Systematic literature review of built environment effects on physical activity and active transport – an update and new findings on health equity
Smith et al. International Journal of Behavioral Nutrition and Physical Activity
Systematic literature review of built environment effects on physical activity and active transport - an update and new findings on health equity
Melody Smith 0
Jamie Hosking 2
Alistair Woodward 2
Karen Witten 1
Alexandra MacMillan 6
Adrian Field 5
Peter Baas 4
Hamish Mackie 3
0 School of Nursing, The University of Auckland , Private Bag 92019, Auckland 1142 , New Zealand
1 SHORE and Whāriki Research Centre, School of Public Health, Massey University , Box 6137, Wellesley Street, Auckland, PO , New Zealand
2 School of Population Health, The University of Auckland , Private Bag 92019, Auckland 1142 , New Zealand
3 Mackie Consulting Limited , Box 106525, Auckland, PO 1143 , New Zealand
4 Transport Engineering Research New Zealand Limited , Box 11029, Auckland, PO 1542 , New Zealand
5 Dovetail Consulting Ltd , Box 78-146, Grey Lynn, Auckland, PO 1245 , New Zealand
6 Dunedin School of Medicine, University of Otago , Box 56, Dunedin, PO 9054 , New Zealand
Background: Evidence is mounting to suggest a causal relationship between the built environment and people's physical activity behaviours, particularly active transport. The evidence base has been hindered to date by restricted consideration of cost and economic factors associated with built environment interventions, investigation of socioeconomic or ethnic differences in intervention effects, and an inability to isolate the effect of the built environment from other intervention types. The aims of this systematic review were to identify which environmental interventions increase physical activity in residents at the local level, and to build on the evidence base by considering intervention cost, and the differential effects of interventions by ethnicity and socioeconomic status. Methods: A systematic database search was conducted in June 2015. Articles were eligible if they reported a quantitative empirical study (natural experiment or a prospective, retrospective, experimental, or longitudinal research) investigating the relationship between objectively measured built environment feature(s) and physical activity and/or travel behaviours in children or adults. Quality assessment was conducted and data on intervention cost and whether the effect of the built environment differed by ethnicity or socioeconomic status were extracted. Results: Twenty-eight studies were included in the review. Findings showed a positive effect of walkability components, provision of quality parks and playgrounds, and installation of or improvements in active transport infrastructure on active transport, physical activity, and visits or use of settings. There was some indication that infrastructure improvements may predominantly benefit socioeconomically advantaged groups. Studies were commonly limited by selection bias and insufficient controlling for confounders. Heterogeneity in study design and reporting limited comparability across studies or any clear conclusions to be made regarding intervention cost. Conclusions: Improving neighbourhood walkability, quality of parks and playgrounds, and providing adequate active transport infrastructure is likely to generate positive impacts on activity in children and adults. The possibility that the benefits of infrastructure improvements may be inequitably distributed requires further investigation. Opportunities to improve the quality of evidence exist, including strategies to improve response rates and representativeness, use of valid and reliable measurement tools, cost-benefit analyses, and adequate controlling for confounders.
Walking; Cycling; Health equality; Urban form; Causation; Playgrounds; Walkability
Physical activity is fundamental to human health and
]. Insufficient physical activity is a major
contributor to the occurrence of non-communicable
diseases and is responsible for about 9% of premature
mortality globally [
]. Increasing focus is being placed on
the role of the built environment in promoting physical
activity, recognising the sustained nature and potential
for broad reach of environmental interventions, and the
potential to promote substantial changes in
populationlevel physical activity . Active transport also
contributes to health-promoting levels of physical activity [
In addition, replacing motorised trips with active forms
of transportation also brings numerous co-benefits, such
as reduced traffic congestion; improved air quality; and
reduced fatalities due to traffic, air pollution, and
]. Accordingly walking and cycling for
transport are particular behaviours of interest for researchers
and policy-makers alike.
A growing body of evidence shows clear associations
between the neighbourhood built environment and
physical activity behaviours [
systematic reviews of the literature have shown that
environments characterised as more walkable (i.e., facilitating
walking through higher destination accessibility, street
connectivity, presence and quality of active transport
infrastructure, etc.) are associated with physical activity
accumulation for both children and adults [
McCormack et al. [
] systematically examined the
relationship between physical activity and
objectivelyassessed built environment, improving on earlier reviews
by only including cross-sectional studies that adjusted
for self-selection, and quasi-experiments. Findings
showed land use mix, connectivity and population
density and overall neighbourhood design (i.e., walkability,
neighbourhood type) were “important determinants of
physical activity”. Similarly, Mayne et al. [
systematically examined the impact of natural or
quasiexperimental studies of built environment changes on
physical activity. Findings showed greater impacts on
physical activity of interventions that were designed to
impact active transport. Stronger results were also
reported in papers where specific activity constructs (e.g.,
walking or cycling, rather than total physical activity)
Relationships may differ depending on the physical
activity construct of interest (e.g., active transport, such as
walking or cycling for transport, versus leisure time
physical activity) and the type of intervention [
12, 28, 29
particular, environmental features may be more closely
related to active transportation than overall physical activity
or recreational activity [
]. Indeed, reviews have
consistently shown associations between active transport and
built environments that are characterised as “walkable”,
including aspects of active transport infrastructure
14, 16, 30, 31
]. Less is known with regard to cycling. A
systematic review showed cross-sectional associations
between cycling and the presence of dedicated cycle
routes or paths, separation of cycling from other
traffic, high population density, short trip distance, and
proximity of a cycle path or green space . For
children, an association has been demonstrated between
cycling and the promotion of ‘safe routes to school’
]. Negative environmental factors were traffic
danger, long trip distance, steep inclines and distance from
cycle paths. This review also demonstrated some
evidence for causality with statistically significant impacts
of new cycle routes on cycling prevalence from a
limited number of studies [
]. Similarly in their
systematic review, Yang et al. [
] observed modest increases
in cycling associated with high quality cycling
Relationships may also differ by population group (e.g.,
children, adults) [
]. Associations for children seem
more complex than for adults, with inconsistencies in
relationships observed [
], although this may in part be
due to the limited evidence base. In their systematic
review and meta-analysis of built environments and
physical activity in children and youth, McGrath et al.
] reported adolescents’ physical activity was positively
associated with walkability features, play facilities, parks
and playgrounds, but these relationships were negative
for younger children. Even less is known with regard to
older adults, though one systematic review of
quantitative and qualitative research reported environmental
associates of physical activity in this population, including
street lighting, destination accessibility, and pedestrian
The quality of the built environment may be an
important contributor to health inequalities, especially by
influencing opportunities for active transport. To the
authors’ knowledge, only one systematic review published
to date has considered the impact that
sociodemographic factors may have on the efficacy of built
environment interventions [
]. In their systematic review,
Schüle et al. [
] included only studies that
simultaneously considered at least one indicator of
“neighbourhood socioeconomic position” (e.g., socioeconomic
status, SES) and adjustment for at least one individual
socioeconomic factor (ethnicity alone was not
considered sufficient) in multilevel modelling of the relationship
between the built environment and health outcomes.
Almost all the studies in this review showed interactions
between “neighbourhood socioeconomic position” and the
built environment or individual characteristics, or between
the built environment and individual characteristics
(including “individual socioeconomic position”). However,
substantial heterogeneity in study design and reporting of
results hindered any ability to generate clear insights.
