Association between walkability and physical activity among children and adolescents: a systematic review

Bruno, Giancarlo Bazarele Machado; Delpino, Felipe Mendes; Pimenta, Ludmila Pereira; Silva, Clécio Homrich da; Mello, Elza Daniel de

doi:10.1590/1809-2950/e24004124en

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 31 • 2024 • https://doi.org/10.1590/1809-2950/e24004124en linkcopy

Association between walkability and physical activity among children and adolescents: a systematic review

Asociación entre caminabilidad y actividad física entre niños y adolescentes: una revisión sistemática

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Housing conditions in a neighborhood may be associated with physical activity among children and adolescents. This study aimed to evaluate the association between walkability and physical activity levels in children and adolescents. We conducted a systematic review, searching for articles published until April 2023 in the following databases: PubMed, SPORTDiscus, LILACS, Web of Science, Scopus, Embase, and Cochrane. It included studies that evaluated the association between walkability and physical activity among children and adolescents. The Newcastle Ottawa scale was used to assess the individual quality of the studies. In total, 35 studies were included, 5 longitudinal. The sample size ranged from 143 to 45,392 participants. Most of the studies found a positive association between walkability and physical activity, ~86%. Of the 19 studies that evaluated physical activity using objective methods (most of them accelerometers), 74% found positive results; for subjective methods, the percentage was 94%. Walkability was positively associated with higher levels of physical activity among children and adolescents.

Keywords
Walkability; Physical Activity; Children; Adolescents; Systematic Review

