Pub Date: Thursday, Aug 13, 2020
Author: Jamie F. Chriqui, PhD, MHS
Affiliation: School of Public Health, University of Illinois Chicago
Regular physical activity provides both physical and mental health benefits; yet, in the United States, rates of physical activity are far from the meeting the National Physical Activity Guideline recommendations that adults get a minimum of 150 to 300 minutes of moderate-intensity aerobic physical activity per week.1 As of 2017, only 50.3 percent of adults achieved at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity per week and an additional 26.6 percent of adults engaged in no leisure time physical activity whatsoever.2 Notably, physical activity rates are lower and sedentary behavior is higher for non-Hispanic Black and Hispanic adults as compared to non-Hispanic White adults; similar disparities exist by income, with lower income adults reporting significantly lower rates of activity than higher-income adults.2
In addition to recreational or leisure time physical activity, Americans can reap physical activity benefits through active travel to and from places where they live, work, go to school, shop, and play. Active travel can be achieved through walking, bicycling, or taking public transit (which typically provides an average of 19 minutes daily of additional walking to/from3) to everyday destinations. Yet, rates of active commuting to work via walking or taking public transit are also low; data from the American Community Survey 2014-2018 5-year estimates indicate that only 5 percent of Americans report taking public transit to work and only 2.7 percent walked to work.4
Given these population-level trends, it will take population-level solutions such as those included in the AHA Science Advisory on Built Environment Approaches to Increase Physical Activity and the AHA Policy Statement on Creating Built Environments that Expand Active Transportation and Active Living Across the United States,5,6 to provide supportive built environments to enable more Americans to achieve the recommended amounts of weekly physical activity and to garner the associated health benefits. The Science Advisory summarizes the 2016 findings of the Community Preventive Services Task Force (CPSTF) which recommended a combination of land use and pedestrian or bicycle transportation approaches for increasing physical activity, and identifies needs for implementation guides to support communities seeking to implement the CPSTF recommendation as well as additional data and research needs.5,7 The Policy Statement expands upon the Science Advisory by recommending strategies for improving transportation systems, enhancing land use design, and providing education to support active travel-oriented policies and practices.6 Taken together, these two documents provide actionable strategies that federal, state, and local jurisdictions can take to foster active travel and active living nationwide. Additionally, they collectively provide a call to action for what will be needed to support the types of land use and transportation changes that they recommend and/or have identified (e.g., comprehensive planning and mixed-use zoning, complete streets, public transit usage, traffic safety, and street scale design). I would like to highlight policy and practice strategies as well as research and evaluation needs that were highlighted in these papers and that, collectively, will move us in the direction of an environment that truly supports active travel and physical activity by all Americans, every day.
Policy and Practice Strategies
Multi-sectoral partnerships and approaches that support active travel and activity-friendly community design. A key strategy identified in the AHA Policy Statement6 is the need for multi-sectoral partnerships and approaches to support active travel and activity-friendly or supportive environments. In most jurisdictions, planning and zoning officials regulate the land use and design of the community while transportation and public works departments regulate streets including the implementation of complete streets initiatives. At the same time, other sectors such as housing, parks and recreation, community and economic development, all are engaged in decisions that impact the built environment, overall health, and physical activity.8,9 Public health practitioners and decisionmakers also have a key role to play in informing decisions made by these other sectors. All too often public health representatives do not have a seat at the table in planning, transportation, economic development, and related discussions but they need to so as to ensure that policies, programs, and projects are designed in a way that will support activity-related behaviors rather than hinder them.10-12
Investment in the transportation and public transit infrastructure, nationwide. Funding for transportation-related projects and public transit infrastructure is crucial to supporting active travel to places where people live, work, go to school, shop, and play. In the United States, transportation funding has been variable at the federal level and is subject to a patchwork of appropriations and budgeting decisions made by regional transportation planning as well as state and local transportation agencies. The AHA Policy Statement6 identified a variety of ways for governments to raise revenue to support transportation and public transit infrastructure including through gasoline and other taxes; business and activity-related funding including through rental car and parking fees and payroll and room occupancy taxes; revenues from projects such as transit-oriented developments (TOD), tax increment financing, and special assessment districts; user fees such as vehicle usage and congestion pricing; and through government bonds and loans. Public support is key for such investments13 but can be garnered as in the case of the Rebuild Illinois bill which was passed in 2019 with bipartisan support by the state legislature and includes over $45 billion in transportation-related funding. Rebuild Illinois includes capital funding for transportation, roadway, and public transit-related projects throughout the state that will be financed primarily through gas and other tax increases and vehicle registration fees.14,15
Equitable allocation of projects and funding to support communities most in need and with the lowest rates of physical activity. Given the low rates of physical activity and higher rates of sedentary behavior among communities of color and lower-income individuals,2 it is imperative that built environment and transit-related projects that provide the infrastructure to support these communities is key. Some jurisdictions, such as the City of Denver, use an equity index to prioritize complete streets and other transportation-related projects for communities in greatest need.10,16 Initiatives such as those of Denver’s should be standard practice for all communities to ensure that those most in need have access to public transit and activity-friendly built environments that enable all residents to be physically active on a regular basis.