Hopgood et al. [
] found that traffic calming intensity
was more common around less deprived schools in
Auckland, New Zealand, whereas Zhu et al. [
that schools in Austin, Texas with higher proportions of
poor or Hispanic students had better sidewalks and
walkability. Interventions to improve the built environment
may also have important effects on health equity, for
example, improved infrastructure may be used more often by
residents with a higher educational or income level [
Transport infrastructure is expensive but given the
substantial economic burden caused by physical
], built environment interventions that help people
get active and stay active may be attractive options from
a cost-benefit perspective. In terms of benefit:cost ratios,
active transport interventions tend to compare well to
other major transport investments, such as new roads or
public transport [
]. Studies in this field use a range
of methodologies and processes to describe and evaluate
infrastructural interventions and to model economic
outcomes. Even so, findings from a 2008 systematic
review reported large positive benefit:cost ratios for walking
and cycling infrastructure interventions, with median
magnitudes of 5:1 . An updated systematic review
reported benefit:cost ratios ranging between −39:1 to 59:1,
with positive ratios reported by 26 of the 32 studies
included (81%) [
]. More information is needed about
specific infrastructural factors at a local level to guide specific
investment and planning decisions.
Often, changes in the built environment, experienced
either by changing residential location or by intervention
in a familiar setting, do not occur in isolation. For
example, infrastructural interventions may have associated
social media campaigns or supplementary programmes
to support behaviour change [
]. It is challenging, yet
important, to tease out the effect of built environment
changes on physical activity behaviours to enable
effective decision making for planning and resourcing
environmental change interventions. In one systematic review
all included studies that combined built environment
and physical activity promotion interventions were
reported as being effective in increasing activity, while only
half of the built environment intervention only studies
showed a positive impact on activity [
]. Only one
study in this review was concerned solely with physical
activity promotion, limiting comparability between the
Notwithstanding frequent calls for research to
understand causality [
19, 21, 28, 39
], until recently, the
evidence base has remained predominantly cross-sectional.
Likewise, despite calls for studies to improve specificity
by examining behaviour-specific environmental
attributes and improve objectivity in environmental
], numerous gaps still remain. The lack of
evidence has been attributed to gaps in collaboration
between disciplines (e.g., research, urban planning) [
cost of conducting quality research [
complexities in evaluating interventions [
] and modelling their
effectiveness across population groups [
]. These are
substantial barriers, but there has recently been an
increase in studies utilising objective and
behaviourspecific measures where causality can be inferred (e.g.,
longitudinal studies, controlled trials).
Some of the difficulties faced in assessing this broad
evidence base include variable study quality, insufficient
(or no) quality assessment of articles included in reviews
], a narrow focus on specific population groups or
behaviours of interest (restricting understanding from a
broader population health perspective), and the
predominance of cross-sectional studies (reducing ability to
understand causality). There is a dearth of systematic
reviews that: (a) consider cost and economic factors
associated with built environment interventions, (b) describe
socioeconomic or ethnic differences in intervention
effects, or (c) where the ability to isolate the effect of the
built environment from other intervention types is
For these reasons, we believe it is timely to re-examine
the evidence base, with a focus on updating and
improving on previous reviews, by: (1) only including studies
where causality can be implied, (2) considering
intervention cost, (3) examining whether intervention effects
differ by ethnicity or SES, (4) conducting rigorous article
quality assessment, (5) including all age groups and
physical activity behaviours, and (6) attempting to isolate
the effect of the built environment from other
interventions occurring in studies. Our aims are to: (1) conduct
a new systematic review to identify which environmental
interventions increase physical activity in residents at
the local level, with the goal of informing future policy
and practice in community design; and (2) to build on
the limited evidence base on the effectiveness of built
environment interventions for influencing health
inequalities by systematically exploring the effectiveness of
these interventions by ethnicity and SES.
The review protocol was prepared following the
PROSPERO International prospective register of systematic
reviews protocols [https://www.crd.york.ac.uk/prospero/]
and published on figshare [
Articles were eligible if they reported a quantitative
empirical study (natural experiment or a prospective,
retrospective, experimental, or longitudinal research
(including repeated cross-sectional surveys)) investigating
the relationship between objectively measured built
environment feature(s) and physical activity and/or
travel behaviours in children or adults. Qualitative
studies, or those that did not measure change in both the
independent and dependent variables were excluded. For
trials, no control group was required for the study to be
included in the review.
A systematic search of Scopus, Ovid (all journals),
ProQuest Science, ProQuest Social Science, and the
Transport Research International Documentation database
(comprising the US Transportation Research Board’s
Transport Research Information Services database and
the Organisation for Economic Co-operation and
Development Joint Transport Research Centre’s International
Transport Research Documentation database), was
conducted by the lead author (MS) in June 2015. Databases
were identified in consultation with a subject-specific
librarian, and the wider research team comprising
specialists in transport, built environments, physical activity,
active transport, epidemiology, and health. We
acknowledge the value of grey literature in some circumstances
but did not include studies reported in this form in this
study. We sought the most robust evidence available,
ensuring our methods were as robust and replicable as
], and reducing the risk of bias in outcome
reporting that may occur in the grey literature, for instance
in settings where funding for infrastructural work is at
stake. Bibliographies of included articles were also searched
for possible relevant articles (using the article title).
Keyword searches of article abstracts and titles were
conducted using three categories: 1) environments, 2)
physical activity or travel modes, and 3) natural
experiments, or prospective, retrospective, experimental, or
longitudinal. Search terms were identified from MeSH
subject headings in PubMed, previous similar reviews
5, 12, 46
], and the knowledge and expertise of the
research team. Test searches were conducted to gauge
the sensitivity and specificity of the search terms, and
amendments were made accordingly. Searches were
limited to English-language articles that were
published or in press, with no date restrictions. The final
search strategy is outlined in Additional file 1.
Titles and abstracts of articles were screened by the lead
author and included if they met the eligibility criteria.
Where it was unclear whether articles met the inclusion
and exclusion criteria from the abstract and title,
fulltext articles were sourced. Where bibliography searches
identified article titles as possibly relevant, article
abstracts were sourced and screened using the above
criteria. All processes (i.e., identification of articles, data
extraction, quality assessment) were duplicated by a
coauthor (JH) with a random selection of 10% of each
]. Any disagreement was resolved through
discussion, and any necessary amendments made to each
For the purposes of this examination, a relatively
broad definition of built environment was used, with the
aim of identifying and understanding the range of
modifiable factors in the external neighbourhood
environment that may impact people’s physical activity or travel
behaviours. Accordingly, ‘built environment’
encompassed either interventions or changes occurring at the
individual level (e.g., due to moving), or at the local,
neighbourhood, or town scale. Measures were all
objective and included geographic information
systemsderived variables (e.g., dwelling density, distance to
destinations), community infrastructural or streetscape
intervention typologies (e.g., shared spaces, naked
streets), natural or built aesthetic factors in the
neighbourhood environment (e.g., tree planting, signage,
wayfinding), and measures of other relevant
environmental supports for physical activity or active travel
(e.g., playground features). Recognising the
contribution that public transport use can make to physical
activity accumulation [
], studies assessing
changes in access to public transport (e.g., distance to
closest public transport stop, park-and-ride
interventions) were also eligible. As the focus was on being
able to isolate the effect of built environment features
or interventions, studies investigating aggregate
measures (e.g., walkability, walk score), or studies
combining infrastructural and “soft” (e.g., awareness
programmes, social media, organised programmes)
interventions where the effect of the infrastructural
intervention could not be isolated were not included.
