The Problem: In 2006, approximately two-thirds of adults and one-fifth of children in the United States were either overweight or obese. Each condition increases the risk of heart disease, diabetes, stroke, and some cancers. Kahn LK, et al. Recommended community strategies and measurements to prevent obesity in the United States. MMWR 2009;58(RR-07):1-26. Regular physical activity reduces the risk of obesity and has many other health benefits. Yet, only 25 percent of adults in the United States get the recommended amount of physical activity. CDC. Community interventions to promote healthy social environments: early childhood development and family housing. MMWR 2002;51 (RR-1):1-8.
The Law: Some local governments have attempted to promote exercise at the community level through careful modifications to zoning regulations and building codes. These efforts involve, for example, locating commercial stores, places of work, or schools within walking distance of residential communities to facilitate commuting by foot or bicycle. For example, a Sacramento Ordinance available at the California Healthy Eating Active Living Cities Campaign sets out zoning standards to ensure that streets provide ample space for walking and bicycling. The National Policy and Legal Analysis Network to Prevent Childhood Obesity (NPLAN) has created model “complete street” state laws and ordinances, which are aimed at creating safe environments for walking, jogging and other non-vehicle commuting.
The Evidence: Heath et al. reviewed 12 studies that measured the impact of community-scale urban design and land use policies on levels of physical activity. Heath G, et al. The effectiveness of urban design and land use and transport policies and practices to increase physical activity: a systematic review. Journal of Physical Activity and Health. 2006;3 (Suppl 1):S55-S76. The authors limited their review to studies that focused on physical activity outcomes, measured by incidence of walking or biking for transportation as well as overall physical activity and outdoor active play. The reviewers found evidence that community level urban design and land-use policies increase physical activity. Across all studies, there was a 161 percent median improvement in at least one measure of physical activity (e.g., number of walkers or bicyclists).
The Bottom Line: According to a Community Guide expert panel, there is considerable evidence supporting the effectiveness of community-scale urban design and land use policies as public health interventions to promote physical activity.