., Hassan, M. S., Park, J., Hassan, S.-U.-N., & Parveen, N. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19074228 · Cited by 23
“A number of environmental factors, including access to transport, provision of parks and sports facilities, and a physical atmosphere play a significant role in encouraging people to adopt healthy life style and PA [32,33].”
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Using an Exposome-Wide Approach to Explore the Impact of Urban Environments on Blood Pressure among Adults in Beijing–Tianjin–Hebei and Surrounding Areas of China
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An ecological dynamics perspective on designing urban nature environments for wellbeing and health-enhancing physical activity
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Relationships between Neighborhood Walkability and Objectively Measured Physical Activity Levels in Hemodialysis Patients
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Modal Shift from Cars and Promotion of Walking by Providing Pedometers in Yokohama City, Japan
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“For example, an analysis of 6822 adults from 14 cities in 10 countries found that public transport density is significantly, positively, and linearly correlated with increased PA [32].”
Background
Perceived and objective measures of neighborhood environment: Association with active commuting to school by socioeconomic status in Brazilian adolescents
Dias, A. F., Gaya, A. R., Pizarro, A. I. N., Brand, C., Mendes, T. M., Mota, J. A. P. S., Santos, M. P., & Gaya, A. C. A. (2019) · Journal of Transport & Health · doi:10.1016/j.jth.2019.100612 · Cited by 23
How different are objective operationalizations of walkability for older adults compared to the general population? A systematic review
Akıncı, Z. S., Delclòs‐Alió, X., Vich, G., Salvo, D., Ibarluzea, J. M., & Miralles‐Guasch, C. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03233-x · Cited by 22
Self-citation
The perceived neighborhood environment is associated with health-enhancing physical activity among adults: a cross-sectional survey of 13 townships in Taiwan
Chiang, C., Chiou, S.-T., Liao, Y., & Liou, Y. M. (2019) · BMC Public Health · doi:10.1186/s12889-019-6848-4 · Cited by 22
Macroeconomic, demographic and human developmental correlates of physical activity and sitting time among South American adults
on behalf of the South American Physical Activity and Sedentary Behavior Network (SAPASEN) collaborators, Werneck, A. O., Sadarangani, K. P., Ramírez‐Vélez, R., Baldew, S.-S. M., Gomes, T. N., Ferrari, G., Szwarcwald, C. L., Miranda, J. J., & da Silva, D. R. P. (2020) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-020-01068-6 · Cited by 22
“In this sense, different components of higher urbanization could be associated with higher transport physical activity, such as higher connectivity, a more densely connected environment, and mixed-use land [6, 36].”
BackgroundInfluential
Effect of Major Life Events on Travel Behaviours: A Scoping Review
Larouche, R., Charles-Rodriguez, U., Nayakarathna, R., & Scott, D. R. M. (2020) · Sustainability · doi:10.3390/su122410392 · Cited by 23
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Background
Using Social Media Text Data to Analyze the Characteristics and Influencing Factors of Daily Urban Green Space Usage—A Case Study of Xiamen, China
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Self-citation
Associations Between Latent Classes of Perceived Neighborhood Destination Accessibility and Walking Behaviors in Older Adults of a Low-Density and a High-Density City
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Self-citation
Physical Activity and Active Commuting in Relation to Objectively Measured Built-Environment Attributes Among Adolescents
Queralt, A., & Molina‐García, J. (2019) · Journal of Physical Activity and Health · doi:10.1123/jpah.2018-0170 · Cited by 22
The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study
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“Public open spaces, including parks, provide opportunities for physical activity across a range of diverse population groups [9].”
Background
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Prevalence of Overweight and Obesity among People Aged 18 Years and Over between 2013 and 2018 in Hunan, China
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“High-density population, convenient public transportation and scarcity of parks in urban areas make residents do less physical exercise than in rural areas [28].”
Background
Greening urban areas in line with population density and ecological zone can reduce premature mortality
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“For one, compact cities, exempli ﬁ ed by the European 15-minute-city model 16,17 , encourage active transportation (e.g., walking, bicycling, and rolling) 4,18 , which has individual-and community-level bene ﬁ ts, including increasedphysicalactivityandreducedgreenhousegasemissions 19 .”
Uncovering spatial patterns of environmental influence on the paces of active leisure travel
Zhang, C., Yang, X. Z., Huang, J., & Xiao, Z. (2025) · Cities · doi:10.1016/j.cities.2025.105971 · Cited by 22
Influences of Built Environment with Hilly Terrain on Physical Activity in Dalian, China: An Analysis of Mediation by Perceptions and Moderation by Social Environment
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“The built environment we identified significantly associated with physical activity supported previous studies’ findings [9,10,13] and also provided further evidence on Chinese urban environment (Appendix B).”
BackgroundResult
Study protocol: health survey of Sao Paulo: ISA-Physical Activity and Environment
Florindo, A. A., Teixeira, I. P., Barrozo, L. V., Sarti, F. M., Fisberg, R. M., Andrade, D. R., & García, L. (2021) · BMC Public Health · doi:10.1186/s12889-021-10262-5 · Cited by 21
“Built environment data will be considered within 500 m, 1000m and 1500 m radius and network around the participants’ residence and workplace [33, 34].”
Method

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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