Impacts of built environment changes on physical activity in Canada: a systematic review of natural experiments

The built environment supports physical activity (PA) by providing opportunities to be active in daily life. Natural experiments are valuable for assessing how real-world changes to the built environment affect PA and are critical for guiding policies to improve population-level PA. The objective of this review was to summarize the evidence from natural experiments that investigated the impacts of built environment changes on PA in Canada.

Searches were conducted in MEDLINE, Embase, PsycINFO, ProQuest Public Health and SportDISCUS, from inception to 27 November 2024. Natural experiment evaluations that included a comparator or historical control group and assessed changes in PA associated with changes in the built environment were eligible. A narrative synthesis summarizes the evidence and the certainty of the evidence.

Results from the included natural experiments (n = 25) suggest positive effects, with low to moderate certainty, of increased walkability, new cycling and pedestrian infrastructure, bike share (bike rental) programs and new trails. However, there was very low to low certainty of no significant effects for bus rapid transit, school building and yard improvements and school zone improvements. Some evidence suggests negative effects of off-leash dog park areas on children's park-based PA and of daycare yard improvements on moderate-to-vigorous intensity PA.

Few Canadian studies have evaluated the impact of built environment changes on PA, with most emerging in the last decade. Future studies should include larger and more diverse samples and all regions, control for confounders including seasonal variation in outdoor PA, use well-matched control groups and incorporate objective PA measures.