Conversely, studies that included infrastructural and
soft interventions but where findings enabled the
effect of the infrastructural intervention to be isolated
Likewise, a broad approach was taken to defining
physical activity for this review – encompassing all types
and dimensions of self-reported or objectively assessed
physical activity (e.g., recreational walking, habitual
physical activity, moderate-to-vigorous physical activity).
Physical activity could be assessed retrospectively,
prospectively, using repeated cross-sectional surveys or
direct observation, or before and after an intervention.
While acknowledging the limitations of recall,
welldesigned retrospective studies offer a “plausible
alternative to prospective longitudinal data collection” [
to time efficiency, lack of panel attrition, cost
effectiveness, and quality of survey instruments (as earlier
measures may be obsolete).
Data extraction and quality assessment
A study-specific data extraction form (available in
Additional file 2) was generated from a previous
systematic review of health impacts of new roads [
] and the
Effective Practice and Organisation of Care data
collection form [
]. Data were extracted for all included
articles across seven categories: general information,
population and setting, methods, participants,
intervention groups, outcome measures, and results. In addition,
data were extracted on whether the effect of the built
environment differed by ethnicity or SES. Studies were
eligible for the latter if they reported effect estimates
stratified by ethnicity or SES, or examined effect
modification/interactions between the intervention or exposure
variable and ethnicity or SES. Eligible measures of
ethnicity included self-reported or objectively assigned
ethnicity or race. Eligible measures of SES included income,
educational level, occupation and home ownership, as
well as composite indices such as those for deprivation.
SES could be measured at an individual or area level.
Area-level SES measures were only eligible if the SES
variable was calculated for a smaller area than the study/
intervention area (e.g., meshblock-level deprivation [
calculated in a community-wide project that included
Strength of evidence was determined using the
Evaluation of Public Health Practice Projects Quality
Assessment Tool (EPHPP) as employed in previous similar
], and adapted to improve the suitability
for assessing articles included in this review  as
outlined in Additional file 3. EPHPP scoring criteria are
provided in Additional file 4. Adaptations were made as
a consequence of the duplicate quality assessment
process whereby the reviewers identified a number of
necessary clarifications to facilitate consistency in
scoring. These changes did not impact the final quality
Summary measures, synthesis of results and quality
assessment/risk of bias across studies
The key outcomes of interest were physical activity
(selfreported, observed, or objectively assessed), active
transport (self-reported or observed), and visitation to or use
of a setting (e.g., counts of riders on new cycleways;
counts of playground users). Findings were collated for
each of these outcome measures and considered
separately by population subgroups (children, adults).
Findings were also summarised in the context of study
quality to gauge risk of bias and understand the strength
of evidence provided.
Figure 1 provides the flow diagram of articles included
and excluded from the review [
]. Of the 12,082 articles
identified, 2282 were duplicates, 9757 were excluded at
title or abstract stage, and 43 were assessed at full text
stage. In total, 28 articles met the inclusion criteria for
Key characteristics of studies included are provided in
Table 1. The majority of studies were controlled repeat
cross-sectional examinations (n = 8), followed by
uncontrolled repeat cross-sectional studies and uncontrolled
longitudinal studies (both n = 6). Almost three-quarters
(71%) of studies were conducted in the USA, with the
remainder from Australia (n = 4), and Belgium, England,
Scotland, and New Zealand (all n = 1). A majority of
studies focused on all age groups (n = 13) or adults only
(n = 12). Three (11%) focused on children and no studies
focused specifically on older adults. Intervention types
varied widely, but predominantly involved infrastructural
interventions for facilitating walking and cycling (e.g.,
bicycle boulevards, installation of cycle lanes, improving
sidewalks, etc.). Park and playground improvements or
development also featured regularly. Walking for leisure
or transport was assessed in seven studies, cycling in
two, and overall active transport in six studies. Where
observation of active transport occurred, two studies
directly observed cyclist counts only, and two undertook
counts of pedestrians and cyclists.
Study quality assessment results are provided in Table 2.
Using the EPHPP criteria, only one study was rated as
strong (i.e., having no components with a weak rating),
and a majority (75%) were rated as weak. No studies
rated as moderate or strong assessed walking or cycling
separately from each other. Selection bias was the
quality component most frequently rated as weak. In many
cases this was a consequence of undertaking direct
observation of park users, where no measures of
representativeness could be ascertained. In general, studies
lacked robust means of ensuring generalisability. The
use of direct observation made it difficult to fully control
for confounders. Relevant information on traffic and
street type was also frequently missing in studies that
assessed the effectiveness of streetscape interventions.
Of the studies where it was appropriate (i.e., where there
was a control/comparison group or site), 28% reported
on consistency between treatment conditions. Five
studies noted distance between treatment sites, but no
studies measured contamination directly. Cost of the
intervention was reported in seven studies, all of which
were conducted in the US. These ranged from
US$45,000 per park for implementation of fitness zones
to US$5.5 million for two major playfield renovations.
Records identified through database searching (n = 12,082)
Records screened (n = 9,800)
Full-text articles assessed for eligibility (n = 43)
Studies included in quantitative synthesis (n = 28)
Duplicate records excluded (n = 2,282)
(n = 9,757)
n = 9,106 at title
n = 643 at abstract
n = 8 conference presentations
Full-text articles excluded
(n = 15)
n = 7 could not isolate effect of BE
n = 5 measures at one time point only
n = 2 no objective BE measures
n = 1 no English full-text
Differential effects by ethnicity or socio-economic status
Four studies investigated whether built environment
effects differed by ethnicity/race or SES, using a range of
different approaches. The iConnect CBA study of new
walking and cycling routes in three UK municipalities
over two years found no significant interaction between
the intervention and education, income or employment
when using walking and cycling as the outcome [
When examining use of the infrastructure, lower
educational level and income, but not ethnicity, were
associated with less use. Compared with an annual income of
>£40,000, an income of <£20,000 was associated with a
23% lower likelihood of infrastructure use. Having less
than tertiary-level educational level, compared with
tertiary education, was associated with a 10–20% lower
likelihood of infrastructure use, though the effect was
only statistically significant at one-year (not two-year)
follow-up. People who were not working, who were
retired or were students (compared with working people)
were less likely to use the infrastructure at two-year
follow-up. Students were particularly unlikely to use the
infrastructure (relative ratio = 0.20) [
A randomized controlled trial of the effects of Los
Angeles park improvements informed by community
engagement found a significant increase in the
number of white park users, but no significant changes
for black, Hispanic or other users [
]. Installation of
a one-mile bike lane in New Orleans was associated
with increases in mean daily cycling counts on the
intervention street for both whites (from 48.9 to
192.9/day) and blacks (from 22.8 to 61.3/day; results
for other racial/ethnic groups not reported), while
cycle counts on adjacent control streets dropped
post-intervention. The interaction of intervention,
time and race/ethnicity was not statistically significant
]. In a longitudinal study across several US cities,
the effect of change in neighbourhood recreational
facility density on change in recreational physical
activity (mean follow-up 3.2 years) did not differ
significantly by income or race/ethnicity [
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Impact of built environment on physical activity, active
transport, or visitation/use of settings
Table 3 summarises the key findings in relation to the
impact of the built environment on physical activity, active
transport, and visits or use of settings. With the exception
of two studies showing no significant impact [
one finding a negative impact , all others reported a
significant positive impact on the outcomes of interest.
