New walking and cycling routes and increased physical activity: one- and 2-year findings from the UK iConnect Study

Longitudinal effects of the built environment on transportation and recreational walking and differences by age and sex: A systematic review

Non-communicable diseases (NCDs) and physical inactivity, a well-established risk factor, are prevalent in high-income countries. Walking is an effective means of improving population physical activity levels. Previous, mostly cross-sectional research finds that the built environment encourages or discourages walking for transport and recreation, with this association varying for different age groups and sexes. The objective of this systematic review is to synthesise longitudinal evidence to better understand the built environment in determining transport and recreational walking for men, women, working aged adults, and older adults in high-income countries. A systematic literature search for peer-reviewed journal articles in English was carried out using seven electronic databases. To be included, studies had to be conducted in a high-income country, employed a longitudinal design, used objectively measured neighbourhood attributes, and quantitatively assessed how the built environment impacts transport and recreational walking for adults. The methodological quality of the studies was evaluated using an established instrument. In total, 23 longitudinal studies published between 2012 and 2022 were identified. Notably, the evidence was inconclusive for age- and sex-specific population sub-groups due to the limited number of studies. However, in the general population, we found prospective evidence more consistently supporting the idea that increasing street connectivity, destination accessibility, and access to transit contribute to higher levels of transport walking. Furthermore, we found mixed evidence for the associations of road attributes and residential density with transport walking, as well as for street connectivity and destination accessibility with recreational walking. The findings of the review emphasize the importance of designing neighbourhoods supportive of transport and recreational walking to increase physical activity and, therefore, mitigate NCDs in high-income countries. Further longitudinal studies are needed to investigate how changes in built environment attributes influence transport and recreational walking differently among males, females, working aged adults, and older adults.

Assessing type-2 diabetes risk based on the Indian diabetes risk score among adults aged 45 and above in India

Millions of Indian adults are pre-diabetic with a greater risk of developing type-2 diabetes mellitus (T2DM). We conducted this study to assess the prevalence of type-2 diabetes risk among non-diabetic adults aged 45 years and above and identify the correlates for diabetes risk. We conducted a secondary analysis of Longitudinal Ageing Study in India (LASI) wave 1 data. A sample of 51,315 non-diabetic adults was extracted from LASI data and analysed. Type-2 diabetes risk was assessed based on the Indian Diabetes Risk Score (IDRS) by using four risk factor variables [i.e., (1) age of the respondent, (2) waist circumference, (3) family history of diabetes, and (4) physical activity]. A diabetes risk score of ≥ 60 was considered a high risk for diabetes. Descriptive statistics and multivariate analysis were conducted to assess the prevalence and correlates of diabetes risk respectively. About 41.2% had a high risk of diabetes. Among major Indian states, Kerala leads with 64.4% of its adults 45 years and above at high risk of diabetes. Obese level BMI (AOR  4.17; 95% CI 3.59-4.84), High cholesterol (AOR  1.51; 95% CI 1.22-1.87), History of heart disease and stroke (AOR  1.85; 95% CI 1.60-2.13), and males (AOR 1.25; 95% CI 1.16-1.34) had positive odds for high risk of diabetes. Individuals from scheduled tribes (AOR  0.85; 95% CI 0.76-0.96) had lower odds of diabetes risk. Obese individuals with a history of heart disease/stroke had a significantly higher (AOR  5.30; 95% CI 4.39-6.41) risk for diabetes. The findings suggest that it is essential to establish population-level interventions to tackle the modifiable risk factors for diabetes. Educational programs on diet and physical activity, creation of public spaces conducive to physical activity, promotion of fruit and vegetable intake, and discouragement of processed and ultra-processed diets can directly address inadequate physical activity and obesity, the two primary modifiable risk factors for type-2 diabetes. Additionally, strengthening health systems for early screening and management of diabetes and pre-diabetes is needed to prevent the diabetes epidemic.

Transforming Health Psychology and Behavioral Medicine to Address the Climate Crisis: A Call for Strategic Research and Advocacy

OBJECTIVE

The climate crisis poses the largest threat to human health and survival and has been a public health emergency for many years. It is causing harmful consequences for physical and mental health and is amplifying existing health inequities. In this call to action, we highlight the relevance of the health psychology and behavioral medicine communities in addressing the health impacts of climate change.

METHOD

We identify mitigation and adaptation climate health behaviors and social changes needed that underlie the three essential objectives to address climate change and its associated health consequences: (a) rapid decarbonization, (b) drawdown of atmospheric heat-trapping gases (sequestration), and (c) adap- tation.

RESULTS

To advance the behavioral and systemic changes necessary to protect health, we propose a 1-2-3 Transformational Model in which the larger field of health psychology and behavioral medicine promotes (1) One Health, human and planetary health by (2) targeting climate health behaviors, and (3) social change across major professional areas, including research, interventions, and education/advo- cacy. We urge the adoption of the social quantum change paradigm, a systems approach to understanding the process of social change, where systemic change is viewed as local to global, and the individual has an influential role.

DISCUSSION

These shifts in views, priorities, and methods will bolster hope, collective efficacy, and action to support the next generation of health psychology and behavioral medicine profession- als. With these changes, the health psychology and behavioral medicine communities can have a more immediate and meaningful impact on the climate crisis and its associated health consequences.

The co-benefits of active travel interventions beyond physical activity: a systematic review

Active travel is a widely recognised strategy for promoting active living but its co-benefits beyond increasing physical activity, such as broader health, environmental, and social benefits, have rarely been synthesised. We conducted a systematic review to examine the co-benefits of active travel interventions. Following a preregistered protocol (PROSPERO CRD42022359059), we identified 80 studies for the search period from Jan 1, 2000, to Sept 13, 2022. Across studies, there was consistent evidence that active travel interventions offered co-benefits beyond physical activity. Particularly, 25 (71%) of 35 studies favoured improved safety outcomes, 20 (67%) of 30 showed improved health, 17 (85%) of 20 supported economic benefits, 16 (84%) of 19 highlighted improved transport quality, 12 (92%) of 13 showed environmental benefits, and four (80%) of five documented social benefits. Despite the overall low-certainty evidence, mostly limited by the quasi-experimental design and natural-experimental design of many of the studies, active travel interventions offer unique opportunities to engage stakeholders across sectors to jointly address major societal issues, such as physical inactivity, traffic safety, and carbon emissions. This evidence can inform the design, implementation, and evaluation of active travel interventions.

Cardiovascular response to brisk walking on different surfaces in an innovative senior playground: a randomized trial in older adults

Brisk walking is a simple exercise for older adults. We aimed to assess the cardiovascular response to a short bout of brisk walking on walking loops in an innovative senior playground in Thailand. Twenty older adults were randomly assigned to brisk walking on artificial turf (AT group, n = 10) or an uneven surface (US group, n = 10). We assessed cardiovascular parameters, average walking speed, and rate of perceived exertion. Blood pressure, heart rate, rate-pressure product, and rate perceived exertion were significantly increased, while the mean RR interval of heart rate variability was significantly decreased in both AT and US groups after exercise compared with pre-exercise (p < 0.05). A greater change in systolic blood pressure was observed in the US group than in the AT group (p < 0.05). These data indicated that brisk walking on AT and US increases cardiovascular response. Our findings provide information on planning exercise programs for older adults.

More People, More Active, More Often for Heart Health - Taking Action on Physical Activity

Physical inactivity is a leading contributor to increased cardiovascular morbidity and mortality. Almost 500 million new cases of preventable noncommunicable diseases (NCDs) will occur globally between 2020 and 2030 due to physical inactivity, costing just over US$300 billion, or around US$ 27 billion annually (WHO 2022). Active adults can achieve a reduction of up to 35% in risk of death from cardiovascular disease. Physical activity also helps in moderating cardiovascular disease risk factors such as high blood pressure, unhealthy weight and type 2 diabetes. For people with cardiovascular disease, hypertension, type 2 diabetes and many cancers, physical activity is an established and evidence-based part of treatment and management. For children and young people, physical activity affords important health benefits. Physical activity can also achieve important cross-sector goals. Increased walking and cycling can reduce journeys by vehicles, air pollution, and traffic congestion and contribute to increased safety and liveability in cities.

Impacts of active mobility on individual health mediated by physical activities

Active mobility, encompassing walking and cycling for transportation, is a potential solution to health issues arising from inadequate physical activity in modern society. However, the extent of active mobility's impact on individual physical activity levels, and its association with health as mediated by physical activities, is not fully quantified. This study aims to clarify the direct relationship between active mobility usage and individual health, as well as the indirect relationship mediated by physical activity, with a focus on varying levels of physical activity intensity. Utilizing data from the 2017 U.S. National Household Travel Survey (NHTS), we employed Poisson regression to predict active mobility usage based on socio-demographic and household socio-economic characteristics. A Structural Equation Model (SEM) was then used to investigate the direct and indirect effects of active mobility on individual health, mediated by physical activity. We further segmented individuals according to their intensity of physical activity to examine how such effect differs between different levels of physical activity. The study demonstrates that active mobility usage positively correlates with both the amount and intensity of physical activity. The effect of active mobility on individual health includes a direct positive effect (29% for intensity, 67.7% for amount) and an indirect effect mediated by physical activity (71% for intensity, 32.3% for amount). Notably, the mediation effect of active mobility on health is more substantial in the context of vigorous physical activities compared to light or moderate activities. Our findings reveal a significant positive influence of active mobility on individual health, encompassing both direct and indirect effects mediated by physical activities. These results quantitatively underscore the health benefits of active mobility and suggest the importance of promoting active mobility as a strategy to improve public health.

