Skip to main content

Advertisement

Steps Forward: Review and Recommendations for Research on Walkability, Physical Activity and Cardiovascular Health

Public Health Reviews volume 33, pages484–506(2011)Cite this article

Article metrics

  • 1821 Accesses

  • 41 Citations

Abstract

Built environments that support walking and other physical activities have the potential to reduce cardiovascular disease (CVD). Walkable neighborhoods—characterized by density, land use diversity, and well-connected transportation networks—have been linked to more walking, less obesity, and lower coronary heart disease risk. Yet ongoing research on pedestrian-friendly built environments has the potential to address important gaps. While much of the literature has focused on urban form and planning characteristics, additional aspects of street-scapes, such as natural and architectural amenities, should also be considered. Promising future directions include (1) integration of multiple built environment measures that facilitate an understanding of how individuals perceive and act within their environment; (2) examination of both the daily physical activities that are most feasibly influenced by the local environment and those more deliberate or vigorous patterns of physical activity that are most predictive of CVD; (3) consideration of multiple pathways that could mediate a link between walkability and CVD, including not only physical activity, but also air quality improvements from reduced vehicle mileage and enhanced neighborhood social cohesion from unplanned interactions; (4) testing competing hypotheses that may explain interactions of built environment characteristics with each other and with personal barriers to walking; (5) stronger conceptualization of the multiple neighborhoods or activity spaces that structure opportunities for physical activity throughout the day; (6) collecting and strategically analyzing longitudinal data to support causal inference; and (7) studying neighborhood preferences and selection to move beyond biased assessments of neighborhood health effects. While walkability has been linked to health-related behaviors and CVD risk factors, the implications of the observed correlations are not yet clear. New theoretical insights, measurement technologies, and built environment changes represent opportunities to enhance the evidence base for bringing health promotion and cardiovascular disease prevention into the conversation about how communities are planned and built.

References

  1. 1.

    Gaziano TA. Cardiovascular disease in the developing world and its cost-effective management. Circulation. 2005;112:3547–53.

  2. 2.

    Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray C, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6:e1000058.

  3. 3.

    Fineberg H. Why is Prevention a Hard Sell? Meeting a Crucial Challenge to Improve the Public’s Health. Mailman School of Public Health at Columbia University: Public Health Grand Rounds; 24 September, 2008; New York, NY. Availble from URL: http://www.mailman.columbia.edu/events/grand-rounds/fall-2008-archives (Accessed19 December, 2011).

  4. 4.

    Haskell WL, Lee I. Physical activity and public health. Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;107:185649.

  5. 5.

    Kohl HW, 3rd. Physical activity and cardiovascular disease: evidence for a dose response. Med Sci Sports Exerc. 2001;33:S472–83; discussion S93-4.

  6. 6.

    Wannamethee SG, Shaper AG. Physical activity in the prevention of cardiovascular disease: an epidemiological perspective. Sports Med. 2001;31:101–14.

  7. 7.

    Eyre H, Kahn R, Robertson RM, Clark NG, Doyle C, Hong Y, et al. Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation. 2004;109:3244–55.

  8. 8.

    Norcross JC, Mrykalo MS, Blagys MD. Auld lang Syne: success predictors, change processes, and self reported outcomes of New Year’s resolvers and nonresolvers. J Clin Psychol. 2002;58:397–405.

  9. 9.

    Eilat-Adar S, Eldar M, Goldbourt U. Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor. Am J Epidemiol. 2005;161:352–8.

  10. 10.

    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.

  11. 11.

    Varo JJ, Martínez-González MA, de Irala-Estévez J, Kearney J, Gibney M, Martínez JA. Distribution and determinants of sedentary lifestyles in the European Union. Int J Epidemiol. 2003;32:138.

  12. 12.

    King AC, Castro C, Wilcox S, Eyler AA, Sallis JF, Brownson RC. Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women. Health Psychol. 2000;19:354–64.

  13. 13.

    Taylor WC, Sallis JF, Lees E, Hepworth JT, Feliz K, Volding DC, et al. Changing social and built environments to promote physical activity: recommendations from low income, urban women. Journal of physical activity & health. 2007;4:54–65.