Author, year, country	Study design	Participants characteristics	Physical activity measurement	Main findings
Tappe et al., 2013 ¹⁸	Cross-sectional	724 children aged 6 to 11 years old	Subjective:	Lower street connectivity and better neighborhood aesthetics increase child activity within neighborhoods. Reported safety and walk/cycle facilities boost child activity in public recreation spaces
United States			Days of the week in which participants reported 60+minutes daily
Children’s physical activity and parents’ perception of the neighborhood environment: neighborhood impact on kids study
Carlson et al., 2015 ¹⁹	Cross-sectional	690 adolescents with an average age of 14 years	Objective:	Neighborhood walkability was positively related to walking and bicycling and negatively related to vehicle time
United States			Accelerometers
Association between neighborhood walkability and GPS-measured walking, bicycling and vehicle time in adolescents			Accelerometers
Kasehagen et al., 2012 ²⁰	Cross-sectional	45,392 youth aged 10-17 years old	Subjective:	This analysis identified no association between youths’ minimum physical activity attainment and neighborhood characteristics in unstratified models
United States			Days of the week in which adolescents practiced physical activity for at least 20 minutes
Associations Between Neighborhood Characteristics and Physical Activity Among Youth Within Rural–Urban Commuting Areas in the US
Galvez et al., 2013 ²¹	Cross-sectional	324 children aged at least 6 years old	Subjective and Objective:	Availability of select physical activity resources was associated with reported physical activity levels but not with objective measures of physical activity
United States			MET-hours of physical activity per week and steps per day
Associations between neighborhood resources and physical activity in inner city minority children			MET-hours of physical activity per week and steps per day
Muthuri et al., 2016 ²²	Cross-sectional	563 children aged 9-11 years old	Objective:	Parental perception of positive neighborhood social cohesion, positive environs and connectivity, and negative child safety concerns, were associated with child physical activity
Kenya			Accelerometers
Associations Between Parental Perceptions of the Neighborhood Environment and Childhood Physical Activity: Results from ISCOLE-Kenya			Accelerometers
McGrath et al., 2016 ²³	Cross-sectional	227 children with an average age of 9 years	Objective: Accelerometers	Neighborhoods with greener spaces, attractive streets, or low-walkability streets showed a moderate positive association on non-school day moderate-to-vigorous steps
New Zealand
Associations Between the Neighborhood Environment and Moderate-to-Vigorous Walking in New Zealand Children: Findings from the URBAN Study
Hume et al., 2007 ²⁴	Cross-sectional	280 children aged 10 years old	Objective: Accelerometers	Multiple linear regression analyses showed positive association between walking frequency and number of accessible destinations in the neighborhood among boys. Among girls, neighborhoods that were easy to walk/cycle around and with lots of graffiti were positively associated with walking frequency
Australia
Associations of children’s perceived neighborhood environments with walking and physical activity
Hinckson et al., 2017 ²⁵	Cross-sectional	524 adolescents with an average age of 16 years	Objective:	There was a positive association between walkability and physical activity
New Zealand			Accelerometers
Associations of the perceived and objective neighborhood environment with physical activity and sedentary time in New Zealand adolescents			Accelerometers
Evenson et al., 2010 ²⁶	Longitudinal	847 adolescents with an average age of 12 years	Objective:	There was no positive association between walkability and physical activity
United States			Accelerometers
Examination of perceived neighborhood characteristics and transportation on changes in physical activity and sedentary behavior: The Trial of Activity in Adolescent Girls			Accelerometers
Franzini et al., 2009 ²⁷	Cross-sectional	650 children with an average age of 11 years	Subjective:	Social environment was positively associated with several measures of physical activity
United States			Vigorous and moderate exercise, physical education or gym class, sports participation, physically active free-time activities, participation in other physical activity or lessons, and walking or biking to school
Influences of Physical and Social Neighborhood Environments on Children’s Physical Activity and Obesity
Sallis et al., 2018 ²⁸	Cross-sectional	928 adolescents aged 12-16 years old	Objective:	Walkability was positively and significantly related to objectively measured physical activity
United States			Accelerometers
Neighborhood built environment and socioeconomic status in relation to physical activity, sedentary behavior, and weight status of adolescents			Accelerometers
Goon et al., 2020 ²⁹	Cross-sectional	816 children aged 9-14 years old	Objective:	Children’s perceived availability of parks and sidewalks predicted a higher accumulation of moderate-to-vigorous physical activity