Generation Pep - study protocol for an intersectoral community-wide physical activity and healthy eating habits initiative for children and young people in Sweden

Background

There is overwhelming evidence for the preventive effects of regular physical activity and healthy eating habits on the risk for developing a non-communicable disease (NCD). Increasing attention has been paid to community-wide approaches in the battle against NCDs. Communities can create supportive policies, modify physical environments, and foster local stakeholder engagement through intersectoral collaboration to encourage communities to support healthy lifestyles. The Pep initiative is based on intersectoral community-wide collaboration among Sweden's municipalities. Primary targets are municipality professionals who work with children and young people as well as parents of children <18 years. The goal is to spread knowledge and create commitment to children's and young people's health with a special focus on physical activity and healthy eating habits to facilitate and support a healthy lifestyle. The overarching aim of the research project described in this study protocol is to investigate factors that influence the implementation of the Pep initiative in Sweden, to inform tailored implementation strategies addressing the needs and local prerequisites of the different municipalities.

Methods

The project includes a qualitative and a quantitative study and is framed by a theoretical model involving four complementary forms of knowledge, explicitly recognized in the Pep initiative: knowledge about the issue; knowledge about interventions; knowledge about the context; and knowledge about implementation. Study 1 is a focus group study exploring barriers and facilitators for implementing the Pep initiative. The study will be carried out in six municipalities, selected purposively to provide wide variation in municipality characteristics, including population size and geographical location. Data will be analyzed using thematic analysis. Study 2 is a cross-sectional web-based survey investigating the implementability of the Pep initiative in Sweden's 290 municipalities. Conditions for implementing different areas of the Pep initiative will be examined in terms of the acceptability, appropriateness, and feasibility, three predictors of implementation success. Data will be analyzed using non-parametric statistics.

Discussion

The findings of the two studies will increase understanding of the prerequisites for implementing the Pep initiative in Swedish municipalities, which will provide valuable input into how implementation of the Pep initiative can best be facilitated in the different municipality settings.

Greenway interventions effectively enhance physical activity levels-A systematic review with meta-analysis

Background

Previous studies have examined the impact of greenway interventions on physical activity (PA); however, the results have been inconclusive. In order to address this issue, our study conducted a systematic review with meta-analysis to thoroughly evaluate the evidence and determine the effectiveness of greenway interventions in promoting PA.

Methods

We conducted a comprehensive search of literature databases, such as Web of Science, EMBASE, PubMed (via Medline), Cochrane Library, and Scopus, up to June 15, 2023. To synthesize the available evidence, we performed a meta-analysis using a random effects model. The quality of the included studies was assessed using the criteria developed by the Agency for Healthcare Research and Quality and the Newcastle-Ottawa Scale.

Results

A total of 9 publications were identified, involving 6, 589 individuals. The overall quality of most included studies was rated as moderate to high. Our study found that the greenway was effective in promoting PA among participants. Specifically, active travel (AT) showed a standard mean difference (SMD) of 0.10 [95% confidence interval (CI): 0.04 to 0.17], moderate-to-vigorous PA had an SMD of 0.11 (95% CI: 0.02 to 0.20), and total PA had an SMD of 0.14 (95% CI: 0.06 to 0.21). We also observed significant differences in AT levels among participants based on greenway characteristics, exposure distance, exposure duration, and male-to-female ratio.

Discussion

Newly developed or upgraded greenways have been shown to effectively promote PA. Additionally, research suggests that the longer a greenway has been in existence, the greater the benefits it provides for PA. As a result, the construction of greenways should be recognized as an effective public health intervention.

Walkability and urban built environments-a systematic review of health impact assessments (HIA)

BACKGROUND

Urban environments are important determinants of human health. The term walkability summarizes features of the urban built environment that promote walking and other types of physical activity. While the beneficial effects of active and public transport have been well established, the health impact of other features of walkability are less well documented.

METHODS

We conducted a systematic review of health impact assessments (HIAs) of walkability. Studies were identified through PUBMED and Science Direct, from two German websites related to urban health and reference tracking. Finally, 40 studies were included in the present review. We applied qualitative thematic analysis to summarize the major results from these studies.

RESULTS

Most of the HIAs (n = 31) reported the improvement of health or health behaviour resulting from an investigated project or policy. However, three HIAs reported a lack of improvement or even a decrease of health status. In parallel, 13 HIAs reported a gain in economic value, whereas one reported a lack or loss of economic effects. Moreover, three HIAs reported on social effects and six HIAs gave additional recommendations for policies or the implementation of projects or HIAs.

CONCLUSIONS

Most HIAs investigate the impact of increasing active or public transport. Other features of walkability are less well studied. With few exceptions, HIAs document beneficial impacts of improving walkability on a variety of health outcomes, including reductions of mortality and non-communicable diseases.

COVID-19 Spotlights Connections between Disease and Multiple Lifestyle Factors

The SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2), and the disease it causes (COVID-19), have had a profound impact on global human society and threaten to continue to have such an impact with newly emerging variants. Because of the widespread effects of SARS-CoV-2, understanding how lifestyle choices impact the severity of disease is imperative. This review summarizes evidence for an involvement of chronic, non-resolving inflammation, gut microbiome disruption (dysbiosis with loss of beneficial microorganisms), and impaired viral defenses, all of which are associated with an imbalanced lifestyle, in severe disease manifestations and post-acute sequelae of SARS-CoV-2 (PASC). Humans' physiological propensity for uncontrolled inflammation and severe COVID-19 are briefly contrasted with bats' low propensity for inflammation and their resistance to viral disease. This insight is used to identify positive lifestyle factors with the potential to act in synergy for restoring balance to the immune response and gut microbiome, and thereby protect individuals against severe COVID-19 and PASC. It is proposed that clinicians should consider recommending lifestyle factors, such as stress management, balanced nutrition and physical activity, as preventative measures against severe viral disease and PASC.

Infrastructure, policy and regulatory interventions to increase physical activity to prevent cardiovascular diseases and diabetes: a systematic review

BACKGROUND

Noncommunicable diseases are major contributors to morbidity and mortality worldwide. Modifying the risk factors for these conditions, such as physical inactivity, is thus essential. Addressing the context or circumstances in which physical activity occurs may promote physical activity at a population level. We assessed the effects of infrastructure, policy or regulatory interventions for increasing physical activity.

METHODS

We searched PubMed, Embase and clinicaltrials.gov to identify randomised controlled trials (RCTs), controlled before-after (CBAs) studies, and interrupted time series (ITS) studies assessing population-level infrastructure or policy and regulatory interventions to increase physical activity. We were interested in the effects of these interventions on physical activity, body weight and related measures, blood pressure, and CVD and type 2 diabetes morbidity and mortality, and on other secondary outcomes. Screening and data extraction was done in duplicate, with risk of bias was using an adapted Cochrane risk of bias tool. Due to high levels of heterogeneity, we synthesised the evidence based on effect direction.

RESULTS

We included 33 studies, mostly conducted in high-income countries. Of these, 13 assessed infrastructure changes to green or other spaces to promote physical activity and 18 infrastructure changes to promote active transport. The effects of identified interventions on physical activity, body weight and blood pressure varied across studies (very low certainty evidence); thus, we remain very uncertain about the effects of these interventions. Two studies assessed the effects of policy and regulatory interventions; one provided free access to physical activity facilities and showed that it may have beneficial effects on physical activity (low certainty evidence). The other provided free bus travel for youth, with intervention effects varying across studies (very low certainty evidence).

CONCLUSIONS

Evidence from 33 studies assessing infrastructure, policy and regulatory interventions for increasing physical activity showed varying results. The certainty of the evidence was mostly very low, due to study designs included and inconsistent findings between studies. Despite this drawback, the evidence indicates that providing access to physical activity facilities may be beneficial; however this finding is based on only one study. Implementation of these interventions requires full consideration of contextual factors, especially in low resource settings.

TRIAL REGISTRATION

PROSPERO 2018 CRD42018093429.

Changes in physical activity after joining a bikeshare program: a cohort of new bikeshare users

Background

There are hundreds of bikeshare programs worldwide, yet few health-related evaluations have been conducted. We enrolled a cohort of new bikeshare members in Philadelphia (Pennsylvania, USA) to assess whether within-person moderate and vigorous physical activity (MVPA) increased with higher use of the program and whether effects differed for vulnerable sub-groups.

Methods

During 2015–2018, 1031 new members completed baseline and one-year follow-up online surveys regarding their personal characteristics and past 7-day MVPA minutes per week (minutes per week with- and without walking). Participants were linked to their bikeshare trips to objectively assess program use. Negative binomial (for continuous outcomes) and multinomial (for categorical outcomes) regression adjusted for person characteristics (socio-demographics, health), weather, biking-infrastructure, and baseline biking.

Results

Participant median age was 30, 25% were of Black or Latino race/ethnicity, and 30% were socioeconomically disadvantaged. By follow-up, personal bike ownership increased and 75% used bikeshare, although most used it infrequently. Per 10 day change in past year (PY) bikeshare use, non-walking MVPA min/wk increased 3% (roughly 6 min/wk, P < 0.014). More days of bikeshare was also associated with change from inactive to more active (odds ratio for ≥ 15 days in PY vs. no bikeshare use 1.80, CI 1.05–3.09, P < 0.03). Results were consistent across vulnerable sub-groups. In general, impacts on MVPA were similar when exposure was personal bike or bikeshare.

Conclusions

Bikeshare facilitated increases in cycling, slightly increased non-walking MVPA, and showed potential for activating inactive adults; however, for larger program impact, members will need to use it more frequently.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01353-6.

Impacts of new cycle infrastructure on cycling levels in two French cities: an interrupted time series analysis

BACKGROUND

Cities globally have started to make substantial investment in more sustainable forms of transportation. We aimed to evaluate whether the construction of new cycling infrastructure in Paris and Lyon, France, affected population cycling activity along new or improved routes.

METHODS

Routinely collected cycle count data from January 2014 to March 2020 were acquired for the cities of Paris and Lyon. Improvements were identified at 15 locations with 6 months of pre- and post-intervention data. Comparison streets were chosen within Paris or Lyon for which pre-intervention trends in cycling were similar to those at intervention sites. Controlled interrupted time series analyses and autocorrelation were performed adjusting for seasonality. Random-effects meta-analysis combined results across streets within each city and overall.