  14. 14.

    Frank LD, Engelke PO. The built environment and human activity patterns: exploring the impacts of urban form on public health. J Planning Literature. 2001;16:202–18.

  15. 15.

    Lovasi GS. Built environment and health. In: Rippe JM, editor. Encyclopedia of Lifestyle Medicine and Health: SAGE; In Press.

  16. 16.

    Cervero R, Kockelman K. Travel demand and the 3Ds: density, diversity, and design. Transpn Res-D. 1997;2(3):199–219.

  17. 17.

    Papas MA, Alberg AJ, Ewing R, Helzlsouer KJ, Gary TL, Klassen AC. The built environment and obesity. Epidemiol Rev. 2007;29:129–43.

  18. 18.

    Lee C, Moudon AV. Physical activity and environment research in the health field: implications for urban and transportation planning practice and research. J Planning Literature. 2004;19:147–81.

  19. 19.

    Ottoson JM, Green LW, Beery WL, Senter SK, Cahill CL, Pearson DC, et al. Policy-contribution assessment and field-building analysis of the Robert Wood Johnson Foundation’s Active Living Research Program. Am J Prev Med. 2009;36:S34–43.

  20. 20.

    Perdue WC, Stone LA, Gostin LO. The built environment and its relationship to the public’s health: the legal framework. Am J Public Health. 2003;93:1390–4.

  21. 21.

    Sallis JF, Linton LS, Kraft MK, Cutter CL, Kerr J, Weitzel J, et al. The active living research program: six years of grantmaking. Am J Prev Med. 2009;36:S10–21.

  22. 22.

    Gutman MA, Barker DC, Samples-Smart F, Morley C. Evaluation of active living research progress and lessons in building a new field. Am J Prev Med. 2009;36:S22–33.

  23. 23.

    Porter DE, Kirtland KA, Neet MJ, Williams JE, Ainsworth BE. Considerations for using a geographic information system to assess environmental supports for physical activity. Prev Chronic Dis. 2004;1:A20.

  24. 24.

    Nuckols JR, Ward MH, Jarup L. Using geographic information systems for exposure assessment in environmental epidemiology studies. Environ Health Perspect. 2004;112:1007–15.

  25. 25.

    Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N, et al. To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology. 2010;21:467–74.

  26. 26.

    Riva M, Gauvin L, Barnett TA. Toward the next generation of research into small area effects on health: a synthesis of multilevel investigations published since July 1998. J Epidemiol Community Health. 2007;61:853–61.

  27. 27.

    Unwin DJ. GIS, spatial analysis and spatial statistics. Progress in Human Geography. 1996;20:540–51.

  28. 28.

    Renalds A, Smith TH, Hale PJ. A systematic review of built environment and health. Fam Community Health. 2010;33:68–78.

  29. 29.

    Lovasi GS, Hutson MA, Guerra M, Neckerman KM. Built environments and obesity in disadvantaged populations. Epidemiol Rev. 2009;31:7–20.

  30. 30.

    Leal C, Chaix B. The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda. Obes Rev. 2011;12:217–30.

  31. 31.

    Lee CD, Folsom AR, Blair SN. Physical activity and stroke risk: a meta-analysis. Stroke. 2003;34:2475–81.

  32. 32.

    Ewing R, Cervero R. Travel and the built environment. J Am Planning Assoc. 2010;76(3).

  33. 33.

    Diez Roux AV. The study of group-level factors in epidemiology: rethinking variables, study designs, and analytical approaches. Epidemiol Rev. 2004;26:104–11.

  34. 34.

    Chaix B, Rosvall M, Merlo J. Recent increase of neighborhood socioeconomic effects on ischemic heart disease mortality: a multilevel survival analysis of two large Swedish cohorts. Am J Epidemiol. 2007;165:22–6.

  35. 35.

    Chaix B, Lindstrom M, Rosvall M, Merlo J. Neighbourhood social interactions and risk of acute myocardial infarction. J Epidemiol Community Health. 2008;62:62–8.