Canada			Accelerometers
Neighborhood Built Environment Measures and Association with Physical Activity and Sedentary Time in 9–14-Year-Old Children in Saskatoon, Canada			Accelerometers
Huang et al., 2020 ³⁰	Cross-sectional	16,402 children aged 5-10 years	Objective:	Higher levels of LUM and pedestrian-friendly streets were associated with greater numbers of children in parks and higher moderate-to-vigorous physical activity across all three groups
United States			System for Observing Play and Recreation in Communities (SOPARC)
Neighborhood characteristics associated with park use and park-based physical activity among children in low-income diverse neighborhoods in New York City
Huang et al., 2010 ³¹	Cross-sectional	726 children aged 11-12 years old	Subjective:	Accessibility to facilities had a significant impact on the children’s physical activity
Taiwan			MET-h/week and various physical activities by area
Neighborhood environment and physical activity among Urban and Rural Schoolchildren in Taiwan			MET-h/week and various physical activities by area
Weimann et al., 2015 ³²	Cross-sectional	205 children aged 4-11 years old	Objective:	Children were more physically active in areas with intermediate access to neighborhood resources for physical activity compared to areas with poor access
Sweden			Accelerometers
Neighborhood environment and physical activity among young children: a cross-sectional study from Sweden			Accelerometers
Dias et al., 2020 ³³	Cross-sectional	1,130 school students aged 14-20 years old	Subjective:	Leisure walking was positively associated environmental factors
Brazil	Cross-sectional	1,130 school students aged 14-20 years old	Self-reported leisure walking
Babey et al., 2015 ³⁴	Cross-sectional	3,638 adolescents aged 12-17 years old	Subjective:	Adolescents with a park within walking distance of home and those with a safe park nearby were more likely to be physically active during a park visit
United States			Practice of physical activity in a park
Neighborhood, family and individual characteristics related to adolescent park-based physical activity			Practice of physical activity in a park
Grigsby-Toussaint et al., 2011 ³⁵	Cross-sectional	365 children aged 2-5 years old	Subjective:	Higher levels of neighborhood greenness were associated with higher levels of outdoor playing time among preschool children
United States			Questions about minutes that children spend on active playing, indoor quiet playing, outdoor active playing, and outdoor quiet playing
Where they live, how they play: Neighborhood greenness and outdoor physical activity among preschoolers
Markevych et al., 2016 ³⁶	Cross-sectional	1,192 adolescents aged 16 years old	Objective:	Residing in a neighborhood with high normalized difference vegetation index was associated with 9% more leisure moderate-to-vigorous physical activity
Germany			Accelerometers
Neighbourhood and physical activity in German adolescents: GINIplus and LISAplus			Accelerometers
Datar et al., 2013 ³⁷	Longitudinal	18,900 school-aged children	Subjective:	Children whose parents perceived their neighborhoods as unsafe watched more television and participated in less physical activity
United States			Number of days per week on which the child engaged in at least 20 minutes of vigorous exercise
Parent perceptions of neighborhood safety and children’s physical activity, sedentary behavior, and obesity: evidence from a national longitudinal study
Esteban-Cornejo et al., 2016 ³⁸	Cross-sectional	928 adolescents aged 12-16 years old	Subjective:	Parent-perceived traffic safety was positively associated with adolescents reported physical activity in the neighborhood
United States			Frequency of physical activity in various locations
Parental and Adolescent Perceptions of Neighborhood Safety Related to Adolescents’ Physical Activity in Their Neighborhood			Frequency of physical activity in various locations
De Meester et al., 2014 ³⁹	Cross-sectional	736 children aged 10-12 years old	Subjective:	Parental perceptions of neighborhood environmental characteristics were associated with their level of active transport and total physical activity
Belgium			Questionnaire determining different types of physical activity
Parental perceived neighborhood attributes: associations with active transport and physical activity among 10-12 year old children and the mediating role of independent mobility
Zhang et al., 2021 ⁴⁰	Cross-sectional	2,397 adolescents	Subjective:	There was a significant positive association between the quality of amenities and park‑based moderate‑to‑vigorous physical activity
Hong Kong			Moderate-to-vigorous physical activity was measured using an observation tool for assessing physical activity in recreational places such as urban parks
Park environment and moderate-to-vigorous physical activity in parks among adolescents in a high-density city: the moderating role of neighbourhood income