RESULTS

On average, cycling counts/day increased on both intervention and control streets in Paris and Lyon. In general, results of the ITS analysis indicated no significant change in the level or trend as a result of the improvements in either city. Meta-analysis suggested that intervention streets in Paris had a larger positive pooled effect size for level change (218 cycle counts, 95% CI -189, 626, I² = 0%) compared to Lyon (34, 95% CI -65, 133, I² = 14%); however, confidence intervals for both cities were wide and included no effect.

CONCLUSIONS

The findings suggest that improving or constructing new cycle lanes may be necessary but not sufficient to induce significant changes in cycling levels. There is a need to understand how context, intervention design and other complementary interventions can improve the effectiveness of new cycling infrastructure.

Healthy Behavior and Environmental Behavior Correlate with Bicycle Commuting

Previous studies have identified that environmental awareness correlates with the choice of bicycle travel. However, few studies have considered the relationships with different types of healthy behaviors and environmental behaviors. This study examined the relationships between several healthy and environmental behaviors and the choice of bicycle commute using survey data. A total of 803 residents participated in this questionnaire survey. Using factor analysis, we constructed latent factors of healthy behaviors and environmental behaviors. Using a binary logistic regression model, we examined the relationship between latent factors and cycling usage, controlling for demographic characteristics. Factor analysis revealed three latent factors of healthy behaviors: “healthy diet”, “avoiding tobacco or overdrinking”, and “physical activity”. The latent factors of environmental behaviors were as follows: “household behavior” and “purchasing behavior”. The results showed that “avoiding tobacco or overdrinking”, “physical activity” and “purchasing behavior” correlated positively with bicycle commuting. Differences were also observed in relation to demographic characteristics.

Physical Activity Participation in Rural Areas: A Case Study

Sport participation and physical activity promotion have been intensively studied, especially regarding large cities. However, in many cases, rural municipalities have comparatively reduced services, including health care, due to the low profitability that these have for companies and entities. In this sense, the purpose of this article was to describe a case study of the promotion of physical activity in rural areas based on the results of a European project. Carried out in a rural municipality of around 8500 inhabitants with a population density of less than 25 inhabitants/km², the project's purpose was the promotion of autonomous physical activity among its inhabitants. For this, a diagnostic analysis of the sports areas of the environment and a survey of physical activity habits among the population were carried out. A series of routes were designed, marked, and signposted, and canopies with explanatory posters about the possibilities of healthy physical activity and recommendations were added. Free-use facilities were installed, and opening events were carried out in such a way as to stimulate sports practice among the population. This article presents the results obtained from the analysis, as well as the possibilities of replication in other municipalities with similar needs.

Prescribing Smartphone Apps for Physical Activity Promotion in Primary Care: Modeling Study of Health Gain and Cost Savings

Background

Inadequate physical activity is a substantial cause of health loss worldwide, and this loss is attributable to diseases such as coronary heart disease, diabetes, stroke, and certain forms of cancer.

Objective

This study aims to assess the potential impact of the prescription of smartphone apps in primary care settings on physical activity levels, health gains (in quality-adjusted life years [QALYs]), and health system costs in New Zealand (NZ).

Methods

A proportional multistate lifetable model was used to estimate the change in physical activity levels and predict the resultant health gains in QALYs and health system costs over the remaining life span of the NZ population alive in 2011 at a 3% discount rate.

Results

The modeled intervention resulted in an estimated 430 QALYs gained (95% uncertainty interval 320-550), with net cost savings of 2011 NZ $2.2 million (2011 US $1.5 million) over the remaining life span of the 2011 NZ population. On a per capita basis, QALY gains were generally larger in women than in men and larger in Māori than in non-Māori. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions on intervention uptake and decay. For example, the scenario analysis with the largest benefits, which assumed a 5-year maintenance of additional physical activity levels, delivered 1750 QALYs and 2011 NZ $22.5 million (2011 US $15.1 million) in cost savings.

Conclusions

The prescription of smartphone apps for promoting physical activity in primary care settings is likely to generate modest health gains and cost savings at the population level in this high-income country. Such gains may increase with ongoing improvements in app design and increased health worker promotion of the apps to patients.

The Relationship between Urban Population Density Distribution and Land Use in Guangzhou, China: A Spatial Spillover Perspective

Urban population density distribution contributes towards a deeper understanding of peoples’ activities patterns and urban vibrancy. The associations between the distribution of urban population density and land use are crucial to improve urban spatial structure. Despite numerous studies on population density distribution and land use, the significance of spatial dependence has attained less attention. Based on the Baidu heat map data and points of interests data in the main urban zone of Guangzhou, China, the current paper first investigated the spatial evolution and temporal distribution characteristics of urban population density and examined the spatial spillover influence of land use on it through spatial correlation analysis methods and the spatial Durbin model. The results show that the urban population density distribution is characterized by aggregation in general and varies on weekends and weekdays. The changes in population density within a day present a trend of “rapid growth-gentle decline-rapid growth-rapid decline”. Furthermore, the spatial spillover effects of land use exist and play the same important roles in population density distribution as the direct effects. Additionally, different types of land use show diverse direct effects and spatial spillover effects at various times. These findings suggest that balancing the population density distribution should consider the indirect effect from neighboring areas, which hopefully provide implications for urban planners and policy makers in utilizing the rational allocation of public resources and regarding optimization of urban spatial structure.

Investigating the physical activity, health, wellbeing, social and environmental effects of a new urban greenway: a natural experiment (the PARC study)

BACKGROUND

Evidence for the health benefits of urban green space tends to stem from small, short-term quasi-experimental or cross-sectional observational research, whilst evidence from intervention studies is sparse. The development of an urban greenway (9 km running along 3 rivers) in Northern Ireland provided the opportunity to conduct a natural experiment. This study investigated the public health impact of the urban greenway on a range of physical activity, health, wellbeing, social, and perceptions of the environment outcomes.

METHODS

A repeated cross-sectional household survey of adult residents (aged ≥16 years) who lived ≤1-mile radius of the greenway (intervention sample) and > 1-mile radius of the greenway (control sample) was conducted pre (2010/2011) and 6-months post implementation (2016/2017). We assessed changes in outcomes pre- and post-intervention follow-up including physical activity behaviour (primary outcome measure: Global Physical Activity Questionnaire), quality of life, mental wellbeing, social capital and perceptions of the built environment. Linear regression was used to calculate the mean difference between post-intervention and baseline measures adjusting for age, season, education, car ownership and deprivation. Multi-level models were fitted using a random intercept at the super output area (smallest geographical unit) to account for clustering within areas. The analyses were stratified by distance from the greenway and deprivation. We assessed change in the social patterning of outcomes over time using an ordered logit to make model-based outcome predictions across strata.

RESULTS

The mean ages of intervention samples were 50.3 (SD 18.9) years at baseline (n = 1037) and 51.7 (SD 19.1) years at follow-up (n = 968). Post-intervention, 65% (adjusted OR 0.60, 95% CI 0.35 to 1.00) of residents who lived closest to the greenway (i.e., ≤400 m) and 60% (adjusted OR, 0.64 95% CI 0.41 to 0.99) who lived furthest from the greenway (i.e.,≥1200 m) met the physical activity guidelines - 68% of the intervention sample met the physical activity guidelines before the intervention. Residents in the most deprived quintiles had a similar reduction in physical activity behaviour as residents in less deprived quintiles. Quality of life at follow-up compared to baseline declined and this decline was significantly less than in the control area (adjusted differences in mean EQ5D: -11.0 (95% CI - 14.5 to - 7.4); - 30.5 (95% CI - 37.9 to - 23.2). Significant change in mental wellbeing was not observed despite improvements in some indicators of social capital. Positive perceptions of the local environment in relation to its attractiveness, traffic and safety increased.

CONCLUSIONS

Our findings illustrate the major challenge of evaluating complex urban interventions and the difficulty of capturing and measuring the network of potential variables that influence or hinder meaningful outcomes. The results indicate at this stage no intervention effect for improvements in population-level physical activity behaviour or mental wellbeing. However, they show some modest improvements for secondary outcomes including positive perceptions of the environment and social capital constructs. The public health impact of urban greenways may take a longer period of time to be realised and there is a need to improve evaluation methodology that captures the complex systems nature of urban regeneration.

Tunneling a crosstown highway: a natural experiment testing the longitudinal effect on physical activity and active transport

Background

In the city of Maastricht in the Netherlands, a highway crossing several deprived neighborhoods was tunneled in 2016. The vacant space on top of this tunnel was redesigned and prioritized for pedestrians and cyclists. The aim of this study was to evaluate the effect of this major infrastructural change, named the Green Carpet, on total and transport-based physical activity (PA) levels.

Methods

Participants (≥18 years) were part of one of three area-based exposure groups. The maximal exposure group lived in neighborhoods directly bordering the Green Carpet. The minimal exposure group consisted of individuals living at the other side of the city, and the no exposure group consisted of individuals living in a nearby city. Actual use of the new infrastructure was incorporated as a second measure of exposure. Data were collected before and 3-15 months after the opening of the Green Carpet. Device-based measurements were conducted to obtain PA levels and collect location data. Changes in PA over time and intervention effects were determined using linear mixed models.

Results

PA levels in the Green Carpet area increased for the maximal and minimal exposure groups, but did not lead to an increase in total or transport-based PA. For the no exposure group, transport-based MVPA decreased and transport-based SB increased. The significant interaction (time x exposure) for transport-based SB, indicated differences in trends between the no exposure and maximal exposure group (B=-3.59, 95% CI - 7.15; -0.02) and minimal exposure group (B= -4.02, 95% CI -7.85, -0.19). Trends in the results based on analyses focusing on actual use and non-use of the new infrastructure were similar to those of the area-based analyses.

Conclusions

Results suggest that the Green Carpet led to more PA in this specific area, but did not increase the total volume of PA. The area-based differences might reflect the differences between users and non-users, but we should be careful when interpreting these results, due to possible interference of selective mobility bias. This paper reflects that the relationship between infrastructure and PA is not unambiguous.

Trial registration

This research was retrospectively registered at the Netherlands Trial Register (NL8108).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01180-1.