  36. 36.

    Wilkinson RG. Health, hierarchy, and social anxiety. Ann N Y Acad Sci. 1999;896:48–63.

  37. 37.

    Bird C, Seeman T, Escarce J, Bsurto-Davila R, Finch B, Dubowitz T, et al. Neighborhood Socioeconomic Status and Biological “Wear & Tear” in a Nationally Representative Sample of U.S. Adults. JECH. 2009.

  38. 38.

    Mookadam F, Arthur HM. Social support and its relationship to morbidity and mortality after acute myocardial infarction: systematic overview. Arch Intern Med. 2004;164:1514–8.

  39. 39.

    Rutledge T, Linke SE, Olson MB. Social networks and incident stroke among women with suspected myocardial ischemia. Psychosom Med. 2008;70:282–7

  40. 40.

    Smith KP, Christakis NA. Social networks and health. Ann Rev Sociol. 2008;34:405–29.

  41. 41.

    Cohen S, Wills T. Stress, social support, and the buffering hypothesis. Psycholog Bull. 1985;98:310–957.

  42. 42.

    Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357:370–9.

  43. 43.

    Christakis NA, Fowler JH. The collective dynamics of smoking in a large social network. N Engl J Med. 2008;358:2249–58.

  44. 44.

    Hipp J, Perrin A. The simultaneous effect of social distance and physical distance on the formation of neighborhood ties. City & Community. 2009;8:5–25.

  45. 45.

    Preciado P, Snijders TAB, Burk WJ, Stattin H, Kerr M. Does proximity matter? Distance dependence of adolescent friendships. Social Networks. 2011.

  46. 46.

    Cervero R, Duncan M. Walking, bicycling, and urban landscapes: evidence from the San Francisco Bay Area. Am J Public Health. 2003;93:1478–83.

  47. 47.

    Jacobsen PL. Safety in numbers: more walkers and bicyclists, safer walking and bicycling. Inj Prev. 2003;9:205–9.

  48. 48.

    Duncan SC, Duncan TE, Strycker LA, Chaumeton NR. Neighborhood physical activity opportunity: a multilevel contextual model. Res Q Exerc Sport. 2002;73:457–63.

  49. 49.

    Leyden KM. Social capital and the built environment: the importance of walkable neighborhoods. Am J Public Health. 2003;93:1546–51.

  50. 50.

    Carter SP, Carter SL, Dannenberg AL. Zoning out crime and improving community health in Sarasota, Florida: “Crime Prevention Through Environmental Design”. Am J Public Health. 2003;93:1442–5.

  51. 51.

    Rundle A, Neckerman KM, Freeman L, Lovasi GS, Purciel M, Quinn J, et al. Neighborhood food environment and walkability predict obesity in New York City. Environ Health Perspect. 2009;117:442–7.

  52. 52.

    Wieczorek WF, Hanson CE. New modeling methods: geographic information systems and spatial analysis. Alcohol Health Res World. 1997;21:331–9.

  53. 53.

    Chuang YC, Cubbin C, Ahn D, Winkleby MA. Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smoking. J Epidemiol Community Health. 2005;59:568–73.

  54. 54.

    Eyler AA, Brownson RC, Bacak SJ, Housemann RA. The epidemiology of walking for physical activity in the United States. Med Sci Sports Exerc. 2003;35:1529–36.

  55. 55.

    Jacobs J. The Death and Life of Great American Cities. New York: Vintage Books; 1961.

  56. 56.

    Saelens BE, Handy SL. Built environment correlates of walking: a review. Med Sci Sports Exerc. 2008;40:S550–66.

  57. 57.

    Mujahid MS, Diez Roux AV, Morenoff JD, Raghunathan TE, Cooper RS, Ni H, et al. Neighborhood characteristics and hypertension. Epidemiology. 2008;19:590–8.

  58. 58.

    Auchincloss AH, Diez Roux AV, Brown DG, Erdmann CA, Bertoni AG. Neighborhood resources for physical activity and healthy foods and their association with insulin resistance. Epidemiology. 2008;19:146–57.