For those studies rated higher quality (i.e., moderate or
strong ranking using the EPHPP criteria), significant
positive impacts were found for the following:
Interventions involving multiple streetscape
improvements on active transport in children, and
on physical activity in adults [
Installation of park or playground equipment and
active transport and physical activity in adults
Multiple component park renovations on children’s
physical activity (for children of lower body size
Temporary road closures and provision of play
equipment on children’s physical activity [
Increased density of recreation facilities in the
neighbourhood on physical activity in adults [
The aims of this systematic review were to provide an
update on the evidence for the impact of the built
environment on physical activity behaviours, and to
systematically explore the effectiveness of these
interventions by ethnicity and SES. Drawing from best
practice, we took a systematic approach to identifying
and screening literature, data extraction, and quality
assessment of relevant literature.
aStrength of evidence determined by quality assessment rating of each study using a modified version of the Evaluation of Public Health Practice Projects Quality
Assessment Tool (EPHPP) as described in the supplementary information (Additional File 3)
bEffect for school transport mode only
cModerating effect of body size, whereby intervention was effective in increasing activity in children of lower body size, and decreased activity in children of
higher body size
~ Inconsistent results or no impact of built environment on physical activity behaviour(s) or visitation/use of setting(s)
↓ Negative impact of built environment on physical activity behaviour(s) or visitation/use of setting(s); weak evidence
↑ Positive impact of built environment on physical activity behaviour(s) or visitation/use of setting(s); weak evidence
Findings showed a consistent positive effect of
walkability components, provision of quality parks and
playgrounds, and installation of or improvements in active
transport infrastructure on active transport, physical
activity, and visits or use of settings. Impacts on activity
dimensions were observed in line with expectations (e.g.,
walkability components were related to active transport)
]. Additionally, some interesting patterns emerged
whereby improvements in non-specific activity
dimensions occurred, such as installation of fitness or
playground equipment increasing active transport to that
setting, and improving the streetscape for walking and
cycling increasing physical activity behaviours beyond
active transport. Positive impacts were observed for
children and adults alike, although there was a paucity of
research including older adults. Taken together, these
findings provide new evidence for the substantial
promise that built environment interventions hold for
improving physical activity behaviours across a population
and are in keeping with previous systematic reviews
]. There remains a substantial gap in
understanding relationships with cycling behaviours. None of the
studies rated as strong or moderate quality assessed
cycling independently of other active transport modes.
Most analyses found no statistically significant
differences in intervention effect by ethnicity or SES.
However, one study found that new walking and cycling
routes were used more by people with higher incomes,
higher educational level and by people who were
currently employed. Another study of park improvements
found increased number of white users, but no
significant change for black, Hispanic or other park users.
Although these two studies provide a limited basis from
which to draw inferences, the possibility that
infrastructure improvements may predominantly benefit
socioeconomically advantaged groups warrants further exploration
in future evaluations.
As identified in previous reviews, there was substantial
variability in the methodology, measures, and analytical
processes used to evaluate the impact of environmental
interventions. Overall, this made comparisons between
studies and intervention delivery approaches difficult. In
part, this variability may be a by-product of the
significant differences in intervention typologies and associated
research designs. There remains, however, a need for
improved study quality, which may mitigate this somewhat
(e.g., consistent application of objective assessment of
physical activity, including appropriate control
conditions, employment of strategies to improve response
rates, adequate consideration of confounders, etc.). Our
quality assessment rated three-quarters of included
studies as weak. Studies were frequently limited by lack of
representativeness and generalisability.
In most cases, blinding was not described in studies.
Following the scoring protocol of the EPHPP, this earned
a “Moderate” rating. It is worth noting there are ethical
issues to be considered with participant blinding (such
as informed consent), and that these can sometimes
conflict with quality assessment criteria, where blinding
is desirable to reduce bias associated with participant
self-report or reactivity [
]. We chose to retain this
category for consistency with the EPHPP and previous
research that has used this tool. An indepth consideration
of the issues surrounding the evaluation of blinding in
quality assessment is beyond the scope of this review,
but should be taken into account in future reviews in
Few studies comprehensively controlled for
confounders. While sex and age were commonly controlled
or stratified for in analyses, only some included robust
measures of SES or ethnicity. Depending on study
design, area-level SES (and ethnicity characteristics) may
suffice in order to mitigate challenges around collecting
these data at the individual level. In their systematic
review, Schule et al. [
] recommended the use of
comparable characteristics of neighbourhood-level SES in
studies of the built environment, recognising the need to
“disentangle health impacts and identify vulnerable
neighbourhoods and population groups”.
Issues around contamination and consistency across
intervention sites were rarely considered and were not
controlled for in any analyses. Future studies would also
benefit from considering neighbourhood self-selection as
a possible confounder. In their systematic review,
McCormack et al. [
] reported “an attenuation in
associations between built environment characteristics and
physical activity after accounting for neighbourhood
self-selection”. Likewise, baseline activity was rarely
controlled for in analyses. One recent study to consider this
factor revealed that existing cycling behaviour, as well as
distance to the intervention site, was associated with
increased use of a new bike path in Australian adults [
Overall, there was a lack of research specific to
children or older adults. It is possible that the adult-centric
approach to characterising built environments may not
be sufficiently capturing environments that matter to
younger populations. For example, in their earlier
review, Sugiyama et al. [
] found no link between route
safety and traffic features and adults’ utilitarian and
recreational walking, while these factors have previously
been linked with children’s active transport [
recent systematic review showed that where youth physical
activity was geo-located (i.e., with global positioning
systems devices and geographic information systems),
greater proportions of activity took place in streets and
urban venues than in green spaces [
In keeping with Hunter et al. [
], reporting of
intervention costs was uncommon in the studies included in
this review. The lack of clear and consistent reporting of
intervention cost limited any ability to determine
whether a relationship existed between expenditure and
behaviour change, and whether costs differed
significantly between intervention types. This may also lead to
bias in studies of benefit:cost analyses for built
environment interventions because only a small portion
of evidence is presented, and it is not clear why some
studies report costs and other don’t [
the low quality of evidence found overall negatively
impacts confidence in estimations of cost-effectiveness of
built environment interventions . Given that the
costs of included interventions varied widely (ranging
from USD45,000 to USD5.5 million in the current
study), it is essential that clear reporting of intervention
costs occurs, and that intervention studies also include a
Compared with infrastructural interventions,
relocation studies are less hindered by infrastructural cost.
RESIDE is perhaps the first study of its kind – a natural
experiment involving longitudinal data collection with
new residents of new housing developments [
study commenced in 2003 prior to participants moving,
with follow-up data collection occurring with
participants approximately 12 months after their baseline
(premoving) survey. Improvements in walkability
(specifically, objectively-assessed destination accessibility,
residential density, street connectivity, and access to/
availability of public transit) were associated with
increases in physical activity and use of active transport
]. This important study demonstrates the value of
well-designed residential relocation studies.
