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

Objectively measured 24-h movement behaviours of child-guardian pairs in low-to-middle income households in Nairobi City County, Kenya

Background

The decreasing prevalence of physical activity (PA) among urban children in Sub-Saharan Africa is a growing public health concern. More emphasis should focus on examining the influence of parental PA behaviour on the children's PA patterns. We explored associations of 24 ​hour (h) accelerometer-measured movement behaviours of guardian-child pairs in Nairobi City County, Kenya.

Methods

This cross-sectional study assessed 80 pairs consisting of children aged 9-14 years and their guardians in one area of low and one area of middle socioeconomic status (SES) (Embakasi Sub-County and Lang'ata Sub-County), in Nairobi City County, Kenya. The study used waist worn Tri-axial Actigraph (GT3X+ and ActiSleep+) accelerometers to quantify PA and sedentary time (SED). Association between guardians' and children's PA was examined using linear regression, adjusting for guardians' educational attainment and household wealth.

Results

Of the children, 42 (52.5%) and 76 (96.2%) of the guardians were women. Children in low SES areas spent more time (p ​< ​0.001) in moderate-to-vigorous physical activity compared to children from middle SES area. The guardians in low SES area were younger and spent more time in light PA (p ​= ​0.036) while their counterparts had higher daily SED (p ​= ​0.049). Guardian's SED associated with higher children's SED (p ​= ​0.033) even after adjusting for guardians' educational attainment (p ​= ​0.032) and wealth (p ​= ​0.05). There was no association between guardians' and children's MVPA.

Conclusion

Considered alongside the extant literature, these results suggest that health promotion strategies should aim to reduce parental SED time while also planning to increase children's PA.

Is walkability healthy for all? Using the National Environmental Database to examine equity in the environmental health characteristics of pedestrian-supportive neighborhoods in the U.S

BACKGROUND

Marginalized populations in the U.S. often live in dense urban areas, which could promote active travel and health. However, while compactness can support walkability, it can also create exposure to pollution, noise, injury risk, and urban heat islands. These exposures may be higher for marginalized groups, creating systematic "walkability-related" risks.

OBJECTIVES

We evaluated relationships between walkability, health-related environmental exposures, and social vulnerability, asking: (1) How are sociodemographic groups sorted across space with respect to walkability? (2) Do the environmental health correlates of walkability vary by social vulnerability?

METHODS

We compiled block group-level data for the 30 largest U.S. metropolitan areas. We measured walkability using the National Walkability Index; social vulnerability using indicators of race/ethnicity and socioeconomic status; and environmental exposures using PM2.5, pedestrian fatalities, noise, and tree coverage. We used multilevel mixed-effects regressions to predict (1) walkability as a function of vulnerability and (2) each environmental exposure as a function of the cross-tabulation between walkability and vulnerability.

RESULTS

Higher walkability was associated with higher vulnerability. Compared to highly walkable block groups with low vulnerability, those with high vulnerability had higher PM2.5 and noise levels and lower tree coverage. These differences were even more pronounced among block groups with low walkability, suggesting pervasive inequities.

DISCUSSION

While marginalized groups often live in more walkable places, the "high" walkability to which they are exposed carries greater environmental risks than for privileged populations. Our findings illustrate the importance of mitigating environmental burdens that could dampen the health benefits of walkability in marginalized communities.

Urban health inequities and healthy longevity: traditional and emerging risk factors across the cities and policy implications

Urbanization is reshaping global health, with over 55% of the world's population residing in urban areas, a figure projected to reach 68% by 2050. This demographic shift presents significant challenges and opportunities for public health, as urban environments exacerbate health disparities rooted in social determinants of health, such as economic stability, education, neighborhood conditions, and access to healthcare. Rapid urban growth, particularly in low- and middle-income countries, has led to the emergence of inequitable living conditions, environmental hazards, and limited access to essential health services, contributing to the early onset of multimorbidity and rising non-communicable disease burdens. Urbanization-driven factors such as obesogenic environments, sedentary lifestyles, air pollution, and inadequate sleep exacerbate cardiovascular and metabolic risks, while social exclusion, overcrowding, and inadequate mental health services heighten vulnerabilities. Emerging risks, including urban heat islands, noise pollution, and exposure to endocrine-disrupting chemicals, further compound urban health inequities. Effective mitigation requires multi-sectoral policies that prioritize health-promoting infrastructure, reduce environmental pollutants, foster equitable healthcare access, and address systemic barriers affecting marginalized groups. This review explores the intersections between urbanization and health inequities, emphasizing the importance of addressing traditional and emerging risk factors across the lifespan. Policy implications include promoting green infrastructure, enhancing urban mobility, expanding mental health care, and leveraging participatory governance to foster resilient and inclusive cities. By adopting an integrated approach that prioritizes social equity and sustainability, cities can mitigate health disparities and create healthier, more inclusive urban environments that support the well-being of all residents.

Gender, socioeconomic, and built environment differences in the association of participation in an incentivized walking program with physical and social activity: A prospective cohort study among older adults in Japan

OBJECTIVES

Physical inactivity and social isolation are key obstacles to achieving healthy and active aging. This study evaluated the association between participation in a citywide economic incentive Yokohama Walking Point (YWP) program with walking time, the risk of being homebound, and social isolation. We also explored the heterogeneities in the association across gender, socioeconomic status (SES), and built environment (BE).

METHODS

A prospective cohort study was conducted on 3,171 residents aged ≥65 years from the Japan Gerontological Evaluation Study. YWP participation status was confirmed in 2016, outcomes were measured in 2020, and covariates were obtained in 2013. Built environment variables were measured based on geographic information system. General linear regression and modified Poisson regression models were performed using doubly robust estimation with inverse probability of treatment weighting.

RESULTS

Participation in YWP was associated with an increase of 6.83 min per day of walking time, and a 21 % decreased risk of social isolation. The associations showed heterogeneity; participants with low income and those living near parks had lower risks of being homebound. Men, participants with low education levels, and those living in high population density areas exhibited lower risks of social isolation compared with their counterparts.

CONCLUSIONS

Participation in YWP was associated with improved physical and social activity. Gender, SES, and BE moderated these associations, highlighting their potential role in reducing social health disparity. These findings emphasized the need for integrated policy interventions incorporating program design and urban planning to create an age-friendly community fostering healthy and inclusive aging.

The role of environmental access to exercise opportunities in cardiovascular mortality: evidence from a nationwide study

BACKGROUND

Environmental access to exercise opportunities plays a crucial role in determining the level of physical activity within a population. However, it is unclear how environmental factors contribute to disparities in physical activity and health outcomes. We explored the associations between county-level access to exercise opportunities and cardiovascular disease (CVD) mortality across US counties.

METHODS

We conducted an ecological analysis using aggregated data from two primary sources: the County Health Rankings and Roadmaps data and CDC WONDER mortality data. We compared county-level age-adjusted CVD mortality across county-level quartiles of access to exercise opportunities and physical inactivity. Stratification was performed based on age, sex, race, and urbanization variables. The rate ratio (RR) for CVD mortality was also calculated using generalized linear models.

RESULTS

We observed significant variations in CVD mortality across different levels of exercise opportunities access and physical inactivity, which was consistent across all demographic subgroups (P < 0.001). Access to exercise opportunities was significantly associated with a reduced risk of CVD mortality (RR = 0.93 [0.91-0.95]), and the association was most pronounced for acute myocardial infarction (AMI) mortality (RR, 0.80 [0.76-0.85]). The county-level physical inactivity was significantly associated with an increased risk of CVD mortality (RR, 1.16 [1.14-1.17]), especially for ischemic heart disease (IHD) (RR, 1.35 [1.31-1.38]) and AMI (RR, 1.32 [1.25-1.38]). All demographic subgroups demonstrated similar benefits in reducing the risk of CVD by improving the county-level indicators of physical activity.

CONCLUSIONS

Counties have the potential to make significant environmental strides in improving the cardiovascular health of their populations by enhancing access to exercise opportunities in the context of urbanization.

Exploring the multifaceted factors influencing overweight and obesity: a scoping review

Introduction

Obesity and overweight problems in public health have substantial impacts which affect the health status of individuals and community well-being and healthcare service provision worldwide. This scoping review aims to identify and classify factors from social, technological, environmental, economic and political domains which influence obesity and overweight conditions. The systematic analysis of determinants in this study generates usable information to guide public health intervention design and obesity epidemic management strategies.

Methods

The study utilized the ProQuest, ISI Web of Science, PubMed, and Scopus databases, and it also included grey literature in its analysis. The research objectives focused on identifying factors that contribute to overweight or obesity issues. The researchers used framework analysis to examine the qualitative data collected from these studies.

Results

The synthesis incorporated 121 research studies which satisfied the established criteria. This comprised 98 studies from 46 different countries, 17 studies conducted at the international level, and 6 studies involving multiple countries. Eighty-two factors influencing overweight and obesity were identified as determinants and categorized into five main categories: sociocultural, economic, technological, environmental, and political. Most of the identified determinants belong to the socio-cultural category, which demonstrates their substantial impact on lifestyle and health behaviors.

Conclusion

The implementation of public health prevention and intervention programs depends on complete knowledge of all factors that affect overweight and obesity rates. This issue needs a comprehensive approach which analyzes sociocultural aspects together with economic, technological, environmental, and political factors, as well as other policy goals within defined societal challenges. Effective solutions to resolve this situation depend on multi-sectoral collaboration to tackle obesity and promote health-enhancing factors for the entire community.

