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Given its origins in high-income countries, the field of physical activity and public health research and promotion has broadly followed a choice-based model. However, a substantial amount of the physical activity occurring routinely in many settings, particularly in low- and middle-income countries (LMICs), is the result of economic necessity and is not due to true, free choices. We propose the "necessity- versus choice-based physical activity models" framework as a conceptual tool to ground physical activity and public health research and promotion efforts in LMICs, helping ensure that these efforts are relevant, ethical, responsive, and respectful to local contexts. Identifying ways to ensure that LMIC populations can maintain high levels of active transport while increasing opportunities for active leisure must be prioritized. To promote equity, physical activity research, programs, and policies in LMICs must focus on improving the conditions under which necessity-driven physical activity occurs for a vast majority of the population. Expected final online publication date for the

The current rapid, often unplanned urbanisation across Asia has wide-ranging economic, environmental, health, and social impacts. In an attempt to document the implications of this demographic transition, the Journal of Cities & Health in collaboration with the International Society for Urban Health (ISUH) launched a special issue. This special issue is composed of seven original research papers and one commentary that present a fair geographical coverage of urban Asia. This scholarship aims to: 1) enhance the state-of-the-art understanding of health risks, social vulnerability and adaptation policies in cities across Asia;2) present case studies where local contexts were taken into consideration to respond to local health needs and cultural preferences;3) highlight new evidence of health risks and the impact of the built environment;and 4) examine the use of emerging digital technologies and big data across diverse sectors for a more sustainable urban living environment. In the current context of COVID-19, new challenges, insights, and opportunities for change have arisen. Specifically, some crowded Asian cities offer successful approaches in battling early outbreaks of COVID-19 and provide a model for keeping the pandemic at bay, even if they can’t completely eliminate infections. Asian cities can make changes to design spatially distanced transport and recreation opportunities and the long-term implications for both infectious and chronic diseases. This editorial challenges urban policymakers to better align city planning processes with societal goals and public values, for sustainability, health and health equity, and to hold the people of the city as the central plank in all planning processes. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

"Nature prescriptions" are increasingly being adopted by health sectors as an adjunct to standard care to attend to health and social needs. We investigated levels of need and interest in nature prescriptions in adults with cardiovascular diseases, psychological distress and concomitants (e.g. physical inactivity, sedentary behaviour, obesity, loneliness, burn-out).A nationally-representative survey of 3,319 adults across all states and territories of Australia was completed in February 2021 (response 84.0%). Participants were classified across 15 target groups using validated health indicators and surveyed on (1) time and frequency of visits to green and blue spaces (nature spaces), (2) interest in a nature prescription, and (3) potential confounders (e.g. age, income). Analyses were done using weighted logistic regressions.The sample was 50.5% female, 52.0% were aged ≥45 years, 15.2% were living alone and 19.3% were born overseas in non-English-speaking countries. Two-thirds of the sample spent 2 hours or more a week in nature, but these levels were generally lower in target groups (e.g. 57.7% in adults with type 2 diabetes). Most participants (81.9%) were interested in a nature prescription, even among those spending fewer than 2 hours a week in nature (76.4%). For example, 2 hours a week or more in nature was lowest among sedentary adults (36.9%) yet interest in nature prescriptions in this group was still high (74.0%). Lower levels of nature contact in target groups was not explained by differences in access to or preference for local nature spaces.High levels of interest in nature prescriptions amid low levels of nature contact in many target health groups provides impetus for developing randomised trials of interventions that enable people to spend more time in nature. These findings can inform intervention co-design processes with a wide range of community stakeholders, end-users in target health groups, and the health professionals who support them.

City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries.

Developing urban environments that promote healthy, active living for older adults is at the forefront of global planning policy debates, resulting in concepts and design guidelines to support population ageing. However, current urban planning in India is overlooking the design of age-friendly cities. The share of older adults in India is estimated to increase from 8 per cent in 2015 to 20 per cent in 2050. This demographic shift towards a higher proportion of older adults and the associated health and social care expenditures make healthy ageing a public health priority. Existing studies in gerontology have focused on improving housing environments, but we are now understanding the significance of neighbourhood environments for active ageing. This study contributes to the knowledge on factors shaping active ageing in urban India. We present findings from 55 semi-structured interviews conducted with older adults (age > 60 years) in the metropolitan cities of New Delhi and Chennai in India. The findings explore three themes that emerged from this research: (a) neighbourhood design for active ageing, (b) social participation in community spaces and (c) navigating urban transport and mobility. Across these themes, this study highlights that access to neighbourhood amenities such as transportation, parks and green spaces, and opportunities for leisure and social interaction play a key role in determining older adults’ health and quality of life. In drawing on older adults’ lived experiences in their communities, this study informs policy efforts to improve neighbourhood supports for active ageing in urban India.

Walkable, activity-friendly neighbourhoods are recommended for their benefits for non-communicable diseases, environmental sustainability, and economic performance. But how do activity-friendly neighbourhoods function during infectious disease pandemics like COVID-19? The spread of COVID-19 in some of the world’s dense cities has raised concerns about the risks of urban density and public transit. However, there are several pathways by which dense, mixed-use neighbourhoods with transit access and recreation facilities can reduce the risk of both infectious diseases and non-communicable diseases. Reducing health inequities is a core value for public health, and we comment on strategies for equitably creating activity-friendly communities.

