Res Exerc Epidemiol 2011; 13(2): 111-117.
c 2011 by the Japanese Association of Exercise Epidemiology
Copyright ○【Review Article】

Environmental and Policy Research on
Physical Activity is Going Global
James F. Sallis 1)
1）Department of Psychology, San Diego State University, San Diego, CA USA

ABSTRACT International groups have recommended environmental and policy changes as central strategies in
efforts to increase physical activity worldwide. Research is needed to guide policy actions, but built environment
and physical activity is a relatively new research topic that initially was conducted in just a few countries. The
generalizability of findings cannot be assumed across countries with distinct environments and cultures. Initial
findings, mainly from studies of North America and Australia, indicated that "walkable" community designs wererelated to active transportation, and proximity to parks was related to active recreation. In recent years, thosegeneral findings have mainly been supported in studies from Japan, Europe, and South America. Evidence to dateindicates there may be generalizable principles about how to build communities that facilitate people being active
for transportation and recreation purposes. Country-specific studies are needed to inform local decision making incity planning, transportation, parks, education, and health departments/ministries. Coordinated international
studies are needed to guide international actions to reduce the epidemics of physical inactivity and chronic
diseases.
Key words: exercise, international, built environments, walking
The epidemic of physical inactivity is one of theleading problems in international health. Not only is
physical inactivity the fourth leading cause of deathworldwide, but most of those deaths are in low andmiddle income countries.1) Hundreds of millions ofpeople are leading inactive lifestyles and putting
themselves at risk for numerous chronic diseases.
Though we have very limited international data on
trends in prevalence of physical activity over decades,
there is a strong consensus that changes in technology
are making profound alterations in people's activity
patterns. It seems obvious that mechanization andcomputerization at work over many years havedramatically reduced occupational physical activity.
Automobiles have become the dominant form oftransportation in most countries, severely reducing
Address for correspondence: James F. Sallis; Departmentof Psychology San Diego State University, Active Living
Research; 3900 Fifth Avenue, Suite 310 San Diego, CA
92103 USA; sallis@mail.sdsu.edu; www.drjamessallis.
sdsu.edu

111

active modes of transportation. Many homes are filledwith labor saving devices, largely eliminating anotherhistorical source of daily physical activity. Electronicentertainment has replaced dancing and walking as
frequent leisure time activities. Globalization is taking
these technologies into every country, and perhaps
eventually into every town and village.
Most people welcome these technological advancements because they are associated with economic
progress and improved standards of living. Thoughdifficult to document, it appears that most people
avoid physical activity whenever they can. For
example, they avoid hard physical labor, pay to ridevehicles instead of walk, and in some countries watch
3-4 hours of television per day. One can imagine
people of 100 years ago would be very pleased to live
in a society like ours in which physical activity is nolonger required. They would consider it the lifestyle ofroyalty. The only problem is that inactive lifestyles are
one of the world's biggest killers.
If physical inactivity is a global problem, how
do we find a global solution? The World HealthRes Exerc Epidemiol 2011; 13(2): 111-117.

Organization (WHO)2) has recommended strategies
for increasing physical activity in populations. Someof the strategies are designed to motivate and educate
individuals to be more active by implementing
educational interventions in schools, worksites, andthrough the mass media. However, most of the WHO
global strategy is designed to counter some of thetechnological and societal trends believed to be themain forces behind the epidemic of inactive lifestyles.
In contrast to interventions targeting individuals,
which tend to have weak and short-term effects,
changing environments and policies can affect entire
populations on a relatively permanent basis.
Given that environment and policy changes are thedominant approach to physical activity promotion
worldwide,2,3) it is the responsibility of the scientificcommunity to provide evidence that can inform andguide such interventions. Because environments,
policies, and cultures can vary dramatically acrosscountries, it cannot be assumed that findings from one
country or region can be generalized to other countries.
The purpose of the present paper is to summarize theinternational research on built environments andphysical activity, identify findings that may be a
sufficient basis for interventions, and to recommended
priorities for next steps in research.