Environmental Hypertensionology and the Mosaic Theory of Hypertension

Hypertension is a multifactorial condition influenced by the intricate interplay of biological and genetic determinants. The growing field of Environmental Hypertensionology endorses the outsized role of environmental factors in the pathogenesis and exacerbation of hypertension. It provides a clinical approach to address these factors at the individual and societal levels. Environmental stressors contributing to blood pressure levels can be viewed within the mosaic model of hypertension, which offers a comprehensive framework for understanding blood pressure regulation through its connection with multiple other nodes causally related to the pathogenesis of hypertension. This review synthesizes growing evidence supporting the impact of several factors in the physical environment and adverse stressors embedded in key provisioning systems, including air, noise, and chemical pollution, along with aspects of the built environment, green spaces, food systems, on the global burden of hypertension. Although many factors may not be directly in the causal cascade of hypertension, the web of connections between many behooves an understanding of the important nodes for intervention. Public health strategies emphasizing the redesign of environments present an unprecedented opportunity to enhance global hypertension control rates. Future research should thus focus on integrating environmental risk assessment and interventions into clinical practice, optimizing urban planning, and public policy to achieve meaningful reductions in the global burden of hypertension. By understanding hypertension as a mosaic of interconnected causes, healthcare professionals are better equipped to individualize treatment, combining lifestyle interventions and multiple drug classes to target environmental and genetic factors driving high blood pressure.

Parental neighbourhood perceptions and active commuting to school in children according to their sex using a self-organised map approach: a cross-sectional study

BACKGROUND

Built environment attributes can facilitate or represent barriers to active commuting to and from school (ACS). Even though parental perceptions of the built environment and their influence on ACS in children have been extensively studied, there is very limited evidence as to whether these perceptions can vary based on the sex of children. Hence, the present study aimed to analyse the relationships between parental neighbourhood perceptions and ACS, differentiating between boys and girls.

METHODS

This cross-sectional study was conducted in Valencia, Spain. The sample comprised 808 children and one of their parents. Parent-perceived neighbourhood environment, ACS, and socio-demographic data were self-reported through a questionnaire using validated scales. Self-organising map (SOM) analysis was used to describe the interrelationships between parental perceptions and child profiles. These analyses were carried out separately in boys and girls.

RESULTS

Parents of daughters perceived their neighbourhoods as less safe from crime compared to parents of sons. The number of ACS trips was similar between boys and girls. The clustering of the SOM outcomes resulted in seven clusters, both in boys and girls. However, cluster membership had significant effects on ACS in boys, but not in girls. Globally, in the group of boys, the highest ACS levels were positively correlated with the most supportive built environments in terms of residential density, land use mix, recreational facilities, accessibility and walking facilities, traffic safety, pedestrian infrastructure, safety from crime, and aesthetics. However, some of these factors had low scores in clusters with high ACS levels (e.g., low levels of accessibility and walking facilities, and land use mix).

CONCLUSIONS

These findings support the idea that ACS behaviour depends on the interaction of diverse built environment factors. Our results also suggest that parental perceptions had different effects according to the sex of the child, with ACS in boys being more influenced by these perceptions. In the case of girls, it is possible that ACS interventions should emphasise generating child-friendly social environments in addition to strategies to improve the built environment. Future interventions to encourage ACS should consider these sex-specific differences and address parental concerns through improved infrastructure and safety measures.

Excessive body weight and its contributing factors in visually impaired patients in northwest Ethiopia, 2024

Background

Excessive body weight are global health challenge affecting individuals across all age groups. They result from an imbalance between calorie intake and expenditure. Individuals with visual impairment are particularly vulnerable due to reduced physical activity, leading to higher rates of excessive body weight. This study assessed the prevalence and determinants of excessive body weight among visually impaired patients in northwest Ethiopia in 2024.

Method

A multi-centered institution-based cross-sectional study was done with 384 visually impaired patients selected using a simple random sample technique. An interviewer-administered structured questionnaire and physical assessments were used to gather data. The crude and adjusted odds ratios, as well as the 95% confidence intervals, were calculated. Bivariate and multivariate logistic regression analyses were performed. Variables having a p-value < 0.05 were considered substantially associated with excessive body weight.

Results

The prevalence of excessive body weight was 27.9% (95% CI: 23.2-32.8). Factors significantly associated with excessive body weight included being aged 65 or older (AOR = 5.43, 95% CI: 1.22-24.1), urban residency (AOR = 4.84, 95% CI: 2.95-7.95), and having visual impairment for five or more years (AOR = 3.33, 95% CI: 1.88-5.89).

Conclusion

Excessive body weight affects nearly one-third of visually impaired patients in northwest Ethiopia, with significant associations found for older age, urban residence, and long-term visual impairment. Integrating weight management programs, physical activity promotion, nutritional education, and community support is essential to improve health outcomes. Future studies using prospective cohort designs are recommended to explore causal relationships.

Influence of systematic standard and Nordic walking training on exercise tolerance and body weight components in women over 55 years of age

Background

The most physiological form of movement of human body is walking. The aim of the study was to assess the changes before and after workout programme in body mass components and exercise tolerance in women above 55 years of age, both in standard walking (March training) and walking with poles (Nordic Walking).

Material and methods

77 (55-64 years) women were divided into two groups: I - 37 women, participating in the marching training. II - 40 women participating in the Nordic Walking training. CPET, and body composition analysis were performed in each of the participants before and after workout program.

Results

Significant changes in VO2peak, both in standard walking group and Nordic walking, distance and test duration were observed. The evaluation of body composition Standard and Nordic Walking groups concerned statistically significant changes in the same indicators at the same level of significance: fat content (%), water content inside and outside the cell (%). In Nordic walking group there where some significant correlations between the changes in body fat (%), body weight, visceral obesity and fitness scores, changes in metabolic cost associated with the exercise test, changes in body fat (%) content and increase in the duration of the exercise test, as well as changes in body fat (%) content and increase in the distance of the test.

I simply have to accompany my parents to sell, nothing else!: a multi-method exploration of barriers and facilitators of extracurricular physical activity among Mexican schoolchildren

BACKGROUND

The time spent physically active outside of school (e.g., extracurricular physical activity) is an important contributor to children's total daily physical activity for health and well-being. Little is known about the opportunities available to children to engage in extracurricular physical activity from low- to middle-income countries. This study aims to answer the question: What are the main perceived barriers and facilitators of extracurricular physical activity among school-age children in Mexico?

METHODS

A multi-method cross-sectional study was performed. Six focus groups with children (aged 9-12 years), six focus groups with parents, 10 one-on-one interviews with parents, 12 interviews with teachers, and six interviews with head teachers were conducted across Campeche, Morelos, and Mexico State, Mexico. A questionnaire was applied to explore children's physical activity frequency and preferences for time inside and outside of school. Qualitative data analyses were performed with inductive thematic analysis supported with NVivo software. Quantitative data were analysed with descriptive statistics using IBM SPSS 26.

RESULTS

Three main themes summarise the study's findings: (1) how children spend their time outside of school, (2) the places that children access, and (3) the social environment for physical activity outside of the school. The data suggest that children in Mexico dedicate their spare time to screen, work, do housework, or perform unstructured physical activity mostly at home instead of playing sports or actively outdoors. Family support, enjoyment of physical activity, access to programs and facilities, time, living in a housing complex with open common areas, and mild weather were important facilitators identified. 69.4% of children engage in extracurricular physical activity, none of which was provided by schools. More children commute by walking than riding a bike to and from school. Children living inland spent three times more time at home compared to those in seafront areas.

CONCLUSIONS

Children rely on their families to partake in extracurricular structured physical activity. Policies targeting children's health and well-being should include school-based extracurricular physical activity programs.

Relationship between physical performance and physical activity among community older adults: The suppressing effects of loneliness and perceived neighborhood environment

This study aims to explore the role of loneliness and perceived neighborhood environment in the relationship between physical performance and physical activity among community older adults. A total of 740 older adults were recruited to complete a survey and a physical performance test. Path analysis and bootstrap analysis were performed to explore whether there were conditional indirect effects of loneliness and perceived neighborhood environment on physical activity. The results showed that physical performance had statistically significant positive effects on physical activity (total effect: β=0.378, P < 0.001;direct effect: β=0.523, P < 0.001), the association was mediated by loneliness (β=-0.098, P < 0.001)) and perceived neighborhood environment (β=-0.047, P < 0.05). Older adults would engage in more physical activities if they lived in a friendly neighborhood environment. Meanwhile, attention and social support should be provided to alleviate their loneliness and to promote their physical activity.

Physical Activity Inequalities in Adolescents From Areas of Different Socioeconomic Status

BACKGROUND

Understanding socioeconomic and gender inequalities in physical inactivity during adolescence is a relevant public health issue to promote health in adult life. The aim of this qualitative study is to identify the factors that determine physical activity inequalities in adolescents.

METHODS

We selected 2 educational centers in each of the 3 socioeconomic status areas-low, middle, and high-in the city of Madrid. We conducted a total of 18 semistructured interviews and 12 focus groups involving students, parents, teachers, and school principals. We followed the interpretative/constructivist paradigm within a case study design and grounded theory for the data analysis with the usage of ATLAS.ti 23 software.

RESULTS

Results included 4 main themes: (1) access to off-school structured physical activities; (2) physical activity restrictions due to socioeconomic status; (3) unacknowledged privilege in upper socioeconomic status adolescents; and (4) gender physical activity inequalities.