The concept of biophilic urban planning has inspired neighborhood greening projects in many older urban communities in the USA and beyond. The strengths (e.g., environmental management, biodiversity, heat island mitigation) and challenges (e.g., greenwashing, green gentrification) of such projects are well-documented. Additional research on the relationship between these projects and various social factors (e.g., public perceptions, feelings, and mental health and well-being) is necessary to better understand how people adapt to said projects while struggling to navigate other more pressing socioeconomic issues, especially in communities facing environmental injustice and health inequity. In this article, we focus on one aspect of biophilic urban planning—green stormwater infrastructure (GSI) (e.g., rain gardens, bio-swales, pervious pavements, and wildflower meadows)—in Waterfront South, a post-industrial neighborhood in Camden, NJ, USA, where residents have faced environmental injustices for decades. Our qualitative analysis of in-depth semi-structured interviews of sixteen residents offered a thorough insight into their perceptions and emotions regarding different types of urban GSI projects. Residents acknowledge the many benefits that GSI offers to combat the neighborhood’s social and environmental injustices, but they are cautious about the possibility of some projects prompting new issues and concerns within the community. Our findings reveal potential implications in GSI planning, research, and practice in this neighborhood and similar urban places elsewhere that have yet to undergo gentrification.

An essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probability of engaging in any walking for transport and WHO's target of at least 15% relative reduction in insufficient physical activity through walking. The International Physical Activity and the Environment Network Adult (known as IPEN) study (N=11 615; 14 cities across ten countries) provided data on local urban design and transport features linked to walking. Associations of these features with the probability of engaging in any walking for transport and sufficient physical activity (≥150 min/week) by walking were estimated, and thresholds associated with the physical activity criteria were determined. Curvilinear associations of population, street intersection, and public transport densities with walking were found. Neighbourhoods exceeding around 5700 people per km 2, 100 intersections per km 2, and 25 public transport stops per km 2 were associated with meeting one or both physical activity criteria. Shorter distances to the nearest park were associated with more physical activity. We use the results to suggest specific target values for each feature as benchmarks for progression towards creating healthy and sustainable cities.

Background Evidence for the health benefits of urban green space tends to stem from small, short-term quasi-experimental or cross-sectional observational research, whilst evidence from intervention studies is sparse. The development of an urban greenway (9 km running along 3 rivers) in Northern Ireland provided the opportunity to conduct a natural experiment. This study investigated the public health impact of the urban greenway on a range of physical activity, health, wellbeing, social, and perceptions of the environment outcomes. Methods A repeated cross-sectional household survey of adult residents (aged ≥16 years) who lived ≤1-mile radius of the greenway (intervention sample) and > 1-mile radius of the greenway (control sample) was conducted pre (2010/2011) and 6-months post implementation (2016/2017). We assessed changes in outcomes pre- and post-intervention follow-up including physical activity behaviour (primary outcome measure: Global Physical Activity Questionnaire), quality of life, mental wellbeing, social capital and perceptions of the built environment. Linear regression was used to calculate the mean difference between post-intervention and baseline measures adjusting for age, season, education, car ownership and deprivation. Multi-level models were fitted using a random intercept at the super output area (smallest geographical unit) to account for clustering within areas. The analyses were stratified by distance from the greenway and deprivation. We assessed change in the social patterning of outcomes over time using an ordered logit to make model-based outcome predictions across strata. Results The mean ages of intervention samples were 50.3 (SD 18.9) years at baseline (n = 1037) and 51.7 (SD 19.1) years at follow-up (n = 968). Post-intervention, 65% (adjusted OR 0.60, 95% CI 0.35 to 1.00) of residents who lived closest to the greenway (i.e., ≤400 m) and 60% (adjusted OR, 0.64 95% CI 0.41 to 0.99) who lived furthest from the greenway (i.e.,≥1200 m) met the physical activity guidelines - 68% of the intervention sample met the physical activity guidelines before the intervention. Residents in the most deprived quintiles had a similar reduction in physical activity behaviour as residents in less deprived quintiles. Quality of life at follow-up compared to baseline declined and this decline was significantly less than in the control area (adjusted differences in mean EQ5D: -11.0 (95% CI − 14.5 to − 7.4); − 30.5 (95% CI − 37.9 to − 23.2). Significant change in mental wellbeing was not observed despite improvements in some indicators of social capital. Positive perceptions of the local environment in relation to its attractiveness, traffic and safety increased. Conclusions Our findings illustrate the major challenge of evaluating complex urban interventions and the difficulty of capturing and measuring the network of potential variables that influence or hinder meaningful outcomes. The results indicate at this stage no intervention effect for improvements in population-level physical activity behaviour or mental wellbeing. However, they show some modest improvements for secondary outcomes including positive perceptions of the environment and social capital constructs. The public health impact of urban greenways may take a longer period of time to be realised and there is a need to improve evaluation methodology that captures the complex systems nature of urban regeneration.

Active travel (AT) has gained increasing attention as a way of addressing low levels of physical activity. However, little is known regarding the relationship between income and AT. The aim of this study was to investigate characteristics associated with undertaking AT in an adult population and by low- and high-income groups. Data collected from the Physical Activity and the Rejuvenation of Connswater (PARC) study in 2017 were used. Participants were categorised into socio-economic groups according to their weekly household income, and were categorised as participating in ‘no’ AT or ‘some’ AT and ‘sufficient’ AT. Multivariable logistic regression explored characteristics associated with AT in the full cohort, and the low- and high-income groups separately. Variables associated with AT in the low-income group were body mass index (BMI), physical activity self-efficacy, marital status, long term illness, difficulty walking and housing tenure. For the high-income group, BMI, marital status, housing tenure and education were associated with AT. For both income groups, there were consistent positive associations with the action/maintenance phase of the stage of change model across all AT categories. The findings suggest that population sub-groups may benefit from targeted initiatives to support engagement in AT and prevent further widening of inequalities.

This Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Available standards and targets were often insufficient to promote health and wellbeing, and health-supportive urban design and transport features were often inadequate or inequitably distributed. City planning decisions affect human and planetary health and amplify city vulnerabilities, as the COVID-19 pandemic has highlighted. Hence, we offer an expanded framework of pathways through which city planning affects health, incorporating 11 integrated urban system policies and 11 integrated urban and transport interventions addressing current and emerging issues. Our call to action recommends widespread uptake and further development of our methods and open-source tools to create upstream policy and spatial indicators to benchmark and track progress; unmask spatial inequities; inform interventions and investments; and accelerate transitions to net zero, healthy, and sustainable cities. BG-C was supported by an RMIT Vice-Chancellor's Fellowship. CH was supported through an NHMRC Centre for Research Excellence in Healthy Liveable Communities grant (number 1061404) and The Australian Prevention Partnership Centre (number 9100003). DA was supported by an Impact Acceleration Award from the Economic and Social Research Council and funding from the Global Challenges Research Fund administered by the Department for the Economy, Northern Ireland, UK. EC's research was supported by the Australian Catholic University. SL was supported by the experiential fellowships from College of Social Science and Humanities, Northeastern University. JFS was supported by Australian Catholic University. DS was supported by Washington University in St Louis (MO, USA), Center for Diabetes Translation Research (number P30DK092950 from the US National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institute of Health) and by the Cooperative Agreement Number U48DP006395 from the US Centers for Disease Control and Prevention. SB was supported by an Australian Research Council Linkage Grant (LP160100324) and European Union's Horizon 2020 research and innovation programme under grant agreement #730426 (Urban GreenUP). We would like to thank Belinda Nemec and Judy Boyce. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Benchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. We show this framework by calculating spatial indicators-for 25 diverse cities in 19 countries-of urban design and transport features that support health and sustainability. We link these indicators to cities' policy contexts, and identify populations living above and below critical thresholds for physical activity through walking. Efforts to broaden participation in crowdsourcing data and to calculate globally consistent indicators are essential for planning evidence-informed urban interventions, monitoring policy effects, and learning lessons from peer cities to achieve health, equity, and sustainability goals.

The World Health Organization and the United Nations have increasingly acknowledged the importance of urban green space (UGS) for healthy ageing. However, low- and middle-income countries (LMICs) like India with exponential ageing populations have inadequate UGS. This qualitative study examined the relationships between UGS and healthy ageing in two megacities in India. Participants were recruited using snowball sampling in New Delhi and Chennai and semi-structured interviews were conducted with consenting participants (N = 60, female = 51%, age &gt, 60 years, fluent in English, Hindi, or Tamil). Interviews were recorded, transcribed, translated, and analysed using inductive and thematic analysis. Benefits of UGS included community building and social capital, improved health and social resilience, physical activity promotion, reduced exposure to noise, air pollution, and heat. Poorly maintained UGS and lack of safe, age-friendly pedestrian infrastructure were identified as barriers to health promotion in later life. Neighbourhood disorder and crime constrained older adults’ use of UGS in low-income neighbourhoods. This study underscores the role of UGS in the design of age-friendly communities in India. The findings highlight the benefits of UGS for older adults, particularly those living in socially disadvantaged or underserved communities, which often have least access to high-quality parks and green areas.

Pedestrian accessibility is an important factor in urban transport and land use policy and critical for creating healthy, sustainable cities. Developing and evaluating indicators measuring inequalities in pedestrian accessibility can help planners and policymakers benchmark and monitor the progress of city planning interventions. However, measuring and assessing indicators of urban design and transport features at high resolution worldwide to enable city comparisons is challenging due to limited availability of official, high quality, and comparable spatial data, as well as spatial analysis tools offering customizable frameworks for indicator construction and analysis. To address these challenges, this study develops an open source software framework to construct pedestrian accessibility indicators for cities using open and consistent data. It presents a generalized method to consistently measure pedestrian accessibility at high resolution and spatially aggregated scale, to allow for both within- and between-city analyses. The open source and open data methods developed in this study can be extended to other cities worldwide to support local planning and policymaking. The software is made publicly available for reuse in an open repository.

Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development.

Ciclovia, also known as Open Streets initiatives in other countries, are city streets that are closed to motorized traffic and opened during certain times to residents for engaging in physical activity (PA). These initiatives are viewed by policy makers and health and community advocates as being beneficial to social, environmental, and community health. This study explores the geographic distribution of Ciclovia and Recreovia and the differences in geographic access assessed via distance-based measures, based on the socioeconomic status (SES) of the area. Results from this study show that the median distance to the Ciclovia according to SES ranges from 2930 m for SES 1 (most disadvantaged) to 482 m for SES 6 (wealthiest). The median distance to the Recreovia sites ranges from 5173 m for SES 1 to 3869 m for SES 6. This study found revealing urban inequities in the distribution of Ciclovia, whereas there was less inequalities within the Recreovia sites. This study shows that urban interventions are needed to promote recreational activity and reduce health disparities in under resourced, low SES areas.