  59. 59.

    Mobley LR, Root ED, Finkelstein EA, Khavjou O, Farris RP, Will JC. Environment, obesity, and cardiovascular disease risk in low-income women. Am J Prev Med. 2006;30:327–32.

  60. 60.

    Frank L, Sallis JF, Conway JM, Chapman JE, Saelens BE, Bachman W. Many pathways from land use to health: associations between neighborhood walkability and active transportation, body mass index, and air quality. JAPA. 2006;72:75–87.

  61. 61.

    Ewing R, Schmid T, Killingsworth R, Zlot A, Raudenbush S. Relationship between urban sprawl and physical activity, obesity, and morbidity. Am J Health Promot. 2003;18:47–57.

  62. 62.

    Neckerman KM, Lovasi GS, Davies S, Purciel M, Quinn J, Feder E, et al. Disparities in urban neighborhood conditions: evidence from GIS measures and field observation in New York City. J Public Health Policy. 2009;30:S264–85.

  63. 63.

    Purciel M, Neckerman K, Lovasi G, Quinn J, Weiss C, Bader M, et al. Creating and validating GIS measures of urban design for health research. J Environmental Psychology. 2009;29:457–66.

  64. 64.

    Bell JF, Wilson JS, Liu GC. Neighborhood greenness and 2-year changes in body mass index of children and youth. Am J Prev Med. 2008;35:547–53.

  65. 65.

    Ellaway A, Macintyre S, Bonnefoy X. Graffiti, greenery, and obesity in adults: secondary analysis of European cross sectional survey. BMJ. 2005;331:611–2.

  66. 66.

    Agyemang C, van Hooijdonk C, Wendel-Vos W, Ujcic-Voortman JK, Lindeman E, Stronks K, et al. Ethnic differences in the effect of environmental stressors on blood pressure and hypertension in the Netherlands. BMC Public Health. 2007;7:118.

  67. 67.

    Mitchell R, Popham F. Effect of exposure to natural environment on health inequalities: an observational population study. Lancet. 2008;372:1655–60.

  68. 68.

    Molnar BE, Gortmaker SL, Bull FC, Buka SL. Unsafe to play? Neighborhood disorder and lack of safety predict reduced physical activity among urban children and adolescents. Am J Health Promot. 2004;18:378–86.

  69. 69.

    Mujahid MS, Roux AV, Shen M, Gowda D, Sanchez B, Shea S, et al. Relation between neighborhood environments and obesity in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2008;167:1349–57.

  70. 70.

    Cohen DA, Farley TA, Mason K. Why is poverty unhealthy? Social and physical mediators. Soc Sci Med. 2003;57:1631–41.

  71. 71.

    Ewing R, Handy S. Measuring the unmeasurable: urban design qualities related to walkability. J Urban Design. 2009;14:65–84.

  72. 72.

    Blacksher E, Lovasi GS. Place-focused physical activity research, human agency, and social justice in public health: Taking agency seriously in studies of the built environment. Health Place. 10 September, 2011.

  73. 73.

    Weden MM, Carpiano RM, Robert SA. Subjective and objective neighborhood characteristics and adult health. Soc Sci Med. 2008;66:1256–70.

  74. 74.

    Popay J, Thomas C, Williams G, Bennett S, Gatrell A, Bostock L. A proper place to live: health inequalities, agency and the normative dimensions of space. Soc Sci Med. 2003;57:55–69.

  75. 75.

    Mujahid MS, Diez Roux AV, Morenoff JD, Raghunathan T. Assessing the measurement properties of neighborhood scales: from psychometrics to ecometrics. Am J Epidemiol. 2007;165:858–67.

  76. 76.

    De Vries SI, Van Hirtum HW, Bakker I, Hopman-Rock M, Hirasing RA, Van Mechelen W. Validity and reproducibility of motion sensors in youth: a systematic update. Med Sci Sports Exerc. 2009;41:818–27.

  77. 77.

    Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport. 2000;71:S1–14.

  78. 78.