The substantial inconsistency in timing and number of
follow-up measures post exposure (i.e., through
intervention or moving) limits a clear understanding of the
impact of the built environment on physical activity. In
their systematic review of natural or quasi-experiments,
Mayne et al. [
] found that stronger impacts on
physical activity were found where studies included longer
follow-up times. This phenomenon was observed in the
iConnect study, in which no effect on behaviour was
observed one year after a major environmental
intervention, but significant changes were found at the two-year
]. Pragmatic and economic factors may
limit the feasibility of repeated and longer-term
followup periods in this research field, but where possible this
should be encouraged.
Finally, it is possible that publication bias affected the
balance of studies included in this review. In general,
registration or public release in other forms of study
protocols prior to the publication of findings provides a
check on selective reporting of study results.
Strengths and limitations
This systematic review focused on physical activity
behaviours and use or visitation of settings, and did not
include more distal health measures such as body size
]. While these outcomes are unquestionably
important, this approach was taken recognising that: (a) a
substantial period of time exists between sustained activity
behaviours and manifestation of associated health
outcomes, and (b) studies in this field rarely examine effects
of the built environment on activity behaviours for a
sufficient period of time to expect meaningful changes in
health outcomes that are downstream from improved
physical activity behaviours.
The broad inclusion criteria used here are a strength,
drawing on studies across all quality assessment
categories as well as considering findings in light of study
quality. However, the exclusion of grey literature could have
been a limiting factor, in that it is possible that
significant new lines of inquiry might have been overlooked.
While acknowledging the important role of
perceptions on the relationship between the built environment
and activity behaviours [
], this review focused only
on objectively assessed built environment features. The
association between the built environment and activity
varies, depending on whether perceived or objective
measures are used [
]. Moreover these
differences are not consistent, and vary along with individual
factors such as education level, income, body size, and
physical activity [
]. Individuals who are more
physically active may be more familiar with their local
environment, and more aware of both positive and negative
features, than those who are less active . In the
interest of providing clear and direct information to inform
policy and practice that was not complicated or hindered
by individual perceptions, we chose to focus on objective
measures of the environment. Future reviews may
consider replicating the current study with a focus on
perceived environmental features only, while others may
undertake the task of considering both objective and
subjectively-assessed environments. There is an
emerging body of research that simultaneously considers both
objective and subjective measures of the environment in
relation to physical activity [
]; offering challenges and
opportunities for future reviews in this area.
Our focus was on being able to isolate the effect of
specific built environment features or interventions, thus
studies that employed aggregate measures (e.g.,
neighbourhood walkbability) were excluded from this review.
A range of robust studies exist in the field that have
utilized aggregate measures [
]. The exclusion of this
research limits an understanding of the combination of
features that encompass a pedestrian or cyclist friendly
environment. However, this approach was taken in the
interest of generating specific findings that could be
translated into policy and practice. Measures that
combine variables may be difficult to interpret, if it is not
possible to determine which components are most
effective. Future reviews with differing aims could
consider including aggregate scores, and might extend this
to broader aggregate concepts such as obesogenic
There have been calls for more systematic approaches
in reviews in this field [
]. This study employed robust
systematic procedures following best practice, and
improved on existing reviews by conducting quality
assessment of articles, considering article quality when
summarising results, including literature for children
and adults, excluding cross-sectional studies, and
attempting to isolate the effect of the built environment
from other interventions occurring in studies. With the
intent of providing evidence from the most robust
evidence possible and undertaking a process that was as
replicable as possible, as well as drawing from existing
high quality reviews in this field [
12, 14, 16, 30, 31, 46
this review did not include grey literature or involve
forwards citation searches. Future reviews may undertake
these processes to capture an evidence base that is as
broad and up-to-date as possible [
]. Although our
global quality assessment score does not include
measures of study contamination, consistency, health equity,
or intervention cost, these factors were systematically
considered and presented in the context of
understanding the overall quality of studies presented in this
The systematic and comprehensive approach to
examining study quality and contextualising findings in light of
study quality in this review adds strength to the evidence
base for the positive impact of built environments on
physical activity behaviours, active transport, and visits
to/use of activity settings. Improving neighbourhood
walkability, quality of parks and playgrounds, and
providing adequate active transport infrastructure is likely
to generate positive impacts on activity in children and
adults. Specifically, findings from the current review
suggest that the following show promise for increasing
active transport and physical activity levels in children and
adults: multiple streetscape components for walking or
cycling (including two or more of: crosswalk and
sidewalk improvements, improved and covered bike parking,
installation of traffic calming features (raised platforms,
zebra crossings) and parking bays; creating safe places to
walk); bike boulevard/lane installation; new greenways;
traffic free bridges and boardwalks; installation of
fitness/playground equipment; multiple park renovations
(including two or more of: new equipment, walking
tracks, fencing, landscaping, surfaces, lights); removal of
park/playground seating; retrofitting existing spaces into
pocket parks; temporary road closures and play
equipment; access to and availability of public transport;
higher residential, destination, and recreation density;
increased street connectivity; and increased land use mix.
The strongest evidence existed for multiple streetscape
components (adult PA, child AT), installation of fitness
equipment (adult PA and AT), temporary road closures
and play equipment (child PA), and recreation facility
density (adult PA).
Numerous limitations in the evidence base exist. In
particular, the possibility that the benefits of
infrastructure improvements may be inequitably distributed
requires further investigation. Notwithstanding the
significant challenges in terms of research design, many
opportunities to improve the quality of evidence are
clear, including strategies to improve response rates and
representativeness, use of valid and reliable
measurement tools, cost-benefit analyses, and adequate
controlling for confounders.
Additional file 1: Search terms. (DOCX 11 kb)
Additional file 2: Data extraction form. (DOCX 13 kb)
Additional file 3: Adaptations made to the Evaluation of Public
Health Practice Projects Quality Assessment Tool (EPHPP) scoring
criteria. (DOCX 25 kb)
Additional file 4: Effective Public Health Practice Project (EPHPP) Quality
Assessment Tool for Quantitative Studies - Component Ratings of Study.
(DOCX 12 kb)
EPHPP: Evaluation of Public Health Practice Projects Quality Assessment Tool;
SES: Socioeconomic status; UK: United Kingdom; US: United States;
USD: United States dollars
This research was funded by the New Zealand Ministry for Business,
Innovation and Employment (grant number 29898). MS is supported by a
Health Research Council of New Zealand Sir Charles Hercus Research
Fellowship (grant number 17–013). The funding bodies had no role in the
design of the study; collection, analysis, or interpretation of data; or writing
Availability of data and materials
The dataset used and analysed during the current study are available from
the corresponding author on reasonable request.
All authors conceived the idea, contributed to the search strategy employed,
and read, contributed to, and approved the final manuscript. MS conducted
the literature search, quality assessment, data extraction and analysis, and
wrote the draft manuscript. JH undertook the 10% replication of data
sourcing, extraction, and quality assessment; and conducted the equality
assessment (data extraction, analysis, and write-up, with MS conducting 10%
replication of data extraction).
Ethics approval and consent to participate
Consent for publication
The authors declare they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
1. World Health Organization. Global recommendations on physical activity for health . Geneva; 2010 .
2. Lee I-M , Shiroma EJ , Lobelo F , Puska P , Blair SN , Katzmarzyk PT . Lancet physical activity series working group: effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy . Lancet . 2012 ; 380 : 219 - 29 .