Overweight and obesity are steadily rising in South Asia, the world’s most populous region. India, a low- and middle-income country in South Asia is experiencing an obesity epidemic. Built environment features may profoundly influence physical activity and counter the risk from overweight and obesity. This cross-sectional study investigated built environment correlates of overweight and obesity among adults (N = 370, 47.2% female, mean age = 37.9 years) in Chennai, India. Participants from low-socioeconomic status households were more likely to be overweight/obese (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.1–2.9) than participants from high-socioeconomic status households. Driving to work predicted a three-fold increase in overweight or obesity compared to active commuting (OR = 2.9, 95%CI = 1.3–6.4). Household car ownership was linked with an increased likelihood of overweight or obesity (OR = 1.5, 95%CI = 0.7–3.2). Low walkability neighbourhoods significantly predicted an increase in odds of overweight or obesity (OR = 1.8, 95%CI = 1.1–2.8). By 2030, Indian cities are projected to add 250 million people accompanied by a 9.9% annual motor vehicle growth rate. As car ownership increases across Southern Asia, there is an urgent need to develop interventions to promote physical activity.

Physical activity (PA) has strong relevance for limiting the harms to human health and well-being due to the coronavirus disease-2019 (COVID-19) pandemic.1 Active muscles produce chemicals that improve immune functioning, which in turn reduces the extent of infections, and decreases inflammation, and these are the main causes of the lung damage from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. PA is a powerful preventive and therapeutic intervention for the most common pre-existing chronic conditions that increase risk of severe COVID-19 infections and mortality.2,3 PA's effectiveness in preventing and treating anxiety and depression could have worldwide benefits during this stressful global crisis.2 PA enhances the efficacy of vaccines,4 so active lifestyles will continue to be relevant through every phase of the pandemic. Worldwide, about 23% of men and 32% of women are at risk for the underlying conditions of COVID-19, severe COVID-19 infections, and stress-related psychological symptoms, because they do not meet PA guidelines, based on self-report measures.5,6 It is likely that prolonged shelter-at-home measures will lead to reduced PA and increased sedentary behaviors that adversely affect immune function and enhance risk for chronic health conditions.7,8 Many people, especially with low incomes, do not have equipment, Internet access, or indoor space to make at-home PA realistic. Thus, the current pandemic is almost certain to exacerbate socioeconomic inequities in PA.9, 10, 11 The pandemic is changing the places where people can be physically active because many jurisdictions closed or restricted access to common indoor and outdoor places for PA.12, 13, 14 Though some jurisdictions allowed people to exercise outdoors on the streets, others did not, so for millions of people, being active at home was the only option. As limitations are eased, policies related to indoor and outdoor PA places vary across jurisdictions.15,16 If spikes occur in COVID-19 cases and deaths, movement restrictions may be put back in place. It is unknown how long this dynamic ebb and flow of limits on people's ability to be physically active will last and what the impact will be on PA. There are many unanswered questions about how pandemic-related policies in each jurisdiction are affecting PA. Therefore, it is important to identify the most pressing scientific questions that could be translated to policy and practice aimed at favorably impacting population health outcomes. There is ample evidence to justify making PA promotion a global public health priority during the coronavirus pandemic.1,17 One pathway to increasing the prominence of PA as a solution is to set a public health research agenda for promoting scientific studies to document any health and societal benefits during the COVID-19 pandemic, and to evaluate public health strategies for effectively promoting PA under crisis conditions. We consider research on PA and COVID-19 to be an urgent global public health need. Within this context, relevant PA research can span a broad range from basic science covering in vitro laboratory studies and human studies, to clinical studies with diagnosed patients, to public health studies focusing on prevention. Among the many research needs, the present paper focuses on studies with the potential to guide public health policy and practice, with a secondary focus on studies that could guide clinical practice. Our international author team has proposed priority areas for PA and public health research relevant to the COVID-19 pandemic. Although the current literature provides strong scientific premise for the public health relevance of PA for COVID-19,1,4,8 no research has specifically examined the impact of PA on SARS-CoV-2 infections or produced data directly related to the evaluation of infection control strategies that might impact PA. Evidence on these and other emergent topics is needed in a timely manner to inform PA policy and practice locally and internationally. The author team includes a senior researcher who has studied PA for decades (JFS) and 3 early-career investigators who bring research skills related to PA, the creativity of youth, and diverse geographic and cultural experience, having grown up in India (DA), Nigeria (AO), and Mexico (DS). We have interdisciplinary expertise in behavioral science, spatial epidemiology, urban health, physiotherapy, and health promotion. Our goal is to stimulate research studies that should be started now in multiple countries, especially among those countries most affected by the SARS-CoV-2 virus, to inform effective PA promotion strategies to be applied during the current pandemic, as well as to improve preparedness for future pandemics. Each author nominated study ideas, and consensus was reached on the highest priorities based on the need to conduct the study during the pandemic, direct relevance to practice or policy, and feasibility. The 7 research topics selected for inclusion in the present paper are just a few of those initially nominated by the authors. We encourage investigators to plan studies on the topics suggested here and identify additional questions related to PA and COVID-19 that deserve to be investigated. For each research topic below, we briefly explain the purpose of the study, though few methodological details are provided, on the assumption investigators will bring their own skills and creativity to each study. We provide a rationale for the importance of each topic and summarize the significance for policy or practice. We also highlight a few challenges likely to be encountered in conducting each type of study.