CONCLUSION

Improving the health of adolescents and future adults through increased physical activity requires equity and gender perspectives.

Exploring the relationship between neighborhood walkability and mental health: A study of urban areas in Texas

Background

While importance of walkable neighborhoods for health is increasingly recognized, the relationship between walkability and mental health remains, especially in urban settings, unclear. This study investigated the link between walkability and mental health in urban Texas. We hypothesized that higher neighborhood walkability would correlate with lower mental health encounters.

Methods

A cross-sectional study using Texas adult outpatient encounters from 2014 to 2019 supplemented by ZIP Code-level US-census socioeconomics data. Neighborhood walkability was assessed using the 2019-WalkScore (0-100) and was categorized into four groups: from completely car-dependent to very walkable/walker's paradise. Outpatient mental health encounters included depression, bipolar disorder, anxiety, and stress disorders. Generalized linear models were used to assess the association between walkability and mental health, while adjusting for demographics and socioeconomics.

Results

We included 55 million encounters from 751 Texas ZIP Codes (median WalkScore 28, 73 % < 65 years, 64 % women, 15 % Blacks, 16 % Hispanics, 15 % live in poverty, and 17 % without health insurance). Anxiety/stress disorders contributed to 68 % of the mental health encounters. The rate of mental health encounters was at least 3 times higher (5543 vs 1827 encounters per 100,000 population) (RR 3.03, 95%CI 1.53-6.03) in urban areas with the highest WalkScores, compared to lowest walkability neighborhoods. A similar pattern was found among depression (RR 4.8, 95%CI 2.45-9.46) and bipolar (RR 10.8, 95%CI 4.17-28.07) encounters. After adjusting for demographic and socioeconomic factors, the positive association remained significant for both depression (aRR 1.94, 95%CI 1.19-3.17) and bipolar (aRR 2.76, 95%CI 1.65-4.65) encounters, but not for total mental health encounters (aRR 1.22, 95%CI 0.76-1.96, P = 0.416).

Conclusion

The study findings challenge our initial hypothesis, revealing a positive association between neighborhood walkability and various mental health encounters, emphasizing the complex intersection between urban environment and mental health. This suggests that walkability does not solely determine mental health outcomes. A deeper understanding of how demographics, socioeconomic factors, and neighborhood characteristics interact is essential to inform policies that create more equitable mentally-healthy cities.

Association between neighborhood walkability and physical activity in a community-based twin sample

We investigated associations between neighborhood walkability and physical activity using twins (5477 monozygotic and same-sex dizygotic pairs) as "quasi-experimental" controls of genetic and shared environment (familial) factors that would otherwise confound exposure-outcome associations. Walkability comprised intersection density, population density, and destination accessibility. Outcomes included self-reported weekly minutes of neighborhood walking and moderate-to-vigorous physical activity (MVPA) and days per week using transit services (eg, bus, commuter rail). There was a positive association between walkability and walking, which remained significant after controlling for familial and demographic factors: a 1% increase in walkability was associated with a 0.42% increase in neighborhood walking. There was a positive association between walkability and MVPA, which was not significant after considering familial and demographic factors. In twins with at least 1 day of transit use, a 1-unit increase in log (walkability) was associated with a 6.7% increase in transit use days; this was not significant after considering familial and demographic factors. However, higher walkability reduced the probability of no transit use by 32%, considering familial and demographic factors. Using a twin design to improve causal inference, walkability was associated with walking, whereas walkability and both MVPA and absolute transit use were confounded by familial and demographic factors. This article is part of a Special Collection on Environmental Epidemiology.

Geospatial Determinants of Maternal Overweight, Gestational Diabetes and Large for Gestational Age Birthweight in Melbourne During and After COVID-19 Lockdowns

BACKGROUND

Research has linked postcode-level sociodemographic, food and built environment factors to maternal and perinatal outcomes like overweight (BMI > 25 kg/m2), gestational diabetes mellitus (GDM) and large for gestational age (LGA) birthweight. However, little is known about how these factors were influenced by the COVID-19 pandemic. We examine how postcode-level indicators and lockdown conditions are associated with the prevalence of maternal overweight, GDM and LGA.

MATERIALS AND METHODS

We analysed birth records from 12 public maternity hospitals in Melbourne, integrating postcode-level environmental indicators. Spatial regression models assessed associations between these indicators and maternal health outcomes, distinguishing between (a) the COVID-19 lockdown and (b) post-lockdown periods.

RESULTS

We included 31 083 singleton birth records from 2020 to 2023 across 235 postcodes in Greater Melbourne. The prevalence of maternal overweight, GDM and LGA were 496, 178 and 103 per 1000 births, respectively. Maternal overweight was less prevalent in postcodes with higher median ages and socioeconomic scores, with disparities intensifying during lockdowns. GDM was more common in areas with younger, overseas-born populations, while LGA correlated with higher median age and fewer overseas-born residents. Notably, maternal overweight mediated the effect of socioeconomic status on GDM and LGA.

CONCLUSIONS

The prevalence of maternal overweight, GDM and LGA varies significantly across Melbourne, shaped by postcode-level factors. The pandemic lockdown amplified existing health disparities. The food and built-environment factors independently influence maternal and perinatal outcomes.

Ahmedabad declaration: A framework to combat growing epidemic of young-onset type 2 diabetes in Asia

AIM

Rising prevalence of Type 2 Diabetes (T2D) among young Asians has emerged as a public health crisis that threatens the long-term health, economic stability, and productivity of nations across Asia (1). Early-onset T2D poses unique challenges, including higher rates of undiagnosed cases, more aggressive disease progression, an increased risk of chronic complications and higher mortality (2). Hyperglycemia during the reproductive age especially among the female population can potentially have transgenerational impact through epigenetic changes.

METHODS

A comprehensive search was conducted on PubMed with a combination of relevant keywords. A preliminary draft prepared after review of literature was electronically circulated among a panel of 64 experts from various parts of the region and representatives of the participating organizations - Diabetes India (www.diabetesindia.org.in) and the Diabetes Asia Study Group (DASG, www.da-sg.org).

RESULTS

This Ahmedabad Declaration outlines the scale of the problem, its root causes, and a comprehensive action plan for Asian populations. The objectives of this declaration include raising awareness, addressing systemic barriers, and advocating for evidence-based policies and interventions, limited to people with T2D. Through collaborative efforts, we aim to mitigate the growing burden of diabetes in young Asians and secure a healthier future.

Co-benefits of nature-based solutions: A health impact assessment of the Barcelona Green Corridor (Eixos Verds) plan

INTRODUCTION

The Green Corridors Plan (Eixos Verds Plan), proposed by the Barcelona City Council, aims to enhance urban well-being, environmental sustainability, and resilience by transforming one in every three streets into green corridors. Although initially designed for city-wide implementation, only the first phase, focused on the centric Eixample district, has been completed, and the overall plan implementation has been postponed. Our aim is to evaluate the health co-benefits of implementing the Green Corridors plan citywide, focusing on the direct effects of increased exposure to greenness and the impact of temperature reduction on mortality.

METHODS

We conducted a comprehensive Health Impact Assessment (HIA) considering direct effects of expanding green spaces (GS) and the impact on temperature reduction. Preventable mortality at the census tract level for adult residents was estimated, and to address uncertainties, we performed Monte Carlo iterations. We computed the percentage increase in GS (land use) and tree cover and converted them into Normalized Difference Vegetation Index (NDVI) to conduct the HIA, employing a Generalized Additive Model (GAM). We used the Weather Research and Forecasting model (WRF) coupled with the urban parameterizations "Building Effect Parameterization" (BEP) and "Building Energy Model" (BEM) for temperature modelling. Hourly temperatures from 25/06/2015 to 25/07/2015 were simulated, both with and without Green Corridors Plan implementation.

RESULTS

City-wide implementation of the Green Corridors plan would increase average GS by 3.64 % (IQR: 2.17 % - 4.40 %) and NDVI by 0.286 (IQR: 0.256-0.304) per census tract. This could potentially prevent 178 premature deaths annually (95 % CI: 116-247), equating to 13 deaths per 100,000 inhabitants (95 % CI: 9-19). The average daily temperature reduction per census tract was estimated at 0.05 °C, with a maximum reduction of 0.42 °C. Temperature reduction could potentially prevent 5 deaths during the simulated month. Additionally, we estimated a mean decrease in the thermal stress of 0.11 °C, reaching up to 1.48 °C at its peak.

CONCLUSION

The Green Corridors plan can make significant contributions to a healthier urban environment. To address climate and especially heat impacts, complementary strategies to achieve more substantial temperature reduction are needed. Overall, our findings underscore the potential of nature-based solutions (NbS), exemplified by the Green Corridors Plan, in creating more sustainable and health-promoting urban environments.

Interaction between walkability and fine particulate matter on ischemic heart disease: A prospective cohort study in China

BACKGROUND

Previous studies have suggested that neighborhoods characterized by higher walkability are related to a reduced risk of ischemic heart disease (IHD), whereas exposure to PM2.5 is positively associated with risk of IHD. Nevertheless, their joint impact on IHD warrants further investigation.

METHODS

This prospective cohort study was performed in Yinzhou, Ningbo, China, comprising 47,516 participants. Individual-level walkability and PM2.5 were evaluated using a commercial walkability database and a land use regression (LUR) model, respectively. Hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) were calculated using two Cox proportional hazards models: one based on two-year average PM2.5 levels prior to baseline, and the other incorporating time-varying PM2.5 assessed on a monthly scale. Dose-response relationships were explored using restricted cubic spline (RCS) functions. Interactions on both additive and multiplicative scales were assessed via relative excess risk due to interaction (RERI) and likelihood-ratio tests. Joint effects were explored and visualized using a 3D wireframe plot.