3. Ding D , Lawson KD , Kolbe-Alexander TL , Finkelstein EA , Katzmarzyk PT , van Mechelen W , Pratt M. Lancet physical activity series 2 executive C: the economic burden of physical inactivity: a global analysis of major noncommunicable diseases . Lancet . 2016 ; 388 : 1311 - 24 .
4. Sallis JF , Floyd MF , Rodriguez DA , Saelens BE . Role of built environments in physical activity, obesity, and cardiovascular disease . Circulation . 2012 ; 125 : 729 - 37 .
5. Saunders LE , Green JM , Petticrew MP , Steinbach R , Roberts H . What are the health benefits of active travel? A systematic review of trials and cohort studies . PLoS One . 2013 ; 8 : e69912 .
6. Oliver M , Parker K , Witten K , Mavoa S , Badland H , Donovan P , Chaudhury M , Kearns RA . Children's out-of-school independently mobile trips, active travel, and physical activity: a cross-sectional examination from the kids in the City study . JPAH . 2016 ; 13 : 318 - 24 .
7. Rojas-Rueda D , de Nazelle A , Andersen ZJ , Braun-Fahrlander C , Bruha J , Bruhova-Foltynova H , Desqueyroux H , Praznoczy C , Ragettli MS , Tainio M , Nieuwenhuijsen MJ . Health impacts of active transportation in Europe . PLoS One . 2016 ; 11 : e0149990 .
8. Xia T , Zhang Y , Crabb S , Shah P . Cobenefits of replacing car trips with alternative transportation: a review of evidence and methodological issues . J Environ Public Health . 2013 ; 2013 : 797312 .
9. Lindsay G , Macmillan A , Woodward A . Moving urban trips from cars to bicycles: impact on health and emissions. Moving urban trips from cars to bicycles: impact on health and emissions . 2011 ; 35 : 54 - 60 .
10. Giles-Corti B , Kelty S , Zubrick S , Villanueva K. Encouraging walking for transport and physical activity in children and adolescents: how important is the built environment? Sports Med . 2009 ; 39 : 995 - 1009 .
11. Sallis JF , Cerin E , Conway TL , Adams MA , Frank LD , Pratt M , Salvo D , Schipperijn J , Smith G , Cain KL , et al. Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. Physical activity in relation to urban environments in 14 cities worldwide: a crosssectional study . 2016 . Online First.
12. McCormack GR , Shiell A . Search of causality: a systematic review of the relationship between the built environment and physical activity among adults . Int J Behav Nutr Phys Act . 2011 ; 8 : 125 .
13. Hunter RF , Christian H , Veitch J , Astell-Burt T , Hipp JA , Schipperijn J. The impact of interventions to promote physical activity in urban green space: a systematic review and recommendations for future research . Soc Sci Med . 2015 ; 124 : 246 - 56 .
14. Mayne SL , Auchincloss AH , Michael YL . Impact of policy and built environment changes on obesity-related outcomes: a systematic review of naturally occurring experiments . Obes Rev . 2015 ; 16 : 362 - 75 .
15. McGrath LJ , Hopkins WG , Hinckson EA . Associations of objectively measured built-environment attributes with youth moderate-vigorous physical activity: a systematic review and meta-analysis . Sports Med . 2015 ; 45 : 841 - 65 .
16. Grasser G , Van Dyck D , Titze S , Stronegger W. Objectively measured walkability and active transport and weight-related outcomes in adults: a systematic review . Int J Public Health . 2013 ; 58 : 615 - 25 .
17. Durand CP , Andalib M , Dunton GF , Wolch J , Pentz MA . A systematic review of built environment factors related to physical activity and obesity risk: implications for smart growth urban planning . Obes Rev . 2011 ; 12 : e173 - 82 .
18. Fraser SD , Lock K. Cycling for transport and public health: a systematic review of the effect of the environment on cycling . Eur J Pub Health . 2011 ; 21 : 738 - 43 .
19. Yang L , Sahlqvist S , McMinn A , Griffin SJ , Ogilvie D . Interventions to promote cycling: systematic review . BMJ . 2010 ; 341 : c5293 .
20. Casagrande SS , Whitt-Glover MC , Lancaster KJ , Odoms-Young AM , Gary TL . Built environment and health behaviors among African Americans: a systematic review . Am J Prev Med . 2009 ; 36 : 174 - 81 .
21. Wendel-Vos W , Droomers M , Kremers S , Brug J , van Lenthe F. Potential environmental determinants of physical activity in adults: a systematic review . Obes Rev . 2007 ; 8 : 425 - 40 .
22. Annear M , Keeling S , Wilkinson T , Cushman G , Gidlow B , Hopkins H . Environmental influences on healthy and active ageing: a systematic review . Ageing Soc . 2014 ; 34 : 590 - 622 .
23. Laine J , Kuvaja-Kollner V , Pietila E , Koivuneva M , Valtonen H , Kankaanpaa E . Cost-effectiveness of population-level physical activity interventions: a systematic review . Am J Health Promot . 2014 ; 29 : 71 - 80 .
24. Cavill N , Kahlmeier S , Rutter H , Racioppi F , Oja P. Economic analyses of transport infrastructure and policies including health effects related to cycling and walking: a systematic review . Transp Policy . 2008 ; 15 : 291 - 304 .
25. Schule SA , Bolte G. Interactive and independent associations between the socioeconomic and objective built environment on the neighbourhood level and individual health: a systematic review of multilevel studies . PLoS One . 2015 ; 10 : e0123456 .
26. Oliveira AF , Moreira C , Abreu S , Mota J , Santos R . Environmental determinants of physical activity in children: a systematic review . Archives of Exercise in Health and Disease . 2014 ; 4 : 254 - 61 .
27. Brown V , Diomedi BZ , Moodie M , Veerman JL , Carter R. A systematic review of economic analyses of active transport interventions that include physical activity benefits . Transp Policy . 2016 ; 45 : 190 - 208 .
28. Owen N , Humpel N , Leslie E , Bauman A , Sallis JF . Understanding environmental influences on walking; review and research agenda . Am J Prev Med . 2004 ; 27 : 67 - 76 .
29. Sugiyama T , Neuhaus M , Cole R , Giles-Corti B , Owen N. Destination and route attributes associated with adults' walking: a review . Med Sci Sports Exerc . 2012 ; 44 : 1275 - 86 .
30. Saelens BE , Sallis JF , Frank LD . Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literatures . Ann Behav Med . 2003 ; 25 : 80 - 91 .
31. Saelens BE , Handy SL . Built environment correlates of walking: a review . Med Sci Sports Exerc . 2008 ; 40 : S550 - S66 .
32. Oliver M , Mavoa S , Badland H , Parker K , Donovan P , Kearns RA , Lin E-Y , Witten K. Associations between the neighbourhood built environment and out of school physical activity and active travel: an examination from the kids in the City study . Health & Place . 2015 ; 36 : 57 - 64 .
33. Hopgood T , Percival T , Stewart J , Ameratunga S. A tale of two cities: paradoxical intensity of traffic calming around Auckland schools . N Z Med J. 2013 ; 126 : 22 - 8 .