Introduction Insufficient physical activity (PA) is a key contributor for premature mortality in low- and middle-income countries (LMICs). Despite the well-documented health benefits of PA, few women achieve the recommended levels of PA. The global average of inactivity among women is higher at 31.7% compared to 23.4% for inactive men. The gender gap in PA participation is wider in India where estimates indicate that 44% women are insufficiently active, compared to 25% men. Methods This cross-sectional study was conducted in the city of Chennai, India. Participants (N = 370) were recruited from 155 wards stratified by neighborhood walkability and socio-economic status. The adapted Neighborhood Environment Walkability Scale for India (NEWS-India) was used to assess built environment perceptions on density, land-use mix, street infrastructure, aesthetics, traffic and crime safety. Travel and leisure PA were recorded using the International Physical Activity Questionnaire-Long Form (IPAQ-LF). Study protocols were based on recommendations of the I nternational P hysical activity and the E nvironment N etwork (IPEN; www.ipenproject.org ) and previously used in studies in Brazil, Colombia, and Nigeria. Results A greater number of women reported achieving weekly PA levels from travel-related activities (n = 54, 16.0%) compared to men (n = 33, 9.8%). In contrast, a higher percentage of men (n = 75, 22.3%) met weekly PA recommendations during leisure-time compared to women (n = 54, 16.1%). Street connectivity (aOR = 3.2, CI = 1.3, 8.0) and land-use mix access (aOR = 3.7, CI = 1.4, 8.2) significantly increased odds of travel PA among women. Conclusions Low engagement in leisure PA among women can be linked to prevailing socio-cultural norms that constrain women's mobility and hinder their participation in PA. Aspects of gender equity in transportation planning are closely linked with citywide indicators of liveability, sustainability and resilience in LMICs like India. Public health practitioners must address gender-specific barriers to increase PA among women through context-specific group exercise programs, peer support and guidance that emphasize the importance of PA.

The present study aimed to assess the association between sedentary behavior and sarcopenia among adults aged &ge, 65 years. Cross-sectional data from the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Self-reported sedentary behavior was assessed as a continuous variable (hours per day) and also as a categorical variable (0&ndash, &lt, 4, 4&ndash, 8, 8&ndash, 11, &ge, 11 hours/day). Multivariable logistic regression was conducted to assess the association between sedentary behavior and sarcopenia. Analyses using the overall sample and country-wise samples were conducted. A total of 14,585 participants aged &ge, 65 years were included in the analysis. Their mean age was 72.6 (standard deviation, 11.5) years and 55% were females. Compared to sedentary behavior of 0&ndash, 4 hours/day, &ge, 11hours/day was significantly associated with 2.14 (95% CI = 1.06&ndash, 4.33) times higher odds for sarcopenia. The country-wise analysis showed that overall, a one-hour increase in sedentary behavior per day was associated with 1.06 (95% CI = 1.04&ndash, 1.10) times higher odds for sarcopenia, while the level of between-country heterogeneity was low (I2 = 12.9%). Public health and healthcare practitioners may wish to target reductions in sedentary behavior to aid in the prevention of sarcopenia in older adults.

Physical inactivity is the fourth leading risk factor for global mortality, causing an estimated 3.3 million deaths worldwide. Characteristics of the built environment, including buildings, public spaces, pedestrian and cycling infrastructure, transportation networks, parks, trails and green spaces can facilitate or constrain physical activity. However, objective study of built environment interventions on physical activity remains challenging due to methodological limitations and research gaps. Existing methods such as direct observations or surveys are time and labour intensive, and only provide a static, cross-sectional view of physical activity at a specific point in time. The aim of this study was to develop a novel method for objectively and inexpensively assessing how built environment changes may influence physical activity. We used a novel, unobtrusive method to capture real-time, in situ data from a convenience sample of 25 adults along a newly constructed urban greenway in an area of high deprivation in Belfast, UK. Walk/bike-along interviews were conducted with participants using a body-worn or bicycle-mounted portable digital video camera (GoPro HERO 3+ camera) to record their self-determined journeys along the greenway. This is the first study to demonstrate the feasibility of using wearable sensors to capture participants’ responses to the built environment in real-time during their walking and cycling journeys. These findings contribute to our understanding of the impact of real-world environmental interventions on physical activity and the importance of precise, accurate and objective measurements of environments where the activity occurs.

India is currently facing a non-communicable disease epidemic. Physical activity (PA) is a preventative factor for non-communicable diseases. Understanding the role of the built environment (BE) to facilitate or constrain PA is essential for public health interventions to increase population PA. The objective of this study was to understand BEs associations with PA occurring in two major life domains or life areas-travel and leisure-in urban India. Between December 2014 and April 2015, in-person surveys were conducted with participants (N=370; female=47.2%) in Chennai, India. Perceived BE characteristics regarding residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure for walking and bicycling, aesthetics, traffic safety, and safety from crime were measured using the adapted Neighborhood Environment Walkability Scale-India (NEWS-India). Self-reported PA was measured the International Physical Activity Questionnaire. High residential density was associated with greater odds of travel PA (aOR=1.9, 95% CI=1.2, 3.2). Land use mix-diversity was positively related to travel PA (aOR=2.1, 95%CI=1.2, 3.6), but not associated with leisure or total PA. The aggregate NEWS-India score predicted a two-fold increase in odds of travel PA (aOR=1.9, 95% CI=1.1, 3.1) and a 40% decrease in odds of leisure PA (aOR=0.6, 95% CI=0.4, 1.0). However, the association of the aggregated score with leisure PA was not significant. RESULTS suggest that relationships between BE and PA in low-and-middle income countries may be context-specific, and may differ markedly from higher income countries. FINDINGS have public health implications for India suggesting that caution should be taken when translating evidence across countries.Copyright © 2016. Published by Elsevier Inc. Language: en