    Lovasi GS, Moudon AV, Pearson AL, Hurvitz PM, Larson EB, Siscovick DS, et al. Using built environment characteristics to predict walking for exercise. Int J Health Geographics. 2008;7:10.

  79. 79.

    Li F, Fisher KJ, Brownson RC, Bosworth M. Multilevel modelling of built environment characteristics related to neighbourhood walking activity in older adults. J Epidemiol Community Health. 2005;59:558–64.

  80. 80.

    Bertoni AG, Whitt-Glover MC, Chung H, Le KY, Barr RG, Mahesh M, et al. The association between physical activity and subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2009;169:444–54.

  81. 81.

    Pope CA, 3rd, Ezzati M, Dockery DW. Fine-particulate air pollution and life expectancy in the United States. N Engl J Med. 2009;360:376–86.

  82. 82.

    Williamson T. Sprawl, politics, and participation: A preliminary analysis. Nat Civic Rev. 2002;91:235–44.

  83. 83.

    Galea S, Ahern J, Rudenstine S, Wallace Z, Vlahov D. Urban built environment and depression: a multilevel analysis. J Epidemiol Community Health. 2005;59:822–7.

  84. 84.

    Cohen-Cole E, Fletcher JM. Detecting implausible social network effects in acne, height, and headaches: longitudinal analysis. BMJ. 2008;337:a2533.

  85. 85.

    Fullilove MT. Root Shock. How Tearing Up City Neighborhoods Hurts America, and What We Can Do About It. New York: Balantine Books; 2004.

  86. 86.

    Kumanyika S, Grier S. Targeting interventions for ethnic minority and low-income populations. The Future of children / Center for the Future of Children, the David and Lucile Packard Foundation. 2006;16:187–207.

  87. 87.

    Lovasi GS, Neckerman KM, Quinn JW, Weiss CC, Rundle A. Effect of individual or neighborhood disadvantage on the association between neighborhood walkability and body mass index. Am J Public Health. 2009;99:279–84.

  88. 88.

    Brownson RC, Baker EA, Housemann RA, Brennan LK, Bacak SJ. Environmental and policy determinants of physical activity in the United States. Am J Public Health. 2001;91:1995–2003.

  89. 89.

    Joshu CE, Boehmer TK, Brownson RC, Ewing R. Personal, neighbourhood and urban factors associated with obesity in the United States. J Epidemiol Community Health. 2008;62:202–8.

  90. 90.

    Alfonzo MA. To walk or not to walk? The hierarchy of walking needs. Environment Behavior. 2005;37:808.

  91. 91.

    Jelinski DEW, J. The modifiable areal unit problem and implications for landscape ecology. Landscape Ecology. 1996;11:129–40.

  92. 92.

    Rainham D, McDowell I, Krewski D, Sawada M. Conceptualizing the healthscape: contributions of time geography, location technologies and spatial ecology to place and health research. Soc Sci Med. 2010;70:668–76.

  93. 93.

    Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association of the built environment with physical activity and obesity in older persons. Am J Public Health. 2007;97:486–92.

  94. 94.

    Duncan M, Mummery K. Psychosocial and environmental factors associated with physical activity among city dwellers in regional Queensland. Prev Med. 2005;40:363–72.

  95. 95.

    Hess P, Moudon AV, Snyder M, Stanilov K. Site design and pedestrian travel. Transportation Research Record. 1999;1674:9–19.

  96. 96.

    Hoehner CM, Brennan LK, Brownson RC, Handy SL, Killingsworth R. Opportunities for integrating public health and urban planning approaches to promote active community environments. Am J Health Promot. 2003;18:14–20.

  97. 97.

    Coulton CJ, Korbin J, Chan T, Su M. Mapping residents’ perceptions of neighborhood boundaries: a methodological note. Am J Community Psychol. 2001;29:371–83.

  98. 98.

    Colabianchi N, Dowda M, Pfeiffer KA, Porter DE, Almeida MJ, Pate RR. Towards an understanding of salient neighborhood boundaries: adolescent reports of an easy walking distance and convenient driving distance. Int J Behav Nutr Phys Act. 2007;4:66.