34. Zhu X , Lee C . Walkability and safety around elementary schools. Economic and ethnic disparities . Am J Prev Med . 2008 ; 34 : 282 - 90 .
35. Goodman A , Sahlqvist S , Ogilvie D. iConnect c: who uses new walking and cycling infrastructure and how? Longitudinal results from the UK iConnect study . Prev Med . 2013 ; 57 : 518 - 24 .
36. Macmillan A , Connor J , Witten K , Kearns R , Rees D , Woodward A . The societal costs and benefits of commuter bicycling: simulating the effects of specific policies using system dynamics modeling. The societal costs and benefits of commuter bicycling: simulating the effects of specific policies using system dynamics modeling . 2014 ; 122 : 335 - 44 .
37. Davis A : Value for money: an economic assessment of Investment in Walking and Cycling . United Kingdom; 2010 .
38. Pucher J , Dill J , Handy S . Infrastructure, programs, and policies to increase bicycling: an international review . Prev Med . 2010 ; 50 ( Suppl 1 ): S106 - 25 .
39. McCormack G , Giles-Corti B , Lange A , Smith T , Martin K , Pikora TJ . An update of recent evidence of the relationship between objective and selfreport measures of the physical enviornment and physical activity behaviours. An update of recent evidence of the relationship between objective and self-report measures of the physical enviornment and physical activity behaviours . 2004 ; 7 : 81 - 91 .
40. Glanz K , Handy S , Henderson KE , Slater SJ , Davis EL , Powell LM . Built environment assessment: multidisciplinary perspectives . SSM - Population Health . 2016 ; 2 : 24 - 31 .
41. Benton JS , Anderson J , Hunter RF , French DP . The effect of changing the built environment on physical activity: a quantitative review of the risk of bias in natural experiments . Int J Behav Nutr Phy . 2016 ; 13
42. Coghill CL , Valaitis RK , Eyles JD . Built environment interventions aimed at improving physical activity levels in rural Ontario health units: a descriptive qualitative study . BMC Public Health . 2015 ; 15
43. Mehdipanah R , Manzano A , Borrell C , Malmusi D , Rodriguez-Sanz M , Greenhalgh J , Muntaner C , Pawson R . Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven realist approach . Soc Sci Med . 2015 ; 124 : 266 - 74 .
44. Smith M. Systematic Review Protocol . figshare. 2017. Retrieved September 26 , 2017 . https://doi.org/10.17608/k6.auckland. 5445586 . v1 .
45. Godin K , Stapleton J , Kirkpatrick SI , Hanning RM , Leatherdale ST . Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada . Syst Rev . 2015 ; 4 : 138 .
46. Chillón P , Evenson KR , Vaughn A , Ward DS . A systematic review of interventions for promoting active transportation to school . Int J Behav Nutr Phys Act . 2011 ;8 doi:10.1186/ 479 -5868-8-10.
47. Moher D , Tetzlaff J , Tricco AC , Sampson M , Altman DG . Epidemiology and reporting characteristics of systematic reviews . PLoS Med . 2007 ; 4 : e78 .
48. Page MJ , Shamseer L , Altman DG , Tetzlaff J , Sampson M , Tricco AC , CatalaLopez F , Li L , Reid EK , Sarkis-Onofre R , Moher D . Epidemiology and reporting characteristics of systematic reviews of biomedical research: a cross-sectional study . PLoS Med . 2016 ; 13 : e1002028 .
49. Rissel C , Curac N , Greenaway M , Bauman A . Physical activity associated with public transport use-a review and modelling of potential benefits . Int J Environ Res Public Health . 2012 ; 9 : 2454 - 78 .
50. Brown BB , Werner CM . A new rail stop: tracking moderate physical activity bouts and ridership . Am J Prev Med . 2007 ; 33 : 306 - 9 .
51. Mayer KU . Retrospective longitudinal research: the German life history study . In: Handbook of Longitudinal Research: Design, Measurement, and Analysis . Edited by Menard S. Burlington, MA: Elsevier; 2008 . p. 85 - 106 .
52. Egan M , Petticrew M , Hamilton V , Ogilvie D. Health impacts of new roads: a systematic review . Am J Public Health . 2003 ; 93 : 1463 - 71 .
53. Data collection form. EPOC Resources for review authors . http://epoc. cochrane. org/epoc-specific-resources-review-authors.
54. Salmond CE , Crampton P . Development of New Zealand's deprivation index (NZDep) and its uptake as a national policy tool . Can J Public Health. 2012 ; 103 : S7 - S11 .
55. Moher D , Liberati A , Tetzlaff J , Altman DG . The PRISMA group: preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement . PLoS Med . 2009 ; 6:e1000097 . doi: 10 .1371/journal.pmed.
56. Goodman A , Sahlqvist S , Ogilvie D . New walking and cycling routes and increased physical activity: one- and 2-year findings from the UK iConnect study . Am J Public Health . 2014 : e1 - 9 .
57. Cohen D , Marsh T , Williamson S , Golinelli D , McKenzie TL . Impact and costeffectiveness of family fitness zones: a natural experiment in urban public parks . Health Place . 2012 ; 18 : 39 - 45 .
58. Parker KM , Gustat J , Rice JC . Installation of bicycle lanes and increased ridership in an urban, mixed-income setting in New Orleans, Louisiana . J Phys Act Health . 2011 ; 8 ( Suppl 1 ): S98 - S102 .
59. Ranchod YK , Roux AVD , Evenson KR , Sanchez BN , Moore K. Longitudinal associations between neighborhood recreational facilities and change in recreational physical activity in the multi-ethnic study of atherosclerosis, 2000 - 2007 . Am J Epidemiol. 2014 ; 179 : 335 - 43 .
60. West ST , Shores KA . Does building a greenway promote physical activity among proximate residents ? J Phys Act Health . 2015 ; 12 : 52 - 7 .
61. Clark S , Bungum T , Shan G , Meacham M , Coker L . The effect of a trail use intervention on urban trail use in southern Nevada . Prev Med . 2014 ; 67 : S17 - 20 .
62. Dill J , McNeil N , Broach J , Ma L. Bicycle boulevards and changes in physical activity and active transportation: findings from a natural experiment . Prev Med . 2014 ; 69 ( Suppl 1 ): S74 - 8 .
63. Gustat J , Rice J , Parker KM , Becker AB , Farley TA . Effect of changes to the neighborhood built environment on physical activity in a low-income African American neighborhood . Prev Chronic Dis . 2012 ; 9 : E57 .
64. McDonald NC , Yang YZ , Abbott SM , Bullock AN . Impact of the safe routes to school program on walking and biking: Eugene, Oregon study . Transp Policy . 2013 ; 29 : 243 - 8 .
65. Quigg R , Reeder AI , Gray A , Holt A , Waters D. The effectiveness of a community playground intervention . J Urban Health . 2012 ; 89 : 171 - 84 .
66. D'Haese S , Van Dyck D , De Bourdeaudhuij I , Deforche B , Cardon G. Organizing "play streets" during school vacations can increase physical activity and decrease sedentary time in children . Int J Behav Nutr Phys Act . 2015 ; 12 : 14 .
67. Boutron I , Guittet L , Estellat C , Moher D , Hrobjartsson A , Ravaud P . Reporting methods of blinding in randomized trials assessing nonpharmacological treatments . PLoS Med . 2007 ; 4 : e61 .