Mendonça et al., 2018 ⁴¹	Cross-sectional	2,874 adolescents aged 14-19 years old	Subjective:	There was a positive association between some environmental variables and different types of exercises
Brazil			Measured using questionnaires, classifying adolescents as physically active or inactive
Perceived neighborhood environmental characteristics and different types of physical activity among Brazilian adolescents
Zhang et al., 2021 ⁴²	Cross-sectional	4,027 adolescents aged 10-20 years old	Subjective:	There was a positive association between availability of physical activity resources and physical activity
Chine			Self-reported moderate-to-vigorous physical activity
Psychosocial Characteristics, Perceived Neighborhood Environment, and Physical Activity Among Chinese Adolescents			Self-reported moderate-to-vigorous physical activity
D’Haese et al., 2014 ⁴³	Cross-sectional	606 children aged 9-12 years old	Objective:	No univocal relation between neighborhood walkability and physical activity was found in 9-12-year-old children
Belgium			Accelerometers
The association between objective walkability, neighborhood socio-economic status, and physical activity in Belgian children			Accelerometers
Colley et al., 2019 ⁴⁴	Cross-sectional	4,030 children aged 3-11 years old and another sample with participants aged 12- 79 years old	Objective:	Walkability was positively associated with accelerometer-measured moderate-to-vigorous physical activity in youth (12-17 years)
Canada			Accelerometers
The association between walkable neighbourhoods and physical activity across the lifespan			Accelerometers
Cheng et al., 2022 ⁴⁵	Cross-sectional	3,424 participants with an average age of 19 years	Subjective:	One scale score increases in neighborhood walkable environmental was associated with an increase in moderate physical activity
China			Questionnaire regarding physical activity using the Global Physical Activity Questionnaire
The relationship between neighborhood environment and physical activity in Chinese youth: a retrospective cross-sectional study
Mitáš et al., 2018 ⁴⁶	Cross-sectional	2,001 adolescents with an average age of 16 years	Objective:	A safe neighborhood environment significantly predicts walking activities among girls
Poland and the Czech Republic			Pedometers
The Safety of the Neighborhood Environment and Physical Activity in Czech and Polish Adolescents			Pedometers
Timperio et al., 2017 ⁴⁷	Cross-sectional and Longitudinal	1,210 children aged 5-6 years old and 10-12 years old	Objective:	Some cross-sectional associations with behavior were found. Longitudinally, the cluster characterized by mixed land use and many playgrounds and sport venues was associated with less television viewing on weekends three years later
Australia			Accelerometers
Typologies of neighbourhood environments and children’s physical activity, sedentary time and television viewing			Accelerometers
Wayas et al., 2023 ⁴⁸	Cross-sectional	143 adolescents aged 13-18 years old	Subjective:	The association between neighborhood walkability and physical activity was inconsistent
South Africa			Measured using questionnaire validated against objectively measured physical activity
Association of Perceived Neighbourhood Walkability with Self-Reported Physical Activity and Body Mass Index in South African Adolescents
Carver et al., 2023 ⁴⁹	Cross-sectional and Longitudinal	727 children aged 6-12 years old	Objective:	There were no significant total or direct effects of environmental attributes and physical activity, both in cross-sectional and longitudinal analysis
United States			Accelerometers
Associations of home and neighborhood environments with children’s physical activity in the U.S.-based Neighborhood Impact on Kids (NIK) longitudinal cohort study			Accelerometers
Bird et al., 2022 ⁵⁰	Longitudinal	409 participants aged 8-10 years old	Objective:	Girls who lived in more walkable neighborhoods had 10% higher daily moderate-to-vigorous physical activity
Canada			Accelerometers
Associations of neighborhood walkability with moderate to vigorous physical activity: an application of compositional data analysis comparing compositional and non-compositional approaches			Accelerometers
de Castro et al., 2022 ⁵¹	Cross-sectional	1,637 participants aged 15-24 years old	Subjective:	Neighborhoods with attributes favorable to practice physical activity and elements of urbanization increase the chance of active behavior during leisure time among adolescents
Brazil			Measured the International Physical Activity Questionnaire (IPAQ), short version
Perceived neighborhood characteristics and practice of physical activity among adolescents and young adults: a model with distal outcomes
Nakabazzi et al., 2021 ⁵²	Cross-sectional	256 children aged 10-12 years	Objective:	There was a negative association between neighborhood and physical activity. A better perception of crime safety was associated with less Moderate-to-vigorous physical activity among boys and girls
Uganda			Accelerometers
Parental-perceived home and neighborhood environmental correlates of accelerometer-measured physical activity among school-going children in Uganda			Accelerometers