recreation, and household.4)
Most of the early environmental research was
conducted in a few high-income countries, mainly theUnited States and Australia. This literature mainly
relates to environmental corr elates of recreationand transportation activity domains, because these
domains seem the most promising intervention targets.
The literature has been reviewed numerous times, andthere are some consistently supported associations,especially for adults. 5-9) Neighborhood walkability
refers to an environment that supports walking andbicycling for transportation. Walkable neighborhoods
have high residential density, mixed land use thatplaces destinations near homes, and connected streetsthat provide direct routes. Walkable neighborhoods
and their components have consistently been
associated with active transportation and total physicalactivity, and the effects can be substantial. For
example, our study conducted in two regions of the
USA found a difference of 35-49 minutes per week ofphysical activity between residents of high- comparedto low-walkability neighborhoods, based on accelerometer monitoring.10) An Australian study using
similar methods found a strong association of
walkability with reported walking for transportation.11) Among children and adolescents, mixed land
use is the component that is most often related tophysical activity.5) Presence and quality of sidewalks,
bicycle facilities, and street designs that slow traffic
are not convincingly related to physical activity.
A different set of environmental attributes is related
to recreational physical activity. There is goodevidence that living near recreation facilities, likeparks and trails, is positively related to use of thosefacilities and recreational physical activity for adults
and youth.5,8,9) There is emerging data that the designof parks and trails can affect physical activity. For
example, people were most likely to be active in parks
with trails,12) and urban trails that were used most had
a variety of views, amenities like cafes and restrooms,
and vegetation that was not too thick. 13)
The main limitation of these studies is that they arecross-sectional, so it possible that findings could be
explained by self-selection bias. Other limitations
include inconsistent definitions of environmental
attributes and reliance on self-report measures. The

Built environments and physical activity research:
Conceptual background and early studies
The research has focused mainly on built
environments because physical activity is done in
specific places, and most of those places can beaffected by people and by policies. Environment andpolicy research is guided by ecological models of
behavior change. The main principle is that because
behavior is affected by influences at the individual,social/cultural, organizational, community environment, and policy levels, to be effective, interventions
should operate at multiple levels. Ecological models
are needed because more traditional psychologicalmodels of behavior do not provide guidance about
environments and policies.4) Ecological models mustbe specific to the behavior. In physical activity,
models need to be specific to the major activity
domains of occupational, transportation, leisure/112

Res Exerc Epidemiol 2011; 13(2): 111-117.

literature on built environments and physical activity
has been widely accepted. 7) A critical question is how
do these findings, derived mainly from studies in the
USA and Australia, apply to countries with different
environments and cultures?

from Western countries, in spite of clear differences inbuilt environments and culture.
A study of adults in Thailand had a limitedassessment of built environment variables, consistingof distance from home to a few destinations. 17)
Reported active transportation was related to distanceto shopping but not to distance to work or a religious
establishment. Active recreation was not related to
distance to the nearest recreation facility. This study
partially supported findings from prior studies.
Built environment studies have been conducted in
Latin America as well. A study in Bogota, Colombia
examined a wide range of environmental variables
among adults and reported walking for transportation
was related to street connectivity and proximity to
public transit stations, but not to mixed use andresidential density as in other countries. 18) One
interpretation was that almost all of Bogota is densely
populated and has mixed land use, so there is little
variation in those attributes. As in other countries,
recreational physical activity was related to proximity
to parks, but in a new finding, was also related toproximity to public transit. Because the vast majorityof people in Bogota do not have access to automobiles,
public transit may support several domains of physicalactivity. Reis and colleagues19) conducted a study ofadolescents and park use in Curitiba, Brazil. They
found being active in parks was related to having
sufficient space to be active, opportunity for a varietyof activities, and equipment available. Some
associations varied by sex, and it is difficult tocompare to studies from other countries, but findings
generally supported that built environment features
are important correlates of physical activity.
There is one published built environment study
conducted in Africa. This study of Nigerian university
students found several significant associations ofperceived environmental variables with physicalactivity, but about half of the associations were in theunexpected direction.20) This is the only study that
does not support the overall pattern of international
results. However, this study had an important
limitation that all participants lived on the same
university campus, so there was very little variation inenvironments. The environmental measure used may
not have represented well the African context.