68. Rissel C , Greaves S , Wen LM , Crane M , Standen C . Use of and short-term impacts of new cycling infrastructure in inner-Sydney, Australia: A quasiexperimental design . Int J Behav Nutr Phys Act . 2015 ; 12 : 129 .
69. Giles-Corti B , Bull F , Knuiman M , McCormack G , Van Niel K , Timperio A , Christian H , Foster S , Divitini M , Middleton N , Boruff B. The influence of urban design on neighbourhood walking following residential relocation: longitudinal results from the RESIDE study . Soc Sci Med . 2013 ; 77 : 20 - 30 .
70. Beenackers MA , Foster S , Kamphuis CB , Titze S , Divitini M , Knuiman M , van Lenthe FJ , Giles-Corti B . Taking up cycling after residential relocation: built environment factors . Am J Prev Med . 2012 ; 42 : 610 - 5 .
71. Knuiman MW , Christian HE , Divitini ML , Foster SA , Bull FC , Badland HM , Giles-Corti B . A longitudinal analysis of the influence of the neighborhood built environment on walking for transportation: the RESIDE study . Am J Epidemiol . 2014 ; 180 : 453 - 61 .
72. Chiu M , Rezai MR , Maclagan LC , Austin PC , Shah BR , Redelmeier DA , JV T. Moving to a highly walkable neighborhood and incidence of hypertension: a propensity-score matched cohort study . Environ Health Perspect . 2015 ;
73. Hoehner CM , Ramirez LKB , Elliott MB , Handy SL , Brownson RC . Perceived and objective environmental measures and physical activity among urban adults . Am J Prev Med . 2005 ; 28 : 105 - 16 .
74. Jauregui A , Salvo D , Lamadrid-Figueroa H , Hernandez B , Rivera-Dommarco JA , Pratt M. Perceived and objective measures of neighborhood environment for physical activity among Mexican adults , 2011 . Prev Chronic Dis. 2016 ; 13
75. Gebel K , Bauman AE , Sugiyama T , Owen N. Mismatch between perceived and objectively assessed neighborhood walkability attributes: prospective relationships with walking and weight gain . Health Place . 2011 ; 17 : 519 - 24 .
76. Hinckson E , Cerin E , Mavoa S , Oliver M , Badland H , Stewart T , Duncan S , Schofield G . Associations of the perceived and objective neighborhood environment with physical activity and sedentary time in New Zealand adolescents . Int J Behav Nutr Phys Act . in submission
77. Orstad SL , McDonough MH , Stapleton S , Altincekic C , Troped PJ . A systematic review of agreement between perceived and objective neighborhood environment measures and associations with physical activity outcomes. A systematic review of agreement between perceived and objective neighborhood environment measures and associations with physical activity outcomes . 2017 ; 49 : 904 - 32 .
78. Gebel K , Bauman A , Owen N. Correlates of non-concordance between perceived and objective measures of walkability . Ann Behav Med . 2009 ; 37 : 228 - 38 .
79. Adams MA , Ryan S , Kerr J , Sallis JF , Patrick K , Frank LD , Norman GJ . Validation of the neighborhood environment walkability scale (NEWS) items using geographic information systems . J Phys Act Health . 2009 ; 6 : S113 - S23 .
80. Krizek K. Pretest-posttest strategy for researching neighborhood-scale urban form and travel behavior . Trans Res Rec . 1722 ; 2000 : 48 - 55 .
81. Krizek KJ . Residential relocation and changes in urban travel: does neighborhood-scale urban form matter? JAPA. 2003 ; 69 : 265 - 81 .
82. Mackenbach JD , Rutter H , Compernolle S , Glonti K , Oppert J-M , Charreire H , De Bourdeaudhuij I , Brug J , Nijpels G , Lakerveld J . Obesogenic environments: a systematic review of the association between the physical environment and adult weight status, the SPOTLIGHT project . BMC Public Health . 2014 ; 14 : 233 .
83. Gebel K , Ding D , Foster C , Bauman AE , Sallis JF . Improving current practice in reviews of the built environment and physical activity. Improving current practice in reviews of the built environment and physical activity . 2015 ; 45 : 297 - 302 .
84. Kuper H , Nicholson A , Hemingway H . Searching for observational studies: what does citation tracking add to PubMed? A case study in depression and coronary heart disease . BMC Med Res Methodol . 2006 ; 6 : 4 .
85. Boarnet MG , Day K , Anderson C , McMillan T , Alfonzo M. California's safe routes to school program . J Am Plan Assoc . 2005 ; 71 : 301 - 17 .
86. Brown BB , Werner CM . Before and after a new light rail stop: resident attitudes, travel behavior, and obesity . J Am Plan Assoc . 2008 ; 75 : 5 - 12 .
87. Cohen DA , Marsh T , Williamson S , Han B , Derose KP , Golinelli D , McKenzie TL . The potential for pocket parks to increase physical activity . Am J Health Prom . 2014 ; 28 : S19 - 26 .
88. Cohen DA , Han B , Isacoff J , Shulaker B , Williamson S , Marsh T , McKenzie TL , Weir M , Bhatia R . Impact of park renovations on park use and park-based physical activity . J Phys Act Health . 2015 ; 12 : 289 - 95 .
89. Fitzhugh EC , Bassett DR , Jr. , Evans MF : Urban trails and physical activity: a natural experiment . Am J Prev Med 2010 ; 39 : 259 - 262 .
90. Harduar-Morano L , Price JR , Parker D , Blackmore C. PACE EH post project assessment of quality of life changes in a Florida community related to infrastructure improvements . J Environ Health . 2008 ; 70 : 40 - 6 .
91. Lott DF , Tardiff T . Evaluation by experienced riders of a new bicycle lane in an established bikeway system . Transp Res Rec . 1979 ; 683 : 40 - 6 .
92. Morrison DS , Thomson H , Petticrew M . Evaluation of the health effects of a neighbourhood traffic calming scheme . J Epidemiol Community Health . 2004 ; 58 : 837 - 40 .
93. Parker KM , Rice J , Gustat J , Ruley J , Spriggs A , Johnson C . Effect of bike lane infrastructure improvements on ridership in one New Orleans neighborhood . Ann Behav Med . 2013 ; 45 ( Suppl 1 ): S101 - 7 .
94. Roemmich JN , Beeler JE , Johnson L. A microenvironment approach to reducing sedentary time and increasing physical activity of children and adults at a playground . Prev Med . 2014 ; 62 : 108 - 12 .
95. Shu S , Quiros DC , Wang R , Zhu YF . Changes of street use and on-road air quality before and after complete street retrofit: an exploratory case study in Santa Monica , California. Transport Res D-Tr E. 2014 ; 32 : 387 - 96 .
96. Tester J , Baker R . Making the playfields even: evaluating the impact of an environmental intervention on park use and physical activity . Prev Med . 2009 ; 48 : 316 - 20 .
97. Veitch J , Ball K , Crawford D , Abbott GR , Salmon J . Park improvements and park activity: a natural experiment . Am J Prev Med . 2012 ; 42 : 616 - 9 .
98. West ST , Shores KA . The impacts of building a greenway on proximate residents' physical activity . J Phys Act Health . 2011 ; 8 : 1092 - 7 .