Safety perceptions of older adults on an urban greenway: Interplay of the social and built environment

BACKGROUND

Creating neighbourhood places for older adults to be socially and physically active is a global health priority. Safety is integral to older adult mobility. In greenway research, perceived safety is often only partially or superficially explored. Our study comprehensively examines older adults' experiences and perceived safety for walking on a new urban greenway in Vancouver, Canada-the Arbutus Greenway.

METHODS

We integrated mixed methods: i) observational count data to describe the use and context of the greenway over 3 years (2017; 2018; 2019), and; ii) semi-structured interviews with older adults at two time points (2017, n = 27; 2019, n = 16).

RESULTS

and discussion: We conducted thematic analysis to illuminate older adults' experiences across three safety domains: personal safety, traffic safety, and security. Built environment features such as benches, paving, road markings, and natural foliage buffers intersected with elements of the social environment to influence older adults' perceived safety. While the greenway supported active transportation, leisure, and social engagement for many older adults, certain factors also provoked fears, especially for older adults with mobility limitations. We advocate for a multidimensional lens to better understand how urban interventions influence perceived safety, and identify practical solutions to encourage mobility for all ages and abilities.

Determinants of bicycle commuting and the effect of bicycle infrastructure investment in London: Evidence from UK census microdata

Worldwide, concern about physical inactivity and excessive car dependence has encouraged ambitious targets and policies to promote cycling. But policy making is hindered by limited knowledge about why cycling prevalence and trends vary greatly between different geographic areas (e.g. in London (UK) <1% cycle to work in Harrow compared to>15 % in Hackney) and individuals (e.g. by age or gender). The role of cycle infrastructure investment in explaining part of these patterns and trends is also unknown. We linked individual-level data on 317,117 London commuters (including 11,199 cyclists) in the 2001 and 2011 UK census to relevant geographic data, including on area-level cycling infrastructure investment during the period. Whilst cycle commuting increased over time on average, concentration curves and indices demonstrated that in contrast with England as a whole, cycling in London shifted from being dominated by commuters with lower socioeconomic status to commuters with higher socioeconomic status. In our first set of regression analyses, we showed that observed differences and time trends in cycling prevalence were partially explained by area-level differences in topography, greenspace, footpaths and crime levels and by differences and changes in population structures. In the second, we conducted a cost-effectiveness analysis which showed that expenditure on cycling infrastructure was associated with increased cycling at a marginal rate of £4915 per additional commuter cyclist, with some variation between groups: ethnic minorities were more responsive, and females, older people and those with lower socioeconomic status appeared less responsive. If planned increases in expenditure in England for the period 2020-25 were as cost-effective, and were sustained for the whole decade, our study suggests that commuter cycling prevalence could increase in England by 0.5 to 1.1 percentage points (this equates to a 16% to 34% increase in commuter cycling prevalence if compared to 2011 levels). More research is necessary to assess the impact on broader measures of cycling, active travel and overall physical activity, and to determine whether such expenditure constitutes good or equitable value for money.

Public Roads as Places of Interspecies Conflict: A Study of Horse-Human Interactions on UK Roads and Impacts on Equine Exercise

Real or perceived traffic risk is a significant barrier to walking and cycling. To understand whether similar barriers influence equestrians, this study obtained exercise behaviours, road use and experiences of road-related incidents from UK equestrians (n = 6390) via an online questionnaire. Multivariable logistic regression models were used to identify factors associated with road use and experiencing a near-miss or injury-causing incident in the previous year. Content analysis identified themes around equestrians' decisions not to use roads. Our results show that most equestrians (84%) use roads at least once weekly, and in the previous year, 67.7% had a near-miss and 6.1% an injury-causing incident. Road use differs regionally, with exercise type and off-road route availability. Road-using equestrians covered greater daily distances and were younger. However, younger equestrians were at higher risk of near-misses. Respondents' decisions not to use roads were based on individualised risk assessments arising from: the road itself, perceptions of other road users, the individual horse and the handler's own emotional management. Roads were perceived as extremely dangerous places with potentially high conflict risk. Injury-causing incidents were associated with increasing road-use anxiety or ceasing to use roads, the proximity of off-road routes, having a near-miss and type of road use. Targeted road-safety campaigns and improved off-road access would create safer equestrian spaces.

Field Test of a Passive Infrared Camera for Measuring Trail-Based Physical Activity

Introduction: Trails are ubiquitous and far-reaching, but research on the impact trails have on physical activity is limited by the lack of resource-efficient, accurate, and practical systematic observation tools. Commonly used infrared trail sensors count trail use and may broadly differentiate activity (i.e., bicyclist vs. pedestrian), but cannot detect nuances needed for outcomes research such as frequency, intensity, time, and type of activity. Motion-activated passive infrared cameras (PICs), used in ecological research and visitor management in wildlife areas, have potential applicability as a systematic observation data collection tool. Materials and Methods: We conducted a 7-month field test of a PIC as a systematic observation data collection tool on a hiking trail, using photos to identify each trail user's physical activity type, age, sex, and other characteristics. We also tallied hourly trail use counts from the photos, using Bland-Altman plots, paired t-tests, Concordance Correlation Coefficient, Kendall's Tau-b, and a novel inter-counter reliability measure to test concordance against concurrent hourly counts from an infrared sensor. Results: The field test proved informative, providing photos of 2,447 human users of the trail over 4,974 h of data collection. Nearly all of the users were walkers (94.0%) and most were male (69.2%). More of the males used the trail alone (44.8%) than did females (29.8%). Concordance was strong between instruments (p < 0.01), though biased (p < 0.01). Inter-counter reliability was 91.1% during the field study, but only 36.2% when excluding the hours with no detectable trail use on either device. Bland-Altman plots highlighted the tendency for the infrared sensor to provide higher counts, especially for the subsample of hours that had counts >0 on either device (14.0%; 694 h). Discussion: The study's findings highlight the benefits of using PICs to track trail user characteristics despite the needs to further refine best practices for image coding, camera location, and settings. More widespread field use is limited by the extensive amount of time required to code photos and the need to validate the PICs as a trail use counter. The future potential of PICs as a trail-specific PA research and management tool is discussed.

Climate Change, Physical Activity and Sport: A Systematic Review

BACKGROUND

Climate change impacts are associated with dramatic consequences for human health and threaten physical activity (PA) behaviors.

OBJECTIVE

The aims of this systematic review were to present the potential bidirectional associations between climate change impacts and PA behaviors in humans and to propose a synthesis of the literature through a conceptual model of climate change and PA.

METHODS

Studies published before October 2020 were identified through database searches in PubMed, PsycARTICLES, CINAHL, SPORTDiscus, GreenFILE, GeoRef, Scopus, JSTOR and Transportation Research Information Services. Studies examining the associations between PA domains and climate change (e.g., natural disasters, air pollution, and carbon footprint) were included.

RESULTS

A narrative synthesis was performed and the 74 identified articles were classified into 6 topics: air pollution and PA, extreme weather conditions and PA, greenhouse gas emissions and PA, carbon footprint among sport participants, natural disasters and PA and the future of PA and sport practices in a changing world. Then, a conceptual model was proposed to identify the multidimensional associations between climate change and PA as well as sport practices. Results indicated a consistent negative effect of air pollution, extreme temperatures and natural disasters on PA levels. This PA reduction is more severe in adults with chronic diseases, higher body mass index and the elderly. Sport and PA communities can play an important mitigating role in post-natural disaster contexts. However, transport related to sport practices is also a source of greenhouse gas emissions.

CONCLUSION

Climate change impacts affect PA at a worldwide scale. PA is observed to play both a mitigation and an amplification role in climate changes.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42019128314.

Evaluation of a New Urban Cycling Infrastructure in Caceres (Spain)

The purpose of the research is the evaluation of the impact of a new bike lane network built in Cáceres (Spain) in October 2019, a city with a weak tradition in the use of bicycles. Prior to the new project, the percentage of displacement by bicycle was under 0.2% (by contrast, private cars was 56%). The project has introduced a real network in 33 new streets and avenues, and 250 new parking places for bicycles. The impact has been evaluated by two online surveys, one conducted in November–December 2019 just after the inauguration, and the other conducted in January–February 2020. For that, the impact evolution after the first 3 months has also been evaluated. The result allows to analyze the citizens’ response to the new infrastructure; the main conclusion is that the effect of the built infrastructure is clearly positive in terms of new users, new potential users, and bike general image for the citizens. Moreover, this positive effect has grown after the first 3 months.

Study protocol: health survey of Sao Paulo: ISA-Physical Activity and Environment

Background

Many studies have investigated the association between the built environment and physical activity behavior in urban settings. However, most of the studies conducted in low- and middle-income countries were cross-sectional, which are limited to identify behavioral determinants. We propose a prospective cohort study to verify the relationship between built environment features and leisure-time and transport-related physical activity in adults from Sao Paulo city, Brazil.

Methods

Prospective multilevel cohort, denominated “ISA-Physical Activity and Environment”. It will build on the Health Survey of Sao Paulo in 2015 (“Inquérito de Saúde de São Paulo (ISA)” in Portuguese). The Health Survey of Sao Paulo, originally designed as a cross-sectional survey, had a multi-stage sample, covering 150 census tracts distributed in five health administrative areas. Data collection was performed by face-to-face interviews until December 2015 and the sample comprised 4043 individuals aged 12 years or more. The ISA-Physical Activity and Environment study will reassess people who are aged 18 years or more in 2020, including telephone and household interviews. The primary outcome will be leisure-time and transport-related physical activity, assessed through the International Physical Activity Questionnaire long version. Exposure variables will be built environment features in the areas participants live and work in the follow-up. Data analysis will include multivariate multilevel linear and logistic models. We will also conduct cost-effectiveness analysis and develop agent-based models to help inform decision-makers. The study will be conducted by an interdisciplinary research team specialized in physical activity epidemiology, nutritional epidemiology, georeferencing applied to health, statistics, agent-based modeling, public health policy, and health economics.

