Recent Advances in Preventive Cardiology and Lifestyle Medicine Role of Built Environments in Physical Activity, Obesity, and Cardiovascular Disease

Summary and Conclusions There is a growing consensus that large changes in populationlevels of physical activity and other behaviors required toimprove cardiovascular health will require major modifica-tions in environments and policies. Ecological models are theconceptual basis for comprehensive interventions that empha-size environmental and policy changes and that can havewidespread and sustainable effects. These interventions arecomplemented with individual education and motivation andefforts to change social support and norms. Physical activity–specific ecological models indicate which environmental factorsare expected to be related to physical activity in multiple lifedomains: Leisure/recreation/exercise, occupation (school foryouth), transportation, and household. Over the past decade, aproliferation of interdisciplinary research has generally sup-portedhypothesesderivedfromecologicalmodelsandidentifiedspecific built environment attributes and combinations of attri-butes that are related to physical activity, mainly for recreationand transportation purposes, and obesity. It is becoming clearthat racial/ethnic minority and low-income communities aredisadvantaged in access to recreation facilities, positiveaesthetics, and protection from traffic. These results providean empirical rationale for intervention.There are recent examples of environmental changes orcommunity-wide multilevel interventions that had positive ef-fects on physical activity or obesity. Continuing research needsare to improve the rigor of study designs, confirm subgroup- orcontext-specific built environment associations, identify optimalcombinations of attributes, improve understanding of the policychange processes required to achieve environmental changes,and evaluate multilevel interventions.Both research teams and community-based initiatives arecollaborating with a wide range of professionals and sectorsof society, such as recreation, transportation, city planning,architecture, landscape architecture, geography, criminal jus-tice, and law, in addition to health professionals and behav-ioral scientists. These diverse teams have stimulated innova-tions in research, new approaches to intervention, andimproved connections with decision makers who can makeenvironment and policy changes in nonhealth sectors ofsociety. The practice of physical activity promotion, obesityprevention, and CVD risk reduction has changed to reflect theshift to multilevel interventions. Major foundations andpublic health agencies are implementing community-basedinterventions targeting environment and policy change. Con-tinuing challenges for these community-wide interventionsare to maintain support for the multisector, long-term effortsrequired to change environments, evaluate interventions sothey become ever more evidence-based, and integrate explicitchronic disease prevention objectives into professional prac-tices of diverse disciplines, government agencies, and indus-tries whose primary work can affect physical activity andhealth.