	Inclusion criteria	Exclusion criteria
Participants	Children and adolescents	Studies with animals or in vitro, review and opinion articles, repeated studies
Intervention	Walkability	Not applied
Comparison	Subgroup’s analysis according to age (children and adolescents)	None
Outcomes	Physical activity	Studies that did not evaluate physical activity levels
Study type	Observational: cross-sectional and longitudinal	Studies that were not carried out on humans, conference abstracts, and reviews
Language	No limit
Year of publication	No limit

Perspectives
Study	Selection				Comparability	Outcome			Score
Longitudinal Studies	Representativeness of the exposed cohort	Selection of the non-exposed cohort	Ascertainment of exposure	Demonstration that outcome of interest was not present at start of study	Comparability of cohorts based on design or analysis	Assessment of outcome	Was follow-up long enough for outcomes to occur?	Adequacy of follow up of cohorts	0 to 9
Evenson et al., ²⁶	1	1	0	1	1	1	1	1	7
Datar et al., ³⁷	1	1	0	1	2	0	1	0	6
Timperio et al., ⁴⁷	1	1	0	1	2	1	1	0	7
Carver et al., ⁴⁹	1	1	1	1	0	1	1	0	6
Bird et al., ⁵⁰	1	1	1	1	0	1	0	1	6
Study	Selection				Comparability	Outcome		Score
Cross-sectional studies	Representativeness of the sample	Sample size	Non-respondents	Assessment of exposure	The subjects in different outcome groups are comparable, based on the study design or analysis.	Assessment of outcome	Statistical analysis	0 to 8
Tappe et al., ¹⁸	1	0	0	1	1	1	1	5
Carlson et al., ¹⁹	1	0	0	1	2	1	1	6
Kasehagen et al., ²⁰	1	0	1	0	2	0	1	5
Galvez et al., ²¹	1	0	0	0	2	1	1	5
Muthuri et al., ²²	1	0	1	1	0	1	1	5
McGrath et al., ²³	1	0	1	1	2	1	1	7
Hume et al., ²⁴	1	0	0	1	2	1	1	6
Hinckson et al., ²⁵	1	0	0	1	2	1	1	6
Franzini et al., ²⁶	1	0	1	0	1	0	1	4
Sallis et al., ²⁷	1	0	0	1	2	1	1	6
Goon et al., ²⁹	1	0	0	1	2	1	1	6
Huang et al., ²⁸	1	1	0	1	1	0	1	5
Huang et al., ³⁰	1	1	0	0	1	0	1	4
Weimann et al., ³²	1	0	0	0	2	1	1	5
Dias et al., ³³	1	1	1	1	1	0	1	6
Babey et al., ³⁴	1	1	0	0	2	0	1	5
Grigsby-Toussaint et al., ³⁵	1	0	1	0	2	1	1	6
Markevych et al., ³⁶	1	0	0	0	2	1	1	5
Esteban-Cornejo et al., ³⁸	1	0	0	1	2	0	1	5
De Meester et al., ³⁹	1	0	0	1	1	1	1	5
Zhang et al., ³⁸	1	1	0	1	0	0	1	4
Mendonça et al., ⁴¹	1	1	1	0	2	0	1	6
Zhang et al., ⁴⁰	1	0	0	1	1	1	1	5
D’Haese et al., ⁴³	1	0	0	1	1	1	1	5
Colley et al., ⁴⁴	1	0	0	1	2	1	1	6
Cheng et al., ⁴⁵	1	0	0	1	2	0	1	5
Mitáš et al., ⁴⁶	1	0	0	0	0	1	1	3
Wayas et al., ⁴⁸	1	0	0	1	2	0	1	5
de Castro et al., ⁵¹	1	1	1	0	1	0	1	5
Nakabazzi et al., ⁵²	1	1	0	1	1	1	1	6