With relatively few exceptions, the majority of evidence concerning the health benefits of physical activity (PA) has been gleaned from high-income countries (HICs).1 In the opening editorial to this special issue,2 the editors suggest that under-representation of lower and middle-income countries (LMICs, often referred to as ‘Global South’) in the PA literature is more than ‘just another research gap’. Arguably, this gap reflects very real differences in context, competing health and developmental priorities, available resources and undoubtedly, political will. Juxtaposed against the clear benefits of PA, most LMICs are characterised by the coexistence of both non-communicable and infectious chronic diseases, such as tuberculosis and HIV/AIDS.3 Obesity often coexists with maternal and childhood undernutrition and household food insecurity and health disparities have been exacerabated by the COVID-19 crisis. Political circumstances are often adverse, with many LMICs experiencing conflict, humanitarian crises, and/or social unrest and embedded inequalities (eg, the legacy of apartheid in South Africa). Lack of safety from crime and traffic, poorly designed and often overcrowded urban environments, low prioritisation of physical education in schools, and inequitable distribution of green space, are endemic to most LMICs.4 5 Thus, PA, even for transport, is difficult at best, and largely undertaken by necessity rather than by choice. Meanwhile, recreational PA is inaccessible for most in these settings.6 As such, and with rapid urbanisation in LMICs, often into poverty,7 we are required to view PA through the ‘lens’ of equity. This demands us to elevate the discussion for PA above health, and frame it as a …

Burnout has been included as an occupational phenomenon in the International Classification of Diseases. Health promotion through workplace physical activity policies, incentives, and supports has the potential to prevent burnout.

Objectives. To examine the impact of environmental restructuring on attendees at a physical activity conference when provided with standing tables and given point-of-decision prompts (PODPs; e.g., health messages). Methods. This randomized controlled trial took place at the Health-Enhancing Physical Activity Europe 2016 conference in Belfast, United Kingdom, September 2016. We randomly allocated 14 oral sessions to either the intervention group (standing tables + PODPs; n = 7) or the control group (PODPs only; n = 7). Conference volunteers discreetly recorded the number of attendees standing and sitting and estimated the number of women and attendees aged 40 years or older. Results. There was a significant difference (P = .04) in the proportion of attendees standing during the intervention (mean = 16.8%; SD = 9.5%) than during control sessions (mean = 6.0%; SD = 5.8%). There was no differential response between gender and age groups in the proportion standing during intervention sessions (P > .05). Conclusions. Providing standing tables may be a feasible and effective strategy to reduce sitting at physical activity conferences.

Background: Few studies have assessed built environment correlates of active commuting in low-and-middle-income countries, but the different context could yield distinct findings. This cross-sectional study investigated associations between home neighbourhood environment characteristics and active commuting in Chennai, India.Methods: Adults (N = 370, 47.2% female, mean age = 37.9 years) were recruited from 155 wards in the metropolitan area of Chennai in southern India between January and June 2015. Participants self-reported their usual mode of commute to work, with responses recoded into three categories: (1) multi-modal or active commuting (walking and bicycling); (2) public transit; and (3) private transport. Environmental attributes around participants’ homes were assessed using the Neighborhood Environment Walkability Scale-India (NEWS-India). Associations between environmental characteristics and likelihood of active commuting and public transit use were modelled using logistic regression with private transport (driving alone or carpool) as the reference category, adjusting for age, gender, and household car ownership.Results: Consistent with other international studies, participants living in neighbourhoods with a mix of land-uses and a transit stop within a 10-minute walk from home were more likely to use active commuting (bothp < 0.01). Land-use mix was significantly associated with the use of public transit compared to private transport (aOR = 5.2, p = 0.002). Contrary to findings in high-income countries, the odds of active commuting were reduced with improved safety from crime (aOR = 0.2, p = 0.003), aesthetics (aOR = 0.2, p = 0.05) and street connectivity (aOR = 0.2, p = 0.003).Conclusions: Different environmental attributes were associated with active commuting, suggesting that these relationships are complex and may distinctly differ from those in high-income countries. Unexpected inverse associations of perceived safety from crime and aesthetics with active commuting emphasize the need for high quality epidemiologic studies with greater context-specificity in the study of physical activity in LMICs. Findings have public health implications for India and suggest that caution should be taken when translating evidence across countries.

Promoting the use of public transit and active transport (walking and cycling) instead of car driving is an appealing strategy to increase overall physical activity.To quantify the combined associations between self-reported home and worksite neighborhood environments, worksite support and policies, and employees' commuting modes.Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone (n = 1,338) and provided information on socio-demographic characteristics, home and worksite neighborhoods, and worksite support and policies. Commuting mode was self-reported and categorized into car driving, public transit, and active commuting. Commuting distance was calculated using geographic information systems. Commuters providing completed data were included in the analysis. Multivariate logistic regression models were used to examine the correlates of using public transit and active commuting.The majority of participants reported commuting by driving (88.9%); only 4.9% used public transit and 6.2% used active modes. After multivariate adjustment, having transit stops within 10-15 minutes walking distance from home (p=0.05) and using worksite incentive for public transit (p0.001) were associated with commuting by public transit. Commuting distance (p0.001) was negatively associated with active commuting. Having free or low cost recreation facilities around the worksite (p=0.04) and using bike facilities to lock bikes at the worksite (p0.001) were associated with active commuting.Both environment features and worksite supports and policies are associated with the choice of commuting mode. Future studies should use longitudinal designs to investigate the potential of promoting alternative commuting modes through worksite efforts that support sustainable commuting behaviors as well as the potential of built environment improvements.

