Systematic Review of the Relationship Between the Presence and Quality of Sidewalks and Children's Physical Health

This systematic review synthesized existing research about associations between sidewalk availability and quality and children's physical health outcomes.

Google Scholar, PubMed, Scopus, and Web of Science were searched. The initial search strategy was intentionally broad, encompassing all age groups and physical health outcomes in relation to sidewalk access, quality, and connectivity. One hundred and eighty-four eligible studies were identified among 17,726; the retained studies were categorized by age group. This review focuses on 39 articles that specifically examined associations between sidewalk infrastructure and physical health outcomes in children. Eligible studies included both observational and experimental designs, were published in English through March 2025, and reported at least one physical health metric in relation to some aspect of sidewalk characteristics.

The included studies (n = 39) were conducted in diverse geographic regions, with the majority based in North America. Most studies employed cross-sectional designs, and both objective and subjective measures for sidewalk metrics and health outcomes were common. The most frequently analyzed health outcomes were physical activity (PA), active transportation, and outdoor play (n = 23), followed by BMI or weight-related measures (n = 11), or both (n = 5). Overall, sidewalk presence and quality were consistently associated with higher levels of various forms of PA, while associations with weight-related outcomes were inconsistent.

Current evidence indicates that sidewalk availability and quality are more consistently linked to children's PA behaviors. Computer vision, deep learning, and automated image-based environmental audits should be used to assess sidewalk attributes that increase children's PA. Future research should also prioritize longitudinal and quasi-experimental approaches to improve causal inference.