Influence of Urbanization on Physical Activity Across High, Middle and Low Income Countries

Abstract

BACKGROUND AND AIM: There is a growing body of literature examining how urbanization influence physical activity (PA), but most research is from developed countries. Limited evidence is available to inform how urbanization influences PA, and the specific domains of PA, in low and middle-income countries (LMICs). METHODS: We evaluated the associations between urbanization and total PA, as well as work, leisure, home, and transport PA, for 138,206 adults (35-70 years) living in 800 communities across 27 countries within the Prospective Urban and Rural Epidemiology (PURE) study. PA was measured using the 1-week total PA long-form International PA Questionnaire (IPAQ) collected at study baseline (2005-2015). We measured urbanization using population density and impervious surface area for PURE communities and examined change per year for the 5-year period prior to PA measurements in each community. Hierarchical linear regression models were used to examine associations between urbanization metrics and PA. RESULTS:The baseline mean (SD) population density and percent impervious area for study communities was 4276 people/sq km (7284) and 45% (36) respectively. Over a 5-year period prior to baseline, population density and impervious surface area change rate per year was 2 (1.4) and 4 (11), respectively. Change in population density was associated with decreases in total PA [-353 MET × min per week (95% CI: -584, -123) per 2% people/sq km increase). Small increases in transportation and recreational physical activity were associated with increased population density. Stratified analyses revealed increases in population density was associated with a larger decrease in total PA in HIC, in rural communities and for men. No consistent associations were observed for changes in impervious surface area of communities. CONCLUSIONS:Urbanization influences PA levels, but the relationship is context dependent. This information will help to understand how urbanization influences PA and how urbanization can be optimized to enhance PA levels across different income countries. KEYWORDS: urbanization,physical activity, adult