Database	Terms	Results
PubMed	Search: ((((((((((((Neighborhood[Title]) OR (Neighborhood buffer[Title])) OR (Neighborhood context[Title])) OR (Walking locations[Title])) OR (Space syntax[Title])) OR (Street layout[Title])) OR (Street design[Title])) OR (Urban design[Title])) OR (Urban form[Title])) OR (Urban planning[Title])) OR (Walkability[Title])) OR (Walkable[Title])) AND (((((((((physical activity[Title]) OR (motor activity[Title])) OR (exercise[Title])) OR (walking[Title])) OR (sports[Title])) OR (fitness[Title])) OR (inactivity[Title])) OR (sedentarism[Title])) OR (sedentary[Title]))	707
SPORTDiscus	S1: TI Neighborhood OR TI Neighborhood buffer OR TI Neighborhood context OR TI Walking locations OR TI Space syntax OR TI Street layout OR TI Street design OR TI Urban design OR TI Urban form OR TI Urban planning OR TI Walkability OR TI Walkable	284
	S2: TI physical activity OR TI motor activity OR TI exercise OR TI walking OR TI sports OR TI fitness OR TI inactivity OR TI sedentarism OR TI sedentary
	S3: (TI physical activity OR TI motor activity OR TI exercise OR TI walking OR TI sports OR TI fitness OR TI inactivity OR TI sedentarism OR TI sedentary) AND (S2 AND S3)
LILACS	((ti:(Neighborhood)) OR (ti:(Neighborhood buffer)) OR (ti:(Neighborhood context)) OR (ti:(Walking locations)) OR (ti:(Space syntax)) OR (ti:(Street layout)) OR (ti:(Street design)) OR (ti:(Urban design)) OR (ti:(Urban form)) OR (ti:(Urban planning)) OR (ti:(Walkability)) OR (ti:(Walkable))) AND ((ti:(physical activity)) OR (ti:(motor activity)) OR (ti:(exercise)) OR (ti:(walking)) OR (ti:(sports)) OR (ti:(fitness)) OR (ti:(inactivity)) OR (ti:(sedentarism)) OR (ti:(sedentary)))	13
Web of Science	#1 Neighborhood (Título) or Neighborhood buffer (Título) or Neighborhood context (Título) or Walking locations (Título) or Space syntax (Título) or Street layout (Título) or Street design (Título) or Urban design (Título) or Urban form (Título) or Urban planning (Título) or Walkability (Título) or Walkable (Título)	1.555
	#2 physical activity (Título) or motor activity (Título) or walking (Título) or sports (Título) or fitness (Título) or inactivity (Título) or sedentarism (Título) or sedentary (Título) and exercise (Todos os campos)
	#1 AND #2
Scopus	( ( TITLE ( neighborhood ) OR TITLE ( neighborhood AND buffer ) OR TITLE ( neighborhood AND context ) OR TITLE ( walking AND locations ) OR TITLE ( space AND syntax ) OR TITLE ( street AND layout ) OR TITLE ( street AND design ) OR TITLE ( urban AND design ) OR SRCTITLE ( urban AND form ) AND TITLE ( urban AND planning ) OR TITLE ( walkability ) OR TITLE ( walkable ) ) ) AND ( ( TITLE ( physical AND activity ) OR TITLE ( motor AND activity ) OR TITLE ( exercise ) OR TITLE ( walking ) OR TITLE ( sports ) OR TITLE ( fitness ) OR TITLE ( inactivity ) OR TITLE ( sedentarism ) OR SRCTITLE ( sedentary ) ) )	130
Embase	#1 neighborhood:ti OR ‘neighborhood buffer’:ti OR ‘neighborhood context’:ti OR ‘walking locations’:ti OR ‘space syntax’:ti OR ‘street layout’:ti OR ‘street design’:ti OR ‘urban design’:ti OR ‘urban form’:ti OR ‘urban planning’:ti OR walkability:ti OR walkable:ti	758
	#2 ‘physical activity’:ti OR ‘motor activity’:ti OR exercise:ti OR walking:ti OR sports:ti OR fitness:ti OR inactivity:ti OR sedentarism:ti OR sedentary:ti
	#3 #1 AND #2
Cochrane	#1 (Neighborhood):ti OR (Neighborhood buffer):ti OR (Neighborhood context):ti OR (Walking locations):ti OR (Space syntax):ti	59
	#2 (Street layout):ti OR (Street design):ti OR (Urban design):ti OR (Urban form):ti OR (Urban planning):ti
	#3 (Walkability):ti OR (Walkable):ti
	#4 (physical activity):ti OR (motor activity):ti OR (exercise):ti OR (walking):ti OR (sports):ti
	#5 (fitness):ti OR (inactivity):ti OR (sedentarism):ti OR (sedentary):ti
	#6 #1 OR #2 OR #3
	#7 #4 OR #5
	#8 #6 AND #7
Total		3.506

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