RESULTS

Over a median follow-up of 5.14 years, 1735 incident cases of IHD were identified. Adjusted HRs (95 % CIs) were 1.56 (1.34-1.81) per 10 μg/m3 increase in PM2.5 and 0.96 (0.94-0.98) per 10-unit increase in walkability, with both exposures exhibiting non-linear dose-response relationships. Walkability and PM2.5 were positively correlated (rs = 0.12, P < 0.001), and a multiplicative interaction was detected (Pinteraction = 0.019).

CONCLUSION

Walkability was inversely associated with risk of IHD, whereas exposure to PM2.5 was positively associated with IHD. Notably, the pernicious effects of PM2.5 could be attenuated in areas with higher levels of walkability. Our findings underscore the significance of walkable urban design, air quality improvement, as preventive strategies for IHD.

Interplay Between Residential Nature Exposure and Walkability and Their Association with Cardiovascular Health

Background

Green space has been linked with cardiovascular (CV) health. Nature access and quality may have significant impact on CV risk factors and health.

Objectives

The authors aimed to investigate the relationship between NatureScore, a composite score for natural environment exposure and quality of green spaces, with CV risk factors and atherosclerotic cardiovascular diseases (ASCVD).

Methods

A cross-sectional study including one million adult patients from the Houston Methodist Learning Health System Outpatient Registry (2016-2022). NatureScore is a composite measure of natural environment exposure and quality (0-100) calculated for each patient based on residential address. NatureScores was divided into 4 categories: nature deficient/light (0-39), nature adequate (40-59), nature rich (60-79), and nature utopia (80-100). CV risk factors included hypertension, diabetes, dyslipidemia, and obesity.

Results

Among 1.07 million included patients (mean age 52 years, female 59%, Hispanic 16%, Non-Hispanic Black 14%), median NatureScore was 69.4. After adjusting for neighborhood walkability, patients living in highest NatureScore neighborhoods had lower prevalence of CV risk factors (OR: 0.91, 95% CI: 0.90-0.93) and ASCVD (OR: 0.96, 95% CI: 0.93-0.98) than those in lowest NatureScore neighborhoods. A significant interaction existed between NatureScore and Walkability (P < 0.001), where those in high NatureScore (≥60) high walkability (≥40) areas had lower prevalence of CV risk factors (OR: 0.93, 95% CI: 0.90-0.97, P < 0.001) and were more likely to have optimal CV risk profile (relative risk ratio: 1.09, 95% CI: 1.04-1.14, P = 0.001).

Conclusions

These findings suggest that while green spaces benefit health, their accessibility through walkable environments is crucial for cardiovascular disease protection.

Government Support, Community Recreation Facilities, and Physical Activity in China: A Cross-Sectional Socioecological Analysis

BACKGROUND

In the context of rising noncommunicable diseases, Chinese authorities emphasize the need for local governments to provide public sports services to support physical activity (PA).

METHODS

Employing a socioecological theoretical framework, and drawing on a hierarchical data set synthesized from the China Health and Nutrition Survey, China Stock Market & Accounting Research Database, and Wind Financial Terminal from 2015, a multilevel analysis of the association between provincial government expenditure on culture, sports, and media from 12 provinces, the recreation facilities provided by 287 communities, and PA of n = 10,305 individuals is performed. The number of, and time allocated to, PAs undertaken as well as their METs equivalent in relation to World Health Organization guidelines are investigated.

RESULTS

Controlling for a large set of individual confounders, the results show that community recreation facilities and provincial government expenditure have a significant positive association with PA participation that exceeds health guidelines.

CONCLUSIONS

The results confirm the importance of government support for sport and the provision of community sport and PA facilities in China. This has implications for public health policy generally including the Western context. It remains, however, that the cultural context of engagement also needs further consideration.

Daily walking time effects of the opening of a multifunctional facility "ONIKURU" using propensity score matching and GPS tracking techniques

Urban design focused on improving walkability has received attention as a method of increasing physical activity among the population. However, only a few studies have examined the effect of walking time of opening multifunctional facilities as an architecture-scale intervention. This study aimed to clarify the effect of opening a multifunctional facility on residents' daily walking time. In addition, this study analyzed the gender and age subgroups. The natural experiment was conducted using the case of the Ibaraki City Cultural and Childcare Complex "ONIKURU," a public multifunctional facility. This study used GPS-trajectory data based on GPS tracking techniques, which is anonymized location data for smartphone users. The causal relationship was analyzed using propensity score matching and difference-in-differences analysis. The results showed that the opening of ONIKURU significantly increased the average walking time of visitors to 3.165 [- 1.697, 8.027] min/day compared with that of non-visitors. Specifically, visitors' average daily walking time improved to a level comparable to that of non-visitors after the opening of ONIKURU. In addition, opening ONIKURU significantly increased female young adults' average walking time to 3.385 [- 4.906, 11.676] min/day. Therefore, this study provides theoretical contributions to a health-promoting built environment significantly affecting walking at an architecture-scale intervention.

Association between community walkability and hypertension: Evidence from the Wuhan Chronic Disease Cohort Study

While community walkability is recognized as a key environmental factor for health status, evidence linking it specifically to hypertension is rather limited. To fill the knowledge gap, we concluded a cross-sectional study among 6421 eligible participants from the Wuhan Chronic Disease Cohort. A well-developed algorithm was performed to evaluate community walkability across Wuhan, quantified as Walk Score. We then calculated each participant residential Walk Score using the geographic information system. The logistic and linear regression models were conducted to determine the relationship between walkability, hypertension and blood pressure, respectively. We further performed the mediation analysis to explore potential mechanisms. After adjusting for extra confounders, we observed a higher community walk score was associated with a lower hypertension risk (OR = 0.73; 95% CI: 0.63, 0.84), a lower systolic blood pressure (β = -3.152 mmHg; 95% CI: -4.25, -2.05), a lower diastolic blood pressure (β = -2.237 mmHg; 95% CI: -2.95, -2.53) and a lower mean arterial pressure (β = -2.976 mmHg; 95% CI: -3.75, -2.20). The effect of community walkability on hypertension was partially mediated by body fat rate. Our study indicates a positive correlation between high walkability and a reduced odds of hypertension in China. This highlights the potential role of urban design in hypertension prevention, emphasizes the need for walkability-focused planning strategies to foster healthier communities, and guides future interventions and research to mitigate hypertension.

Integrating accelerometry, GPS, GIS and molecular data to investigate mechanistic pathways of the urban environmental exposome and cognitive outcomes in older adults: a longitudinal study protocol

INTRODUCTION

Maintaining cognitive health in later life is a global priority. Encouraging individuals to make health behaviour changes, such as regular physical activity, and providing supportive urban environments can help maintain cognitive health, thereby preventing or delaying the progress of dementia and cognitive decline. However, the mechanistic pathways by which the urban environmental exposome influences cognitive health outcomes are poorly understood. The aim of this study is to use granular measures of the urban environment exposome (encompassing the built, natural and social environment) and physical activity to explore how these interact with a person's biology to ultimately influence cognitive health outcomes.

METHODS AND ANALYSIS

This ongoing study uses a cohort design, recruiting participants from the Northern Ireland Cohort for the Longitudinal study of Ageing and the Harmonised Cognitive Assessment Protocol study. Participants (n=400 at each wave) will be aged ≥65 years and have the capacity to provide written informed consent. Measures include device-measured physical activity (Actigraph wGT3XP-BT), environmental location data (Global Positioning System, Qstarz BT-Q1000XT), linked to a battery of neuropsychological tests, including the Mini Mental State Examination and the Centre for Epidemiological Studies Depression Scale. Blood-derived biochemical, genetic and epigenetic data will be included in multimodal analyses. These data will be integrated with urban environment Geographic Information System data and analysed using causal inference and mediation methods to investigate plausible mechanistic pathways.

ETHICS AND DISSEMINATION

This study has been approved by the Queen's University Belfast, Faculty of Medicine, Health and Life Sciences Research Ethics Committee (MHLS 21_72). Alongside peer-reviewed publications in high-ranking international journals, dissemination activities include conference presentations, project videos, working papers, policy briefing papers, newsletters, summaries and case study stories.

Diabetes in China part 1: epidemiology and risk factors

The prevalence of diabetes in China is rapidly increasing. China now has the largest number of people living with diabetes worldwide, accounting for approximately one-quarter of the global diabetes population. Since the late 1970s, China has experienced profound changes and rapid economic growth, leading to shifts in lifestyle. Changing dietary patterns, reduced physical activity, and stress have contributed to the growing prevalence of overweight and obesity, which are important determinants potentiating the link between insulin resistance and diabetes. Social and environmental factors, such as education, air pollution, and exposure to endocrine-disrupting chemicals, have also contributed to the growing diabetes epidemic in China. The country has one of the fastest ageing populations in the world, which forecasts continued increases in the prevalence of diabetes and its complications. This Review provides an overview of the ongoing diabetes epidemic and risk factors, providing evidence to support effective implementation of public health interventions to slow and prevent the diabetes epidemic in China.