International studies on built environments andphysical activity
Built environment studies conducted in diverse
countries are now appearing in the literature, and thissection gives examples of studies relevant to active
transportation and active recreation. The USA andAustralia are two of the least walkable countries, so it
has been questioned whether findings in thesecountries would be similar to results in countries withmuch higher walkability, such as in Europe. Twostudies of adults that used similar study designs andmethods to the USA study cited earlier 10) suggest
findings tend to generalize across countries. A Belgian
study reported differences of about 49 minutes
per week across high- versus low-walkability
neighborhoods in accelerometer-measured physicalactivity, very similar to USA results. 14) A Swedish
study found only about half the walkability effect (21minutes per week comparing high- and lowwalkability neighborhoods).15) Both European studies
and the USA study found strong associations withactive transportation. Though there were somedifferences in findings across continents, European
studies to date support the principle that neighborhood
walkability is related to active transportation and total
physical activity in the context of mostly highwalkable environments.
A recent study in Japan used different methods
to examine similar study questions. Inoue andcolleagues16) recruited adults in four cities withdiverse built environments and studied perceived
environment characteristics in relation to reported
physical activity for transportation and recreation
purposes. Components of walkability were related towalking for transportation, as were walking/cycling
facilities (such as sidewalks) and aesthetics. Walking
for recreation was related to walking/cycling facilities,
aesthetics, and perceived safety from traffic. The
Japanese findings were generally supportive of results

113

Res Exerc Epidemiol 2011; 13(2): 111-117.

Particularly strong evidence of the international
relevance of built environments comes from an
11-country study of adults that included countries
from Asia (Hong Kong/China, Japan, New Zealand),Europe (Belgium, Lithuania, Norway, Sweden, United
Kingdom), South America (Brazil, Colombia), andNorth America (Canada, USA).21) All countries had
7 common items assessing perceived environment
attributes as well as the same self-report measure of
total physical activity. Five of the seven environment
variables were related to meeting physical activity
guidelines: mixed land use, access to transit,
sidewalks, bicycling facilities, and low cost recreation
facilities. Only residential density and safety from
crime were not significant correlates. When an
index of favorable built environment attributes wasconstructed, those living in a neighborhood with themost supportive environments were twice as likely tomeet physical activity guidelines as those without any
supportive features. This study conducted in extremely diverse environments and cultures demonstrated
that built environments are strongly related to physicalactivity.
My own interpretation of these international studies
is that they provide strong support for the generalprinciple that built environments are important
contributors to physical activity. A second conclusion
is that several of the associations of specific built
environment attributes with physical activity domains
verified in systematic reviews 5-9) are often supported
by international studies. There are certainly someinconsistencies across countries, especially whenanalyzing by subgroups defined by sex andsocioeconomic status. However, findings related towalkability and its components, and access to parks
and recreation facilities, tend to be confirmed ininternational studies.

are to tailor measures and studies to optimize countryspecific results and to use international studies to
identify the most generalizable findings.
It is understood that behavioral research needs to be
specific to the context. Built environments differ
greatly across countries, and measures should assess
the most relevant attributes in each country. A good
example is the ALPHA project in which European
investigators identified the most promising attributes
that facilitated and hindered physical activity inEurope that were not represented in existing built
environment surveys. Then they developed andevaluated a survey that was appropriate for theEuropean context, building on measures validated
elsewhere.22) It would be useful for groups ofinvestigators to collaborate on regional built environment measures tailored for Asia, Latin America,
Africa and other regions. Current concepts andmeasures of activity-supportive built environments are
relevant to urban and suburban settings, but not torural areas. Thus, additional measurement development is needed within each region to develop
measures appropriate for rural areas. This work has
begun23) but needs to be expanded.
Use of built environments for physical activity may
be moderated by a variety of factors, such associodemographic variables and social environments.
For example, people are likely to use parks differently
depending on their age, sex, and family composition.
Perceptions of crime safety and traffic safety may
affect the extent to which people take advantage of
supportive
environments.
Despiteworldwide
variations in climate, there has been little study of
how extremes of heat, cold, and precipitation affectthe relation of built environments to physical activity.
Studies that identify effective strategies for adapting
to extreme climates would be particularly valuable.
More country-specific studies that examine social andphysical contextual factors of particular local
significance should improve both the science and thepolicy relevance of the studies.
Studies to date have confirmed that built
environment features are related to physical activity,
but they have not provided specific data that could be
useful in designing communities that are optimallysupportive of physical activity. Studies need to answer

Next steps in international research on built
environments and physical activity
There are two categories of next steps that I
recommend at the present time. One is to improve theinternational data base, and the other is to use theresearch to inform changes in policy and practice.
Two important aspects of improving the evidence base114

Res Exerc Epidemiol 2011; 13(2): 111-117.