Research and Evaluation Needs
Need for local-level active travel and physical activity data, nationwide. One of the key challenges that researchers face is the lack of local-level physical activity and active travel behavior-related data for all jurisdictions nationwide. Currently, there are several nationwide physical activity-related behavioral surveillance systems but they do not provide data at the local level that are geocoded to enable linkages to key built environment, public transit, and policy data that may influence activity and active travel behaviors.17 The American Community Survey provides municipal, county, state, and national estimates of the percentage of persons walking and taking public transit to work,4 but these are aggregate level data only and do not include individual-level (de-identified) data that could be linked with geocodes relevant built environment, active travel, and policy-level data at the given jurisdictional level of interest. The Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) provides publicly available individual-level physical activity and sedentary behavior data geocoded at the state level,18 but given that the active travel and built environment policy and practice supports occur at the municipal or county levels, state-level identifiers are not useful. Even the restricted use BRFSS files only provide county-level geocodes which, again, are too ecological for most of the relevant policies and practices. Relatedly, CDC’s SMART BRFSS provides individual-level physical activity prevalence data geocoded for selected metropolitan and micropolitan statistical areas and metropolitan divisions (MMSAs) in the U.S.,19 but built environment and active travel related policies and programs often occur at the municipal level and do not cross jurisdictional boundaries such as those represented by MMSAs.
Systematic surveillance of built environment and active travel-related supports and related policies and practices, nationwide. Concomitant with the need for micro-scale physical activity data, the research community also is desperately in need of nationwide surveillance systems that capture built environment-related supports such as bike lanes, sidewalks, public transit stops, trails, etc. that support active travel and physically activity generally in all jurisdictions (urban, suburban, and rural; large and small).17 While many jurisdictions have geographic information systems (GIS) units within their planning departments, researchers studying the implementation and/or impact of built environment and active travel-related policy, systems, and environmental or programmatic changes across jurisdictions are at a disadvantage in that they are unable to access this type of micro-scale street feature data across jurisdictions. Furthermore, the GIS data that are available nationwide and that are used in walkability index measures nationwide only include measures of street connectivity and neighborhood density20-22 rather than street-scale features of the built environment.
Need for robust, longitudinal studies of the implementation and impact of built environment and active travel-related programs and policies. The CPSTF built environment and transportation-related recommendations7 and the new AHA Science Advisory statement5 are based on the best available peer-reviewed scientific evidence available at the time of the CPSTF review. CPSTF reviews grade the evidence included in the reviews, giving weight to randomized control trials and other study designs with comparison or control groups; time series studies are also considered but pre-/post-studies without comparison groups or cross-sectional studies showing the association between a natural experiment such as a built environment or transportation-related policy or program change and outcomes of interest such as walking or biking are not considered in the evidence base.23,24 Thus, natural experiments are often missed in CPSTF and similar reviews (e.g., Cochrane reviews25). Researchers should consider this fact when designing studies to ensure that if comparison groups are not possible, then at least planning for multiple data collection points to at least allow for time series evaluation of the implementation and impact of built environment and active travel-related natural experiments.
Recognition of the role that the built environment can play in supporting health-promoting behaviors such as physical activity and active travel has gained much traction in recent years. Now is the time to leverage this momentum and for governments at all levels to adopt and implement the strategies identified in the AHA Science Advisory and the accompanying Policy Statement so as to create environments that support active travel and active living for all.