Differences in Physical Activity and Self-Rated Health Levels Based on Satisfaction with Physical Environment of Local Communities: From School to Lifelong Physical Education

BACKGROUND

In Korea, substantial disparities exist in physical environments across regions, exacerbating the polarization between metropolitan and provincial areas and urban and rural regions.

OBJECTIVES

This study examines the differences in the physical activity and self-rated health of local communities in relation to satisfaction with the physical environment. By identifying and addressing these underlying causes of health disparities, the study provides foundational data to inform policy efforts.

METHODS

The study utilized data from the 2023 Community Health Survey conducted by the Korea Disease Control and Prevention Agency. It included 231,752 individuals aged 19 and older (105,754 men and 125,998 women) selected through a two-stage probability proportional systematic sampling method. One-on-one online interviews were conducted from 16 May to 31 July 2023. The physical environment was assessed based on public satisfaction with safety, natural and living environments, public transportation, and medical services. Study variables included subjective health status and physical activity, with subvariables for physical activity encompassing the duration of vigorous and moderate physical activity, walking, and flexibility exercises. For data analysis, MANOVA and ANOVA were conducted, with Bonferroni correction for multiple comparisons.

RESULTS

Considerable variations in physical activity were observed based on satisfaction with the local community environment. Regarding self-rated health, significant differences were found in safety levels, living environment, and medical services. Satisfaction with the physical environment positively influenced physical activity and self-rated health.

CONCLUSION

Therefore, it is imperative to reduce disparities in the physical environment between regions and enhance residents' satisfaction.

Green Streets, Healthy Hearts: Exploring the Roles of Urban Nature and Walkability in Cardiovascular Health

With the growing evidence that connects urban environments with public health outcomes, the role of urban planning has become increasingly critical in addressing public health challenges. Cardiovascular diseases (CVDs) are the leading cause of mortality in urban areas and worldwide and are impacted by characteristics of the built environment, such as walkability and nature exposure. In this literature view, we explore the influence of the physical built environment, specifically green spaces and walkability, on cardiovascular health. Results from prior studies show a clear reduction in cardiovascular disease-related risk factors, morbidity, and mortality in neighborhoods that integrate green spaces and/or walkability. Cumulative evidence suggests that urban environments that integrate green spaces (such as parks) and walkability (eg, safe sidewalks) can significantly improve cardiovascular health. Urban planning policies and strategies that prioritize the integration of green infrastructure and walkable designs can contribute to improving cardiovascular health in urban residents while also enhancing the overall well-being and quality of life.

Facilitators and barriers of initiation and maintenance of physical activity among people with coronary heart disease: a qualitative study

PURPOSE

We aimed to describe the facilitators and barriers of physical activity for patients with coronary heart disease.

METHODS

A qualitative descriptive study using semi-structured interviews was conducted with 15 participants with coronary heart disease. The interview guide was developed based on a multi-theory model. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis.

RESULTS

Two main themes were identified: facilitators of initiation and maintenance of physical activity (behavioral motivation, perceived benefits, behavioral confidence, supportive physical environment, positive emotional experience, self-regulation, supportive social environment, illness perception, and excellent self-control), barriers of initiation and maintenance of physical activity (perceived barriers, restricted physical environment, psychological distress, insufficient social support, and poor self-control).

CONCLUSIONS

This study presents an in-depth theory-based exploration of facilitators and barriers to initiating and maintaining physical activity among people with coronary heart disease. Relevant factors should be taken into account to increase their effectiveness when designing the target interventions to encourage a physically active lifestyle in this population.

Associations between adherence to 24-hour movement guidelines and socio-emotional competence among preschool children: A cross-sectional study

BACKGROUND

This study investigated the association between adherence to 24-h movement guidelines and socioemotional competence among Chinese preschool children.

METHODS

A total of 1288 parents of Chinese preschoolers (54.64 % boys, 45.36 % girls; Mage = 4.48, SD = 0.97) reported the time their children spent on physical activity (PA), screen time (ST), and sleep duration (SD), and completed questionnaires measuring socioemotional competence. Multiple logistic regression analyses were used to explore the associations between individual and combined measures of PA, ST, and SD, and the risk of low socioemotional competence.

RESULTS

The risk of low socioemotional competence was significantly lower for children aged 4 (odds ratio [OR] = 0.47, 95 % CI: 0.31-0.71), 5 (OR = 0.23, 95 % CI: 0.15-0.35), and 6 (OR = 0.16, 95 % CI: 0.10-0.25) compared to 3-year-olds. Children with a family income level higher than 20,000CNY had a significantly lower risk of low socioemotional competence than those with a family income level not higher than 3000CNY (OR = 0.21, 95 % CI: 0.08-0.59). Urban residency was associated with significantly lower odds of low socioemotional competence than rural residency (OR = 0.41, 95 % CI: 0.21-0.82). Adherence to the PA-only guidelines (OR = 0.45, 95 % CI: 0.22-0.94), SD-only guidelines (OR = 0.25, 95 % CI: 0.08-0.72), ST + SD guidelines (OR = 0.33, 95 % CI: 0.16-0.67), and PA + ST + SD guidelines (OR = 0.36, 95 % CI: 0.18-0.70) were associated with a lower risk of low socioemotional competence. In addition, among boys, only adherence to the PA + ST + SD guidelines (OR = 0.36, 95 % CI: 0.14-0.90) was associated with a lower risk of low socioemotional competence. Among girls, adherence to SD guidelines only (OR = 0.22, 95 % CI: 0.04-0.90), ST + SD guidelines (OR = 0.17, 95 % CI: 0.06-0.49), and PA + ST + SD guidelines (OR = 0.37, 95 % CI: 0.14-0.91) were all associated with a lower risk of low socioemotional competence.

CONCLUSIONS

Adhering to 24-h movement guidelines is crucial for enhancing socioemotional competence in preschool children, especially girls. Interventions should focus on promoting physical activity, reducing screen time, and ensuring adequate sleep.

Estimating the Reduction of Socioeconomic Inequalities for a More Physically Active Society: A Cross-Sectional Study of the European Union Country Members

BACKGROUND

Socioeconomic inequalities significantly impact the accessibility of resources necessary for physical activity, thereby influencing overall physical activity levels and contributing to broader health disparities. Nevertheless, evidence is lacking on quantifying the increase of people who would be physically active through reducing inequalities by a higher socioeconomic position.

METHODS

We conducted secondary data analysis on the 2017 cross-sectional survey of the European Union's population aged ≥18 years (n = 27,538). By estimating socioeconomic status percentages and odds ratios between socioeconomic status (education, occupational social class, and economic issues) and physical activity, we calculated age-standardized Prevented Fraction for Population and the total number of individuals that would meet physical activity guidelines by a higher socioeconomic status (eg, from low to middle or high socioeconomic status), along with scenarios of reduced socioeconomic disparities, controlling for age, gender, place of residence, and marital status.

RESULTS

A higher socioeconomic status could promote physical activity for a total of 93.0 (84.5-101.8) million people through university education, 28.5 million via high-ranked occupations (24.6-32.8), and 137.9 (129.5-146.2) million by less economic issues (compared with primary education, low-manual occupations, and having economic issues most of the time, respectively)-equivalent to 35.46%, 14.49%, and 55.42% of the Prevented Fraction for Population. Reducing socioeconomic inequalities by 50% could raise these estimations to 148.1 million (134.0-162.8) through education, 43.5 million (37.5-50.3) through occupation, and 223.6 million (209.3-237.8) through less economic issues.

CONCLUSIONS

Enhancing access to university education, high-ranked occupations, and income impacts physical activity population levels in the European Union.

Association of urban environments with Atherosclerotic cardiovascular disease: A prospective cohort study in the UK Biobank

Urban environments and cardiovascular health are closely linked, yet only a few specific exposures have been explored in isolation and mostly adopting cross-sectional design. The influence of socioeconomic status and genetic predisposition also remains unclear. Hence, leveraging the UK Biobank data (n = 206,681), we conducted a prospective analysis of 213 urban environmental variables and their association with atherosclerotic cardiovascular disease (ASCVD). The ExWAS and regularized Cox models analyses highlighted air pollution, industrial sites, and complex street networks as primary environmental risk factors. Instead, land-use density of leisure, public services, infrastructure and residential, and drinking water hardness showed a negative association with ASCVD risk. By integrating sparse canonical correlation and mediation analyses, we found distinct urban environment patterns through diverse pathways influence ASCVD. The environment characterized by pollution and complex streets impact ASCVD through adverse mental health (mediation proportion:30.7 %, 95 % CI:22.4 %-44.0 %), while highly-developed community and high-water hardness environment via cardiometabolic status (22.6 %, 95 % CI:19.7 %-26.0 %). Further, we found low socioeconomic status amplifies disadvantaged urban environment effects on ASCVD, yet there were no similar findings for ASCVD genetic predisposition. This research deepened our understanding of city-cardiovascular health links and the role of socioeconomic status, with implications for urban planning and public health interventions.

Qualitative exploration of determinants of active mobility and social participation in Urban neighborhoods: individual perceptions over objective factors?

BACKGROUND

Urban neighborhood environments play an important role in facilitating or hindering residents to engage in active mobility and social participation. However, while there is much quantitative research, in-depth knowledge that contextualizes residents' subjective perceptions of barriers and facilitators of active mobility and social participation is still insufficient. Therefore, a qualitative approach was used to collect subjectively perceived barriers and facilitators of active mobility and social participation of residents from different neighborhoods with objectively determined high vs. low walkability. Furthermore, to better understand (non) concordance of objective environmental characterizations and actual levels of behavior, low and high walkability neighborhood-specific barriers, proposed improvements, and particularities that determine (non) engagement in active mobility and social participation were explored.