Discussion

There are few longitudinal studies on the relationship between the built environment and physical activity behavior in low- and middle-income countries. We believe that the ISA-Physical Activity and Environment study will contribute with important results for the progress of the knowledge in this field and for the implementation of policies that promote leisure-time physical activity and active travel in Sao Paulo and similar cities across the world.

The role of the built environment in promoting movement and physical activity across the lifespan: Implications for public health

Engaging in regular physical activity (PA) and reducing time spent in sedentary behaviors is critically important to prevent and control non-communicable diseases (NCDs). However, global public health efforts to promote and encourage maintenance of PA behavior on a population level remains challenging. To address what is now described as a global physical inactivity pandemic, a breadth of research has focused on understanding the relation of built environment characteristics, including aspects of urban design, transportation and land-use planning, to PA behavior across multiple domains in life, and subsequently how changes in environmental attributes influence changes in PA patterns in diverse populations and subgroups. This review describes the role the built environment has on improving the promotion and the engagement of PA, particularly in the context of active transportation and leisure time domains of PA. An additional focus will be on the disparities in access to activity-promoting environments and the differential effects of environmental interventions in disadvantaged populations. This paper will further discuss opportunities for public health and policy to advocate for and prioritize the implementation of equitable and effective interventions that aim to expand/improve activity-supportive infrastructures within neighborhoods and communities with the ultimate goal of meaningful population-level increases in PA.

Is cycle network expansion cost-effective? A health economic evaluation of cycling in Oslo

BACKGROUND

Expansion of designated cycling networks increases cycling for transport that, in turn, increases physical activity, contributing to improvement in public health. This paper aims to determine whether cycle-network construction in a large city is cost-effective when compared to the status-quo. We developed a cycle-network investment model (CIM) for Oslo and explored its impact on overall health and wellbeing resulting from the increased physical activity.

METHODS

First, we applied a regression technique on cycling data from 123 major European cities to model the effect of additional cycle-networks on the share of cyclists. Second, we used a Markov model to capture health benefits from increased cycling for people starting to ride cycle at the age of 30 over the next 25 years. All health gains were measured in quality-adjusted life years (QALYs). Costs were estimated in US dollars. Other data to populate the model were derived from a comprehensive literature search of epidemiological and economic evaluation studies. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses.

RESULTS

Our regression analysis reveals that a 100 km new cycle network construction in Oslo city would increase cycling share by 3%. Under the base-case assumptions, where the benefits of the cycle-network investment relating to increased physical activity are sustained over 25 years, the predicted average increases in costs and QALYs per person are $416 and 0.019, respectively. Thus, the incremental costs are $22,350 per QALY gained. This is considered highly cost-effective in a Norwegian setting.

CONCLUSIONS

The results support the use of CIM as part of a public health program to improve physical activity and consequently avert morbidity and mortality. CIM is affordable and has a long-term effect on physical activity that in turn has a positive impact on health improvement.

Autonomous vehicles and cycling: Policy implications and management issues

Cycling as a form of active transport has great benefits for individuals and society, yet prevalence rates in many countries are low. The advent of autonomous vehicles (AVs) is likely to have substantial implications for cyclists, however little is known about the nature and magnitude of the likely impacts and the resulting implications for government planning and policy. The aim of this exploratory study was to consult with a range of stakeholder groups to identify relevant issues and stimulate debate about future efforts to maximize the benefits of vehicle autonomy for cycling outcomes. Interviews were conducted with key stakeholders representing government (local, state, and federal departments responsible for transport, health, and/or infrastructure), cycling organizations, technology firms, AV manufacturing/servicing companies, trade unions, the law, insurers (public and private), transport policy consortia, and academia. The results suggest that AVs have the potential to increase cycling prevalence while reducing cycling accidents, but that a range of issues will need to be addressed to optimize these outcomes. In particular, informed decisions need to be made about the infrastructure and equipment investments that could encourage larger numbers of commuters to select cycling as their primary form of transport.

Active design of built environments for increasing levels of physical activity in adults: the ENABLE London natural experiment study

Background

Low physical activity is widespread and poses a serious public health challenge both globally and in the UK. The need to increase population levels of physical activity is recognised in current health policy recommendations. There is considerable interest in whether or not the built environment influences health behaviours, particularly physical activity levels, but longitudinal evidence is limited.

Objectives

The effect of moving into East Village (the former London 2012 Olympic and Paralympic Games Athletes’ Village, repurposed on active design principles) on the levels of physical activity and adiposity, as well as other health-related and well-being outcomes among adults, was examined.

Design

The Examining Neighbourhood Activities in Built Environments in London (ENABLE London) study was a longitudinal cohort study based on a natural experiment.

Setting

East Village, London, UK.

Participants

A cohort of 1278 adults (aged ≥ 16 years) and 219 children seeking to move into social, intermediate and market-rent East Village accommodation were recruited in 2013–15 and followed up after 2 years.

Intervention

The East Village neighbourhood, the former London 2012 Olympic and Paralympic Games Athletes’ Village, is a purpose-built, mixed-use residential development specifically designed to encourage healthy active living by improving walkability and access to public transport.

Main outcome measure

Change in objectively measured daily steps from baseline to follow-up.

Methods

Change in environmental exposures associated with physical activity was assessed using Geographic Information System-derived measures. Individual objective measures of physical activity using accelerometry, body mass index and bioelectrical impedance (per cent of fat mass) were obtained, as were perceptions of change in crime and quality of the built environment. We examined changes in levels of physical activity and adiposity using multilevel models adjusting for sex, age group, ethnic group, housing sector (fixed effects) and baseline household (random effect), comparing the change in those who moved to East Village (intervention group) with the change in those who did not move to East Village (control group). Effects of housing sector (i.e. social, intermediate/affordable, market-rent) as an effect modifier were also examined. Qualitative work was carried out to provide contextual information about the perceived effects of moving to East Village.

Results

A total of 877 adults (69%) were followed up after 2 years (mean 24 months, range 19–34 months, postponed from 1 year owing to the delayed opening of East Village), of whom 50% had moved to East Village; insufficient numbers of children moved to East Village to be considered further. In adults, moving to East Village was associated with only a small, non-significant, increase in mean daily steps (154 steps, 95% confidence interval –231 to 539 steps), more so in the intermediate sector (433 steps, 95% confidence interval –175 to 1042 steps) than in the social and market-rent sectors (although differences between housing sectors were not statistically significant), despite sizeable improvements in walkability, access to public transport and neighbourhood perceptions of crime and quality of the built environment. There were no appreciable effects on time spent in moderate to vigorous physical activity or sedentary time, body mass index or percentage fat mass, either overall or by housing sector. Qualitative findings indicated that, although participants enjoyed their new homes, certain design features might actually serve to reduce levels of activity.

Conclusions

Despite strong evidence of large positive changes in neighbourhood perceptions and walkability, there was only weak evidence that moving to East Village was associated with increased physical activity. There was no evidence of an effect on markers of adiposity. Hence, improving the physical activity environment on its own may not be sufficient to increase population physical activity or other health behaviours.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information. This research was also supported by project grants from the Medical Research Council National Prevention Research Initiative (MR/J000345/1).

A systematic review of empirical and simulation studies evaluating the health impact of transportation interventions

Urban transportation is an important determinant of health and environmental outcomes, and therefore essential to achieving the United Nation's Sustainable Development Goals. To better understand the health impacts of transportation initiatives, we conducted a systematic review of longitudinal health evaluations involving: a) bus rapid transit (BRT); b) bicycle lanes; c) Open Streets programs; and d) aerial trams/cable cars. We also synthesized systems-based simulation studies of the health-related consequences of walking, bicycling, aerial tram, bus and BRT use. Two reviewers screened 3302 unique titles and abstracts identified through a systematic search of MEDLINE (Ovid), Scopus, TRID and LILACS databases. We included 39 studies: 29 longitudinal evaluations and 10 simulation studies. Five studies focused on low- and middle-income contexts. Of the 29 evaluation studies, 19 focused on single component bicycle lane interventions; the rest evaluated multi-component interventions involving: bicycle lanes (n = 5), aerial trams (n = 1), and combined bicycle lane/BRT systems (n = 4). Bicycle lanes and BRT systems appeared effective at increasing bicycle and BRT mode share, active transport duration, and number of trips using these modes. Of the 10 simulation studies, there were 9 agent-based models and one system dynamics model. Five studies focused on bus/BRT expansions and incentives, three on interventions for active travel, and the rest investigated combinations of public transport and active travel policies. Synergistic effects were observed when multiple policies were implemented, with several studies showing that sizable interventions are required to significantly shift travel mode choices. Our review indicates that bicycle lanes and BRT systems represent promising initiatives for promoting population health. There is also evidence to suggest that synergistic effects might be achieved through the combined implementation of multiple transportation policies. However, more rigorous evaluation and simulation studies focusing on low- and middle-income countries, aerial trams and Open Streets programs, and a more diverse set of health and health equity outcomes is required.

Health Gain, Cost Impacts, and Cost-Effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Physical Activity: Modeling Study

BACKGROUND

Physical activity smartphone apps are a promising strategy to increase population physical activity, but it is unclear whether government mass media campaigns to promote these apps would be a cost-effective use of public funds.

OBJECTIVE

We aimed to estimate the health impacts, costs, and cost-effectiveness of a one-off national mass media campaign to promote the use of physical activity apps.

METHODS

We used an established multistate life table model to estimate the lifetime health gains (in quality-adjusted life years [QALYs]) that would accrue if New Zealand adults were exposed to a one-off national mass media campaign to promote physical activity app use, with a 1-year impact on physical activity, compared to business-as-usual. A health-system perspective was used to assess cost-effectiveness. and a 3% discount rate was applied to future health gains and health system costs.

RESULTS

The modeled intervention resulted in 28 QALYs (95% uncertainty interval [UI] 8-72) gained at a cost of NZ $81,000/QALY (2018 US $59,500; 95% UI 17,000-345,000), over the remaining life course of the 2011 New Zealand population. The intervention had a low probability (20%) of being cost-effective at a cost-effectiveness threshold of NZ $45,000 (US $32,900) per QALY. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions around the maintenance of physical activity behaviors beyond the duration of the intervention.

