BACKGROUND: Physical inactivity is a global pandemic responsible for over 5 million deaths annually through its effects on multiple non-communicable diseases. We aimed to document how objectively measured attributes of the urban environment are related to objectively measured physical activity, in an international sample of adults. METHODS: We based our analyses on the International Physical activity and Environment Network (IPEN) adult study, which was a coordinated, international, cross-sectional study. Participants were sampled from neighbourhoods with varied levels of walkability and socioeconomic status. The present analyses of data from the IPEN adult study included 6822 adults aged 18-66 years from 14 cities in ten countries on five continents. Indicators of walkability, public transport access, and park access were assessed in 1·0 km and 0·5 km street network buffers around each participant's residential address with geographic information systems. Mean daily minutes of moderate-to-vigorous-intensity physical activity were measured with 4-7 days of accelerometer monitoring. Associations between environmental attributes and physical activity were estimated using generalised additive mixed models with gamma variance and logarithmic link functions. RESULTS: Four of six environmental attributes were significantly, positively, and linearly related to physical activity in the single variable models: net residential density (exp[b] 1·006 [95% CI 1·003-1·009]; p=0·001), intersection density (1·069 [1·011-1·130]; p=0·019), public transport density (1·037 [1·018-1·056]; p=0·0007), and number of parks (1·146 [1·033-1·272]; p=0·010). Mixed land use and distance to nearest public transport point were not related to physical activity. The difference in physical activity between participants living in the most and least activity-friendly neighbourhoods ranged from 68 min/week to 89 min/week, which represents 45-59% of the 150 min/week recommended by guidelines. INTERPRETATION: Design of urban environments has the potential to contribute substantially to physical activity. Similarity of findings across cities suggests the promise of engaging urban planning, transportation, and parks sectors in efforts to reduce the health burden of the global physical inactivity pandemic. FUNDING: Funding for coordination of the IPEN adult study, including the present analysis, was provided by the National Cancer Institute of National Institutes of Health (CA127296) with studies in each country funded by different sources.

Auckland University of Technology Auckland New Zealand

Baker IDI Heart and Diabetes Institute Melbourne VIC Australia

Centre for Research and Action in Public Health University of Canberra Bruce ACT Australia

Department of Family Medicine and Public Health University of California San Diego CA USA

Department of Geography The University of Hong Kong China

Department of Movement and Sport Sciences Ghent University Ghent Belgium

Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark

Health and Community Design Lab Schools of Population and Public Health and Community and Regional Planning University of British Columbia Vancouver Canada

Hubert Department of Global Health Rollins School of Public Health Emory University Atlanta GA USA

Institute for Environment Sustainability and Regeneration Staffordshire University Stoke on Trent UK

Institute of Active Lifestyle Faculty of Physical Culture Palacky University Olomouc Czech Republic

Michael and Susan Dell Center for Healthy Living The University of Texas Health Science Center at Houston School of Public Health Austin Regional Campus Austin TX USA; Center for Nutrition and Health Research National Institute of Public Health of Mexico Cuernavaca Mexico

Pontiff Catholic University of Parana Curitiba Brazil; Federal University of Parana Curitiba Brazil

School of Medicine Universidad de los Andes Bogota Colombia

School of Nutrition and Health Promotion and Global Institute of Sustainability Arizona State University Tempe AZ USA

The University of Hong Kong Hong Kong China; Institute for Health and Ageing Australian Catholic University Melbourne VIC Australia

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Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: and analysis of burden of disease and life expectancy. Lancet 2012; 380: 219–99. PubMed PMC

Beaglehole R, Bonita R, Horton R, et al. Priority actions for the non-communicable disease crisis. Lancet 2011; 377: 1438–47. PubMed

WHO. Draft comprehensive global monitoring framework and targets for the prevention and control of noncommunicable diseases. Sixty-sixth World Health Assembly. March 15, 2013. Geneva: World Health Organization, 2013.

Kohl HW 3rd, Craig CL, Lambert EV, et al., for The Lancet Physical Activity Series Working Group. The pandemic of physical inactivity: global action for public health. Lancet 2012; 380: 294–305. PubMed

WHO. Global strategy on diet, physical activity and health. Geneva: World Health Organization. May 2004. http://www.who.int/dietphysicalactivity/en (accessed June 25, 2015).

Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin BW, on behalf of The Lancet Physical Activity Series Working Group. Correlates of physical activity: why are some people physically active and others not? Lancet 2012; 380: 258–71. PubMed

Heath G, Brownson R, Kruger J, et al. The effectiveness of urban design and land use and transport policies and practices to increase physical activity: a systematic review. J Phys Act Health 2006; 3: S55–71. PubMed

Ding D, Gebel K. Built environment, physical activity, and obesity: what have we learned from reviewing the literature? Health Place 2012; 18: 100–05. PubMed

van Holle V, Deforche B, van Cauwenberg J, et al. Relationship between the physical environment and different domains of physical activity in European adults: a systematic review. BMC Public Health 2012; 12: 807. PubMed PMC

Kerr J, Sallis JF, Owen N, et al. Advancing science and policy through a coordinated international study of physical activity and built environments: IPEN methods. J Phys Act Health 2013; 10: 581–601. PubMed

Frank LD, Sallis JF, Saelens BE, et al. The development of a walkability index: application to the Neighborhood Quality of Life Study. Br J Sports Med 2010; 44: 924–33. PubMed

Freedson PS, Miller K. Objective monitoring of physical activity using motion sensors and heart rate. Res Q Exerc Sport 2000; 71: S21–29. PubMed

Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 2008; 40: 181–88. PubMed

Welk GJ. Use of accelerometry-based activity monitors to assess physical activity. In: Welk GJ, ed. Physical activity assessments for health-related research. Champaign: Human Kinetics, 2002: 125–42.

Cain K Accelerometer scoring protocol for the IPEN adult study. University of California; San Diego, CA. 2013. http://www.ipenproject.org/documents/methods_docs/IPEN_Protocol.pdf. (accessed July 1, 2015).

Winkler EA, Paul A, Healy GN, et al. Distinguishing true sedentary from accelerometer non-wearing time: accuracy of two automated wear-time estimations. Med Sci Sports Exerc 2009; 41: 171–72.

Freedson PS, Melanson E, Sirard J. Calibration of the computer science and applications, Inc. accelerometer. Med Sci Sports Exerc 1998; 30: 777–81. PubMed

Adams MA, Frank LD, Schipperijn J, et al. International variation in neighborhood walkability, transit, and recreation environments using geographic information systems: the IPEN adult study. Int J Health Geogr 2014; 13: 43. PubMed PMC

Cerin E, Cain K, Conway TL, et al. Neighborhood environments and objectively measured physical activity in 11 countries. Med Sci Sports Exerc 2014; 46: 2253–64. PubMed PMC

Wood SN. Generalized additive models: an introduction with R. Boca Raton: Chapman and Hall, 2006.

Burnham KP, Anderson DR. Model selection and multimodel inference: a practical information-theoretic approach, 2nd edn. New York: Springer, 2002.

WHO. Global recommendations on physical activity for health. Geneva: World Health Organization, 2010. PubMed

Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating more physically active communities. Annu Rev Public Health 2006; 27: 297–322. PubMed

Gebel K, Bauman AE, Petticrew M. The physical environment and physical activity: a critical appraisal of review articles. Am J Prev Med, 2007. 32: 361–69. PubMed

Frank LD. Land use and transportation interaction: implications on public health and quality of life. J Plan Educ Res 2000; 20: 6–22.

Shoham DA, Dugas LR, Bovet P, et al. Association of car ownership and physical activity across the spectrum of human development: Modeling the Epidemiologic Transition Study (METS). BMC Public Health 2015; 15: 173. PubMed PMC

Cao X, Mokhtarian P, Handy S. Examining the impacts of residential self-selection on travel behavior: a focus on empirical findings. Transp Rev 2009; 29: 359–95.

Ewing R, Bartholomew K, Winkelman S, Walters J, Chen D. Growing cooler: the evidence on urban development and climate change. Washington: Urban Land Institute, 2008.

Sallis JF, Spoon C, Cavill N, et al. Co-benefits of designing communities for active living: an exploration of literature. Int J Behav Nutr Phys Act 2015; 12: 30. PubMed PMC

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