METHODS

Three focus groups (N = 6, N = 6, and N = 5) with 17 participants (7 women, 10 men) aged 21-64 (mean age 43.4 ± 14,6 years) were conducted utilizing a pre-structured interview guideline. Participants lived in 11 different neighborhoods with either high or low objectively determined walkability. The focus groups were transcribed verbatim, followed by a thematic analysis of the content with deductive and inductive code categories, utilizing the MAXQDA software.

RESULTS

Notable was the consensus of many perceived barriers and facilitators of active mobility and social participation along with their assignability to the same context (points-of-interest, infrastructure; safety, communication, community; topography, physical compositions, weather, aesthetics; personal / individual attitudes, influences, evaluations). Another main finding was that high and low walkability neighborhood-specific particularities were revealed that are in contrast to some objective characterizations of walkability: For example, too high density can inhibit active mobility, and too many options can inhibit social participation.

CONCLUSIONS

The consensus of many barriers and facilitators of active mobility and social participation suggests that valuable synergies could be created by coordinating interventions aiming to promote both active mobility and social participation in urban neighborhoods. Also, considering subjective perceptions of residents helps to identify neighborhood-specific factors that determine (non) engagement in active mobility and social participation. The findings can help city planners and public health officials improve the promotion of active mobility and social participation in the creation of health-enhancing urban neighborhoods.

Measuring Environmental and Behavioral Drivers of Chronic Diseases Using Smartphone-Based Digital Phenotyping: Intensive Longitudinal Observational mHealth Substudy Embedded in 2 Prospective Cohorts of Adults

BACKGROUND

Previous studies investigating environmental and behavioral drivers of chronic disease have often had limited temporal and spatial data coverage. Smartphone-based digital phenotyping mitigates the limitations of these studies by using intensive data collection schemes that take advantage of the widespread use of smartphones while allowing for less burdensome data collection and longer follow-up periods. In addition, smartphone apps can be programmed to conduct daily or intraday surveys on health behaviors and psychological well-being.

OBJECTIVE

The aim of this study was to investigate the feasibility and scalability of embedding smartphone-based digital phenotyping in large epidemiological cohorts by examining participant adherence to a smartphone-based data collection protocol in 2 ongoing nationwide prospective cohort studies.

METHODS

Participants (N=2394) of the Beiwe Substudy of the Nurses' Health Study 3 and Growing Up Today Study were followed over 1 year. During this time, they completed questionnaires every 10 days delivered via the Beiwe smartphone app covering topics such as emotions, stress and enjoyment, physical activity, access to green spaces, pets, diet (vegetables, meats, beverages, nuts and dairy, and fruits), sleep, and sitting. These questionnaires aimed to measure participants' key health behaviors to combine them with objectively assessed high-resolution GPS and accelerometer data provided by participants during the same period.

RESULTS

Between July 2021 and June 2023, we received 11.1 TB of GPS and accelerometer data from 2394 participants and 23,682 survey responses. The average follow-up time for each participant was 214 (SD 148) days. During this period, participants provided an average of 14.8 (SD 5.9) valid hours of GPS data and 13.2 (SD 4.8) valid hours of accelerometer data. Using a 10-hour cutoff, we found that 51.46% (1232/2394) and 53.23% (1274/2394) of participants had >50% of valid data collection days for GPS and accelerometer data, respectively. In addition, each participant submitted an average of 10 (SD 11) surveys during the same period, with a mean response rate of 36% across all surveys (SD 17%; median 41%). After initial processing of GPS and accelerometer data, we also found that participants spent an average of 14.6 (SD 7.5) hours per day at home and 1.6 (SD 1.6) hours per day on trips. We also recorded an average of 1046 (SD 1029) steps per day.

CONCLUSIONS

In this study, smartphone-based digital phenotyping was used to collect intensive longitudinal data on lifestyle and behavioral factors in 2 well-established prospective cohorts. Our assessment of adherence to smartphone-based data collection protocols over 1 year suggests that adherence in our study was either higher or similar to most previous studies with shorter follow-up periods and smaller sample sizes. Our efforts resulted in a large dataset on health behaviors that can be linked to spatial datasets to examine environmental and behavioral drivers of chronic disease.

Accelerometer-derived moderate-to-vigorous physical activity and incident nonalcoholic fatty liver disease

BACKGROUND

The liver effects of concentrated vs. more evenly distributed moderate-to-vigorous physical activity (MVPA) patterns remain unclear. We aimed to examine the association of accelerometer-measured MVPA and different MVPA patterns with liver outcomes.

METHODS

Eighty-eight thousand six hundred fifty-six participants without prior liver diseases from UK Biobank were included. MVPA was measured by a wrist-worn accelerometer. Based on the guideline-based threshold (≥ 150 min/week), MVPA patterns were defined as inactive (< 150 min/week), active weekend warrior (WW; ≥ 150 min/week with ≥ 50% of total MVPA achieved within 1-2 days), and regularly active (≥ 150 min/week but not active WW) patterns. The primary outcome was incident nonalcoholic fatty liver disease (NAFLD).

RESULTS

During a median follow-up of 6.8 years, 562 participants developed NAFLD. Overall, there was a nonlinear inverse association of total MVPA with incident NAFLD (P for nonlinearity = 0.009): the risk of NAFLD rapidly decreased with the increment of MVPA (per 100 min/week increment: HR = 0.68; 95%CI, 0.57-0.81) when MVPA < 208 min/week, while moderately declined (HR = 0.91; 95%CI, 0.84-0.99) when MVPA ≥ 208 min/week. For MVPA patterns, compared with inactive group, both active WW (HR = 0.55, 95%CI, 0.44-0.67) and active regular (HR = 0.49, 95%CI, 0.38-0.63) group were associated with a similar lower risk of NAFLD. Similar results were observed for each secondary outcome, including incident severe liver diseases, incident liver cirrhosis, and liver magnetic resonance imaging-based liver steatosis and fibrosis.

CONCLUSIONS

Regardless of whether MVPA was concentrated within 1 to 2 days or spread over most days of the week, more MVPA was associated with a lower risk of incident liver outcomes, including NAFLD, liver cirrhosis, liver steatosis, and fibrosis, to MVPA more evenly distributed.

Sedentarism and Chronic Health Problems

Increased mechanization and technological advances have simplified our lives on the one hand and increased sedentary behaviors on the other hand, paving the way for emerging global health concerns, i.e., sedentarism, which could be the leading cause of all major chronic health problems worldwide. Sedentarism is a habitual behavior of choosing and indulging in low-energy expenditure activities (≤1.5 metabolic equivalents), such as chairtype (sitting, studying, traveling) or screen-type activities (TV, computers, mobile). With technological advancements, there is a significant transition in the lifestyles of people from being active (walking) to being more deskbound (sitting). Prolonged sitting can have unintended consequences for health with sitting time >7 h/d, leading to a 5% increase in all-cause mortality with each additional hour spent sitting (i.e., +7 h/d), while considering physical activity levels. This review will highlight how sedentarism is emerging as a major risk factor for the rising incidence of non-communicable diseases, especially among young adults and adults. Chronic diseases, such as obesity, diabetes, coronary heart disease, and cancer, are the leading causes of death worldwide. Hence, there is an urgent need for collective action to mitigate the burgeoning public health crisis posed by sedentarism in the 21st century. This paper intends to set in motion a call for all policymakers and public health professionals placed nationally or internationally to reach a consensus on ending sedentarism and provide viable resolutions for effective management of excessive sedentary behaviors and healthy adoption and maintenance of active lifestyles among individuals of all age groups.

Worldwide burden of liver cancer across childhood and adolescence, 2000-2021: a systematic analysis of the Global Burden of Disease Study 2021

Background

Liver cancer is a significant contributor to the global disease burden, of which hepatoblastomas are the most common liver tumors in children, with 90% of cases occurring within the first 5 years of life. It is important for pediatricians and subspecialists in pediatric gastroenterology and hepatology to have knowledge of the epidemiology and incidence trends of pediatric hepatic cancer, despite its rarity. In the present study, we first provide estimates of the incidence and mortality burden of hepatoblastoma and liver cancer from 2000 to 2021 in the childhood and adolescence.

Methods

Liver cancer burden and its attributable risk factors were estimated using data from the Global Burden of Disease Study (GBD) 2021. Percentage change was estimated to show the trend of liver cancer estimates from 2000 to 2021. The age-standardized rate (ASR) and estimated annual percentage change (EAPC) were utilized for measuring hepatoblastomas incidence and deaths rate trends. In accordance with the GBD framework, 95% uncertainty intervals (UIs) for all estimates by averaging the data from 1000 draws, with the lower and upper bounds of the 95% UIs.