CONCLUSIONS

A mass media campaign to promote smartphone apps for physical activity is unlikely to generate much health gain or be cost-effective at the population level. Other investments to promote physical activity, particularly those that result in sustained behavior change, are likely to have greater health impacts.

The effect of moving to East Village, the former London 2012 Olympic and Paralympic Games Athletes' Village, on mode of travel (ENABLE London study, a natural experiment)

BACKGROUND

Interventions to encourage active modes of travel (walking, cycling) may improve physical activity levels, but longitudinal evidence is limited and major change in the built environment / travel infrastructure may be needed. East Village (the former London 2012 Olympic Games Athletes Village) has been repurposed on active design principles with improved walkability, open space and public transport and restrictions on residential car parking. We examined the effect of moving to East Village on adult travel patterns.

METHODS

One thousand two hundred seventy-eight adults (16+ years) seeking to move into social, intermediate, and market-rent East Village accommodation were recruited in 2013-2015, and followed up after 2 years. Individual objective measures of physical activity using accelerometry (ActiGraph GT3X+) and geographic location using GPS travel recorders (QStarz) were time-matched and a validated algorithm assigned four travel modes (walking, cycling, motorised vehicle, train). We examined change in time spent in different travel modes, using multilevel linear regresssion models adjusting for sex, age group, ethnicity, housing group (fixed effects) and household (random effect), comparing those who had moved to East Village at follow-up with those who did not.

RESULTS

Of 877 adults (69%) followed-up, 578 (66%) provided valid accelerometry and GPS data for at least 1 day (≥540 min) at both time points; half had moved to East Village. Despite no overall effects on physical activity levels, sizeable improvements in walkability and access to public transport in East Village resulted in decreased daily vehicle travel (8.3 mins, 95%CI 2.5,14.0), particularly in the intermediate housing group (9.6 mins, 95%CI 2.2,16.9), and increased underground travel (3.9 mins, 95%CI 1.2,6.5), more so in the market-rent group (11.5 mins, 95%CI 4.4,18.6). However, there were no effects on time spent walking or cycling.

CONCLUSION

Designing walkable neighbourhoods near high quality public transport and restrictions on car usage, may offer a community-wide strategy shift to sustainable transport modes by increasing public transport use, and reducing motor vehicle travel.

The effects of small-scale physical and social environmental interventions on walking behaviour among Dutch older adults living in deprived neighbourhoods: results from the quasi-experimental NEW.ROADS study

PURPOSE

Improving the physical and social conditions of residential neighbourhoods may increase walking, especially among older people. Evidence on the effects of physical and social environmental interventions, and particularly the combination of both, on walking behaviour is scarce. We evaluated the effects of a small-scale physical environmental intervention (designated walking route), a social environmental intervention (neighbourhood walking group) and the combination of both on walking behaviour of older adults living in deprived neighbourhoods.

METHODS

Survey data of 644 older adults residing in four deprived neighbourhoods of Rotterdam, the Netherlands, were used to compare changes in walking behaviour over time (weekly minutes spent recreational walking, utilitarian walking and total walking) of those exposed to 1) a designated walking route (physical condition), 2) walking groups (social condition), 3) walking routes and walking groups (combined condition), and 4) no intervention (control condition). Measurements took place at baseline (T0), and 3 months (T1) and 9 months (T2) after the intervention. Data were analysed on a multiple imputed dataset, using multi-level negative binomial regression models, adjusting for clustering of observations within individuals. All models were adjusted for demographic covariates.

RESULTS

Total time spent walking per week increased between T0 and T1 for all conditions. The Incidence Rate Ratio (IRR) for the physical condition was 1.46 (95% CI:1.06;2.05) and for the social intervention 1.52 (95%CI:1.07;2.16). At T2, these differences remained significant for the physical condition, but not for the social condition and the combined condition. These findings were mirrored for utilitarian walking. No evidence was found for an effect on recreational walking.

CONCLUSION

Implementing small scale, feasible, interventions in a residential neighbourhood may increase total and utilitarian walking behaviour among older adults.

Built Environment Interventions to Increase Active Travel: a Critical Review and Discussion

PURPOSE OF REVIEW

To review the literature on built environment interventions to increase active travel, focusing on work since 2000 and on methodological choices and challenges affecting studies.

RECENT FINDINGS

Increasingly, there is evidence that built environment interventions can lead to more walking or cycling. Evidence is stronger for cycling than for walking interventions, and there is a relative lack of evidence around differential impacts of interventions. Some of the evidence remains methodologically weak, with much work in the 'grey' literature. While evidence in the area continues to grow, data gaps remain. Greater use of quasi-experimental techniques, improvements in routine monitoring of smaller schemes, and the use of new big data sources are promising. More qualitative research could help develop a more sophisticated understanding of behaviour change.

A systematic review of the effect of infrastructural interventions to promote cycling: strengthening causal inference from observational data

Background

Previous reviews have suggested that infrastructural interventions can be effective in promoting cycling. Given inherent methodological complexities in the evaluation of such changes, it is important to understand whether study results obtained depend on the study design and methods used, and to describe the implications of the methods used for causality. The aims of this systematic review were to summarize the effects obtained in studies that used a wide range of study designs to assess the effects of infrastructural interventions on cycling and physical activity, and whether the effects varied by study design, data collection methods, or statistical approaches.

Methods

Six databases were searched for studies that evaluated infrastructural interventions to promote cycling in adult populations, such as the opening of cycling lanes, or the expansion of a city-wide cycling network. Controlled and uncontrolled studies that presented data before and after the intervention were included. No language or date restrictions were applied. Data was extracted for any outcome presented (e.g. bikes counted on the new infrastructure, making a bike trip, cycling frequency, cycling duration), and for any purpose of cycling (e.g. total cycling, recreational cycling, cycling for commuting). Data for physical activity outcomes and equity effects was extracted, and quality assessment was conducted following previous methodologies and the UK Medical Research Council guidance on natural experiments. The PROGRESS-Plus framework was used to describe the impact on subgroups of the population.

Studies were categorized by outcome, i.e. changes in cycling behavior, or usage of the cycling infrastructure. The relative change was calculated to derive a common outcome across various metrics and cycling purposes. The median relative change was presented to evaluate whether effects differed by methodological aspects.

Results

The review included 31 studies and all were conducted within urban areas in high-income countries. Most of the evaluations found changes in favor of the intervention, showing that the number of cyclists using the facilities increased (median relative change compared to baseline: 62%; range: 4 to 438%), and to a lesser extent that cycling behavior increased (median relative change compared to baseline: 22%; range: − 21 to 262%). Studies that tested for statistical significance and studies that used subjective measurement methods (such as surveys and direct observations of cyclists) found larger changes than those that did not perform statistical tests, and those that used objective measurement methods (such as GPS and accelerometers, and automatic counting stations). Seven studies provided information on changes of physical activity behaviors, and findings were mixed. Three studies tested for equity effects following the opening of cycling infrastructure.

Conclusions

Study findings of natural experiments evaluating infrastructural interventions to promote cycling depended on the methods used and the approach to analysis. Studies measuring cycling behavior were more likely to assess actual behavioral change that is most relevant for population health, as compared to studies that measured the use of cycling infrastructure. Triangulation of methods is warranted to overcome potential issues that one may encounter when evaluating environmental changes within the built environment.

Trial registration

The protocol of this study was registered at PROSPERO (CRD42018091079).

Area-level and individual correlates of active transportation among adults in Germany: A population-based multilevel study

This study aimed at estimating the prevalence in adults of complying with the aerobic physical activity (PA) recommendation through transportation-related walking and cycling. Furthermore, potential determinants of transportation-related PA recommendation compliance were investigated. 10,872 men and 13,144 women aged 18 years or older participated in the cross-sectional 'German Health Update 2014/15 - EHIS' in Germany. Transportation-related walking and cycling were assessed using the European Health Interview Survey-Physical Activity Questionnaire. Three outcome indicators were constructed: walking, cycling, and total active transportation (≥600 metabolic equivalent, MET-min/week). Associations were analyzed using multilevel regression analysis. Forty-two percent of men and 39% of women achieved ≥600 MET-min/week with total active transportation. The corresponding percentages for walking were 27% and 28% and for cycling 17% and 13%, respectively. Higher population density, older age, lower income, higher work-related and leisure-time PA, not being obese, and better self-perceived health were positively associated with transportation-related walking and cycling and total active transportation among both men and women. The promotion of walking and cycling among inactive people has great potential to increase PA in the general adult population and to comply with PA recommendations. Several correlates of active transportation were identified which should be considered when planning public health policies and interventions.

A systematic review of the effect of infrastructural interventions to promote cycling: strengthening causal inference from observational data

BACKGROUND

Previous reviews have suggested that infrastructural interventions can be effective in promoting cycling. Given inherent methodological complexities in the evaluation of such changes, it is important to understand whether study results obtained depend on the study design and methods used, and to describe the implications of the methods used for causality. The aims of this systematic review were to summarize the effects obtained in studies that used a wide range of study designs to assess the effects of infrastructural interventions on cycling and physical activity, and whether the effects varied by study design, data collection methods, or statistical approaches.

METHODS

Six databases were searched for studies that evaluated infrastructural interventions to promote cycling in adult populations, such as the opening of cycling lanes, or the expansion of a city-wide cycling network. Controlled and uncontrolled studies that presented data before and after the intervention were included. No language or date restrictions were applied. Data was extracted for any outcome presented (e.g. bikes counted on the new infrastructure, making a bike trip, cycling frequency, cycling duration), and for any purpose of cycling (e.g. total cycling, recreational cycling, cycling for commuting). Data for physical activity outcomes and equity effects was extracted, and quality assessment was conducted following previous methodologies and the UK Medical Research Council guidance on natural experiments. The PROGRESS-Plus framework was used to describe the impact on subgroups of the population. Studies were categorized by outcome, i.e. changes in cycling behavior, or usage of the cycling infrastructure. The relative change was calculated to derive a common outcome across various metrics and cycling purposes. The median relative change was presented to evaluate whether effects differed by methodological aspects.

