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

Kwadwo Boakye, Marit Bovbjerg, John Schuna, Adam Branscum, Ravi Prasad Varma, Rosnah Ismail, Olga Barbarash, Juan Dominguez, Yuksel Altuntas, Ranjit Mohan Anjana, Rita Yusuf, Roya Kelishadi, Patricio Lopez-Jaramillo, Romaina Iqbal, Pamela Serón, Annika Rosengren, Paul Poirier, P. V.M. Lakshmi, Rasha Khatib, Katarzyna ZatonskaBo Hu, Lu Yin, Chuangshi Wang, Karen Yeates, Jephat Chifamba, Khalid F. Alhabib, Álvaro Avezum, Antonio Dans, Scott A. Lear, Salim Yusuf, Perry Hystad

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12 Citations (Scopus)


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.

Original languageEnglish
Article number290
JournalScientific Reports
Issue number1
Publication statusPublished - Dec 2023


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