Findings

Globally, from 2000 to 2021 in the age 5-19 years group, the incidence cases and deaths cases due to liver cancer decreased from 2449.2 (95% UI: 2235.9-2689.8) to 1692.9 (95% UI: 1482.0-1992.5) and 2248.5 (95% UI: 2053.7-2474.9) to 1516.6 (95% UI: 1322.1-1797.9), respectively. Meanwhile, from 2000 to 2021 in the age 20-24 years group, the incidence cases and deaths cases due to liver cancer decreased from 1453.5 (95% UI: 1327.8-1609.4) to 1285.1 (95% UI: 1159.2-1447.2) and 1432.3 (95% UI: 1307.6-1585.7) to 1195.5 (95% UI: 1066.1-1355.2), respectively. In addition, the prevalence of liver cancer decreased from 41.9% (95% UI: 18.7%-64.7%) to 26.4% (95% UI: 14.2%-39.1%) in the age 5-19 years group, and 46.6% (95% UI: 42.8%-51.5%) to 36.5% (95% UI: 33.1%-40.9%) in the age 20-24 years. From 2000 to 2021, in the age group of 5-19 years, the proportion of liver cancer incidence due to hepatitis B has decreased from 42.2% to 37.9%, while the proportion due to hepatitis C has increased from 1.1% to 1.6%. Additionally, there has been an increase in the proportion of NASH-induced liver cancer incidence from 5.2% to 9.4%, and alcohol use induced liver cancer incidence has also increased from 0.5% to 0.7% over the same period. Globally, from 2000 to 2021, the incidence cases and deaths cases due to hepatoblastoma decreased from 6131.8 (95% UI: 5234.8-6961.9) to 4045.6 (95% UI: 3250-4995.8) and 4059.2 (95% UI: 3494.5-4621.2) to 2416 (95% UI: 1940.2-3022.5), respectively. There was some variation in age-related sex-specific patterns, the highest number of hepatoblastoma incidence cases occurred in children between 2 and 4 years old and females in the age range of 12 months to 9 years had a higher number of new cases. Importantly, the incidence of hepatoblastoma was started to increase sharply after the age of 1 month.

Interpretation

The results of the present study are significant for liver health policy and practice in childhood and adolescence. Differentiated intervention and outreach strategies based on age and gender would be necessary to reduce the impact of liver cancer. Early screening and interventions for hepatoblastoma is important especially in the population of under 9 years old.

Funding

This study was supported by the National Key R&D Program of China (grant numbers 2023YFC2307000), National Natural Science Foundation of China [grant numbers 82170571 and 81974068], China Postdoctoral Science Foundation (grant numbers 2023M741283).

Impact of apparent temperatures on park visitation behavior: A comprehensive analysis using large-scale mobility data

As many regions continue to show record temperatures and high frequencies of extreme climate events, climate change is disrupting human health and prosperity. This study focuses on how temperature changes and extreme heat as key climate components can impact park visitations (key physical activities indicator). Using the large mobility dataset SafeGraph, this study introduced a causal machine learning approach to estimate marginal heterogenous treatment effects (HTE) of daily apparent temperatures for different park properties and activity types. Our results revealed the declining effects of park visitations as apparent temperature increases and the significant disturbances under extreme heat. Different temperature thresholds that may harm park visitations were identified. Nearby green and public spaces (e.g. neighborhood parks) are the most susceptible category to summer heat. Dog parks, Playgrounds and Ball Field/Sports were well used during the heat. Pool/Splash pad and Community center have shown capabilities of mitigating heat stress. Effectiveness of other park facilities, including Restroom/Drinking Fountain, Water Body, Shade Area Facility were also presented. This study estimates climate impact on park behaviors for multiple usage and environmental situations. Our findings may help future planners, policymakers, landscape architects and park managers better understand climate-related risks when making investment and development decisions.

Associations of Park Use with Physical Activity in Renovated Parks Serving Low-Income Communities in New York City: Insights from the Community Parks Initiative

Parks have the potential to encourage physical activity among urban communities. However, existing research on the link between park use and physical activity has produced inconsistent results. Mixed findings in the past may be due in part to differences in park quality across studies. The aim of this study was to explore the association between park use and physical activity among New York City adults in low-income communities that recently received city-sponsored park renovation as part of the Community Parks Initiative (CPI). Using population-weighted survey data from eight neighborhoods with recent park renovation (n = 2,000), we measured associations between park use frequency (≥ once/week vs. < once/week) and self-reported physical activity (high vs. low-moderate based on the International Physical Activity Questionnaire). We adjusted models for age, sex, education, race/ethnicity, income, study site, and use of other (non-CPI) parks, and conducted stratified analysis for demographic variables with significant interactions with park use. After adjusting for covariates, we observed a positive association between park use and physical activity (prevalence ratio [PR] = 1.30, 95% CI = 1.16-1.46). Greater frequency of park use was more strongly associated with high physical activity among adults ≤ 50 y (PR = 1.39, 95% CI = 1.14-1.69), individuals with annual household income < $25,000 (PR = 1.54, 95% CI = 1.13-2.08), and Latinos (PR = 1.77, 95% CI = 1.44-2.18). Our findings suggest that high-quality parks might be particularly beneficial for promoting physical activity among those with a lower socioeconomic background and in younger and Latino adults, emphasizing the importance of continued investment in park revitalization among urban communities of color.

Exploring the impact of the environment on physical activity in patients with chronic obstructive pulmonary disease (EPCOT)-A comparative analysis between suggested and free walking: Protocol study

BACKGROUND

Individuals with chronic obstructive pulmonary disease (COPD) exhibit reduced levels of physical activity, which are associated with poorer outcomes. The number of clinical trials aiming to promote behavioral changes to increase physical activity in this population has grown; therefore, these trials have yet to produce satisfactory results. An ecological model encompassing individual, social, environmental, and political factors represent a potentially more effective approach to promoting physical activity. While favorable urban environments can positively impact physical activity, specifically tailored environmental interventions for individuals with COPD could enhance their engagement in physical activity. Therefore, the aim of this randomized controlled trial (RCT) study was to analyze the effects of walking in a suggested environment and free walking on physical activity levels in individuals with COPD.

METHODS

The environment on physical activity for chronic obstructive disease (EPCOT) is a randomized controlled clinical trial protocol approved by our institution's Ethics Committee and registered with The Brazilian Registry of Clinical Trials (ReBEC) (https://ensaiosclinicos.gov.br, number RBR-4tfwdhp). This protocol will involve 38 volunteers diagnosed with COPD recruited from the pulmonary physiotherapy and rehabilitation service. The volunteers were randomly divided into two walking groups: an experimental group (ERG) with guidance for walking in a suggested environment and an active control group (ACG) instructed to choose their own routes. The intervention consisted of eight consecutive weeks, with progressive walks carried out 3 to 5 times weekly. The primary outcome will be assessing participants' physical activity levels. Secondary outcomes will include exercise capacity, quality of life, dyspnea levels, motivation, anxiety, depression, and perceptions of the environment. All assessments will occur before and after the intervention period, aiming to fill a literature gap by investigating the impact of urban environments on COPD-related physical activity. The results may shed light on the importance of environmental factors in promoting physical activity among individuals with COPD, helping to develop more effective interventions.

Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study

BACKGROUND

Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time.

OBJECTIVE

The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures.

METHODS

We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes.

RESULTS

Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness.

CONCLUSIONS

Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study's application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change.

FirstStep2Health: A cluster randomised trial to promote healthy behaviours and prevent obesity amongst low-income preschoolers

OBJECTIVE

To evaluate the preliminary effects of a theory-based, multi-component intervention on improving healthy lifestyle behaviours and preventing obesity amongst low-income preschoolers.

METHODS

A cluster randomised controlled trial was conducted at 10 daycare centres. The 16-week FirstStep2Health intervention, grounded in the Actor-Partner Interdependence Model and the Social Cognitive Theory, included five components: a Facebook-based parent programme, three virtual parent meetings, three weekly motivational text messages, parent-child learning via weekly child letters and daycare centre-based child programme.

RESULTS

A total of 95 preschoolers (53 intervention and 42 control) participated. Preschoolers' mean age was 49.27 months, with 57.9% being female, 12.6% being Hispanic and 40% being African American. The intervention significantly decreased intervention preschoolers' fat intake (B = -33.76, p = 0.047) and % body fat (B = -1.18, p = 0.036) compared to the control. During year 2, there were significant intervention effects on increasing skin carotenoids (B = 87.06, p = 0.035). Although not statistically significant, the intervention showed positive effects on increasing preschoolers' fruit/vegetable intake; and decreasing screen time, body mass index z-score and proportion of overweight/obesity.

CONCLUSIONS

Even with some potential limitations (small sample size, measurement concerns and confounding with Coronavirus Disease 2019 pandemic), the study's results support the preliminary efficacy of the FirstStep2Health intervention in preventing obesity amongst low-income racially diverse preschoolers.

Results from the ENJOY MAP for HEALTH: a quasi experiment evaluating the impact of age-friendly outdoor exercise equipment to increase older people's park visitations and physical activity

BACKGROUND

Recreational parks can play a significant role in older people's health, with emerging evidence suggesting that changes in the physical environment, such as refurbishments of local parks, can increase park visitations and physical activity engagement. The ENJOY MAP for HEALTH aimed to evaluate the impact of Seniors Exercise Park installations and associated capacity building activities on older people's park visitation, and park-based physical activity.

METHOD

The ENJOY MAP for HEALTH was a quasi-experiment study design that involved the installation of specialised Seniors Exercise Park equipment as part of park refurbishment, supported by promotion and community capacity building activities in six municipalities in Victoria, Australia. Direct observations of park users took place prior to park upgrades, one-month post upgrade and 12-months from baseline. The overall number and characteristics of park visitors, and the type and level of physical activity undertaken, were summarised descriptively. Generalised linear models were used to examine the impact of park refurbishment (equipment installation and site activation) on the total number of older people observed in the park, and their engagement in physical activity, accounting for site and seasonal effects.