RESULTS

The review included 31 studies and all were conducted within urban areas in high-income countries. Most of the evaluations found changes in favor of the intervention, showing that the number of cyclists using the facilities increased (median relative change compared to baseline: 62%; range: 4 to 438%), and to a lesser extent that cycling behavior increased (median relative change compared to baseline: 22%; range: - 21 to 262%). Studies that tested for statistical significance and studies that used subjective measurement methods (such as surveys and direct observations of cyclists) found larger changes than those that did not perform statistical tests, and those that used objective measurement methods (such as GPS and accelerometers, and automatic counting stations). Seven studies provided information on changes of physical activity behaviors, and findings were mixed. Three studies tested for equity effects following the opening of cycling infrastructure.

CONCLUSIONS

Study findings of natural experiments evaluating infrastructural interventions to promote cycling depended on the methods used and the approach to analysis. Studies measuring cycling behavior were more likely to assess actual behavioral change that is most relevant for population health, as compared to studies that measured the use of cycling infrastructure. Triangulation of methods is warranted to overcome potential issues that one may encounter when evaluating environmental changes within the built environment.

TRIAL REGISTRATION

The protocol of this study was registered at PROSPERO (CRD42018091079).

Barriers to investing in cycling: Stakeholder views from England

BACKGROUND

Planners and politicians in many countries seek to increase the proportion of trips made by cycling. However, this is often challenging. In England, a national target to double cycling by 2025 is likely to be missed: between 2001 and 2011 the proportion of commutes made by cycling barely grew. One important contributory factor is continued low investment in cycling infrastructure, by comparison to European leaders.

METHODS

This paper examines barriers to cycling investment, considering that these need to be better understood to understand failures to increase cycling level. It is based on qualitative data from an online survey of over 400 stakeholders, alongside seven in-depth interviews.

RESULTS

Many respondents reported that change continues to be blocked by chronic barriers including a lack of funding and leadership. Participants provided insights into how challenges develop along the life of a scheme. In authorities with little consideration given to cycling provision, media and public opposition were not reported as a major issue. However, where planning and implementation have begun, this can change quickly; although examples were given of schemes successfully proceeding, despite this. The research points to a growing gap between authorities that have overcome key challenges, and those that have not.

Environmental, health, wellbeing, social and equity effects of urban green space interventions: A meta-narrative evidence synthesis

BACKGROUND

As populations become increasingly urbanised, the preservation of urban green space (UGS) becomes paramount. UGS is not just dedicated recreational space such as public parks, but other types of informal green space are important, for example, street trees and roof gardens. Despite the potential from cross-sectional evidence, we know little about how to design new, or improve or promote existing UGS for health, wellbeing, social and environmental benefits, or known influencing factors such as physical activity.

OBJECTIVES

To perform a meta-narrative review of the evidence regarding the health, wellbeing, social, environmental and equity effects, or known influencing factors of these outcomes, of UGS interventions.

DATA SOURCES

Eight electronic databases were searched ((Medline, PsycINFO, Web of Science (Science and Social Science Citation Indices), PADDI (Planning Architecture Design Database Ireland), Zetoc, Scopus, Greenfiles, SIGLE (System for Information on Grey Literature in Europe)), and reference lists of included studies and relevant reviews were hand searched for further relevant studies.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS

Eligibility criteria included: (i) evaluation of an UGS intervention; and (ii) health, wellbeing, social or environmental outcome(s), or known influencing factors of these outcomes, measured. Interventions involving any age group were included. Interventions must have involved: (a) physical change to green space in an urban-context including improvements to existing UGS or development of new UGS, or (b) combination of physical change to UGS supplemented by a specific UGS awareness, marketing or promotion programme to encourage use of UGS.

STUDY APPRAISAL AND SYNTHESIS METHODS

Following a meta-narrative approach, evidence was synthesised by main intervention approach, including: (i) park-based; (ii) greenways/trails; (iii) urban greening; (iv) large green built projects for environmental purposes. Outcomes such as economic (e.g. cost effectiveness and cost-benefit analyses), adverse effects and unintended consequences were also extracted. Evidence was synthesised following the RAMESES guidelines and publication standards, the PROGRESS-plus tool was used to explore equity impact, and risk of bias/study quality was assessed. The findings from the evidence review were presented at an expert panel representing various disciplines in a workshop and these discussions framed the findings of the review and provide recommendations that are relevant to policy, practice and research.

RESULTS

Of the 6997 studies identified, 38 were included. There was strong evidence to support park-based (7/7 studies) and greenway/trail (3/3 studies) interventions employing a dual-approach (i.e. a physical change to the UGS and promotion/marketing programmes) particularly for park use and physical activity; strong evidence for the greening of vacant lots (4/4 studies) for health, wellbeing (e.g. reduction in stress) and social (e.g. reduction in crime, increased perceptions of safety) outcomes; strong evidence for the provision of urban street trees (3/4 studies) and green built interventions for storm water management (6/7 studies) for environmental outcomes (e.g. increased biodiversity, reduction in illegal dumping). Park-based or greenway/trail interventions that did not employ a dual-approach were largely ineffective (7/12 studies showed no significant intervention effect). Overall, the included studies have inherent biases owing to the largely non-randomized study designs employed. There was too little evidence to draw firm conclusions regarding the impact of UGS interventions on a range of equity indicators. LIMITATIONS; CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: UGS has an important role to play in creating a culture of health and wellbeing. Results from this study provide supportive evidence regarding the use of certain UGS interventions for health, social and environmental benefits. These findings should be interpreted in light of the heterogeneous nature of the evidence base, including diverging methods, target populations, settings and outcomes. We could draw little conclusions regarding the equity impact of UGS interventions. However, the true potential of UGS has not been realised as studies have typically under-evaluated UGS interventions by not taking account of the multifunctional nature of UGS. The findings have implications for policymakers, practitioners and researchers. For example, for policymakers the trajectory of evidence is generally towards a positive association between UGS and health, wellbeing, social and environmental outcomes, but any intervention must ensure that negative consequences of gentrification and unequal access are minimised.

Walkability, Overweight, and Obesity in Adults: A Systematic Review of Observational Studies

We conducted a systematic review to describe and summarize possible associations between the walkability index, overweight, and obesity. Systematic searches using seven electronic databases and reference lists were conducted to identify papers published until December 2017. Observational studies, describing associations using regression-based statistical methods, published in English and Portuguese, reporting markers of overweight and obesity, and involving adults (≥18 years) were included. Of the 2469 references initially retrieved, ten were used for the descriptive synthesis. Seven studies showed significant inverse associations between walkability and overweight and obesity, however, all were cross-sectional studies. High risk of bias scores were observed in "selection bias" and "withdrawals and dropouts". All studies were published in high-income countries with sample sizes ranging among 75 to 649,513 participants. Weight and height as measures for determining BMI tended to be self-reported. Indicators of walkability, such as land-use mix, street connectivity and residential density were used as components of the indices. Based on this review, more studies should be conducted in low, middle, and middle-high income countries, using longitudinal designs that control neighborhood self-selection; other indicators of the neighborhood environment, such as food access, physical activity facilities, sidewalks, and safety and crime prevention should be considered.

The effect of moving to East Village, the former London 2012 Olympic and Paralympic Games Athletes' Village, on physical activity and adiposity (ENABLE London): a cohort study

BACKGROUND

The built environment can affect health behaviours, but longitudinal evidence is limited. We aimed to examine the effect of moving into East Village, the former London 2012 Olympic and Paralympic Games Athletes' Village that was repurposed on active design principles, on adult physical activity and adiposity.

METHODS

In this cohort study, we recruited adults seeking new accommodation in East Village and compared physical activity and built environment measures with these data in control participants who had not moved to East Village. At baseline and after 2 years, we objectively measured physical activity with accelerometry and adiposity with body-mass index and bioimpedance, and we assessed objective measures of and participants' perceptions of change in their built environment. We examined the change in physical activity and adiposity between the East Village and control groups, after adjusting for sex, age group, ethnicity, housing tenure, and household (as a random effect).

FINDINGS

We recruited participants for baseline assessment between Jan 24, 2013, and Jan 7, 2016, and we followed up the cohort after 2 years, between Feb 24, 2015, and Oct 24, 2017. At baseline, 1819 households (one adult per household) consented to initial contact by the study team. 1278 adults (16 years and older) from 1006 (55%) households participated at baseline; of these participants, 877 (69%) adults from 710 (71%) households were assessed after 2 years, of whom 441 (50%) participants from 343 (48%) households had moved to East Village. We found no effect associated with moving to East Village on daily steps, the time spent doing moderate-to-vigorous physical activity (either in total or in 10-min bouts or more), daily sedentary time, body-mass index, or fat mass percentage between participants who had moved to East Village and those in the control group, despite sizeable improvements in walkability and neighbourhood perceptions of crime and quality among the East Village group relative to their original neighbourhood at baseline.

INTERPRETATION

Despite large improvements in neighbourhood perceptions and walkability, we found no clear evidence that moving to East Village was associated with increased physical activity. Improving the built environment on its own might be insufficient to increase physical activity.

FUNDING

National Institute for Health Research and National Prevention Research Initiative.

Closing the loop: short term impacts on physical activity of the completion of a loop trail in Sydney, Australia

BACKGROUND

In Australia, an estimated 57% of the population do not meet physical activity recommendations for health. The built environment is important for active living, and recreational trails provide safe and pleasant settings for this purpose. However, evidence for positive impacts on physical activity from real world natural experiments is sparse. We describe the impact of transforming a recreational trail into a loop on usage by cyclists and pedestrians and users' physical activity levels.

METHOD

We conducted time series analyses of pre and post-completion (November 2013-July 2015) counts taken from infrared electronic counters of pedestrians and cyclists on two established sections of the trail adjusted for underlying trend, trend change, weather, holidays and trail closures. Chi-square analyses of pre and post-completion visual counts examined change in the distribution of pedestrian/cyclist, adult/child, and male/female users. Descriptive and bivariate analyses of post-completion intercept survey data of 249 trail users were conducted to examine user characteristics and impact on physical activity.

