How can we measure walkability for the pediatric population? A protocol for a systematic review of the literature.
Creators: name: Gori, Davide
name: Rochira, Andrea
name: Ubiali, Andrea
name: Raguzzoni, Gloria
name: Fantini, Maria Pia
Publisher: name: figshare
Year: 2018
Subjects: subject: 111706 Epidemiology
subject: FOS: Health sciences
subject: FOS: Health sciences
subject: 111799 Public Health and Health Services not elsewhere classified
subject: 111716 Preventive Medicine

description: Physical inactivity among children and adolescents is considered nowadays a major public health problem, being an important determinant for chronic disease. A sedentary lifestyle can significantly increase the risk of developing conditions such as type 2 diabetes, cardiovascular disease, obesity and cancers. Despite the World Health Organization’s (WHO) guidelines recommending at least 60 minutes of daily moderate to vigorous physical activity (PA), most part of the world’s pediatric population is still not active enough. It is estimated that 80% of the adolescents aged 11-17 years in 105 countries of the world do not achieve the target of recommended PA. The spread of a sedentary lifestyle throughout all daily activities has, in fact, determined a decreasing trend in children’s PA levels in the last decades. Several factors are implicated in influencing global PA levels in a community, including individual factors, social factors and environmental factors. The relevance of environmental factors, particularly those related to built environment, is growing since the number of persons living in urban settings is rapidly increasing. WHO suggests that developing urban environments supportive for PA and active transport would be a key strategy to face global sedentary habit<sup>,</sup>. In order to do that, however, specific environmental factors influencing PA levels have to be identified and then effectively defined and measured. Recent works in urban health focused on the concept of “walkability”. The term has been used to define the degree to which an area’s built environment is conducive to walking and active commuting. Evidence shows a correlation between high walkable areas and higher levels of active transport among resident children. Evidence available though is from cross-sectional studies, while longitudinal ones are still lacking, so limiting the possibility to draw causal and timing inference. Some authors, furthermore, identified the lack of standard definitions and measures as one major flaw on this topic. Different tools and methods can be used to assess built environment. The consistency of association with PA was found to vary mostly according to the method of choice. Moreover, since many environmental factors are potentially able to influence walking and active transport, it’s not clear which walkability variables should be included for the assessment. Lack of standards and shared methods inhibits synthetization of findings from different sources. Finally, it is important to note that standards should not be universal, but subgroup specific, since defined populations can have specific needs based on their socio-economic and demographic characteristics. Aim of our study will be to systematically review the scientific literature in order to browse and describe all possible methods and tools that have been used to measure walkability in pediatric population, as well as the environmental variables assessed.