questions related to the best range of walkability, howmany destinations are needed to stimulate walking fortransport among a variety of population subgroups,
how close do parks need to be to substantially increaseuse, and what types of amenities of parks and trails aremost likely to stimulate active use?
There is value in studies that use common methods
across countries and attempt to identify generalizableprinciples of environmental influences on physicalactivity. If it can be demonstrated that low-walkablecommunity designs, lack of sidewalks, and lack ofaccess to parks are contributing to epidemics ofphysical inactivity and chronic diseases in many
countries, that would increase the policy relevance ofthe data. The goal of the International Physical
Activity and Environment Network (IPEN) is tosupport a coordinated set of international studies toadvance knowledge on built environment correlates ofphysical activity (www.ipenproject.org). In addition
to encouraging use of common study designs and acommon core of measures to enhance comparability
among the hundreds of network members, IPEN is
conducting a study of adults in 12 countries using
detailed objective and perceived measures of built
environments as well as objective and domain-specificreported physical activity measures in most countries.
Because within-country studies have limited environmental variation that underestimates trueassociations, a major goal of IPEN is to represent
the worldwide variation in built environments.
Coordinated international studies of other age groups
are underwa y or planned, and the Council on
Environment and Physical Activity (CEPA) is also
supporting advancements in research and its application to policy and practice (http://www.ispah.org/
ispah-groups/ispah-groups/council-on-environmentand-physical-activity).
As stated at the beginning of the present paper,international efforts to use environmental and policy
strategies to increase physical activity worldwide2,3)
are a major rationale for placing high priority on built
environment research. However, merely conducting
the research and reporting it in scientific journals is
likely to have little or no impact on built environmentsor public health. Built environment research on
physical activity is relevant to policies made in city

planning, transportation, parks and recreation, sports,
housing, education, and health departments andministries. The research indicates likely consequencesof decisions made, but the decision makers do notread the scientific papers. Thus, specific efforts need
to be made to communicate the results of the research
to those who can use the information in their decision
making process. Though research is only one sourceof influence in policy decision making, it can be
influential at times.
Efforts are being made to encourage and prepare
researchers to communicate findings to those who can
put it into practice, and the approach to communication needs to be quite different from that usedwith scientific audiences.24,25) Though scientists canbe credible and effective spokespersons, they may not
be motivated to act in this capacity, and there arealternative approaches. For example, most countries
will have advocacy groups interested in influencing
policy in the multiple sectors relevant to physicalactivity. Those groups tend to be skilled in communicating research to policy makers and are motivatedto find and use research. Thus, sending research to
advocates may be an efficient way of inserting
research into the policy process.
There is growing evidence that decisions made inseveral sectors of society whose mission is not healthdo have substantial impact on physical activity. 5-9)
Because city planners, transportation engineers, andpark designers usually do not consider the effect of
their decisions on physical activity, research on built
environments is needed to provide insights into likely
health consequences of the environments they build.
Based mainly on research in the USA and Australia,
there is a consensus that walkability and access torecreation facilities is consistently, and perhaps
strongly, related to physical activity. 5-9) Thoughquestions have been raised about the extent to whichthese findings apply to very different environments
and cultures, there is recent confirmatory evidence
from diverse countries in Asia, South America, andEurope. Built environment associations with physicalactivity are largely replicated across countries,
suggesting there are generalizable principles about
how to build communities that facilitate people
being active for transportation and recreation. Built

115

Res Exerc Epidemiol 2011; 13(2): 111-117.

environment interventions are promising approaches
to combating the epidemic of inactive lifestyles, butcountry-specific research is needed to inform national
actions, and international research is needed to inform
international action.