Background Physical inactivity has been associated with obesity and related chronic diseases. Understanding built environment (BE) influences on specific domains of physical activity (PA) around homes and workplaces is important for public health interventions to increase population PA. Purpose To examine the association of home and workplace BE features with PA occurring across specific life domains (work, leisure, and travel). Methods Between 2012 and 2013, telephone interviews were conducted with participants in four Missouri metropolitan areas. Questions included sociodemographic characteristics, home and workplace supports for PA, and dietary behaviors. Data analysis was conducted in 2013; logistic regression was used to examine associations between BE features and domain-specific PA. Results In home neighborhoods, seven of 12 BE features (availability of fruits and vegetables, presence of shops and stores, bike facilities, recreation facilities, crime rate, seeing others active, and interesting things) were associated with leisure PA. The global average score of home neighborhood BE features was associated with greater odds of travel PA (AOR=1.99, 95% CI=1.46, 2.72); leisure PA (AOR=1.84, 95% CI=1.44, 2.34); and total PA (AOR=1.41, 95% CI=1.04, 1.92). Associations between workplace neighborhoods' BE features and workplace PA were small but in the expected direction. Conclusions This study offers empirical evidence on BE supports for domain-specific PA. Findings suggest that diverse, attractive, and walkable neighborhoods around workplaces support walking, bicycling, and use of public transit. Public health practitioners, researchers, and worksite leaders could benefit by utilizing worksite domains and measures from this study for future BE assessments.

Background: Pokemon GO is the most played augmented reality game in history. With more than 44 million players at the peak of its popularity, the game has sparked interest on its effects on the young population’s health. Objective: This pilot study examined motivations to start playing Pokemon GO among a sample of US college students, and how motivations were associated with perceived outcomes of the playing experience and physical activity derived while playing. Methods: In November 2016, we asked a sample of 47 US college students (all Pokemon GO players) to complete online surveys and install an ecological momentary assessment (EMA) tool and step counter on their smartphones. The EMA tool prompted a set of questions on playing behavior and physical activity, 3 times per day (12:00 PM, 7:00 PM, and 10:00 PM), for 7 days. We used a factorial analysis to identify 3 distinctive groups of players based on their motivations to start playing Pokemon GO. We tested differences across motivation groups related to 5 unique outcomes using 1-way analysis of variance. Results: We extracted 3 interpretable factors from the clustering of motivations to start playing Pokemon GO: Pokemon and video game fans (n=26, 55% of the sample), physical activity seekers (n=8, 17%), and curious & social (n=13, 28%). The clusters differed significantly on the enjoyment of different aspects of the game, particularly battling, discovering new places, and meeting new people, as well as differences in agreement that playing improved mood and made them more social. Days when playing Pokemon GO were associated with higher number of steps reported at the end of the day, especially among physical activity seekers, but also for Pokemon and video game fans. All groups perceived traffic as a major threat to playing. Conclusions: Days during which Pokemon GO was played were positively associated with a set of beneficial health behaviors, including higher physical activity levels, more socialization, and better mood. Results, however, depended on personal motivations and expectations when joining the game. These results highlight the importance of taking motivation into account when attempting to extract conclusions from the Pokemon GO phenomenon to enhance future exergames’ designs or health interventions. [JMIR Serious Games 2017;5(4):e21]

Introduction: Data on built environment (BE) and physical activity (PA) in low- and middle- income countries is sparse. This study compared BE features, PA levels, and weight status among adults living in neighborhoods stratified by walkability and socio-economic status (SES) in the city of Chennai, India.Methods: This cross sectional study design surveyed 370 adults (≥18 years) from four neighborhoods with differing walkability and socio-economic status. Participants were asked to complete a survey on their neighborhood environment, leisure and travel PA, height, weight, and demographic characteristics. One-way analysis of variance tests were used to examine differences across neighborhoods.Results: Residents of high-walkability/high-SES neighborhoods reported higher land use mix diversity, land use mix access, street connectivity, aesthetics, and safety from crime. Residential density and walking/bicycling infrastructure were highest in the high-walkability/low-SES neighborhood. Transport PA was the maximum contributor to total PA in low-SES neighborhoods, while residents of high-SES neighborhoods reported greater levels of leisure-time PA. Sitting time and BMI were greater among high-SES participants. Patterns of PA, sedentary time, and weight status varied significantly by neighborhood walkability and SES.Conclusions: An understanding of BE correlates of domain-specific PA can support the development of contextually tailored interventions to promote physical activity and reverse the determinants of inactivity occurring through patterns of urbanization and sedentary behaviors in India.

Dietary behaviors are associated with obesity, and may be influenced by the environment. The objective of the current work was to investigate whether perceptions of built environment factors related to eating in the residential neighborhood will have different, independent associations with BMI and dietary behaviors than perceived built environment factors in the worksite neighborhood. In 2012–2013, a cross-sectional telephone-survey of Missouri adults (n = 2015) assessed perceptions of home and workplace built environment factors related to eating, dietary behaviors, and height and weight. Logistic regression models explored associations between perceived neighborhood built environment variables, diet, and obesity. The only variable associated with any of the outcomes explored in the fully adjusted models was the home neighborhood composite scale. None of the work environment variables were significantly associated with any of the health/behavior outcomes after adjustment. Few associations were found after adjustment for personal and job-related characteristics, and none were identified with the workplace neighborhood environment. While few home environment associations were found after adjustment, and none were identified with the perceived workplace neighborhood environment, the current study adds to the limited literature looking at associations between the perceived neighborhood around the workplace neighborhood and the perceived neighborhood around the home and dietary behaviors and obesity in adults. Future studies are needed to determine whether relationships between these environments and behavior exist, and if so, if they are causal and warrant intervention attempts., Highlights • Perceived neighborhood environments may be related to diet behaviors and obesity. • Home and work neighborhoods may differ in these relationships. • A home neighborhood composite scale was associated with obesity but not diet behavior. • No associations were found with the perceived work neighborhood environment.

