Physical activity and the environment: Successes and lessons learned from case studies in Europe

Most people’s daily living environments – including transport, housing and occupational, school and leisure settings – have become less supportive of physical activity over the last decades.

For example, in western European countries (for which numbers are more readily available than other countries in the WHO European Region), the growing demand for mobility in recent decades has largely been satisfied by the increased use of private cars while the use of public transport increased far less and the use of active means of transportation such as cycling and walking has remained on a historic low since the 1970s. About 80% of journeys are by car. Nevertheless, cycling and brisk walking could be efficient and effective ways to provide the recommended level of physical activity: at least 30 minutes per day of at least moderate-intensity activity (1). There is great potential for more trips being made on foot or by bicycle. Regardless of the increasing total amount of motorized transport, more than 50% of trips currently made by car are shorter than 5 km, a distance that could be covered by about 15–20 minutes of cycling. More than 30% of the trips by car are even less than 3 km long and could be covered conveniently in about 30–50 minutes’ brisk walking (2).

From an urban and neighbourhood development perspective, two main driving factors influence the level of physical activity in the Region. The increasing geographical separation of living, working, shopping and leisure activities results in an increasing demand for motorized transport and reduces the opportunities for physically active use of the neighbourhood. In addition, the quality of the neighbourhood environment affects residents’ opportunity and willingness to actively use common spaces. Overall, the built environment can influence physical activity in different settings: home, workplace, school, travel, neighbourhood and leisure. There is convincing evidence of the link between the built environment and physical activity (for example 3,4). Environmental and residential conditions are also one mechanism by which socioeconomic status affects health and well-being.

Also workplace environments have become less physically active places for many employees. These developments and possibilities to counteract them have been discussed in more detail in recent WHO publications (5,6,7).

This paper will present examples of successful initiatives to address these unfavourable trends with a focus on the transport and urban settings.

For example, the transport sector offers a variety of possibilities for win-win-approaches which address both classic transport topics such as traffic safety, traffic calming or congestion and increase at the same time levels of cycling and walking. In Norway, the benefits of area-wide speed and traffic management exceeded costs almost tenfold. Interventions in the transport field both directly aimed at increasing cycling (such as in Denmark) or focused on other goals such as reducing congestion (such as in the United Kingdom) can achieve considerable increases in cycling levels while at the same time the number of accidents could be decreased.

Also successful examples of increasing children’s’ active travel exist, such as the “walk to school” projects. A recent WHO project provides guidance for the economic valuation of health benefits from cycling and walking (8) since the cost argument can be an important factor to win the support of non-health sectors. Also from urban environments, examples of successful interventions to increase physical activity exist. For example, lessons can be learned from communities that have put pedestrians as first priority when making decisions related to land use and transport planning. Development of unused spaces into parks through participatory processes can lead to increased active leisure time. Particular attention has to be given to low income groups of the population.

An increasing number of countries have embarked in the development of policies to promote physical activity, including through environmental approaches such as cycling and walking. The international inventory of documents on physical activity promotion (9) has been developed recently through HEPA Europe, the European network for the promotion of health-enhancing physical activity, a collaborative project which works closely with WHO Europe. The inventory intends to make these experiences more readily available. HEPA Europe aims at facilitating multisectoral approaches and supporting cooperation, partnerships and collaboration with other related sectors.

References:

1. Global Strategy on Diet, Physical Activity and Health. Geneva, WHO, 2004 (http://www.who.int/dietphysicalactivity/strategy/eb11344/en/index.html)

2. EU Transport in figures. Statistical pocketbook. Brussels, European Commission, 2000.

3. Atkinson JL et al. The association of neighborhood design and recreational environments with physical activity. American Journal of Health Promotion, 2005, 19:304–309

4. Gebel K et al. Creating healthy environments: A review of links between the physical environment, physical activity and obesity. Sydney, North South Wales Health Department and North South Wales Centre for Overweight and Obesity, 2005

5. Macro- and microenvironmental determinants of physical activity. In: The challenge of obesity in the WHO European Region and the strategies for response. Copenhagen, WHO Regional Office for Europe, 2007:138-151 (http://www.euro.who.int/document/E90711.pdf).

6. Physical activity and health in Europe: evidence for action. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.int/document/e89490.pdf).

7. Promoting physical activity and active living in urban environments: the role of local governments. The solid facts. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.int/document/e89498.pdf).

8. Economic assessment of transport infrastructure and policies. Methodological guidance on the economic appraisal of health effects related to walking and cycling. WHO Regional Office for Europe and United Nations Economic Council for Europe (UNECE). Copenhagen WHO Regional Office for Europe, 2007.

9. International inventory of documents on physical activity promotion [web site]. WHO Regional Office for Europe, Copenhagen, 2006.