Urbanization and physical activity in the global Prospective Urban and Rural Epidemiology study


Kwadwo Boakye, Department of Public Health and Health Services Administration, California State University, Chico, CA, USA.
Marit Bovbjerg, College of Public Health and Human Sciences, Oregon State University, 2520 SW Campus Way, Corvallis, OR, 97331, USA.
John Schuna, College of Public Health and Human Sciences, Oregon State University, 2520 SW Campus Way, Corvallis, OR, 97331, USA.
Adam Branscum, College of Public Health and Human Sciences, Oregon State University, 2520 SW Campus Way, Corvallis, OR, 97331, USA.
Ravi Prasad Varma, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Rosnah Ismail, Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Medical Center, Kuala Lumpur, Malaysia.
Olga Barbarash, Federal State Budgetary Institution Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation.Follow
Juan Dominguez, Estudios Clínicos Latino América, 160, Rosario, Argentina.
Yuksel Altuntas, Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey.Follow
Ranjit Mohan Anjana, Madras Diabetes Research Foundation, Chennai, India.
Rita Yusuf, School of Life Sciences, Independent University, Dhaka, Bangladesh.
Roya Kelishadi, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Patricio Lopez-Jaramillo, Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia.
Romaina Iqbal, Department of Community Health Sciences and Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan.
Pamela Serón, Faculty of Medicine, Universidad de La Frontera, Claro Solar 115, Temuco, Chile.
Annika Rosengren, Sahlgrenska University Hospital, Göteborg, Sweden.
Paul Poirier, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Québec, Canada.
P V. Lakshmi, Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Rasha Khatib, Advocate Aurora HealthFollow
et al


Advocate Aurora Research Institute


Urbanization may influence physical activity (PA) levels, although little evidence is available for low- and middle- income countries where urbanization is occurring fastest. We evaluated associations between urbanization and total PA, as well as work-, leisure-, home-, and transport-specific PA, for 138,206 adults living in 698 communities across 22 countries within the Prospective Urban and Rural Epidemiology (PURE) study. The 1-week long-form International PA Questionnaire was administered at baseline (2003-2015). We used satellite-derived population density and impervious surface area estimates to quantify baseline urbanization levels for study communities, as well as change measures for 5- and 10-years prior to PA surveys. We used generalized linear mixed effects models to examine associations between urbanization measures and PA levels, controlling for individual, household and community factors. Higher community baseline levels of population density (- 12.4% per IQR, 95% CI - 16.0, - 8.7) and impervious surface area (- 29.2% per IQR, 95% CI - 37.5, - 19.7), as well as the rate of change in 5-year population density (- 17.2% per IQR, 95% CI - 25.7, - 7.7), were associated with lower total PA levels. Important differences in the associations between urbanization and PA were observed between PA domains, country-income levels, urban/rural status, and sex. These findings provide new information on the complex associations between urbanization and PA.

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