Leisure Sciences. 2007; 29: 315-54.
9） Saelens BE, Handy SL. Built environment
correlates of walking: a review. Med Sci Sports
Exerc. 2008; 40(7 Suppl): S550-66.
10） Sallis JF, Saelens BE, Frank LD, Conway TL,
Slymen DJ, et al. Neighborhood built environment and income: examining multiple healthoutcomes. Soc Sci Med. 2009; 68: 1285-93.
11） Owen N, Cerin E, Leslie E, et al. Neighborhood
walkability and the walking behavior ofAustralian adults. Am J Prev Med. 2007; 33:
387-95.
12） Kaczynski AT, Potwarka LR, Saelens BE.
Association of park size, distance, and featureswith physical activity in neighborhood parks.
Am J Public Health. 2008; 98: 1451-6.
13） Reynolds KD, Wolch J, Byrne J, et al. Trailcharacteristics as correlates of urban trail use.
Am J Health Promot. 2007; 21(4 Suppl): 33545.
14） Van Dyck D, Cardon G, Deforche B, et al.
Neighborhood SES and walkability are related
to physical activity behavior in Belgian adults.
Prev Med. 2010; 50(Suppl 1): S74-9.
15） Sundquist K, Eriksson U, Kawakami N, et al.
Neighborhood walkability, physical activity, andwalking behavior: the Swedish Neighborhoodand Physical Activity (SNAP) Study. Soc Sci
Med. 2011; 72: 1266-73.
16）Inoue S, Ohya Y, Odagiri Y, Takamiya T, Ishii K,
et al. Association between perceived neighborhood environment and walking among adults in
4 cities in Japan. J Epidemiol. 2010; 20: 277-86.
17） Churangsarit S, Chongsuvivatwong V. Spatialand social factors associated with transportation
and recreational physical activity among adults
in Hat Yai City, Songkhla, Thailand. J Phys Act
Health. 2011; 8: 758-65.
18） Cervero RB, Sarmiento O, Jacoby E, Gomez L,
Nieman A. Influences of built environments on
walking and cycling: lessons from Bogotá.
Internat J Sustain Transport. 2009; 3: 203-26.
19） Reis RS, Hino AAF, Florindo AA, Anez CCR,
Domingues MR. Association between physicalactivity in parks and perceived environment: astudy with adolescents. J Phys Act Health.

Acknowledgment
This work was support by NIH grant number
CA127296.

References
1） World Health Organization. Global health risks:mortality and burden of disease attributable toselected major risks. WHO, Geneva, 2009.
http://www.who.int/healthinfo/global_burden_disease/en/.
2） World Health Organization. Global strategy on
diet, physical activity and health. WHO, Geneva,
2004.
3） Global Advocacy for Physical Activity (GAPA)
the Advocacy Council of the International
Society for Physical Activit y and Health(ISPAH). NCD Prevention: Investments thatWork for Physical Activity, 2011.
www.globalpa.org.uk/investmentsthatwork
4） Sallis JF, Cervero RB, Ascher W, Henderson
KA, Kraft MK, Kerr J. An ecological approachto creating active living communities. Annu Rev
Public Health. 2006; 27: 297-322.
5） Ding D, Sallis JF, Kerr J, Lee S, Rosenberg DE.
Neighborhood environment and physical activeity among youth: A review. Am J Prev Med.
2011. (in press)
6） Gebel K, Bauman AE, Petticrew M. The
physical environment and physical activity: acritical appraisal of review articles. Am J Prev
Med. 2007; 32: 361-9.
7） Heath GW, Brownson RC, Kruger J, Miles R,
Powell K, Ramsey LT. The effectiveness ofurban design and land use and transport policies
and practices to increase physical activity: asystematic review. J Phys Act Health. 2006; 3(Suppl 1): S55-76.
8） Kaczynski AT, Henderson KA. Envrionmental
correlates of physical activity: a review of
evidence about parks and recreation amenities.
116

Res Exerc Epidemiol 2011; 13(2): 111-117.

2009; 19: 503-9.
20） Oyeyemi AL, Adegoke BOA, Oyeyemi AY,
Sallis JF. Perceived environmental correlates ofphysical activity and walking in African young
adults. Am J Health Promot. 2011; 25(5):e10-9.
21）Sallis JF, Bowles HR, Bauman A, Ainsworth BE,
Bull FC, et al. Neighborhood environments andphysical activity among adults in 11 countries.
Am J Prev Med. 2009; 36: 484-90.
22） Spittaels H, Foster C, Oppert JM, et al.
Assessment of environmental correlates ofphysical activity: development of a European
questionnaire. Int J Behav Nutr Phys Act.

2009; 6: 39.
23） Yousefian A, Hennessy E, Umstattd MR,
Economos CD, Hallam JS, et al. Developmentof the rural active living assessment tools:
measuring rural environments. Prev Med. 2010;
50(Suppl 1): S86-92.
24） Brownson RC, Royer C, Ewing R, McBride TD.
Researchers and policymakers: travelers inparallel universes. Am J Prev Med. 2006; 30:
164-72.
25） Shilton T. Creating and making the case: Global
advocacy for physical activity. J Phys Act
Health. 2008; 5: 765-76.

117