Role of built environments in physical activity, obesity, and cardiovascular disease.

Abstract

There is a growing consensus that large changes in population levels of physical activity and other behaviors required to improve cardiovascular health will require major modifications in environments and policies. Ecological models are the conceptual basis for comprehensive interventions that emphasize environmental and policy changes and that can have widespread and sustainable effects. These interventions are complemented with individual education and motivation and efforts to change social support and norms. Physical activity-specific ecological models indicate which environmental factors are expected to be related to physical activity in multiple life domains: Leisure/recreation/exercise, occupation (school for youth), transportation, and household. Over the past decade, a proliferation of interdisciplinary research has generally supported hypotheses derived from ecological models and identified specific built environment attributes and combinations of attributes that are related to physical activity, mainly for recreation and transportation purposes, and obesity. It is becoming clear that racial/ethnic minority and low-income communities are disadvantaged in access to recreation facilities, positive aesthetics, and protection from traffic. These results provide an empirical rationale for intervention. There are recent examples of environmental changes or community-wide multilevel interventions that had positive effects on physical activity or obesity. Continuing research needs are to improve the rigor of study designs, confirm subgroup- or context-specific built environment associations, identify optimal combinations of attributes, improve understanding of the policy change processes required to achieve environmental changes, and evaluate multilevel interventions. Both research teams and community-based initiatives are collaborating with a wide range of professionals and sectors of society, such as recreation, transportation, city planning, architecture, landscape architecture, geography, criminal justice, and law, in addition to health professionals and behavioral scientists. These diverse teams have stimulated innovations in research, new approaches to intervention, and improved connections with decision makers who can make environment and policy changes in nonhealth sectors of society. The practice of physical activity promotion, obesity prevention, and CVD risk reduction has changed to reflect the shift to multilevel interventions. Major foundations and public health agencies are implementing community-based interventions targeting environment and policy change. Continuing challenges for these community-wide interventions are to maintain support for the multisector, long-term efforts required to change environments, evaluate interventions so they become ever more evidence-based, and integrate explicit chronic disease prevention objectives into professional practices of diverse disciplines, government agencies, and industries whose primary work can affect physical activity and health. Among the largest initiatives was the Centers for Disease Control and Prevention's Communities Putting Prevention to Work grant program, which awarded more than $250 million in 2010 to change environments and policies to improve nutrition and physical activity and prevent obesity. Recommended strategies were based on MAPPS: Media, Access, Point of decision information, Price, and Social support/services. Strategies ranged from improving physical activity in school physical education (access) to subsidizing memberships to recreational facilities (price) to promoting safe routes to school (eg, social support/services). Experience with these initiatives, as well as systematic evaluations, will lead to a better understanding of how to accomplish policy and environmental change in diverse communities and provide important information about the impact of these changes. Language: en