Young DR, Cradock AL, Eyler AA, Fenton M, Pedroso M, Sallis JF, Whitsel LP; on behalf of the American Heart Association Advocacy Coordinating Committee. Creating built environments that expand active transportation and active living across the United States: a policy statement from the American Heart Association [published online ahead of print August 13, 2020]. Circulation. doi: 10.1161/CIR.0000000000000878.
- U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd edition. Washington, D.C.: U.S. Department of Health and Human Services; 2018.
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity. Data, trend and maps. Published 2020. Updated July 8, 2020. Accessed August 1, 2020.
- Besser LM, Dannenberg AL. Walking to public transit: steps to help meet physical activity recommendations. Am J Prev Med. 2005;29(4):273-280.
- U.S. Census Bureau. American Community Survey, 2014-2018 selected economic characteristics, table DP03. Published 2020. Accessed August 1, 2020.
- Omura JD, Carlson SA, Brown DR, et al. Built environment approaches to increase physical activity. AHA Science Advisory. Circulation. 2020. doi:10.1161/CIR.0000000000000884.
- Young DR, Cradock AL, Eyler AA, et al. Creating built environments that expand active transportation and active living across the United States: A policy statement from the American Heart Association. Circulation. 2020. doi:10.1161/CIR.0000000000000878.
- Community Preventive Services Task Force. Physical activity: built environment approaches combining transportation system interventions with land use and environmental design. Published 2016. Accessed August 1, 2020.
- Taylor LA. Housing and health: an overview of the literature. Health Affairs Health Policy Brief. 2018. doi:10.1377/hpb20180313.396577. Published June 7, 2018. Accessed August 5, 2020.
- Lau C. Parks and Public Health: Working Together to Advance Health and Wellness. Published 2018. Accessed August 2, 2020.
- Sansone C, Sadowski J, Chriqui JF. Public health engagement in complete streets initiatives: examples and lessons learned. In: Chicago, IL: Institute for Health Research and Policy, University of Illinois at Chicago; 2019: Accessed July 31, 2020.
- Hodgson K. Comprehensive Planning for Public Health. American Planning Association. 2011.
- American Public Health Association. Transportation and Health. Published 2020. Accessed August 2, 2020.
- Cradock AL, Barrett JL, Chriqui JF, et al. Driven to support: individual- and county-level factors associated with public support for active transportation policies. Am J Health Promot. 2018;32(3):657-666.
- Illinois Department of Transportation. Governor Pritzker Signs $45 Billion Rebuild Illinois Capital Plan. Published 2019. Accessed July 31, 2020.
- State of Illinois. Rebuild Illinois: Investing in Infrastructure for a Better Illinois (PDF). 2019. Accessed July 31, 2020.
- City of Denver, Department of Public Health & Environment. Denver Neighborhood Equity Index. Published 2020. Accessed August 2, 2020.
- Pate RR, Berrigan D, Buchner DM, et al. Actions to improve physical activity surveillance in the United States, discussion paper. NAM Perspectives. 2018. doi:10.31478/201809f.
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Behavioral Risk Factor Surveillance System. Updated November 5, 2019. Accessed August 1, 2020.
- Centers for Disease Control and Prevention. SMART: BRFSS city and county data and documentation. Updated November 15, 2018. Accessed August 1, 2020.
- Ewing R, Hamidi S. Measuring urban sprawl and validating sprawl measures (PDF). 2014. Accessed 2015/03/01/.
- U.S. Environmental Protection Agency. Smart location mapping: Interactive maps and data for measuring location efficiency and the built environment. Published 2020. Updated May 18, 2018. Accessed August 1, 2020.
- Ewing R, Cervero R. Travel and the built environment. Journal of the American Planning Association. 2010;76(3):265-294.
- Zaza S, Wright-De Aguero LK, Briss PA, et al. Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services. Task Force on Community Preventive Services. Am J Prev Med. 2000;18(1 Suppl):44-74.
- Guide to Community Preventive Services. Our methodology. Updated August 28, 2019. Accessed August 1, 2020.
- Cochrane Library. John Wiley & Sons, Inc. Published 2020. Accessed August 1, 2020.
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-- The opinions expressed in this commentary are not necessarily those of the editors or of the American Heart Association --