  99. 99.

    Levine R, Norenzayan A. The pace of life in 31 countries. J Cross-Cultural Psychology. 1999;30:178–205.

  100. 100.

    Neckerman KM, Bader MD, Richards CA, Purciel M, Quinn JW, Thomas JS, et al. Disparities in the food environments of New York City public schools. Am J Prev Med. 2010;39:195–202.

  101. 101.

    Rainham D, Krewski D, McDowell I, Sawada M, Liekens B. Development of a wearable global positioning system for place and health research. Int J Health Geographics. 2008;7:59.

  102. 102.

    Ewing R. Can the physical environment determine physical activity levels? Exerc Sport Sci Rev. 2005;33:69–75.

  103. 103.

    Maclure M, Mittleman MA. Should we use a case-crossover design? Annu Rev Public Health. 2000;21:193–221.

  104. 104.

    Angrist JD, Krueger AB. Instrumental variables and the search for identification: from supply and demand to natural experiments. J Economic Perspectives. 2001;15:69–85.

  105. 105.

    Fisher KJ, Li F, Michael Y, Cleveland M. Neighborhood-level influences on physical activity among older adults: a multilevel analysis. J Aging Phys Act. 2004;12:45–63.

  106. 106.

    Humpel N, Marshall AL, Leslie E, Bauman A, Owen N. Changes in neighborhood walking are related to changes in perceptions of environmental attributes. Ann Behav Med. 2004;27:60–7.

  107. 107.

    Plantinga A, Bernell S. The association between urban sprawl and obesity: is it a two-way street? J Regional Sci. 2007;47:857–79.

  108. 108.

    Handy S, Cao X, Mokhtarian P. Self-selection in the relationship between the built environment and walking. J Am Planning Assoc. 2006;72:55–74.

  109. 109.

    Berry TR, Spence JC, Blanchard CM, Cutumisu N, Edwards J, Selfridge G. A longitudinal and cross-sectional examination of the relationship between reasons for choosing a neighbourhood, physical activity and body mass index. Int J Behav Nutr Phys Act. 2010;7:57.

  110. 110.

    Kaufman JS, Kaufman S, Poole C. Causal inference from randomized trials in social epidemiology. Soc Sci Med. 2003;57:2397–409.

  111. 111.

    Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000;11:550–60.

  112. 112.

    Angrist JD, Imbens GW, Rubin DB. Identification of causal effects using instrumental variables. J Am Statistical Assoc. 1996;91:444–55.

  113. 113.

    Eid J, Overman H, Puga D, Turner M. Fat city: Questioning the relationship between urban sprawl and obesity. J Urban Economics. 2008;63:385–404.

  114. 114.

    Levine J, Frank L. Transportation and land-use preferences and residents’ neighborhood choices: the sufficiency of compact devleopment in the Atlanta region. Transportation. 2007;34:255–74.

  115. 115.

    Kaczynski AT, Sharratt MT. Deconstructing Williamsburg: Using focus groups to examine residents’ perceptions of the building of a walkable community. Int J Behav Nutr Phys Act. 2010;7:50.

Download references

Author information

Affiliations

  1. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St, Room 804, New York, NY, 10032, USA

    • Gina S. Lovasi PhD, MPH
    • , Stephanie Grady
    •  & Andrew Rundle DrPH, MPH

Authors

  1. Search for Gina S. Lovasi PhD, MPH in:

  2. Search for Stephanie Grady in:

  3. Search for Andrew Rundle DrPH, MPH in:

Corresponding author

Correspondence to Gina S. Lovasi PhD, MPH.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lovasi, G.S., Grady, S. & Rundle, A. Steps Forward: Review and Recommendations for Research on Walkability, Physical Activity and Cardiovascular Health. Public Health Rev 33, 484–506 (2011) doi:10.1007/BF03391647

Download citation

Key words

  • Residence characteristics
  • spatial behavior
  • physical activity
  • Body Mass Index
  • cardiovascular diseases

Public Health Reviews

ISSN: 2107-6952

Contact us