Testing the Physical Activity Transition Model Among Children and Adolescents in Low- and Middle-Income Countries: A...

Low- and middle-income countries (LMICs) are experiencing rapid urbanization, which may lead to lower physical activity (PA) levels especially in urban areas, as posited by the PA transition model. This review aimed to summarize existing evidence on the PA transition among children and adolescents in LMICs.

We screened 5147 articles from 6 databases and extracted data from 84 studies across 29 LMICs, involving 530,908 participants aged 3-19 years. Study and evidence quality were assessed using the AXIS or Joanna Briggs Institute tools and the GRADE approach. Data were narratively synthesized or meta-analyzed as appropriate. Meta-analyses compared device-based moderate- to vigorous-intensity PA estimates between urban and rural participants, further stratified by World Bank Income classification.

Among studies reporting significant urban-rural differences, 68% indicated higher PA levels among rural participants and 32% among urban participants. The main meta-analysis indicated that, on average, urban LMIC participants accumulated 10 fewer minutes of moderate- to vigorous-intensity PA daily compared with their rural counterparts, representing about one-sixth of the World Health Organization PA guidelines (Cohen's d: -0.38; 95% CI, -0.58 to - 0.18). Stratified analyses showed lower moderate- to vigorous-intensity PA among participants in urban low- (mean difference = -16.08; 95% CI, -31.69 to -0.47) and lower-middle (-9.48; 95% CI, -17.28 to -1.67) income countries, compared with rural participants.

Urbanization is associated with lower PA levels among children and adolescents in LMICs, consistent with the PA transition model. As urban growth accelerates in LMICs, policymakers, public health professionals, and urban planners should prioritize designing cities that foster active living among children and adolescents.