RESULTS

Pedestrian and cyclist counts on established trail sections increased by between 200 and 340% from pre to post-completion. Visual count data showed a significant 7% increase in children (vs adults) using the trail at one site pre to post (p = 0.008). Of previous users, 48% reported doing more physical activity at the trail and this was additional to (not replacing) physical activity done elsewhere. Those users not meeting physical activity recommendations were more likely to report increased total physical activity since the loop was created (55.5% vs 39.2%, p = 0.031). The connected loop nature of the trail and its length was perceived to encourage more and different forms of physical activity.

CONCLUSION

Creating an accessible loop trail away from motorised traffic can lead to increased trail use and potentially total physical activity. The modification to the trail encouraged proportionate and real increases in usage among vulnerable populations such as children and perhaps greater total physical activity especially for people not meeting physical activity recommendations. The findings suggest that the benefits of environmental changes such as these can accrue to those most in need of support for being physically active.

Title: Can changing the physical environment promote walking and cycling? A systematic review of what works and how

Environmental changes aimed at encouraging walking or cycling may promote activity and improve health, but evidence suggests small or inconsistent effects in practice. Understanding how an intervention works might help explain the effects observed and provide guidance about generalisability. We therefore aimed to review the literature on the effects of this type of intervention and to understand how and why these may or may not be effective. We searched eight electronic databases for existing systematic reviews and mined these for evaluative studies of physical environmental changes and assessed changes in walking, cycling or physical activity. We then searched for related sources including quantitative or qualitative studies, policy documents or reports. We extracted information on the evidence for effects ('estimation'), contexts and mechanisms ('explanation') and assessed credibility, and synthesised material narratively. We identified 13 evaluations of interventions specifically targeting walking and cycling and used 46 related sources. 70% (n = 9 evaluations) scored 3 or less on the credibility criteria for effectiveness. 6 reported significant positive effects, but higher quality evaluations were more likely to report positive effects. Only two studies provided rich evidence of mechanisms. We identified three common resources that interventions provide to promote walking and cycling: (i) improving accessibility and connectivity; (ii) improving traffic and personal safety; and (iii) improving the experience of walking and cycling. The most effective interventions appeared to target accessibility and safety in both supportive and unsupportive contexts. Although the evidence base was relatively limited, we were able to understand the role of context in the success of interventions. Researchers and policy makers should consider the context and mechanisms which might operate before evaluating and implementing interventions.

A workplace-based intervention to increase levels of daily physical activity: the Travel to Work cluster RCT

Background

There may be opportunities for working adults to accumulate recommended physical activity levels (≥ 150 minutes of moderate-intensity physical activity in bouts of ≥ 10 minutes throughout the week) during the commute to work. Systematic reviews of interventions to increase active transport indicate that studies are predominantly of poor quality, rely on self-report and lack robust statistical analyses.

Objectives

To assess the effectiveness, cost and consequences of a behavioural intervention to increase walking during the commute to work.

Design

A multicentre, parallel-arm, cluster randomised controlled trial incorporating economic and process evaluations. Physical activity outcomes were measured using accelerometers and GPS (Global Positioning System) receivers at baseline and the 12-month follow-up.

Setting

Workplaces in seven urban areas in south-west England and south Wales.

Participants

Employees (n = 654) in 87 workplaces.

Interventions

Workplace-based Walk to Work promoters were trained to implement a 10-week intervention incorporating key behaviour change techniques.

Main outcome measures

The primary outcome was the daily number of minutes of moderate to vigorous physical activity (MVPA). Secondary outcomes included MVPA during the commute, overall levels of physical activity and modal shift (from private car to walking). Cost–consequences analysis included employer, employee and health service costs and consequences. Process outcomes included barriers to, and facilitators of, walking during the daily commute.

Results

There was no evidence of an intervention effect on MVPA at the 12-month follow-up [adjusted difference in means 0.3 minutes, 95% confidence interval (CI) –5.3 to 5.9 minutes]. The intervention cost was on average, £181.97 per workplace and £24.19 per participating employee. In comparison with car users [mean 7.3 minutes, standard deviation (SD) 7.6 minutes], walkers (mean 34.3 minutes, SD 18.6 minutes) and public transport users (mean 25.7 minutes, SD 14.0 minutes) accrued substantially higher levels of daily MVPA during the commute. Participants who walked for ≥ 10 minutes during their commute were more likely to have a shorter commute distance (p < 0.001). No access to a car (p < 0.001) and absence of free workplace car parking (p < 0.01) were independently related to walking to work and using public transport. Higher quality-of-life scores were observed for the intervention group in a repeated-measures analysis (mean 0.018, 95% CI 0.000 to 0.036; scores anchored at 0 indicated ‘no capability’ and scores anchored at 1 indicated ‘full capability’).

Conclusions

Although this research showed that walking to work and using public transport are important contributors to physical activity levels in a working population, the behavioural intervention was insufficient to change travel behaviour. Broader contextual factors, such as length of journey, commuting options and availability of car parking, may influence the effectiveness of behavioural interventions to change travel behaviour. Further analyses of statistical and qualitative data could focus on physical activity and travel mode and the wider determinants of workplace travel behaviour.

Trial registration

Current Controlled Trials ISRCTN15009100.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 11. See the NIHR Journals Library website for further project information. Living Streets, a UK charity promoting everyday walking, provided funding for the intervention booklets and free pedometers for distribution to participants in the intervention group.

Searching for health equity: validation of a search filter for ethnic and socioeconomic inequalities in transport

BACKGROUND

Efforts to improve health equity should be informed by the best available evidence. However, equity-related research is inconsistently indexed, and uses a variety of terms to describe key concepts, making it difficult to reliably identify all relevant studies. We report the development and validation of a search strategy for studies investigating whether the effects of interventions differ by ethnicity or socio-economic status, using the field of transport and health as an example.

METHODS

Adapting previously described methods, we followed four steps: generation of a test set of eligible studies, search strategy development, search strategy validation, and documentation.

RESULTS

Drawing from 12 systematic reviews, supplemented by additional studies identified by experts and colleagues, we identified a test set of 11 studies that met our eligibility criteria. We assigned five studies to a development set, which we used to develop and refine our search strategy. We assigned the remaining six studies to a validation set, against which we tested our final search strategy. The final search strategy identified all studies in both validation and development sets.

CONCLUSIONS

The validated search strategy derived in this study facilitates the conduct of systematic reviews and other literature searches investigating whether the effects of interventions differ by ethnicity or socio-economic status and may be further developed in future for other equity-focused searches and reviews.

Prevention of Childhood Obesity in Child Health Services: Follow-Up of the PRIMROSE Trial

BACKGROUND

Childhood obesity is an urgent public health concern, and there's a need for long-term, high-quality, primary prevention trials targeting parents of young children. The aim of the current study was to evaluate the long-term effect of a parental support program based on motivational interviewing (MI).

METHODS

A cluster randomized controlled trial was carried out in eight Swedish counties. Participating families (N = 1355) were enrolled when the child was 9 months old, and participated in nine sessions during ∼39 months. The aim was to pomote healthy food and physical activity (PA) habits using MI and principles from cognitive behavioral therapy. Nurses in Swedish child health services delivered the intervention, and the control group received usual healthcare. The current study was a 1-year follow-up of effects on children's weight-related measures. Regression analyses were conducted using generalized estimating equations, including analyses to investigate potential parental moderators of the effect.

RESULTS

There were no statistically significant intervention effects at follow-up [BMI difference = -0.13, p = 0.29, overweight relative risk (RR) = 0.96, p = 0.78, obesity RR = 0.57, p = 0.20]. Maternal waist circumference and unhealthy eating and paternal PA moderated the effect, but effects were small and failed to reach statistical significance after correction for multiple comparisons.

CONCLUSIONS

A parent-focused primary prevention intervention based on MI delivered within child health services did not result in effects at 1-year follow-up. The results were in line with those obtained at post-assessment and indicated no late onset of effect. Further studies exploring individual and contextual factors influencing the outcome are called for.

Physical activity-related health and economic benefits of building walkable neighbourhoods: a modelled comparison between brownfield and greenfield developments

BACKGROUND

A consensus is emerging in the literature that urban form can impact health by either facilitating or deterring physical activity (PA). However, there is a lack of evidence measuring population health and the economic benefits relating to alternative urban forms. We examined the issue of housing people within two distinct types of urban development forms: a medium-density brownfield development in an established area with existing amenities (e.g. daily living destinations, transit), and a low-density suburban greenfield development. We predicted the health and economic benefits of a brownfield development compared with a greenfield development through their influence on PA.

METHODS

We combined a new Walkability Planning Support System (Walkability PSS) with a quantitative health impact assessment model. We used the Walkability PSS to estimate the probability of residents' transport walking, based on their exposure to urban form in the brownfield and greenfield developments. We developed the underlying algorithms of the Walkability PSS using multi-level multivariate logistic regression analysis based on self-reported data for transport walking from the Victorian Integrated Survey of Transport and Activity 2009-10 and objectively measured urban form in the developments. We derived the difference in transport walking minutes per week based on the probability of transport walking in each of the developments and the average transport walking time per week among those who reported any transport walking. We then used the well-established method of the proportional multi-cohort multi-state life table model to translate the difference in transport walking minutes per week into health and economic benefits.

RESULTS

If adult residents living in the greenfield neighbourhood were instead exposed to the urban development form observed in a brownfield neighbourhood, the incidence and mortality of physical inactivity-related chronic diseases would decrease. Over the life course of the exposed population (21,000), we estimated 1600 health-adjusted life years gained and economic benefits of A$94 million.

DISCUSSION

Our findings indicate that planning policies that create walkable neighbourhoods with access to shops, services and public transport will lead to substantial health and economic benefits associated with reduced incidence of physical inactivity related diseases and premature death.