PURPOSE: Environmental changes are potentially effective population-level physical activity (PA) promotion strategies. However, robust multisite evidence to guide international action for developing activity-supportive environments is lacking. We estimated pooled associations of perceived environmental attributes with objectively measured PA outcomes, between-site differences in such associations, and the extent to which perceived environmental attributes explain between-site differences in PA. METHODS: This was a cross-sectional study conducted in 16 cities located in Belgium, Brazil, Colombia, Czech Republic, Denmark, China, Mexico, New Zealand, Spain, United Kingdom, and United States of America. Participants were 6968 adults residing in administrative units stratified by socioeconomic status and transport-related walkability. Predictors were 10 perceived neighborhood environmental attributes. Outcome measures were accelerometry-assessed weekly minutes of moderate-to-vigorous PA (MVPA) and meeting the PA guidelines for cancer/weight gain prevention (420 min·wk of MVPA). RESULTS: Most perceived neighborhood attributes were positively associated with the PA outcomes in the pooled, site-adjusted, single-predictor models. Associations were generalizable across geographical locations. Aesthetics and land use mix-access were significant predictors of both PA outcomes in the fully adjusted models. Environmental attributes accounted for within-site variability in MVPA, corresponding to an SD of 3 min·d or 21 min·wk. Large between-site differences in PA outcomes were observed; 15.9%-16.8% of these differences were explained by perceived environmental attributes. All neighborhood attributes were associated with between-site differences in the total effects of the perceived environment on PA outcomes. CONCLUSIONS: Residents' perceptions of neighborhood attributes that facilitate walking were positively associated with objectively measured MVPA and meeting the guidelines for cancer/weight gain prevention at the within- and between-site levels. Associations were similar across study sites, lending support for international recommendations for designing PA-friendly built environments.

15Department of Public Health School of Medicine Universidad de los Andes Bogotá COLOMBIA

Auckland University of Technology Human Potential Centre Auckland NEW ZEALAND

Baker IDI Heart and Diabetes Institute Melbourne AUSTRALIA

Center for Nutrition and Health Research National Institute of Public Health Cuernavaca Morelos MEXICO

Centre for Physical Activity and Nutrition Research School of Exercise and Nutrition Sciences Deakin University Burwood Victoria AUSTRALIA

Centre for Research and Action in Public Health Canberra University Canberra Australian Capital Territory AUSTRALIA

Department of Family and Preventive Medicine University of California San Diego CA

Department of Health Sciences Public University of Navarra Pamplona Navarra SPAIN

Department of Movement and Sport Sciences Ghent University Ghent BELGIUM

Department of Physical Education Federal University of Paraná Curitiba BRAZIL

Institute of Active Lifestyle Faculty of Physical Culture Palacký University Olomouc CZECH REPUBLIC

Institute of Human Performance University of Hong Kong Hong Kong CHINA

Institute of Sports Science and Clinical Biomechanics University of Southern Denmark DENMARK

Nutrition and Health Sciences Program Graduate Division of Biological and Biomedical Sciences Emory University Atlanta GA

Stanford Prevention Research Center Stanford University School of Medicine Palo Alto CA

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