RESULTS

Overall number of visits increased following park upgrades, with the largest number of visitors observed one-month post upgrade (n = 12,501). The proportion of older people observed at the parks remained relatively low prior to and one-month post upgrade compared to other age groups. However, after adjusting for site and seasonal effects, the number of older people observed in the parks increased significantly post upgrade and site activation compared to prior to the refurbishment (incidence rate ratios (IRR) 3.55; 95% CI 2.68, 4.70). The number of older people observed to be exercising at the Seniors Exercise Park also increased by 100% at 12-months post-installation relative to one-month post upgrade (IRR 2.00; 95% CI 1.26, 3.17).

CONCLUSION

Installation of the Seniors Exercise Parks and the supportive programs and activities following six park upgrades resulted in an increase in older people's park visitation and engagement in physical activity. Community engagement and training of volunteers with the support of local governments are likely to contribute to the increased park usage by older people.

TRIAL REGISTRATION

This trial was registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12621000965808. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380745&isReview=true .

Green space exposure and Chinese residents' physical activity participation: empirical evidence from a health geography perspective

Background

With continuous efforts made to promote the strategic goals of carbon neutrality and carbon peak, it is crucial to meet the growing and diversified needs of the public for fitness by practicing the concept of green development and promote the combination of national fitness and ecological civilization.

Methods

To achieve this purpose, an OLS regression model was applied to estimate the role of green space exposure in Chinese residents' participation in physical activity and its underlying mechanisms, using the microdata from the China General Social Survey (CGSS) data and the Provincial Vegetation Cover Index (NDVI) matched macrostatistical data.

Results

The empirical results show that green space exposure significantly increases the probability of residents' physical activity participation, and creating a green environment is conducive to creating a favorable physical activity environment for residents. Also, the core conclusions still hold after the year-by-year regression test is passed and the endogeneity problem is addressed. As revealed by mechanistic studies, green space exposure has indirect effects on the physical activity participation of residents through the independent mediating roles of reducing carbon emissions and promoting social interaction. According to heterogeneity results, males, those in marriage, and urban dweller groups are more inclined to perform physical activity in green spaces.

Conclusion

The results show that the exposure of green space can help increase the probability of residents' participation in physical exercise, and can that it achieved through two channels: reducing carbon emissions and enhancing social interaction. It is necessary to further strengthen the protection of the ecological lifestyle, give full play to the advantages of greenness and low-carbon, and create favorable conditions for the green development of a new model of national fitness.

The use of Virtual Reality (VR) to assess the impact of geographical environments on walking and cycling: a systematic literature review

BACKGROUND

Geographical environments influence people's active mobility behaviors, contributing to their physical and mental health. The use of Virtual Reality (VR) in experimental research can unveil new insights into the relationship between exposure to geographic environments and active mobility behaviors. This systematic review aims to (1) identify environmental attributes investigated in relation with walking and cycling, using VR, (2) assess their impacts on active mobility behaviors and attitudes, and (3) identify research gaps, strengths and limitations in VR-based experimental research.

METHODS

Articles published between January 2010 and February 2022 within five databases (PubMed, Scopus, EBSCO, IEEE Xplore, and Cochrane Library) were explored using three keywords and their synonyms: Virtual Reality, Active mobility behavior, and Geographical environments. Studies focusing on indoor environments, driving simulation, disease-specific groups, non-relevant disciplines (e.g. military, emergency evacuation), VR methodology/software optimization, and those with static participants' involvement were excluded. The full protocol is available from PROSPERO (ID = CRD42022308366).

RESULTS

Out of 3255 articles, 18 peer-reviewed papers met the selection criteria, mostly focusing on walking (83%). Most studies used head-mounted displays (94%) and relied on convenience sampling (72% below 100 participants). Both static (33%) and dynamic (45%) environmental attributes have been investigated, with only 22% of them simultaneously in the same virtual environment. Greenness and crowd density were the most frequent attributes, rather consistently associated with emotional states and movement behaviors. Few studies have taken into account participant's previous VR experience (33%) and cybersickness (39%) while both are likely to affect an individual's perception and behavior.

CONCLUSIONS

Future research should explore a broader range of environmental attributes, including static and dynamic ones, as well as a more complex integration of these attributes within a single experiment to mimic the effect of realistic environments on people's active mobility behaviors and attitudes. Larger and more diverse population samples are deemed required to improve result generalizability. Despite methodological challenges, VR emerges as a promising tool to disentangle the effect of complex environments on active mobility behaviors.

The greener the living environment, the better the health? Examining the effects of multiple green exposure metrics on physical activity and health among young students

The sedentary and less active lifestyle of modern college students has a significant impact on the physical and mental well-being of the college community. Campus Green Spaces (GSs) are crucial in promoting physical activity and improving students' health. However, previous research has focused on evaluating campuses as a whole, without considering the diverse spatial scenarios within the campus environment. Accordingly, this study focused on the young people's residential scenario in university and constructed a framework including a comprehensive set of objective and subjective GSs exposure metrics. A systematic, objective exposure assessment framework ranging from 2D (GSs areas), and 2.5D (GSs visibility) to 3D (GSs volume) was innovatively developed using spatial analysis, deep learning technology, and unmanned aerial vehicle (UAV) measurement technology. Subjective exposure metrics incorporated GSs visiting frequency, GSs visiting duration, and GSs perceived quality. Our cross-sectional study was based on 820 university students in Nanjing, China. Subjective measures of GSs exposure, physical activity, and health status were obtained through self-reported questionnaires. The Generalized Linear Model (GLM) was used to evaluate the associations between GSs exposure, physical activity, and perceived health. Physical activity and social cohesion were considered as mediators, and path analysis based on Structural Equation Modeling (SEM) was used to disentangle the mechanisms linking GSs exposure to the health status of college students. We found that (1) 2D indicator suggested significant associations with health in the 100m buffer, and the potential underlying mechanisms were: GSs area → Physical activity → Social cohesion → Physical health → Mental health; GSs area → Physical activity → Social cohesion → Mental health. (2) Subjective GSs exposure indicators were more relevant in illustrating exposure-response relationships than objective ones. This study can clarify the complex nexus and mechanisms between campus GSs, physical activity, and health, and provide a practical reference for health-oriented campus GSs planning.

Supporting health and wellbeing in health care employees: a documentary review of organizational policies, strategies and frameworks

Background

Health care workers are crucial for a productive and thriving health care system, yet the health and lifestyle behaviour of key groups within this workforce (for example nurses and healthcare assistants/support workers) is typically poor. The extent of health and wellbeing documents that guide action towards improving their health and wellbeing is unknown. Using one health care system, NHS Scotland, as an example, the aim of this study was to assess the number of NHS health boards with workplace documents focused on health and wellbeing of employees, the quality of these documents and the extent to which they reference lifestyle behaviours, namely physical activity.

Methods

Documentary analysis was undertaken on employee health and wellbeing policies (and wider documents). These were sourced through online searches on Google search engine and Freedom of Information Requests sent to all 14 Scottish NHS Health Boards. Titles and content were assessed for relevance to employee health and wellbeing. Content analysis was used to analyse the included documents against eight predefined codes.

Results

Thirteen documents were retrieved with 11 of the 14 Health Boards having at least one relevant document. The content varied greatly between documents with regards to how many reported the eight codes and the quality of content within these. Nine documents mentioned physical activity but mainly in relation to current activities rather than in the context of a future healthy workforce.

Conclusions

Despite the importance of a healthy, health care workforce, more work is needed to ensure high level documents are able to support these efforts, especially with reference to lifestyle behaviours.

A systematic review on the associations between the built environment and adult's physical activity in global tropical and subtropical climate regions

BACKGROUND

Physical inactivity is a major public health concern, exacerbated in countries with a (sub)tropical climate. The built environment can facilitate physical activity; however, current evidence is mainly from North American and European countries with activity-friendly climate conditions. This study explored associations between built environment features and physical activity in global tropical or subtropical dry or desert climate regions.

METHODS

A systematic review of four major databases (Web of Science, Scopus, PubMed, and SportDISCUS) was performed. To be included, studies had to investigate associations between perceived or objective built environment characteristics and adult's physical activity and had to be conducted in a location with (sub)tropical climate. Each investigated association was reported as one case and results were synthesized based upon perceived and objectively assessed environment characteristics as well as Western and non-Western countries. Study quality was evaluated using a tool designed for assessing studies on built environment and physical activity.

RESULTS

Eighty-four articles from 50 studies in 13 countries with a total of 2546 built environment-physical activity associations were included. Design (connectivity, walking/cycling infrastructure), desirability (aesthetics, safety), and destination accessibility were the built environment characteristics most frequently associated with physical activity across the domains active transport, recreational physical activity, total walking and cycling, and moderate-to-vigorous physical activity, particularly if multiple attributes were present at the same time. Very few studies assessed built environment attributes specifically relevant to physical activity in (sub)tropical climates. Most studies were conducted in Western countries, with results being largely comparable with non-Western countries. Findings were largely generalizable across gender and age groups. Results from natural experiments indicated that relocating to an activity-friendly neighborhood impacted sub-groups differently.

CONCLUSIONS

Built environment attributes, including destination accessibility, connectivity, walking and cycling infrastructure, safety, and aesthetics, are positively associated with physical activity in locations with (sub)tropical climate. However, few studies focus on built environment attributes specifically relevant in a hot climate, such as shade or indoor recreation options. Further, there is limited evidence from non-Western countries, where most of the urban population lives in (sub)tropical climates. Policy makers should focus on implementing activity-friendly environment attributes to create sustainable and climate-resilient cities.