Publicly available, outdoor webcams continuously view the world and share images. These cameras include traffic cams, campus cams, ski-resort cams, etc. The Archive of Many Outdoor Scenes (AMOS) is a project aiming to geolocate, annotate, archive, and visualize these cameras and images to serve as a resource for a wide variety of scientific applications. The AMOS dataset has archived over 750 million images of outdoor environments from 27,000 webcams since 2006. Our goal is to utilize the AMOS image dataset and crowdsourcing to develop reliable and valid tools to improve physical activity assessment via online, outdoor webcam capture of global physical activity patterns and urban built environment characteristics.

Physical inactivity is the fourth leading risk factor for global mortality, with most of these deaths occurring in low and middle-income countries (LMICs) like India. Research from developed countries has consistently demonstrated associations between built environment features and physical activity levels of populations. The development of culturally sensitive and reliable measures of the built environment is a necessary first step for accurate analysis of environmental correlates of physical activity in LMICs. This study systematically adapted the Neighborhood Environment Walkability Scale (NEWS) for India and evaluated aspects of test-retest reliability of the adapted version among Indian adults. Cultural adaptation of the NEWS was conducted by Indian and international experts. Semi-structured interviews were conducted with local residents and key informants in the city of Chennai, India. At baseline, participants (N = 370; female = 47.2%) from Chennai completed the adapted NEWS-India surveys on perceived residential density, land use mix-diversity, land use mix-access, street connectivity, infrastructure and safety for walking and cycling, aesthetics, traffic safety, and safety from crime. NEWS-India was administered for a second time to consenting participants (N = 62; female = 53.2%) with a gap of 2–3 weeks between successive administrations. Qualitative findings demonstrated that built environment barriers and constraints to active commuting and physical activity behaviors intersected with social ecological systems. The adapted NEWS subscales had moderate to high test-retest reliability (ICC range 0.48–0.99). The NEWS-India demonstrated acceptable measurement properties among Indian adults and may be a useful tool for evaluation of built environment attributes in India. Further adaptation and evaluation in rural and suburban settings in India is essential to create a version that could be used throughout India.

Results and figures of the article by Adlakha et al. (2014) contained minor errors, which we hereby rectify. Results show that a large majority of running and walking routes were through or tangential to a park or green space. A total of 1,722.01 miles from 287 running routes and 236.84 miles from 71 walking routes appear in Figure ​Figure11 and Table ​Table1.1. The average lengths of a run and walk in this sample were 6.00 and 3.33 miles, respectively. Of all the parks in the study area, 70% were located in low-income neighborhoods. Of the 287 running routes, 80.80% traversed a park at some point during the run and 6.97% of these runs took place in parks located in low-SES neighborhoods. Of the 71 walking routes, 70.40% traversed a park at some point during the walk and 15.50% of walking routes occurred in parks located in low-SES neighborhoods. Figure ​Figure22 illustrates the availability of many parks across St. Louis, but shows fewer mapped running or walking routes in the northern half of the region that features more low-SES neighborhoods. Figure 1 Running routes, walking routes, and poverty rate in St. Louis, MO, USA. Table 1 Use of parks in St. Louis, MO for physical activity in 2012a. Figure 2 Running and walking routes in parks and poverty rate in St. Louis, MO, USA. The odds of reported running and walking routes traversing low-SES neighborhoods were significantly lower than the odds of running and walking routes reported in higher-SES neighborhoods (runs: OR = 0.36, CI = 0.21–0.62; walks: OR = 0.41, CI = 0.23–0.73) (Table ​(Table2).2). The odds of running in a park in a low-SES neighborhood were 52% lower than running in a park in a higher-SES neighborhood (OR = 0.48, CI = 0.29–0.79). The odds of walking reported in a park in a low-SES neighborhood were 64% lower than walking in a park in a higher-SES neighborhood (OR = 0.36, CI = 0.16–0.82). Table 2 Logistic regression: odds of running and walking in a low-SES neighborhood (N = 238) and park (N = 511), compared to higher-SES neighborhoods. Revised results indicate decreased odds of reported running and walking in low-SES St. Louis neighborhoods compared to higher-SES St. Louis neighborhoods (Table ​(Table1).1). This finding is consistent with the disparate rates of PA in low versus higher-SES areas (1, 2). Overall, the lower odds of reported running and walking in low-SES neighborhoods and parks located in these low-SES neighborhoods compared to higher-SES neighborhoods and parks corroborates several health and environmental disparities between north and south St. Louis.

The Archive of Many Outdoor Scenes has captured 400 million images. Many of these cameras and images are of street intersections, a subset of which has experienced built environment improvements during the past seven years. We identified six cameras in Washington, DC, and uploaded 120 images from each before a built environment change (2007) and after (2010) to the crowdsourcing website Amazon Mechanical Turk (n=1,440). Five unique MTurk workers annotated each image, counting the number of pedestrians, cyclists, and vehicles. Two trained Research Assistants completed the same tasks. Reliability and validity statistics of MTurk workers revealed substantial agreement in annotating captured images of pedestrians and vehicles. Using the mean annotation of four MTurk workers proved most parsimonious for valid results. Crowdsourcing was shown to be a reliable and valid workforce for annotating images of outdoor human behavior.