Abstract
Insufficient physical activity (PA) is the fourth major risk factor for many non-communicable diseases and premature mortality worldwide. Features of the built environment (BE) play a considerable role in determining population PA behaviors. The majority of evidence for PA-BE relationships comes from high-income countries and may not be generalizable to low- and middle-income countries (LMICs). We aim to systematically review the literature and assess the associations between perceived and/or objective BE characteristics and PA domains in LMICs. This review adopted a systematic search strategy for English language articles published between January 2000 and June 2019 from four electronic databases—Medline, Embase, Web of Science and PubMed—adhering to the PRISMA guidelines. Studies addressing the associations between self-reported and/or objective BE and PA were only included if they were conducted in LMICs, according to the World Bank classification list. Articles investigating PA-BE relationships across any age groups were included, and all study designs were eligible, except for qualitative studies and reviews. Thirty-three studies were included for evidence synthesis. Cross-sectional studies were the most prevailing study design (97%), revealing a notable gap in longitudinal PA-BE research in LMICs. A majority of the BE factors were not associated with different PA domains while others (e.g., density, proximity to services, aesthetics) exhibited an inconsistent association. Land-use mix diversity was positively associated with transport PA and the presence of recreation facilities resulted in an increase in PA during leisure-time. Increased safety from crime at night consistently increased total PA and walking levels. Research exploring the associations between BE attributes and PA behaviors in LMICs appears to be limited and is primarily cross-sectional. Longitudinal research studies with objective measures are needed for inferring well-grounded PA-BE causal relationships and informing the design of evidence-based environmental interventions for increasing PA levels in LMICs.
Highlights
Physical inactivity is a global public health issue and the fourth leading risk factor for many non-communicable diseases (NCDs), including obesity, diabetes, cardiovascular disease, stroke and some cancers [1]
We identified a supportive role of the built environment (BE) environment on physical activity (PA) domains, there were considerable variations in BE correlates across different PA domains in low- and middle-income countries (LMICs)
Our results reveal that availability of infrastructure for safe walking and cycling was not significantly associated with any PA domains across LMICs
Summary
Physical inactivity is a global public health issue and the fourth leading risk factor for many non-communicable diseases (NCDs), including obesity, diabetes, cardiovascular disease, stroke and some cancers [1]. The global health care costs of physical inactivity have been estimated to exceed international $53 billion annually [2]. About 3.2 million deaths are attributed to insufficient physical activity (PA) annually, with low- and middle-income countries (LMICs) carrying a disproportionate share of the disease burden [3]. 82% of the global NCDs deaths take place in LMICs, where the risk of premature NCD mortality is 1.5 times higher than high-income country populations [4]. A recent study of 168 countries by Guthold et al [7] did not reveal a significant decrease in the worldwide prevalence of insufficient PA between 2001 and 2016, (28.5 vs 27.5%, respectively), indicating slow progress towards meeting the global target and highlighting an urgent need for accelerated actions and policy changes for reversing these trends
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